e10vk
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-K
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934 |
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For the fiscal year ended December 31, 2005 |
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934 |
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For the transition period
from to |
Commission File Number 001-31574
AMERIGROUP Corporation
(Exact name of registrant as specified in its charter)
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Delaware
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54-1739323 |
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(State or Other Jurisdiction of Incorporation or
Organization) |
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(I.R.S. Employer Identification No.) |
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4425 Corporation Lane, Virginia Beach, Virginia |
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23462 |
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(Address of principal executive offices) |
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(Zip Code) |
Registrants telephone number, including area code:
(757) 490-6900
Securities registered pursuant to Section 12(b) of the
Act:
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| Title of Each Class |
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Name of Each Exchange on Which Registered |
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Common Stock, $.01 par value |
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New York Stock Exchange |
Indicate by check mark if the registrant is a well-known
seasoned issuer, as defined in Rule 405 of the Securities
Act. Yes o No þ
Indicate by check mark if the registrant is not required to file
reports pursuant to Section 13 or Section 15(d) of the
Act. Yes o No þ
Indicate by check mark whether the registrant: (1) has
filed all reports required to be filed by Section 13 or
15(d) of the Securities Exchange Act of 1934 during the
preceding 12 months (or for such shorter period that the
registrant was required to file such reports), and (2) has
been subject to such filing requirements for the past
90 days. Yes þ No o
Indicate by check mark if disclosure of delinquent filers
pursuant to Item 405 of
Regulation S-K is
not contained herein, and will not be contained, to the best of
the registrants knowledge, in definitive proxy or
information statements incorporated by reference in
Part III of this
Form 10-K or any
amendment to
this 10-K. o
Indicate by check mark whether the registrant is a large
accelerated filer, an accelerated filer, or a non-accelerated
filer. See definition of accelerated filer and large
accelerated filer in
Rule 12b-2 of the
Exchange Act. (Check one):
Large accelerated
filer Yes þ No o Accelerated
filer Yes o No þ Non-accelerated
filer Yes o No þ
Indicate by check mark whether the registrant is a shell company
(as defined in
Rule 12b-2 of the
Exchange
Act). Yes o No þ
As of June 30, 2005 the aggregate market value of the
registrants common stock held by non-affiliates of the
registrant was $2,056,434,417.
Indicate the number of shares outstanding of each of the
issuers classes of common stock, as of the latest
practicable date.
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Outstanding at February 27, 2006 |
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Common Stock, $.01 par value |
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51,590,002 |
Documents Incorporated by Reference
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Parts Into Which Incorporated |
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Proxy Statement for the Annual Meeting of Stockholders
to be held May 10, 2006 (Proxy Statement) |
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Part III |
TABLE OF CONTENTS
1
Forward-looking Statements
This Annual Report on
Form 10-K, and
other information we provide from
time-to-time, contains
certain forward-looking statements as that term is
defined by Section 27A of the Securities Act of 1933 and
Section 21E of the Securities Exchange Act of 1934. All
statements regarding our expected future financial position,
membership, results of operations or cash flows, our continued
performance improvements, our ability to service our debt
obligations and refinance our debt obligations, our ability to
finance growth opportunities, our ability to respond to changes
in government regulations and similar statements including,
without limitation, those containing words such as
believes, anticipates,
expects, may, will,
should, estimates, intends,
plans and other similar expressions are
forward-looking statements.
Forward-looking statements involve known and unknown risks and
uncertainties that may cause our actual results in future
periods to differ materially from those projected or
contemplated in the forward-looking statements as a result of,
but not limited to, the following factors:
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national, state and local economic conditions, including their
effect on the rate increase process, timing of payments, as well
as their effect on the availability and cost of labor, utilities
and materials; |
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the effect of government regulations and changes in regulations
governing the healthcare industry, including our compliance with
such regulations and their effect on certain of our unit costs
and our ability to manage our medical costs; |
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changes in Medicaid payment levels and methodologies and the
application of such methodologies by the government; |
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liabilities and other claims asserted against us; |
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our ability to attract and retain qualified personnel; |
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our ability to maintain compliance with all minimum capital
requirements; |
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the availability and terms of capital to fund acquisitions and
capital improvements; |
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the competitive environment in which we operate; |
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our ability to maintain and increase membership levels; |
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demographic changes; |
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terrorism; and |
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the unfavorable resolution of pending litigation. |
Investors should also refer to Item 1A entitled Risk
Factors for a discussion of risk factors. Given these
risks and uncertainties, we can give no assurances that any
forward-looking statements will, in fact, transpire and,
therefore, caution investors not to place undue reliance on them.
2
PART I.
Overview
We are a multi-state managed healthcare company focused on
serving people who receive healthcare benefits through publicly
sponsored programs, including Medicaid, State Childrens
Health Insurance Program (SCHIP), FamilyCare and Special Needs
Plans (SNP) for members who are eligible for both Medicaid and
Medicare, or dual eligibles. We believe that we are
better qualified and positioned than many of our competitors to
meet the unique needs of our target populations because of our
focus on providing managed care to these populations, our
medical management programs and our community-based education
and outreach programs. Unlike many managed care organizations
that attempt to serve the general commercial population, as well
as Medicare and Medicaid populations, we are focused primarily
on the Medicaid, SCHIP and FamilyCare populations. Additionally,
effective January 1, 2006 we began serving a discrete group
of the Medicare population through a SNP program. In general, as
compared to commercial or traditional Medicare populations, our
target population is younger, accesses healthcare in an
inefficient manner and has a greater percentage of medical
expenses related to obstetric services, diabetes, circulatory
and respiratory conditions. We design our programs to address
the particular needs of our members, for whom we facilitate
access to healthcare benefits pursuant to agreements with the
applicable regulatory authority. We combine medical, social and
behavioral health services to help our members obtain quality
healthcare in an efficient manner. Our success in establishing
and maintaining strong relationships with our government
partners, providers and members has enabled us to obtain new
contracts and to establish a leading market position in many of
the markets we serve. Providers are hospitals, physicians and
ancillary medical programs that provide medical services to our
members. Members are said to be enrolled with our
health plans to receive benefits. Accordingly, our total
membership is generally referred to as our enrollment. As of
December 31, 2005, we provided an array of products to
approximately 1,129,000 members in the District of Columbia,
Illinois, Florida, Maryland, New Jersey, New York, Ohio, Texas
and Virginia.
We were incorporated in Delaware on December 9, 1994 as
AMERICAID Community Care by a team of experienced senior
managers led by Jeffrey L. McWaters, our Chairman and Chief
Executive Officer. We have expanded through developing products
and markets and negotiating contracts with various state
governments. During 1996, we began enrolling Medicaid members in
our Fort Worth, New Jersey and Illinois plans. In 1997, we
obtained a contract and began enrolling members in our Houston
plan. In 1999, we began operating in Maryland and the District
of Columbia, and obtained a contract and began enrolling members
in our Dallas plan. Our subsidiaries have grown through organic
membership growth, acquisitions of contract rights and related
assets and through stock acquisitions. In 2003, we began
operations in Florida as a result of an acquisition of PHP
Holdings, Inc. and its subsidiary, Physicians Health Plans, Inc.
(PHP). Effective January 1, 2005, we acquired CarePlus,
LLC, which operates as CarePlus Health Plan (CarePlus), in New
York City and Putnam County, New York. In September 2005, we
began enrolling Medicaid members in our Ohio and Virginia plans.
Market Opportunity
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Emergence of managed care |
Healthcare in the United States has grown from a
$27 billion industry in 1960 to a highly regulated market
of approximately $1.9 trillion in 2004, an increase of 7.9% from
2003, accounting for 16% of Gross Domestic Product (GDP),
according to the federal governments Centers for
Medicare & Medicaid Services (CMS).
CMS projects total U.S. healthcare spending to reach $3.6
trillion in 2014, growing at an average annual rate of 7.1% from
2003 through 2014. In response to the dramatic increases in
healthcare-related costs in the late 1960s, Congress enacted the
Federal Health Maintenance Organization Act of 1973, a statute
designed to encourage the establishment and expansion of care
and cost management. The private sector responded to this
legislation by forming health maintenance organizations (HMOs).
HMOs were intended to address the needs of employers, insurers,
government entities and healthcare providers who sought a
cost-effective alternative to traditional indemnity insurance.
Since the establishment of HMOs, enrollment has increased more
than twelve-
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fold from 6.0 million in 1976 to nearly 76.1 million
in 2002. Over that time, many HMOs have been formed to focus on
a specific or specialty population of healthcare such as
commercial plans for employees, Medicare, Medicaid, dental care
and behavioral healthcare. Additionally, HMOs have been formed
in a variety of sizes, from small community-based plans to
multi-state organizations.
Despite these efforts to organize care delivery, the costs
associated with medical care have continued to increase. As a
result, it has become increasingly important for HMOs to
understand the populations they serve in order to develop an
infrastructure and programs tailored to the medical and social
profiles of their members.
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Medicaid, SCHIP, FamilyCare and SNP Programs |
Medicaid, a state-administered program, was enacted in 1965 to
make federal matching funds available to all states for the
delivery of healthcare benefits to eligible individuals,
principally those with incomes below specified levels who meet
other state-specified requirements. Medicaid is structured to
allow each state to establish its own eligibility standards,
benefits package, payment rates and program administration under
broad federal guidelines. By contrast, Medicare is a program
administered by the federal government and is made available to
the aged and disabled. Some of the differences between Medicaid
and Medicare are set forth below:
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Medicare |
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state administered
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federally operated |
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state and matching federal funds
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federal funds only |
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average age of our members is 14
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average age of recipients is over 70 |
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30 million people in managed care in 2004
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5 million people in managed care in 2004 |
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prescription drug coverage
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prescription drug coverage began January 2006 |
Most states determine threshold Medicaid eligibility by
reference to other federal financial assistance programs,
including Temporary Assistance to Needy Families (TANF), and
Supplemental Security Income (SSI).
TANF provides assistance to low-income families with children
and was adopted to replace the Aid to Families with Dependent
Children program. SSI is a federal program that provides
assistance to low-income aged, blind or disabled individuals.
However, states can broaden eligibility criteria.
SCHIP, developed in 1997, is a federal/ state matching program
that provides healthcare coverage to children not otherwise
covered by Medicaid or other insurance programs. SCHIP enables a
segment of the large uninsured population in the U.S. to
receive healthcare benefits. States have the option of
administering SCHIP through their Medicaid programs.
FamilyCare programs have been established in several states
including New Jersey, New York, and the District of Columbia.
The New Jersey FamilyCare, for example, is a voluntary federal
and state-funded Medicaid expansion health insurance program
created to help uninsured families, single adults and couples
without dependent children obtain affordable healthcare coverage.
In January 2006, we entered the Medicare market by establishing
a Special Needs Plan (SNP) under Section 231 of the
Medicare Modernization Act (MMA). This is a new program, under
the MMA, that allows Medicare Advantage plans to offer special
health plans that cover dual eligibles (those who are eligible
for both Medicare and Medicaid coverage) for acute care medical
costs funded under the Medicare program. The benefits for this
program include Medicare statutory benefits, Medicare
Part D prescription benefits as well as supplemental
benefits not covered by the Medicare program. We began operating
a SNP on January 1, 2006 in Houston, Texas with
approximately 8,800 members. As a result, some of our revenues
will now be funded by Medicare.
Nationally, approximately 64% of Medicaid spending is directed
toward hospital, physician and other acute care services, and
the remaining approximately 36% is for nursing home and other
long-term care. In general, inpatient and emergency room
utilization tends to be higher within the Medicaid eligible
population than among the general population because of the
inability to afford access to a primary care physician (PCP),
leading to the postponement of treatment until acute care is
required.
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The highest healthcare expenses for the non-elderly and disabled
Medicaid population include:
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obstetric services,
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neonatal care, |
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respiratory illness,
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sickle cell disease, and |
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diabetes,
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HIV/AIDS. |
During fiscal year 2007, the federal government estimates
spending of approximately $200 billion on Medicaid with a
corresponding state match of approximately $150 billion,
and an additional $7.5 billion spent on SCHIP programs. Key
factors driving Medicaid spending include:
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number of eligible individuals who enroll, |
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price of medical and long-term care services, |
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use of covered services, |
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state decisions regarding optional services and optional
eligibility groups, and |
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effectiveness of programs to reduce costs of providing benefits,
including managed care. |
The federal government pays a share of the medical assistance
expenditures under each states Medicaid program. That
share, known as the Federal Medical Assistance Percentage
(FMAP), is determined annually by a formula that compares the
states average per capita income level with the national
average per capita income level. Thus, states with higher per
capita income levels are reimbursed a smaller share of their
costs than states with lower per capita income levels. The FMAP
cannot be lower than 50% or higher than 83%. In fiscal 2006, the
FMAPs vary from 50% in 12 states and five territories to
76% in Mississippi, and 57% overall. In addition, the Balanced
Budget Act of 1997 permanently raised the FMAP for the District
of Columbia from 50% to 70%. The states fiscal
2006 FMAPs for the markets in which we have contracts are
set forth below.
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FMAP | |
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District of Columbia
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70.0 |
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Florida
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58.9 |
% |
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Georgia
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60.6 |
% |
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Illinois
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50.0 |
% |
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Maryland
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50.0 |
% |
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New Jersey
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50.0 |
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New York
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50.0 |
% |
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Ohio
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59.9 |
% |
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Texas
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60.7 |
% |
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Virginia
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50.0 |
% |
The federal government also matches administrative costs,
generally about 50%, although higher percentages are paid for
certain activities and functions, such as development of
automated claims processing systems. Federal payments have no
set limits (other than for SCHIP programs), but rather are made
on a matching basis. In 2004, Medicaid spending surpassed
elementary and secondary education spending in total state
spending, totaling 21.9% of total state spending for Medicaid
and 21.5% for elementary and secondary education. In 2003, 43.5%
of total federal funds provided to states were spent on
Medicaid, the highest category of federal funds provided to
states.
State governments pay the share of Medicaid and SCHIP costs not
paid by the federal government. Some states require counties to
pay part of the states share of Medicaid costs.
Federal law establishes general rules governing how states
administer their Medicaid and SCHIP programs. Within those
rules, states have considerable flexibility, including
flexibility in how they set most provider prices
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and service utilization controls. Generally, state Medicaid
budgets are developed and approved annually by the states
governors and legislatures. Medicaid expenditures are monitored
during the year against budgeted amounts. Federal law requires
states to offer at least two HMOs in any urban market with
mandatory HMO enrollment. If Medicaid HMO market departures
result in only one or no HMOs in an urban area, the affected
state must also offer the fee-for-service Medicaid program.
Under the Health Insurance Flexibility and Accountability
Demonstration Program (HIFA), states can seek waivers from
specific provisions of federal Medicaid requirements to increase
the number of individuals with health coverage through current
Medicaid and SCHIP resource levels. Currently, eight states are
involved in approved waiver programs. The current federal
administration has emphasized providing coverage to populations
with income below 200 percent of the federal poverty level.
Historically, the traditional Medicaid programs made payments
directly to providers after delivery of care. Under this
approach, recipients received care from disparate sources, as
opposed to being cared for in a systematic way. As a result,
care for routine needs was often accessed through emergency
rooms or not at all.
The delivery of episodic healthcare under the traditional
Medicaid program limited the ability of the states to provide
quality care, implement preventive measures and control
healthcare costs. Over the past decade, in response to rising
healthcare costs and in an effort to ensure quality healthcare,
the federal government has expanded the ability of state
Medicaid agencies to explore, and, in some cases, mandate the
use of managed care for Medicaid beneficiaries. If Medicaid
managed care is not mandatory, individuals entitled to Medicaid
may choose either the traditional Medicaid program or a managed
care plan, if available. According to information published by
CMS, from 1993 to 2002, managed care enrollment among Medicaid
beneficiaries increased to more than 57% of all enrollees. All
the markets in which we operate, except Illinois, have
state-mandated Medicaid managed care programs in place.
The AMERIGROUP Approach
Unlike many managed care organizations that attempt to serve the
general population, as well as Medicare and Medicaid
populations, we are focused exclusively on serving people who
receive healthcare benefits through publicly sponsored programs.
We primarily serve Medicaid populations, though we entered the
Medicare market to serve the dual eligible population in one
county in Houston, Texas beginning January 1, 2006. Our
success in establishing and maintaining strong relationships
with government, providers and members has enabled us to obtain
new contracts and to establish a strong market position in the
markets we serve. We have been able to accomplish this by
addressing the various needs of these constituent groups.
We have been successful in bidding for contracts and
implementing new products because of our ability to facilitate
access to quality healthcare services in a cost-effective
manner. Our education and outreach programs, our disease and
medical management programs and our information systems benefit
the communities we serve while providing the government with
predictability of cost. Our education and outreach programs are
designed to decrease the use of emergency care services as the
primary access to healthcare through the provision of certain
programs such as member health education seminars and
system-wide, 24-hour
on-call nurses. Our information systems are designed to measure
and track our performance, enabling us to demonstrate the
effectiveness of our programs to the government. While we
promote ourselves directly in applying for new contracts or
seeking to add new benefit plans, we believe that our ability to
obtain additional contracts and expand our service areas within
a state results primarily from our demonstration of prior
success in facilitating access to quality care, while reducing
and managing costs, and our customer-focused approach to working
in partnership with government. We believe we will also benefit
from this experience when bidding for and acquiring contracts in
new state markets and in future SNP applications.
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In each of the communities where we operate, we have established
extensive provider networks and have been successful in
continuing to establish new provider relationships. We have
accomplished this by working closely with physicians to help
them operate efficiently by providing financial, statistical and
utilization information, physician and patient educational
programs and disease and medical management programs, as well as
enabling electronic funds transfers. In addition, as we increase
our market penetration, we provide our physicians with a growing
base of potential patients in the markets they serve. This
network of providers and relationships assists us in
implementing preventive care methods, managing costs and
improving access to healthcare for members. We believe that our
experience working and contracting with Medicaid providers will
give us a competitive advantage in entering new markets. While
we do not directly market to or through our providers, they are
important in helping us attract new members and retain existing
members.
In both signing up new members and retaining existing members,
we focus on our understanding of the unique needs of the
Medicaid, SCHIP, FamilyCare and SNP populations. We have
developed a system that provides our members with appropriate
access to care. We supplement this care with community-based
education and outreach programs designed to improve the
well-being of our members. These programs not only help our
members control and manage their medical care, but also have
been proven to decrease the incidence of emergency room care,
which is traumatic for the individual and expensive and
inefficient for the healthcare system. We also help our members
access prenatal care which improves outcomes for our members and
is less costly than unmanaged care. As our presence in a market
matures, these programs and other value-added services, help us
build and maintain membership levels.
We focus on the members we serve and the communities where they
live. Many of our employees, including the sales force and
outreach staff, are a part of the communities we serve. We are
active in our members communities through education and
outreach programs. We often provide programs in our
members physician offices, churches and community centers.
Upon entering a new market, we use these programs and other
advertising to create brand awareness and loyalty in the
community.
Strategy
Our objective is to become the leading managed care organization
in the U.S. focused on serving people who receive
healthcare benefits through publicly sponsored programs. To
achieve this objective we intend to:
Increase our membership in existing and new markets through
internal growth and acquisitions. We intend to increase our
membership in existing and new markets through development and
implementation of community-specific products, alliances with
key providers, sales and marketing efforts and acquisitions. We
facilitate access to a broad continuum of healthcare supported
by numerous services such as neonatal intensive care and
high-risk pregnancy programs. These products and services are
developed and administered by us but are also designed to
attract and retain our providers, who are critical to our
overall success. Through strategic and selective contracting
with providers, we are able to customize our provider networks
to meet the unique clinical, cultural and socio-economic needs
of our members. Our providers often are located in the
inner-city neighborhoods where our members live, thereby
providing accessibility to, and an understanding of, the needs
of our members. In our voluntary markets, we have a sales force
to recruit potential members who are currently in the
traditional fee-for-service Medicaid system. The overall effect
of this comprehensive approach reinforces our broad brand-name
recognition as a leading managed healthcare company serving
people who receive publicly sponsored healthcare benefits, while
complying with state-mandated marketing guidelines.
We may also choose to increase membership by acquiring Medicaid
contracts and other related assets from competitors in our
existing markets or in new markets. Since 1996, we have
developed markets in Illinois, New Jersey, Ohio, Texas and
Virginia and acquired additional Medicaid contracts and related
assets in the District of Columbia, Florida, Maryland, New
Jersey, Texas and New York. We evaluate potential new markets
using our
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established government relationships and our historical
experience in managing Medicaid populations. Our management team
is experienced in identifying markets for development of new
operations, including complementary businesses, identifying and
executing acquisitions and integrating these businesses into our
existing operations. For example, in January 2005, we began
operations in New York as a result of the acquisition of
CarePlus, resulting in approximately 115,000 additional members
in New York City (Brooklyn, Manhattan, Queens and Staten Island)
and Putman County.
We may also choose to apply for additional SNP service areas,
under the provisions of the Medicare Modernization Act. This is
a new program and applications for participation by health plans
are subject to approval by CMS. At this time, our focus is on
providing SNP benefits to dual eligibles (members eligible for
both Medicaid and Medicare).
Capitalize on our experience working in partnership with
governments. We continually strive to be an
industry-recognized leader in government relations and an
important resource to our government customers. For example, we
have a dedicated legislative affairs team with experience at the
federal, state and local levels. We are, and intend to continue
to be, an active and leading participant in the formulation and
development of new policies and programs for publicly sponsored
healthcare benefits. This also enables us to competitively
expand our service areas and to implement new products.
Focus on our medical home concept to provide
quality, cost-effective healthcare. We believe that the care
the Medicaid population has historically received can be
characterized as uncoordinated, episodic and short-term focused.
In the long-term, this approach is less desirable for the
patient and more expensive for the state.
Our approach to serving the Medicaid and historically uninsured
populations is based on offering a comprehensive range of
medical and social services intended to improve the well-being
of the member while lowering the overall cost of providing
benefits. Unlike traditional Medicaid, each of our members has a
primary contact, usually a PCP, to coordinate and administer the
provision of care, as well as enhanced benefits, such as
24-hour on-call nurses.
We refer to this coordinated approach as a medical
home.
Utilize population-specific disease management programs and
related techniques to improve quality and reduce costs. An
integral part of our medical home concept is continual quality
management. To help the physician improve the quality of care
and improve the health status of our members, we have developed
a number of programs and procedures to address high frequency,
chronic or high-cost conditions such as pregnancy, respiratory
conditions, diabetes, sickle cell disease and congestive heart
failure. Our procedures include case and disease management,
pre-admission certification, concurrent review of hospital
admissions, discharge planning, retrospective review of claims,
outcome studies and management of inpatient, ambulatory and
alternative care. These policies and programs are designed to
provide high quality care and cost-effective service to our
members.
Products
We have developed several products through which we offer a
range of healthcare services. These products are also
community-based and seek to address the social and economic
issues faced by the populations we serve. Additionally, we seek
to establish strategic relationships with prestigious medical
centers, childrens hospitals and federally qualified
health centers to assist in implementing our products and
medical management programs within the communities we serve. Our
health plans cover various services that vary by state and may
include:
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primary and specialty physician care, |
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inpatient and outpatient hospital care, |
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emergency and urgent care, |
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prenatal care, |
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laboratory and x-ray services, |
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home health and durable medical equipment, |
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behavioral health services and substance abuse, |
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long-term and nursing home care, |
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24-hour on-call nurses, |
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vision care and exam allowances, |
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dental care, |
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chiropractic care, |
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podiatry, |
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prescriptions and limited
over-the-counter drugs, |
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assistance with obtaining transportation for office or health
education visits, |
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memberships in the Boys and Girls Clubs, and |
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welcome calls and health status calls to coordinate care. |
Our products, which we may offer under different names in
different markets, focus on specific populations within the
Medicaid, FamilyCare, SCHIP and SNP programs. The average
premiums for our products vary significantly due to differences
in the benefits offered and underlying medical conditions in the
populations covered.
The following table sets forth the approximate number of our
members in each of our products for the periods presented.
| |
|
|
|
|
|
|
|
|
| |
|
December 31, | |
| |
|
| |
| Product |
|
2005 | |
|
2004 | |
| |
|
| |
|
| |
|
AMERICAID (Medicaid TANF)
|
|
|
800,000 |
|
|
|
662,000 |
|
|
|
|
|
|
|
AMERIKIDS (SCHIP)
|
|
|
197,000 |
|
|
|
182,000 |
|
|
|
|
|
|
|
AMERIPLUS (Medicaid SSI)
|
|
|
88,000 |
|
|
|
79,000 |
|
|
|
|
|
|
|
AMERIFAM (FamilyCare)
|
|
|
44,000 |
|
|
|
13,000 |
|
| |
|
|
|
|
|
|
|
Total
|
|
|
1,129,000 |
|
|
|
936,000 |
|
| |
|
|
|
|
|
|
AMERICAID, our principal product, is our family-focused Medicaid
managed healthcare product designed for the TANF population that
consists primarily of low-income children and their mothers. We
currently offer our AMERICAID product in all markets we serve.
AMERIKIDS is our managed healthcare product for uninsured
children not eligible for Medicaid. This product is designed for
children in the SCHIP initiative. We began offering AMERIKIDS in
1999 and currently offer it in all of the states we serve,
though not in all markets within each state.
AMERIPLUS is our managed healthcare product for SSI recipients.
This population consists of the low-income aged, blind and
disabled. We began offering this product in 1998 and currently
offer it in Florida, New Jersey, New York, Maryland, Houston,
Texas and Virginia. We expect our AMERIPLUS membership to grow
as more states include SSI benefits in mandatory managed care
programs. Included in our AMERIPLUS membership are approximately
1,000 members added through a Florida program called Summit
Care. The Summit Care (Long-Term Care Diversion) program helps
seniors live safely in their homes or assisted living facilities
as an alternative to nursing home care. Also included is
CarePlus Connections, which is our managed long-term care
product which began operations in New York City through our New
York subsidiary, CarePlus, effective December 1, 2005.
AMERIFAM is our FamilyCare managed healthcare product designed
for uninsured segments of the population other than SCHIP
eligibles. AMERIFAMs current focus is on the families of
our SCHIP and Medicaid children. We offer this product in the
District of Columbia, New Jersey, and New York where the program
covers parents of SCHIP and Medicaid children.
9
AMERIVANTAGE is our SNP managed care product for dual eligibles.
AMERIVANTAGE is available in Houston, Texas effective
January 1, 2006. AMERIPLUS members in this market may now
have their Medicare and Part D drug benefits covered in
addition to their Medicaid benefits through AMERIPLUS. We are
currently considering SNP applications for additional markets,
to be submitted to CMS in 2006, in order to qualify for the
January 1, 2007 effective date.
As of December 31, 2005, of our 1,129,000 members, 92% were
enrolled in TANF, SCHIP and FamilyCare programs. The remaining
8% were enrolled in SSI programs. Of these SSI enrollees,
approximately 10,000 were members to whom we provided limited
administrative services but did not provide health benefits.
Disease and Medical Management Programs
We provide specific disease and medical management programs
designed to meet the special healthcare needs of our members
with chronic illnesses, to manage excessive costs and to improve
the overall health of our members. We currently offer disease
and medical management programs in areas such as neonatal,
high-risk pregnancy, asthma and other respiratory conditions,
congestive heart failure, sickle cell disease, diabetes and HIV/
AIDS. These programs focus on preventing acute occurrences
associated with chronic conditions by identifying at-risk
members, monitoring their conditions and proactively managing
their care. We also employ tools such as utilization review and
pre-certification to reduce the excessive costs often associated
with uncoordinated healthcare programs.
Marketing and Educational Programs
An important aspect of our comprehensive approach to healthcare
delivery is our marketing and educational programs, which we
administer system-wide for our providers and members. We often
provide our educational programs in members homes and our
marketing and educational programs in churches and community
centers. The programs we have developed are specifically
designed to increase awareness of various diseases, conditions
and methods of prevention in a manner that supports the
providers, while meeting the unique needs of our members. For
example, we conduct health promotion events in physicians
offices. Direct provider marketing is supported by traditional
marketing venues such as direct mail, telemarketing, television,
radio and cooperative advertising with participating medical
groups.
We believe that we can also increase and retain membership
through marketing and education initiatives. We have a dedicated
staff that actively supports and educates prospective and
existing members and community organizations. Through programs
such as Safe Kids, Power Zone and Taking Care of Baby and
Me®,
a prenatal program for pregnant moms and their babies, we
promote a healthy lifestyle, safety and good nutrition to our
members. In addition to these personal health-related programs,
we remain committed to the communities we serve.
We have developed specific strategies for building relationships
with key community organizations, which help enhance community
support for our products and improve service to our members. We
regularly participate in local events and festivals and organize
community health fairs to promote healthy lifestyle practices.
Equally as important, our employees help support community
groups by serving as board members and volunteers. In the
aggregate, these activities serve to act not only as a referral
channel, but also reinforce the AMERIGROUP brand and foster
member loyalty.
We also have developed a strategy to bring education and
services into the neighborhoods we serve with our Community
Outreach Vehicle (COV). The COV is equipped to allow us to
partner with various physicians, health educators and
community/government organizations to bring health screenings
and other resources into areas that would not typically have
access to these services.
In several markets, we provide value-added benefits as a means
to attract and retain members. These benefits include free
memberships to the local Boys and Girls Clubs and vouchers for
over-the-counter
medications. We believe that our comprehensive approach to
healthcare positions us well to serve our members, their
providers and the communities in which they both live and work.
10
Community Partners
We believe community focus and understanding are important to
attracting and retaining members. To assist in establishing our
community presence in a new market, we seek to establish
relationships with prestigious medical centers, childrens
hospitals, federally qualified health centers, community based
organizations and advocacy groups to offer our products and
programs.
Provider Network
We facilitate access to healthcare services to our members
through mutually non-exclusive contracts with PCPs, specialists,
hospitals and ancillary providers. Either prior to or concurrent
with bidding for new contracts, we establish a provider network
in each of our service areas. The following table shows the
total number of PCPs, specialists, hospitals and ancillary
providers participating in our network as of December 31,
2005:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Primary | |
|
|
|
|
|
|
| |
|
Care | |
|
|
|
|
|
Ancillary | |
| Service Areas |
|
Physicians | |
|
Specialists | |
|
Hospitals | |
|
Providers | |
| |
|
| |
|
| |
|
| |
|
| |
|
Florida
|
|
|
1,745 |
|
|
|
7,067 |
|
|
|
97 |
|
|
|
1,825 |
|
|
|
|
|
|
|
Illinois
|
|
|
642 |
|
|
|
1,438 |
|
|
|
29 |
|
|
|
71 |
|
|
|
|
|
|
|
Maryland and D.C.
|
|
|
1,723 |
|
|
|
7,655 |
|
|
|
50 |
|
|
|
479 |
|
|
|
|
|
|
|
New Jersey
|
|
|
1,875 |
|
|
|
4,575 |
|
|
|
70 |
|
|
|
642 |
|
|
|
|
|
|
|
New York
|
|
|
1,748 |
|
|
|
8,095 |
|
|
|
56 |
|
|
|
1,749 |
|
|
|
|
|
|
|
Ohio
|
|
|
416 |
|
|
|
1,869 |
|
|
|
15 |
|
|
|
31 |
|
|
|
|
|
|
|
Texas
|
|
|
1,640 |
|
|
|
6,493 |
|
|
|
105 |
|
|
|
961 |
|
|
|
|
|
|
|
Virginia
|
|
|
333 |
|
|
|
1,141 |
|
|
|
10 |
|
|
|
58 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
10,122 |
|
|
|
38,333 |
|
|
|
432 |
|
|
|
5,816 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
The PCP is a critical component in care delivery, the management
of costs and the attraction and retention of new members. PCPs
include family and general practitioners, pediatricians,
internal medicine physicians, obstetricians and gynecologists.
These physicians provide preventive and routine healthcare
services and are responsible for making referrals to
specialists, hospitals and other providers. Healthcare services
provided directly by PCPs include the treatment of illnesses not
requiring referrals, periodic physician examinations, routine
immunizations, well-child care and other preventive healthcare
services.
Specialists provide medical care to members generally upon
referral by the PCPs. However, we have identified specialists
that are part of the ongoing care of our members, such as
allergists, oncologists and surgeons, which our members may
access directly without first obtaining a PCP referral. Our
contracts with both the PCPs and specialists usually are for
one- to two-year periods and automatically renew for successive
one-year periods subject to termination by us for cause, if
necessary, based on provider conduct or other appropriate
reasons. The contracts generally can be canceled by either party
without cause upon 90 to 120 days prior written notice.
Our contracts with hospitals are usually for one- to two-year
periods and automatically renew for successive one-year periods.
Generally, our hospital contracts may be terminated by either
party without cause upon 90 to 150 days prior written
notice. Pursuant to the contract, the hospital is paid for all
pre-authorized medically necessary inpatient and outpatient
services and all covered emergency and medical screening
services provided to members. With the exception of emergency
services, most inpatient hospital services require advance
approval from the members PCP and our medical management
department. We require hospitals in our network to participate
in utilization review and quality assurance programs.
We have also contracted with other ancillary providers for
physical therapy, mental health and chemical dependency care,
home healthcare, vision care, diagnostic laboratory tests, x-ray
examinations, ambulance services and durable medical equipment.
Additionally, we have contracted with dental vendors that
provide routine dental care in markets where routine dental care
is a covered benefit and with a national pharmacy benefit
manager that provides a local pharmacy network in our markets
where pharmacy is a covered benefit.
11
In order to ensure the quality of our medical care providers, we
credential and re-credential our providers using standards that
are supported by the National Committee for Quality Assurance.
Additionally, we provide feedback and evaluations on quality and
medical management to them in order to improve the quality of
care provided, increase their support of our programs and
enhance our ability to attract and retain providers.
Provider Payment Methods
Fee-for-Service. This is a reimbursement mechanism that
pays providers based upon services performed. For the year ended
December 31, 2005, approximately 95% of our expenses for
direct health benefits were on a fee-for-service reimbursement
basis, including fees paid to third-party vendors for ancillary
services such as pharmacy, mental health, dental and vision
benefits. The primary fee-for-service arrangements are maximum
allowable fee schedule, per diem, case rates, percent of charges
or any combination thereof. The following is a description of
each of these mechanisms:
|
|
|
| |
|
Maximum Allowable Fee Schedule. Providers are paid the
lesser of billed charges or a specified fixed payment for a
covered service. The maximum allowable fee schedule is developed
using, among other indicators, the state fee-for-service
Medicaid program fee schedule, Medicare fee schedules, medical
costs trends and market conditions. |
| |
| |
|
Per Diem and Case Rates. Hospital facility costs are
typically reimbursed at negotiated per diem or case rates, which
vary by level of care within the hospital setting. Lower rates
are paid for lower intensity services, such as a low birth
weight newborn baby who stays in the hospital a few days longer
than the mother, compared to higher rates for a neonatal
intensive care unit stay for a baby born with severe
developmental disabilities. |
| |
| |
|
Percent of Charges. We contract with providers to pay
them an agreed-upon percent of their standard charges for
covered services. This is typically done where hospitals are
reimbursed under the state fee-for-service Medicaid program on a
percent of charges basis. |
Capitation. Some of our PCPs and specialists are paid on
a fixed-fee per member basis, also known as capitation. Our
arrangements with ancillary providers for vision, dental, home
health, laboratory, durable medical equipment, mental health and
chemical dependency services may also be capitated.
We review the fees paid to providers periodically and make
adjustments as necessary. Generally, the contracts with
providers do not allow for automatic annual increases in
payments. Among the factors generally considered in adjustments
are changes to state Medicaid fee schedules, competitive
environment, current market conditions, anticipated utilization
patterns and projected medical expenses. In order to enable us
to better monitor quality and meet our state contractual
encounter reporting obligations, it is our intention to increase
the number of providers we pay on a fee-for-service basis and
reduce the number of capitation contracts we have. States use
the encounter data to monitor quality of care to members and to
set premium rates.
Our Health Plans
Effective with the January 1, 2005 CarePlus acquisition and
two new market
start-ups in September,
2005, we have nine active health plan subsidiaries offering
healthcare services in the District of Columbia, Florida,
Illinois, Maryland, New Jersey, New York, Ohio, Texas, and
Virginia. Additionally, we have a new health plan in Georgia
that is expected to commence operations in the second quarter of
2006 based on the most recent
12
communication from the State. We expect our relationship with
these jurisdictions to continue. Each of our health plans have
one or more contracts that expire at various times, as set forth
below:
| |
|
|
|
|
| Market |
|
Product |
|
Term End Date |
| |
|
|
|
|
|
|
|
|
|
|
District of Columbia
|
|
TANF, SCHIP, FamilyCare |
|
July 31, 2006 |
|
|
|
|
|
|
Florida
|
|
TANF, SSI, SCHIP |
|
June 30, 2006 |
|
|
|
|
|
|
Florida
|
|
SCHIP |
|
September 30, 2006 |
|
|
|
|
|
|
Florida
|
|
SSI (Summit Care) |
|
June 30, 2006 |
|
|
|
|
|
|
Georgia(a)
|
|
TANF, SCHIP |
|
March 31, 2007 |
|
|
|
|
|
|
Illinois
|
|
TANF, SCHIP |
|
July 31, 2006 |
|
|
|
|
|
|
Maryland(b)
|
|
TANF, SSI, SCHIP |
|
|
|
|
|
|
|
|
New Jersey
|
|
TANF, SSI, SCHIP, FamilyCare |
|
June 30, 2006 |
|
|
|
|
|
|
New York State Contract
|
|
TANF, SSI, FamilyCare |
|
September 30, 2008 |
|
|
|
|
|
|
New York City of New York
|
|
TANF, SSI |
|
September 30, 2007 |
|
|
|
|
|
|
New York
|
|
SCHIP |
|
December 31, 2006 |
|
|
|
|
|
|
New York
|
|
SSI (Managed Long-Term Care) |
|
December 31, 2006 |
|
|
|
|
|
|
Ohio
|
|
TANF, SCHIP |
|
June 30, 2006 |
|
|
|
|
|
|
Virginia
|
|
TANF, SSI |
|
June 30, 2006 |
|
|
|
|
|
|
Virginia
|
|
SCHIP |
|
June 30, 2006 |
|
|
|
|
|
|
Texas
|
|
TANF, SSI, SCHIP |
|
August 31, 2006 |
|
|
|
|
(a) |
|
The Company entered into a contract with the State of Georgia in
July 2005 to offer healthcare coverage to low-income residents
in four of six regions through its subsidiary AMGP Georgia
Managed Care Company, Inc. (d/b/a AMERIGROUP Georgia). We
anticipate that the contract will commence during the second
quarter of 2006, based on the most recent communication from the
State, and continue through June 30, 2007, with six
one-year renewal options thereafter. |
| |
|
(b) |
|
Our Maryland contract does not have a set term but can be
terminated by the Company upon 90 days written notice. |
All of our contracts, except those in the District of Columbia
and New Jersey, contain provisions for termination by us without
cause generally upon written notice with a 30 to
180 day notification period.
Our Maryland subsidiary, AMERIGROUP Maryland, Inc., a Managed
Care Organization, is also licensed as an HMO in the District of
Columbia and became operational in the District of Columbia in
August 1999. As of December 31, 2005, we had approximately
41,000 members in the District of Columbia. We believe that we
have the largest Medicaid health plan membership in the District
of Columbia. We offer AMERICAID, AMERIKIDS and AMERIFAM in the
District of Columbia. Our contract with the District of Columbia
extends through July 31, 2006, with the Districts
option to continue contract extensions for up to two additional
one-year terms through July 31, 2008.
Our Florida subsidiary, AMERIGROUP Florida, Inc., is licensed as
an HMO and became operational in January 2003 with the
acquisition of PHP. In July 2003, we acquired the Medicaid
contract rights and related assets of a health plan known as
St. Augustine. Our current service areas include the
metropolitan areas of Miami/ Fort Lauderdale, Orlando and
Tampa that include 13 counties in Florida. As of
December 31, 2005, we had approximately 219,000 members,
consisting of approximately 60,000 members in Miami/
Fort Lauderdale, 41,000 members in Orlando and 118,000
members in Tampa. We believe we have the second largest Medicaid
health plan membership in the Miami/ Fort Lauderdale and
Orlando markets, and the largest Medicaid health plan membership
in the Tampa market. We offer AMERICAID, AMERIKIDS and AMERIPLUS
in each of our Florida markets. Our TANF, SSI and SCHIP
contracts expire June 30, 2006 and can be terminated by
either party
13
upon 30 days notice. Our Summit Care contract expires
June 30, 2006 and we anticipate the new contract to be
effective as of July 1, 2006. However, either party can
terminate the contract upon 60 days notice. Currently, we
are in good standing with the Department of Elder Affairs, the
agency with regulatory oversight of the Long Term Care program,
and have no reason to believe that the contract will not be
renewed. As a result of a successful Florida SCHIP
re-bid in 2005,
individual county contracts were consolidated into one contract
covering eight counties, through September 30, 2006, with
the option to continue contract extensions for up to two
additional one-year terms.
Our Illinois subsidiary, AMERIGROUP Illinois, Inc., is licensed
as an HMO and became operational in April 1996. Our current
service area includes the counties of Cook and DuPage in the
Chicago area. In Chicago, enrollment in a Medicaid managed care
plan is voluntary. As of December 31, 2005, we had
approximately 41,000 members in Chicago. We believe that we have
the second largest Medicaid health plan membership in Cook
County. We offer AMERICAID and AMERIKIDS in the Chicago area.
Our contract with the State of Illinois, which can be terminated
by either party with 60 days written notice, was extended
through July 31, 2006.
Our Maryland subsidiary, AMERIGROUP Maryland, Inc., a Managed
Care Organization, is authorized to operate as a managed care
organization (MCO) in Maryland and became operational in June
1999. Our current service areas include 20 of the
24 counties in Maryland. As of December 31, 2005, we
had approximately 141,000 members in Maryland. We believe that
we have the largest Medicaid health plan membership in Maryland.
We offer AMERICAID, AMERIKIDS and AMERIPLUS in Maryland. Our
contract with the State of Maryland does not have a set term. We
can terminate our contract with Maryland by notifying the State
by October 1st of any given year for an effective
termination date of January 1st of the following year.
The State may waive this timeframe if the circumstances warrant,
including but not limited to reduction in rates outside the
normal rate setting process or an MCO exit from the program.
Our New Jersey subsidiary, AMERIGROUP New Jersey, Inc., is
licensed as an HMO and became operational in February 1996. Our
current service areas include 20 of the 21 counties in
New Jersey. As of December 31, 2005, we had approximately
109,000 members in New Jersey. We believe that we have the third
largest Medicaid health plan membership in New Jersey. We offer
AMERICAID, AMERIPLUS, AMERIKIDS and AMERIFAM in New Jersey. Our
contract with the State of New Jersey expires on June 30,
2006, with the States option to extend the contract on an
annual basis through an executed contract amendment.
Effective January 1, 2005, we acquired CarePlus, which is
licensed as a Prepaid Health Services Plan (PHSP) in New
York. CarePlus service areas include New York City, within
the boroughs of Brooklyn, Manhattan, Queens and Staten Island,
and Putman County. Effective January 1, 2005, through the
acquisition of CarePlus, we added approximately 115,000 members,
to whom we offer AMERICAID, AMERIKIDS and AMERIFAM. Our TANF,
SSI and FamilyCare contracts with the State were renewed on
October 1, 2005. The renewed State TANF, SSI and FamilyCare
contracts are for a term of three years (through
September 30, 2008) with the State Department of
Healths option to extend for an additional two-year term.
The Citys TANF contract was also renewed effective
October 1, 2005 for a two-year term (through
September 30, 2007) with the City Department of
Healths option to extend for one additional three-year
term. Our SCHIP contract with the State has been continued by
contract extension through December 31, 2006. Effective
August 1, 2005, CarePlus entered into a contract with the
Department of Health to participate in the Managed Long-Term
Care Demonstration project. The initial term of the contract,
August 1, 2005 through December 31, 2005, has been
extended for an additional 12 months and will expire on
December 31, 2006. As of December 31, 2005, we had
approximately 138,000 members in New York. We believe we have
the sixth largest Medicaid health plan membership in New York
City.
14
Our Ohio subsidiary, AMERIGROUP Ohio, Inc., is licensed as an
HMO and began operations in September 2005 in the Cincinnati
service area. As of December 31, 2005, we had approximately
22,000 members in Ohio. We believe we have the second largest
Medicaid health plan membership in the Cincinnati area. We offer
AMERICAID and AMERIKIDS in Ohio. Our contract with the State of
Ohio expires on June 30, 2006.
Our Texas subsidiary, AMERIGROUP Texas, Inc., is licensed as an
HMO and became operational in September 1996. Our current
service areas include the cities of Austin, Dallas,
Fort Worth and Houston and the surrounding counties. As of
December 31, 2005, we had approximately 399,000 members in
Texas, consisting of approximately 16,000 members in Austin,
approximately 101,000 members in Dallas, approximately 126,000
members in Fort Worth and approximately 156,000 members in
Houston. We believe that we have the largest Medicaid health
plan membership in each of our Fort Worth and Houston
markets and the second largest Medicaid health plan membership
in our Austin and Dallas markets. We offer AMERICAID in each of
our Texas markets, AMERIKIDS in Dallas and Houston and AMERIPLUS
in Houston. Our TANF contract in Fort Worth and the Travis
service area, our TANF and SCHIP contracts in Dallas and our
TANF, SCHIP and SSI contracts in Houston are set to expire on
August 31, 2006 as a result of our participation in a
re-procurement process
of all product contracts and all service areas in mid-year 2005.
As a result of this competitive-bidding process, AMERIGROUP
Texas, Inc. was awarded TANF (STAR) and SCHIP contracts in
its current service areas of Houston, Dallas and Fort Worth
and in its new service area of Corpus Christi and a STAR
contract in, Travis County. These contracts expire
August 31, 2006.
Our Virginia subsidiary, AMERIGROUP Virginia, Inc., is licensed
as an HMO and began operations in September 2005 in Northern
Virginia. As of December 31, 2005, we had approximately
19,000 members. We believe we have the second largest Medicaid
health plan membership in Northern Virginia. We offer AMERICAID,
AMERIKIDS and AMERIPLUS in Virginia. Our TANF, SSI, and SCHIP
contracts with the Commonwealth of Virginia expire on
June 30, 2006.
Quality Management
We have a comprehensive quality management plan designed to
improve access to cost-effective quality care. We have developed
policies and procedures to ensure that the healthcare services
arranged by our health plans meet the professional standards of
care established by the industry and the medical community.
These procedures include:
|
|
|
| |
|
Analysis of healthcare utilization data. To avoid
duplication of services or medications, in conjunction with the
PCPs, healthcare utilization data is analyzed and, through
comparative provider data and periodic meetings with physicians,
we identify areas in which a physicians utilization rate
differs significantly from the rates of other physicians. On the
basis of this analysis, we suggest opportunities for improvement
and follow-up with the
PCP to monitor utilization. |
| |
| |
|
Medical care satisfaction studies. We evaluate the
quality and appropriateness of care provided to our health plan
members by reviewing healthcare utilization data and responses
to member and physician questionnaires and grievances. |
| |
| |
|
Clinical care oversight. Each of our health plans has a
medical advisory committee comprised of physician
representatives and chaired by the plans medical director.
This committee reviews credentialing, approves clinical
protocols and practice guidelines and evaluates new physician
group candidates. Based on regular reviews, the medical
directors who head these committees develop recommendations for
improvements in the delivery of medical care. |
| |
| |
|
Quality improvement plan. A quality improvement plan is
implemented in each of our health plans and is governed by a
quality management committee. The quality management committee
is comprised of |
15
|
|
|
| |
|
senior management at our health plans, who review and evaluate
the quality of our health services and are responsible for the
development of quality improvement plans spanning both clinical
quality and customer service quality. These plans are developed
from provider and membership feedback, satisfaction surveys and
results of action plans. Our corporate quality improvement
council oversees and meets regularly with our health plan
quality management committees to help ensure that we have a
coordinated, quality-focused approach relating to our members,
providers and state governments. |
Management Information Systems
The ability to capture, process and allow local access to data
and to translate it into meaningful information is essential to
our ability to operate across a multi-state service area in a
cost-effective manner. We operate with three claims management
applications, AMISYS, FACETS and TXEN, the latter of which was
inherited through our acquisition of CarePlus. We are currently
in the process of converting from AMISYS and TXEN to our
strategic long-term solution, FACETS. This integrated approach
helps to assure that consistent sources of claim, provider and
member information are provided across all of our health plans.
We use these common systems for billing, claims and encounter
processing, utilization management, marketing and sales
tracking, financial and management accounting, medical cost
trending, reporting, planning and analysis. The platform also
supports our internal member and provider service functions,
including on-line access to member eligibility verification, PCP
membership roster, authorization and claims status.
In November 2003, we signed a software licensing agreement with
The Trizetto Group, Inc. for their FACETS Extended
Enterprisetmadministrative
system (FACETS). During 2005, we continued to invest in the
implementation and testing of FACETS with a staggered conversion
to FACETS by health plan beginning in 2005 and continuing
through 2007. As of October 1, 2005, we began processing
claims payments for our Texas health plan with dates of service
subsequent to that date using FACETS. We estimate that our
current primary claims payment system, without FACETS, could be
at full capacity within the next 16 months. We currently
expect that FACETS will meet our software needs and will support
our long-term growth strategies.
Competition
Our principal competitors for state contracts, members and
providers consist of the following types of organizations:
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Traditional Fee-for-Service Original unmanaged
provider payment system whereby the state governments pay
providers directly for services provided to Medicaid members. |
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Primary Care Case Management Programs (PCCMs)
Programs established by the states through contracts with PCPs
to provide primary care services to the Medicaid recipient, as
well as provide limited oversight over other services. |
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Commercial HMOs National and regional commercial
managed care organizations that have Medicaid and Medicare
members in addition to members in private commercial plans. |
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Medicaid HMOs Managed care organizations that focus
solely on serving people who receive healthcare benefits through
Medicaid. |
We will continue to face varying levels of competition as we
expand in our existing service areas or enter new markets. In
Illinois, where enrollment in a managed care plan is voluntary,
we also compete for members with the traditional means for
accessing care, including hospitals and other healthcare
providers. Healthcare reform proposals may cause a number of
commercial managed care organizations already in our service
areas to decide to enter or exit the Medicaid market. However,
the licensing requirements and bidding and contracting
procedures in some states present barriers to entry into the
Medicaid managed healthcare industry.
We compete with other managed care organizations to obtain state
contracts, as well as to attract new members and to retain
existing members. States generally use either a formal proposal
process reviewing many bidders or award individual contracts to
qualified applicants that apply for entry to the program. In
order to be awarded a state contract, state governments consider
many factors, which include providing quality care,
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satisfying financial requirements, demonstrating an ability to
deliver services, and establishing networks and infrastructure.
People who wish to enroll in a managed healthcare plan or to
change healthcare plans typically choose a plan based on the
service offered, ease of access to services, a specific provider
being part of the network and the availability of supplemental
benefits.
In addition to competing for members, we compete with other
managed care organizations to enter into contracts with
independent physicians, physician groups and other providers. We
believe the factors that providers consider in deciding whether
to contract with us include potential member volume,
reimbursement rates, our medical management programs, timeliness
of reimbursement and administrative service capabilities.
Regulation
Our healthcare operations are regulated at both the state and
federal levels and in the case of New York, by the City as well.
Government regulation of the provision of healthcare products
and services is a changing area of law that varies from
jurisdiction to jurisdiction. Regulatory agencies generally have
discretion to issue regulations and interpret and enforce laws
and rules. Changes in applicable laws and rules may also occur
periodically.
Eight of our health plan subsidiaries are authorized to operate
as HMOs in the District of Columbia, Florida, Georgia (expected
to be operational in 2006), Illinois, New Jersey, Ohio, Texas,
and Virginia, as an MCO in Maryland, and as a PHSP in New York.
In each of the jurisdictions in which we operate, we are
regulated by the relevant health, insurance and/or human
services departments that oversee the activities of HMOs, MCOs,
and PHSPs providing or arranging to provide services to Medicaid
enrollees.
The process for obtaining the authorization to operate as an HMO
MCO, or PHSP is lengthy and complicated and requires
demonstration to the regulators of the adequacy of the health
plans organizational structure, financial resources,
utilization review, quality assurance programs and complaint
procedures. Both under state HMO, MCO, and PHSP statutes and
state insurance laws, our health plan subsidiaries must comply
with minimum net worth requirements and other financial
requirements, such as minimum capital, deposit and reserve
requirements. Insurance regulations may also require the prior
state approval of acquisitions of other managed care
organizations businesses and the payment of dividends, as
well as notice for loans or the transfer of funds. Each of our
subsidiaries is also subject to periodic reporting requirements.
In addition, each health plan must meet numerous criteria to
secure the approval of state regulatory authorities before
implementing operational changes, including the development of
new product offerings and, in some states, the expansion of
service areas.
Medicaid was established, as was Medicare, by 1965 amendments to
the Social Security Act of 1935. The amendments, known
collectively as the Social Security Act of 1965, created a joint
federal-state program in which each state:
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establishes its own eligibility standards, |
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determines the type, amount, duration and scope of services, |
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sets the rate of payment for services, and |
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administers its own program. |
Medicaid policies for eligibility, services, rates and payment
are complex, and vary considerably among states, and the state
policies may change from
time-to-time.
States are also permitted by the federal government to seek
waivers from certain requirements of the Social Security Act of
1965. In the past decade, partly due to advances in the
commercial healthcare field, states have been increasingly
interested in experimenting with pilot projects and statewide
initiatives to control costs and expand coverage and have done
so under waivers authorized by the Social Security Act of 1965
and with the
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approval of the federal government. The waivers most relevant to
us are the Section 1915(b) freedom of choice waivers that
enable:
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mandating Medicaid enrollment into managed care, |
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utilizing a central broker for enrollment into plans, |
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using cost savings to provide additional services, and |
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limiting the number of providers for additional services. |
Waivers are approved for two-year periods and can be renewed on
an ongoing basis if the state applies. A 1915(b) waiver cannot
negatively impact beneficiary access or quality of care and must
be cost-effective. Managed care initiatives may be state-wide
and required for all classes of Medicaid eligible recipients, or
may be limited to service areas and classes of recipients. All
jurisdictions in which we operate, except Illinois, have some
sort of mandatory Medicaid program. However, under the waivers
pursuant to which the mandatory programs have been implemented,
there must be at least two managed care plans operating from
which Medicaid eligible recipients may choose.
Many states, including Maryland, operate under a
Section 1115 demonstration rather than a 1915(b) waiver.
This is a more expansive form of waiver that enables the state
to have a Medicaid program that is broader than typically
permitted under the Social Security Act of 1965. For example,
Marylands 1115 waiver allows it to include more
individuals in its managed care program than typically allowed
under Medicaid.
In all the states in which we operate, we must enter into a
contract with the states Medicaid regulator in order to be
a Medicaid managed care organization. States generally use
either a formal proposal process, reviewing many bidders, or
award individual contracts to qualified applicants that apply
for entry to the program. Although other states have done so in
the past and may do so in the future, currently the District of
Columbia, Florida and Texas are the only jurisdictions in which
we operate that use competitive bidding processes.
The contractual relationship with the state is generally for a
period of one to two years and renewable on an annual or
biannual basis. The contracts with the states and regulatory
provisions applicable to us generally set forth in great detail
the requirements for operating in the Medicaid sector including
provisions relating to:
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eligibility, enrollment and disenrollment processes, |
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covered services, |
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eligible providers, |
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subcontractors, |
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record-keeping and record retention, |
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periodic financial and informational reporting, |
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quality assurance, |
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marketing, |
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financial standards, |
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timeliness of claims payment, |
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health education and wellness and prevention programs, |
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safeguarding of member information, |
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fraud and abuse detection and reporting, |
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grievance procedures, and |
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organization and administrative systems. |
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A health plans compliance with these requirements is
subject to monitoring by the state regulator and by CMS. A
health plan is subject to periodic comprehensive quality
assurance evaluation by a third-party reviewing organization and
generally by the insurance department of the jurisdiction that
licenses the health plan. Most health plans must also submit
quarterly and annual statutory financial statements and
utilization reports, as well as many other reports in accordance
with individual state requirements.
In addition, with our entry into the Medicare Advantage Program
through our Special Needs Plan in Houston, Texas, we are subject
to additional regulatory oversight. Compliance with these
requirements is subject to monitoring by agencies of the
U.S. Department of Health and Human Services, most notably,
CMS.
Additional Federal Regulation
In accordance with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), health plans are required to
comply with all HIPAA regulations relating to standards for
electronic transactions and code sets, privacy of health
information, security of healthcare information, national
provider identifiers, and national employer identifiers.
AMERIGROUP providers and healthcare clearinghouses were required
to comply with HIPAA privacy requirements on or before
April 14, 2003, and with HIPAA Transactions and Code Sets
(T&CS) requirements by October 16, 2003, and are
required to comply with the National Provider Identifier by
May 27, 2007.
AMERIGROUP implemented its privacy compliance program by
April 14, 2003. AMERIGROUP received a two-year privacy
accreditation from the Utilization Review Accreditation
Commission (URAC) on November 1, 2003. The Company
received a two-year privacy re-accreditation on November 1,
2005.
On July 24, 2003, CMS issued guidance regarding compliance
with the T&CS regulations in which CMS stated that it would
not impose penalties on covered entities that deployed
contingencies (in order to ensure the smooth flow of payments)
if they have made reasonable and diligent efforts to become
compliant and, in the case of health plans, to facilitate the
compliance of their trading partners. AMERIGROUP implemented a
T&CS contingency plan in March 2003, and has since acted
aggressively to complete implementation of the T&CS
regulations, subject to compliance by its trading partners and
the various state Medicaid programs.
On February 20, 2003, HHS published its final security
regulations. The security rule applies only to protected health
information in electronic form, and is specifically concerned
with security information systems. A security gap analysis was
completed in 2004 and AMERIGROUP met the requirement for
compliance with the security rule as of April 20, 2005.
Implementation of the National Provider Identifier (NPI) is
required by May 27, 2007. A gap analysis for implementation
of the NPI will begin in early 2006. Future costs will be
incurred in 2006 and 2007 to implement the NPI standards, but we
do not yet know the extent of such costs.
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Medicaid Managed Care Regulations |
On January 19, 2001, HHS issued Medicaid managed care
regulations to implement certain provisions of the Balanced
Budget Act of 1997 (BBA). These provisions permit states to
require certain Medicaid beneficiaries to enroll in managed care
programs, give states more flexibility to develop their managed
care programs and provide certain new protections for Medicaid
beneficiaries. States had until August 13, 2003 to bring
their Medicaid managed care programs into compliance with the
requirements of the rule.
The rule implements BBA provisions intended to (i) give
states the flexibility to enroll certain Medicaid recipients in
managed care plans without a federal waiver if the state
provides the recipients with a choice of managed care plans;
(ii) establish protections for members in areas such as
quality assurance, grievance rights and coverage of emergency
services and (iii) eliminate certain requirements viewed by
the states as impediments to the growth of managed care
programs, such as the enrollment composition requirement, the
right to disenroll without cause at any time, and the
prohibition against enrollee cost sharing. The rule also
establishes strict requirements intended to ensure that state
Medicaid managed care capitation rates are actuarially sound.
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According to HHS, this requirement eliminates the generally
outdated regulatory ceiling on what states may pay managed care
plans, a particularly important provision as more state Medicaid
programs include people with chronic illnesses and disabilities.
Although some of the states in which we operate have already
implemented requirements similar to those provided for in the
rule, the manner in which the rule is implemented in each of the
states could increase our healthcare costs and administrative
expenses, reduce our reimbursement rates, and otherwise
adversely affect our business, results of operations, and
financial condition.
On February 8, 2006, President Bush signed the Budget
Reconciliation Bill (the Bill) passed by Congress to reduce the
size of the federal deficit. The Bill reduces federal spending
by $39.5 billion over 5 years. Net savings for
Medicaid totals $4.75 billion over five years, and the
legislation includes a number of reforms to the Medicaid
program. These reform measures include providing states with
greater flexibility in establishing cost-sharing and premium
payments for Medicaid beneficiaries and providing states with
increased flexibility in establishing benchmark benefit packages
for Medicaid beneficiaries. In addition, the Bill tightens rules
on how assets are treated for purposes of qualifying for
Medicaid coverage. The Bill also makes changes to how
prescription drugs are priced within the Medicaid program.
The Bill includes some provisions that directly affect Medicaid
managed care companies. It prohibits the further use of Medicaid
MCO provider taxes for purposes of receiving federal financial
participation. In order for a provider tax to be eligible for a
federal match, it must be broad based and not limited to
Medicaid MCO plans only. The legislation, however, provides an
exemption for states that currently have MCO provider taxes in
effect and allows these programs to remain in existence through
September 2009. The Bill also establishes a payment ceiling for
emergency room services provided by a hospital provider not
under contract with a Medicaid MCO. The legislation limits
payments to no more than amounts under Medicaid Fee-For-Service
for out-of-network
emergency services.
States are just beginning to examine the many changes that this
legislation will bring to the Medicaid program. It is uncertain
if states will make significant changes to their Medicaid
programs in the near future.
The Presidents proposed budget for fiscal year 2007
includes many initiatives involving healthcare that will be top
priorities over the coming year. The President, through the
budget, continues efforts to expand Health Savings Accounts
(HSAs), which were first included in the Medicare Drug law that
Congress, passed in late 2003. HSAs would provide individuals
with an ability to save pre-tax dollars for healthcare expenses,
and to be eligible, individuals would be required to purchase a
high-deductible catastrophic health plan coverage. In addition,
the budget proposal includes provisions to close loopholes in
intergovernmental transfers and phase out the Medicaid
reimbursement for premium tax. The goal of these initiatives is
to increase healthcare coverage in this nation and to reduce
inefficiency and waste in the healthcare system. It is expected
that these issues will be debated throughout the year. It is
unclear at this point if Congress is likely to pass significant
legislation in the healthcare area before the 2006 mid-term
elections.
As part of the Budget deliberations in the spring of 2005,
Congress asked the Secretary of Health and Human Services to
create a bipartisan Medicaid Commission to look at the
challenges facing the Medicaid program, and to make both short-
and long-term recommendations on how to achieve savings and
ensure long-term sustainability of the Medicaid program. The
Commission was formally appointed in July, and its first task
was to make recommendations to the Secretary by
September 1, 2005, on how to achieve $10 billion in
savings over five years in the Medicaid program. That report
recommended making changes in how prescription drugs are priced,
to expand the prescription drug rebate to Medicaid managed care
plans, to allow tiered
co-payment for
prescription drugs, to reform the use of Medicaid managed care
provider taxes, and to make reforms in how assets are treated
for purposes of qualifying for Medicaid coverage. Some of the
recommendations were included
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in the final Bill which Congress passed at the end of 2005 and
included net savings of $4.75 billion to the Medicaid
program.
The Medicaid Commission is currently fulfilling its longer term
charter which is to make recommendations to the Secretary by
December 31, 2006, that ensure the long-term sustainability
of the program. They are currently meeting every other month to
discuss eligibility issues, acute and preventative care,
long-term care, quality and administration. It is expected that
they will meet their responsibilities and complete a report by
the end of 2006. It is uncertain if the Secretary or Congress
will act on any recommendations the Commission may make.
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Patients Rights Legislation |
The U.S. Congress has considered several versions of
patients rights legislation in previous sessions.
Legislation could expand our potential exposure to lawsuits and
increase our regulatory compliance costs. Depending on the final
form of any patients rights legislation, such legislation
could, among other things, expose us to liability for economic
and punitive damages for making determinations that deny
benefits or delay beneficiaries receipt of benefits as a
result of our medical necessity or other coverage
determinations. We cannot predict whether patients rights
legislation will be reconsidered in the future or if enacted,
what final form such legislation might take.
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Other Fraud and Abuse Laws |
Investigating and prosecuting healthcare fraud and abuse has
become a top priority for law enforcement entities. The funding
of such law enforcement efforts has increased in the past few
years and these increases are expected to continue. The focus of
these efforts has been directed at participants in public
government healthcare programs such as Medicaid. These
regulations and contractual requirements applicable to
participants in these programs are complex and changing. We have
re-emphasized our
regulatory compliance efforts for these programs, but ongoing
vigorous law enforcement and the highly technical regulatory
scheme mean that compliance efforts in this area will continue
to require substantial resources.
Customers
As of December 31, 2005, we served members who received
healthcare benefits through our 20 contracts with the
regulatory entities in the jurisdictions in which we operate.
Five of these contracts, which are with the States of Florida,
Maryland, New Jersey, and Texas, individually accounted for 10%
or more of our revenues for the year ended December 31,
2005, with the largest of these contracts representing
approximately 18% of our revenues.
Employees
As of December 31, 2005, we had approximately 2,700
employees. Our employees are not represented by a union. We
believe our relationships with our employees are generally good.
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Available Information
We file annual, quarterly and current reports, proxy statements
and all amendments to these reports and other information with
the U.S. Securities and Exchange Commission (SEC). You may
read and copy any materials we file with the SEC at the
SECs Public Reference Room at 100 F Street, NE,
Room 1580, Washington, DC 20549. You may obtain information
on the operation of the Public Reference Room by calling the SEC
at 1-800-SEC-0330. The
SEC maintains an Internet site that contains reports, proxy and
information statements, and other information regarding issuers
that file electronically with the SEC and the address of that
site is (http://www.sec.gov). We make available free of
charge on or through our website at
www.amerigroupcorp.com our Annual Report on
Form 10-K,
Quarterly Reports on
Form 10-Q, Current
Reports on
Form 8-K, all
amendments to those reports as soon as reasonably practicable
after such material is electronically filed with or furnished to
the SEC, our Corporate Governance Principles, our Audit,
Compensation and Nominating and Corporate Governance charters
and our Code of Business Conduct and Ethics. Further, we will
provide, without charge upon written request, a copy of our
Annual Report on
Form 10-K,
Quarterly Reports on
Form 10-Q, Current
Reports on
Form 8-K, and all
amendments to those reports. Requests for copies should be
addressed to Investor Relations, AMERIGROUP Corporation, 4425
Corporation Lane, Virginia Beach, VA 23462.
In accordance with New York Stock Exchange (NYSE) Rules, on
June 10, 2005, we filed the annual certification by our
Chief Executive Officer certifying that he was unaware of any
violation by us of the NYSEs corporate governance listing
standards at the time of the certification.
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Item 1A. Risk
Factors
RISK FACTORS
Risks related to being a regulated entity
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Changes in government regulations designed to protect
providers and members rather than our stockholders could force
us to change how we operate and could harm our business. |
Our business is extensively regulated by the states in which we
operate and by the federal government. These laws and
regulations are generally intended to benefit and protect
providers and health plan members rather than stockholders.
Changes in existing laws and rules, the enactment of new laws
and rules and changing interpretations of these laws and rules
could, among other things:
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force us to change how we do business, |
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restrict revenue and enrollment growth, |
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increase our health benefits and administrative costs, |
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impose additional capital requirements, and |
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increase or change our claims liability. |
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If state regulators do not approve payments of dividends,
distributions or administrative fees by our subsidiaries to us,
it could negatively affect our business strategy. |
We principally operate through our health plan subsidiaries.
These subsidiaries are subject to regulations that limit the
amount of dividends and distributions that can be paid to us
without prior approval of, or notification to, state regulators.
We also have administrative services agreements with our
subsidiaries in which we agree to provide them with services and
benefits (both tangible and intangible) in exchange for the
payment of a fee. If the regulators were to deny our
subsidiaries requests to pay dividends to us or restrict
or disallow the payment of the administrative fee or not allow
us to recover the costs of providing the services under our
administrative services agreement, the funds available to our
Company as a whole would be limited, which could harm our
ability to implement our business strategy, expand our
infrastructure, improve our information technology systems and
make needed capital expenditures.
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Regulations could limit our profits as a percentage of
revenues. |
Our New Jersey, Maryland and Illinois subsidiaries are subject
to minimum medical expense levels as a percentage of premium
revenue. Our Florida subsidiary is subject to minimum behavioral
health expense levels as a percentage of behavioral health
premium. In Illinois, New Jersey, Maryland and Florida,
contractual sanctions may be imposed if these levels are not
met. In addition, our Ohio subsidiary is subject to certain
administrative limits. These regulatory requirements, changes in
these requirements and additional requirements by our other
regulators could limit our ability to increase or maintain our
overall profits as a percentage of revenues, which could harm
our operating results. We have been required, and may in the
future be required, to make payments to the states as a result
of not meeting these expense levels.
Our Texas health plan is required to pay a rebate to the State
of Texas in the event profits exceed established levels. The
rebate calculation reports that we filed for the contract years
ended August 31, 2000 through 2004 are currently being
audited by a contracted auditing firm. In a preliminary report,
the auditor has challenged inclusion in the rebate calculation
certain expenses incurred by the Company in providing services
to the health plan under the administrative services agreement.
Although we believe that the rebate calculations were done
appropriately, if the regulators were ultimately to disallow
certain of these expenses in the rebate calculation, it could
result in the requirement that we pay the State of Texas
additional amounts for these prior periods and it could reduce
our profitability in future periods.
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Our failure to comply with government regulations could
subject us to civil and criminal penalties and limitations on
our profitability. |
Violation of the laws or regulations governing our operations
could result in the imposition of sanctions, the cancellation of
our contracts to provide services, or in the extreme case, the
suspension or revocation of our licenses. For example, in four
markets in which we operate we are required to spend a minimum
percentage of our premium revenue on medical expenses. If we
fail to comply with this requirement, we could be required to
pay monetary damages. Additionally, we could be required to file
a corrective plan of action with the state and we could be
subject to further fines and additional corrective measures if
we did not comply with the corrective plan of action. Our
failure to comply could also affect future rate determinations
and membership enrollment levels. These regulations could limit
the profits we can obtain. Additionally, we can give no
assurance that the terms of our contracts with the states or the
manner in which we are directed to comply with our state
contracts is in accordance with CMS regulations.
While we have not been subject to any fines or violations that
were material, we cannot assure you that we will not become
subject to material fines or other sanctions in the future. If
we became subject to material fines or if other sanctions or
other corrective actions were imposed upon us, our ability to
continue to operate our business could be materially and
adversely affected. From
time-to-time we have
been subject to sanctions as a result of violations of marketing
regulations in Illinois, Florida and New York and for failure to
meet timeliness of the payment requirements in New Jersey. In
2005, the Florida and New York plans were fined for marketing
violations. In 2004 and 2003, our Florida plan was fined for
marketing violations. We are aware that New York State
authorities are reviewing compliance with marketing and
enrollment rules by Medicaid managed care organizations. The
Companys New York managed care subsidiary is also
reviewing its marketing and enrollment practices with respect to
compliance with these regulations. Although we train our
employees with respect to compliance with state and federal laws
and the marketing rules of each of the states in which we do
business, no assurance can be given that violations will not
occur.
On October 12, 2001, we responded to a Civil Investigative
Demand (CID) of the HMO industry by the Office of the
Attorney General of the State of Texas relating to processing of
provider claims. We understand from the Office of the Attorney
General that responses were required from the nine largest HMOs
in Texas, of which, at the time, we were the ninth. The other
eight are HMOs that primarily provide commercial products. The
CID is being conducted in connection with allegations of unfair
contracting, delegating and payment practices and violations of
the Texas Deceptive Trade Practices Consumer
Protection Act and Article 21.21 of the Texas Insurance
Code by HMOs. It is our understanding that we are not currently
the target of any investigation by the Office of the Attorney
General. We have responded to all of the requests for
information. The Office of the Attorney General could request
additional information or clarification that could be costly and
time consuming for us to produce.
HIPAA broadened the scope of fraud and abuse laws applicable to
healthcare companies. HIPAA created civil penalties for, among
other things, billing for medically unnecessary goods or
services. HIPAA establishes new enforcement mechanisms to combat
fraud and abuse, including a whistle-blower program. Further,
HIPAA imposes civil and criminal penalties for failure to comply
with the privacy and security standards set forth in the
regulation. Despite a press release issued by the Department of
Health and Human Services, (HHS) recommending that Congress
create a private right of action under HIPAA, no such private
cause of action has yet been created, and we do not know when or
if such changes may be enacted.
The federal government has enacted, and state governments are
enacting, other fraud and abuse laws as well. Our failure to
comply with HIPAA or these other laws could result in criminal
or civil penalties and exclusion from Medicaid or other
governmental healthcare programs and could lead to the
revocation of our licenses. These penalties or exclusions, were
they to occur, would negatively impact our ability to operate
our business.
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Compliance with new federal and state rules and
regulations may require us to make unanticipated
expenditures. |
The federal government and the governments of the states in
which we operate have in the past and may in the future pass
laws on implementing regulations which have had or may have the
effect of changing the way we do business or raising the cost of
doing business. Regulations implementing HIPAA have had
such an effect. In
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2003, regulations were promulgated under HIPAA requiring the use
of electronic transactions and code sets for healthcare claims
and payment transactions submitted or received electronically
and to protect the security and privacy of health-related
information. Regulations have now been promulgated requiring the
implementation of the NPI by May of 2007. Costs will be
incurred in the future to implement NPI, although no estimate
can be made at this time as to the cost of compliance and
implementation.
In addition, the Sarbanes-Oxley Act of 2002, as well as rules
subsequently implemented by the SEC and the NYSE, have imposed
various requirements on public companies, including requiring
changes in corporate governance practices. Our management and
other personnel will need to continue to devote a substantial
amount of time to these new compliance initiatives. Moreover,
these rules and regulations have and will continue to increase
our legal and financial compliance costs and will make some
activities more time-consuming and costly.
The Sarbanes-Oxley Act of 2002 also requires that we maintain
effective internal control over financial reporting. In
particular, we must perform system and process evaluation and
testing of our internal control over financial reporting to
allow management to report on, and our independent registered
public accounting firm to attest to, our internal control over
our financial reporting as required by Section 404 of the
Sarbanes-Oxley Act of 2002. Our testing, or the subsequent
testing by our independent registered public accounting firm,
may reveal deficiencies in our internal control over financial
reporting that are deemed to be material weaknesses. Our
compliance with Section 404 will continue to require that
we incur substantial accounting expense and expend significant
management time and effort. Moreover, if we are not able to
continue to comply with the requirements of Section 404 in
a timely manner, or if we or our independent registered public
accounting firm identifies deficiencies in our internal control
over financial reporting that are deemed to be material
weaknesses, the market price of our stock could decline and we
could be subject to sanctions or investigations by the NYSE, SEC
or other regulatory authorities, which would require additional
financial and management resources.
In certain of the markets in which we do business, state laws or
insurance regulations require that our HMO, MCO, and PHSP
subsidiaries participate in guarantee funds to protect consumers
and providers in the event of the insolvency of an HMO or other
insurer. Our HMO, MCO, and PHSP subsidiaries have in the past,
and may in the future, be subject to unanticipated assessments
from such funds which may be material in amount.
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Changes in healthcare laws could reduce our
profitability. |
Numerous proposals relating to changes in healthcare law have
been introduced, some of which have been passed by Congress and
the states in which we operate or may operate in the future.
These include Medicaid reform initiatives in Florida and
Illinois Primary Care Case Management program, as well as
waivers requested by states for various elements of their
programs. Changes in applicable laws and regulations are
continually being considered and interpretations of existing
laws and rules may also change from
time-to-time. We are
unable to predict what regulatory changes may occur or what
effect any particular change may have on our business. Although
some of the recent changes in government regulations, such as
the removal of the requirements on the enrollment mix between
commercial and public sector membership, have encouraged managed
care participation in public sector programs, we are unable to
predict whether new laws or proposals will continue to favor or
hinder the growth of managed healthcare.
We cannot predict the outcome of these legislative or regulatory
proposals, nor the effect which they might have on us.
Legislation or regulations that require us to change our current
manner of operation, provide additional benefits or change our
contract arrangements could seriously harm our operations and
financial results.
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Changes in federal funding mechanisms could reduce our
profitability. |
On February 8, 2006, President Bush signed the Budget
Reconciliation Bill (the Bill) passed by Congress to reduce the
size of the federal deficit. The Bill reduces federal spending
by $39.5 billion over 5 years. Net savings for
Medicaid totals $4.75 billion over five years, and the
legislation includes a number of reforms to the Medicaid
program. These reform measures include providing states with
greater flexibility in establishing cost-sharing and premium
payments for Medicaid beneficiaries, and provide states with
increased flexibility in establishing benchmark benefit packages
for Medicaid beneficiaries. In addition, the Bill tightens rules
on how assets are treated for purposes of qualifying for
Medicaid coverage. The Bill also makes changes to how
prescription drugs are priced within the Medicaid program.
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The Bill includes some provisions that directly affect Medicaid
managed care companies. It prohibits the further use of Medicaid
MCO provider taxes for purposes of receiving federal financial
participation. In order for a provider tax to be eligible for a
federal match, it must be broad based and not limited to
Medicaid MCO plans only. The legislation, however, provides an
exemption for states that currently have MCO provider taxes in
effect and allows these programs to remain in existence through
September of 2009. The Bill also establishes a payment ceiling
for emergency room services provided by a hospital provider not
under contract with a Medicaid MCO. It limits payments to no
more than Medicaid Fee-For-Service amounts for
out-of-network
emergency services.
States are just beginning to examine the many changes that this
legislation will bring to the Medicaid program. It is uncertain
if states will make significant changes to their Medicaid
programs in the near future, but such changes, depending on
their scope, could impact our revenue or membership.
In addition, Congress and the federal government may adopt
changes in Medicare reimbursement levels that might negatively
affect our SNP business.
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Reductions in Medicaid funding by the states could
substantially reduce our profitability. |
Most of our revenues come from state government Medicaid
premiums. The base premium rate paid by each state differs,
depending on a combination of various factors such as defined
upper payment limits, a members health status, age,
gender, county or region, benefit mix and member eligibility
category. Future levels of Medicaid premium rates may be
affected by continued government efforts to contain medical
costs and may further be affected by state and federal budgetary
constraints. Changes to Medicaid programs could reduce the
number of persons enrolled or eligible, reduce the amount of
reimbursement or payment levels, or increase our administrative
or healthcare costs under such programs. States periodically
consider reducing or reallocating the amount of money they spend
for Medicaid. We believe that additional reductions in Medicaid
payments could substantially reduce our profitability. Further,
our contracts with the states are subject to cancellation by the
state in the event of unavailability of state funds. In some
jurisdictions, such cancellation may be immediate and in other
jurisdictions a notice period is required.
State governments generally are experiencing tight budgetary
conditions within their Medicaid programs. Budget problems in
the states in which we operate could result in limited increases
or even decreases in the premiums paid to us by the states. If
any state in which we operate were to decrease premiums paid to
us, or pay us less than the amount necessary to keep pace with
our cost trends, it could have a material adverse effect on our
profitability.
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If state governments do not renew our contracts with them
on favorable terms, our business will suffer. |
As of December 31, 2005, we served members who received
healthcare benefits through 20 contracts with the
regulatory entities in the jurisdictions in which we operate.
Five of these contracts, which are with the States of Florida,
Maryland, New Jersey and Texas, individually accounted for 10%
or more of our revenues for the year ended December 31,
2005, with the largest of these contracts representing
approximately 18% of our revenues. If any of our contracts were
not renewed on favorable terms or were terminated for cause or
if we were to lose a contract in a
re-bidding process, our
business would suffer. All our contracts have been extended
until at least mid-2006. All of our contracts will come up for
renewal in 2006 except Georgia, Maryland and the New
York State Contract and New York City of
New York contract. Termination or non-renewal of any single
contract could materially impact our revenues and operating
results.
Some of our contracts are subject to a
re-bidding or
re-application process.
For example, our Texas markets are
re-bid every six years
and the re-bidding
process occurred in 2005. We currently are in the process of
implementing the changes resulting from this
re-bid. If we lost a
contract through the
re-bidding process, or
if an increased number of competitors were awarded contracts in
a specific market, our operating results could be materially and
adversely affected.
Though the State could
re-bid the program in
2006, our SCHIP contract covering our Florida markets will
likely re-bid in 2007.
We can give no assurance that the contract will extended and not
be re-bid. If we lost
the contract through the re-bidding process, or if an increased
number of competitors were awarded contracts in a specific
market, our operating results could be materially and adversely
affected.
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If a state fails to renew its federal waiver application
for mandated Medicaid enrollment into managed care or such
application is denied, our membership in that state will likely
decrease. |
States may only mandate Medicaid enrollment into managed care
under federal waivers or demonstrations. Waivers and programs
under demonstrations are approved for two-year periods and can
be renewed on an ongoing basis if the state applies. We have no
control over this renewal process. If a state does not renew its
mandated program or the federal government denies the
states application for renewal, our business would suffer
as a result of a likely decrease in membership.
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Delays in program expansions, renewals or contract changes
could negatively impact our business. |
In any program
start-up, expansion, or
re-bid, the
states ability to manage the implementation as designed
may be affected by factors beyond our control. These include
political considerations, network development, contract appeals,
membership assignment/allocation for members who do not
self-select, and errors in the bidding process, as well as
difficulties experienced by other private vendors involved in
the implementation, such as enrollment brokers. Our business,
particularly plans for expansion or increased membership levels,
could be negatively impacted by these delays or changes. For
example, in 2006, we anticipate a significant increase in our
business related to entering the State of Georgia. If the State
delays or changes the contract terms, including the enrollment
process, marketing rules, or reimbursement rules, our business
could be negatively impacted.
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We rely on the accuracy of eligibility lists provided by
the state government, and in the case of our Special Needs Plan
members in Houston, by the federal government. Inaccuracies in
those lists would negatively affect our results of
operations. |
Premium payments to us are based upon eligibility lists produced
by government enrollment data. From
time-to-time,
governments require us to reimburse them for premiums paid to us
based on an eligibility list that a government later discovers
contains individuals who are not in fact eligible for a
government sponsored program or are eligible for a different
premium category or a different program. Alternatively, a
government could fail to pay us for members for whom we are
entitled to receive payment. Our results of operations would be
adversely affected as a result of such reimbursement to the
government if we had made related payments to providers and were
unable to recoup such payments from the providers.
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If state regulatory agencies require a statutory capital
level higher than the state regulations we may be required to
make additional capital contributions. |
Our operations are conducted through our wholly-owned
subsidiaries, which include HMOs, one MCO and one PHSP. HMOs.
MCOs, and PHSPs are subject to state regulations that, among
other things, require the maintenance of minimum levels of
statutory capital, as defined by each state. Additionally, state
regulatory agencies may require, at their discretion, individual
regulated entities to maintain statutory capital levels higher
than the state regulations. If this were to occur to one of our
subsidiaries, we may be required to make additional capital
contributions to the affected subsidiary. Any additional capital
contribution made to one of the affected subsidiaries could have
a material adverse effect on our liquidity and our ability to
grow.
Risks related to our business
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Receipt of inadequate or significantly delayed premiums
would negatively impact our revenues, profitability and cash
flow. |
Most of our revenues are generated by premiums consisting of
fixed monthly payments per member. These premiums are fixed by
contract, and we are obligated during the contract period to
facilitate access to healthcare services as established by the
state governments. We have less control over costs related to
the provision of healthcare than we do over our selling, general
and administrative expenses. Historically, our expenses related
to health benefits as a percentage of premium revenue have
fluctuated. For example, our expenses related to health benefits
were 84.7% of our premium revenue in 2005, and 81.0% of our
premium revenue in 2004. If health benefits costs increase at a
higher rate than premium increases, our earnings would be
impacted negatively. In addition, if there is a significant
delay in our receipt of premiums to offset previously incurred
health benefits costs increases, our earnings could be
negatively impacted.
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Maryland sets the rates that must be paid to hospitals by all
payors. In 2005, the State increased rates payable to the
hospitals without granting a corresponding increase in premiums
to us. This discrepancy, which is contrary to State rules, is
still in the process of being resolved. If this remains
unresolved or were to occur again, or if other states were to
take similar actions, our profitability would be harmed.
Premiums are contractually payable to us before or during the
month for services that we are obligated to provide to our
members. Our cash flow would be negatively impacted if premium
payments are not made according to contract terms. This
situation is likely to occur in the initial months of the
conversion to the Special Needs Plan under the Medicare
Modernization Act.
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Our inability to manage medical costs effectively would
reduce our profitability. |
Our profitability depends, to a significant degree, on our
ability to predict and effectively manage medical costs. Changes
in healthcare regulations and practices, level of use of
healthcare services, hospital costs, pharmaceutical costs, major
epidemics, new medical technologies and other external factors,
including general economic conditions such as inflation levels
or natural disasters, are beyond our control and could reduce
our ability to predict and effectively control the costs of
healthcare services. Although we attempt to manage medical costs
through a variety of techniques, including various payment
methods to primary care physicians and other providers, advance
approval for hospital services and referral requirements,
medical management and quality management programs, and our
information systems and reinsurance arrangements, we may not be
able to manage costs effectively in the future. In addition, new
products, such as SNP, or new markets, such as Georgia, could
pose new and unexpected challenges to effectively manage medical
costs. It is possible that there could be an increase in the
volume or value of appeals for claims previously denied and
claims previously paid to non-network providers will be appealed
and subsequently reprocessed at higher amounts. This would
result in an adjustment to claims expense. If our costs for
medical services increase, our profits could be reduced, or we
may not remain profitable.
We maintain reinsurance to help protect us against severe or
catastrophic medical claims, but we can provide no assurance
that such reinsurance coverage will be adequate or available to
us in the future or that the cost of such reinsurance will not
limit our ability to obtain it.
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We have a significant relationship with Cook
Childrens Physician Network in Fort Worth, Texas.
Termination of this relationship could negatively affect our
results of operations. |
We had an exclusive risk-sharing arrangement with Cook
Childrens Health Care Network (CCHCN) and Cook
Childrens Physician Network (CCPN), which includes Cook
Childrens Medical Center (CCMC), that was terminated as of
August 31, 2005. In its place, we entered into separate
non-exclusive fee-for-service provider agreements with CCPN and
CCMC. On December 27, 2005, CCPN and CCMC each sent notices
indicating their intent to terminate these agreements as of
March 31, 2006. We do not believe that such terminations
are warranted under these agreements. It is our intent to take
appropriate actions to persuade CCPN and CCMC to rescind their
notices of termination. However, there is no assurance that our
efforts will be successful. CCPN and CCMC control most of the
inpatient and specialty pediatric services available in
Fort Worth, Texas. If these agreements terminate, it would
force us to make alternate arrangements for many services to our
pediatric membership, which may adversely impact our costs and
our membership. Therefore, our results from operations could be
harmed as a result of the termination of these arrangements, and
the impact could be material.
As part of the State of Texas
re-bidding process,
CCHCN obtained its own contract with the State of Texas to
provide healthcare services to Medicaid recipients starting
September 1, 2006. As a result, we may lose members based
upon CCHCNs contract with the State of Texas, and the
impact could be material. In addition, under the risk-sharing
arrangement with CCHCN that terminated as of August 31,
2005, the parties have an obligation to perform annual
reconciliations and settlements of the risk pool for each
contract year. We believe that CCHCN may owe us substantial
payments for the 2004 and 2005 contract years which we estimate
to be approximately $12.5 million as December 31,
2005. As of this date, we have not reached an agreement with
CCHCN as to the settlement amounts for the 2004 and 2005
contract years. If we are unable to agree on a settlement, our
health benefits expenses attributable to these periods may be
adversely affected, and we may incur significant costs in our
efforts to reach a final resolution of this matter.
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Our limited ability to predict our incurred medical
expenses accurately has in the past and could in the future
materially impact our reported results. |
Our medical expenses include estimates of claims that are yet to
be received, or incurred but not reported (IBNR). We estimate
our IBNR medical expenses based on a number of factors,
including authorization data, prior claims experience, maturity
of markets, complexity and mix of products and stability of
provider networks. Adjustments, if necessary, are made to
medical expenses in the period during which the actual claim
costs are ultimately determined or when underlying assumptions
or factors used to estimate IBNR change. In addition to using
our internal resources, we utilize the services of independent
actuaries who are contracted on a routine basis to calculate and
review the adequacy of our medical liabilities. We cannot be
sure that our current or future IBNR estimates are adequate or
that any further adjustments to such IBNR estimates will not
harm or benefit our results of operations. Further, our
inability to accurately estimate IBNR may also affect our
ability to take timely corrective actions, further exacerbating
the extent of the harm on our results. Though we employ our best
efforts to estimate our IBNR at each reporting date, we can give
no assurance that the ultimate results will not materially
differ from our estimates resulting in a material increase or
decrease in our health benefits expenses in the period such
difference is determined. New products, such as SNP, or new
markets, such as Georgia, could pose new and unexpected
challenges to effectively predict medical costs.
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Difficulties in executing our acquisition strategy or
integrating acquired business could adversely affect our
business. |
Historically, acquisitions including the acquisition of Medicaid
contract rights and related assets of other health plans, both
in our existing service areas and in new markets, have been a
significant factor in our growth. Although we cannot predict our
rate of growth as the result of acquisitions with complete
accuracy, we believe that acquisitions similar in nature to
those we have historically executed will be important to our
growth strategy. Many of the other potential purchasers of these
assets have greater financial resources than we have. In
addition, many of the sellers are interested in either
(1) selling, along with their Medicaid assets, other assets
in which we do not have an interest; or (2) selling their
companies, including their liabilities, as opposed to just the
assets of the ongoing business. Therefore, we cannot be sure
that we will be able to complete acquisitions on terms favorable
to us or that we can obtain the necessary financing for these
acquisitions.
We are currently evaluating potential acquisitions that would
increase our membership, as well as acquisitions of
complementary healthcare service businesses. These potential
acquisitions are at various stages of consideration and
discussion and we may enter into letters of intent or other
agreements relating to these proposals at any time. However, we
cannot predict when or whether we will actually acquire these
businesses.
We are generally required to obtain regulatory approval from one
or more state agencies when making acquisitions. In the case of
an acquisition of a business located in a state in which we do
not currently operate, we would be required to obtain the
necessary licenses to operate in that state. In addition,
although we may already operate in a state in which we acquire a
new business, we would be required to obtain the necessary
licenses to operate in that state. In addition, although we may
already operate in a state in which we acquire new business, we
would be required to obtain additional regulatory approval if,
as a result of the acquisition, we will operate in an area of
the state in which we did not operate previously. There can be
no assurance that we would be able to comply with these
regulatory requirements for an acquisition in a timely manner,
or at all.
Our existing credit facility imposes certain restrictions on
acquisitions. We may not be able to meet these restrictions.
In addition to the difficulties we may face in identifying and
consummating acquisitions, we will also be required to integrate
our acquisitions with our existing operations. This may include
the integration of:
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additional employees who are not familiar with our operations, |
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existing provider networks, which may operate on different terms
than our existing networks, |
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existing members, who may decide to switch to another healthcare
provider, and |
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disparate information and record keeping systems. |
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We may be unable to successfully identify, consummate and
integrate future acquisitions, including integrating the
acquired businesses on to our technology platform, or to
implement our operations strategy in order to operate acquired
businesses profitably. We also may be unable to obtain
sufficient additional capital resources for future acquisitions.
There can be no assurance that incurring expenses to acquire a
business will result in the acquisition being consummated. These
expenses could impact our selling, general and administrative
expense ratio. If we are unable to effectively execute our
acquisition strategy or integrate acquired businesses, our
future growth will suffer and our results of operations could be
harmed.
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Failure of a new business would negatively impact our
results of operations. |
Start-up costs
associated with a new business can be substantial. For example,
in order to obtain a certificate of authority and obtain a state
contract in most jurisdictions, we must first establish a
provider network, have systems in place and demonstrate our
ability to be able to process claims. If we were unsuccessful in
obtaining the necessary license, winning the bid to provide
service or attracting members in numbers sufficient to cover our
costs, the new business would fail. We also could be obligated
by the state to continue to provide services for some period of
time without sufficient revenue to cover our ongoing costs or
recover start-up costs.
The costs associated with starting up the business could have a
significant impact on our results of operations. In addition, if
the new business does not operate at underwritten levels, our
profitability could be harmed.
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Ineffective management of rapid growth or our inability to
grow could negatively affect our results of operations,
financial condition and business. |
We have experienced rapid growth. In 1996, we had
$22.9 million of premium revenue. In 2005, we had
$2,311.6 million in premium revenue. This increase
represents a compounded annual growth rate of 67.0%.
Depending on acquisition and other opportunities, we expect to
continue to grow rapidly. Continued growth could place a
significant strain on our management and on other resources. We
anticipate that continued growth, if any, will require us to
continue to recruit, hire, train and retain a substantial number
of new and highly skilled medical, administrative, information
technology, finance and other support personnel. Our ability to
compete effectively depends upon our ability to implement and
improve operational, financial and management information
systems on a timely basis and to expand, train, motivate and
manage our work force. If we continue to experience rapid
growth, our personnel, systems, procedures and controls may be
inadequate to support our operations, and our management may
fail to anticipate adequately all demands that growth will place
on our resources. In addition, due to the initial costs incurred
upon the acquisition of new businesses, rapid growth could
adversely affect our short-term profitability. Our inability to
manage growth effectively or our inability to grow could have a
negative impact on our business, operating results and financial
condition.
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We are subject to competition that impacts our ability to
increase our penetration of the markets that we serve. |
We compete for members principally on the basis of size and
quality of provider network, benefits provided and quality of
service. We compete with numerous types of competitors,
including other health plans and traditional state Medicaid
programs that reimburse providers as care is provided. Some of
the health plans with which we compete have substantially larger
enrollments, greater financial and other resources and offer a
broader scope of products than we do.
While many states mandate health plan enrollment for Medicaid
eligible participants, the programs are voluntary in other
states, such as Illinois. Subject to limited exceptions by
federally approved state applications, the federal government
requires that there be choice for Medicaid recipients among
managed care programs. Voluntary programs and mandated
competition will impact our ability to increase our market share.
In addition, in most states in which we operate we are not
allowed to market directly to potential members, and therefore,
we rely on creating name brand recognition through our
community-based programs. Where we have only recently entered a
market or compete with health plans much larger than we are, we
may be at a competitive disadvantage unless and until our
community-based programs and other promotional activities create
brand awareness.
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Restrictions and covenants in our credit facility could
limit our ability to take actions. |
On May 10, 2005, we entered into an amendment (Amendment)
to our Amended and Restated Credit Agreement (as amended, the
Credit Agreement), which, among other things, provides for an
increase in the commitments under our Credit Agreement then in
existence to $150.0 million and a five-year extension of
the term from the date of the Amendment. The Credit Agreement
contains a provision which allows us to obtain, subject to
certain conditions, an increase in revolving commitments of up
to an additional $50.0 million. The proceeds of the Credit
Agreement are available for general corporate purposes,
including, without limitation, permitted acquisitions of
businesses, assets and technologies. The borrowings under the
Credit Agreement will accrue interest at one of the following
rates, at our option: Eurodollar plus the applicable margin or
an alternate base rate plus the applicable margin. The
applicable margin for Eurodollar borrowings is between 0.875%
and 1.625% and the applicable margin for alternate base rate
borrowings is between 0.00% and 0.75%. The applicable margin
will vary depending on our leverage ratio. The Credit Agreement
is secured by substantially all of the assets of the Company and
its wholly-owned subsidiary, PHP Holdings, Inc., including the
stock of their respective wholly-owned managed care
subsidiaries. There is a commitment fee on the unused portion of
the Credit Agreement that ranges from 0.20% to 0.325%, depending
on the leverage ratio. The Credit Agreement terminates on
May 10, 2010. As of December 31, 2005, there were no
borrowings outstanding under our Credit Agreement.
Events beyond our control, such as prevailing economic
conditions and changes in the competitive environment, could
impair our operating performance, which could affect our ability
to comply with the terms of the Credit Agreement. Breaching any
of the covenants or restrictions could result in the
unavailability of the Credit Agreement or a default under the
Credit Agreement. We can provide no assurance that our assets or
cash flows will be sufficient to fully repay outstanding
borrowings under the Credit Agreement or that we would be able
to restructure such indebtedness on terms favorable to us. If we
were unable to repay, refinance or restructure our indebtedness
under the Credit Agreement, the lenders could proceed against
the collateral securing the indebtedness.
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Our inability to maintain satisfactory relationships with
providers would harm our profitability. |
Our profitability depends, in large part, upon our ability to
contract on favorable terms with hospitals, physicians and other
healthcare providers. Our provider arrangements with our primary
care physicians and specialists usually are for one- to two-year
periods and automatically renew for successive one-year terms,
subject to termination by us for cause based on provider conduct
or other appropriate reasons. The contracts generally may be
canceled by either party upon 90 to 120 days prior written
notice. Our contracts with hospitals are usually for one- to
two-year periods and automatically renew for successive one-year
periods, subject to termination for cause due to provider
misconduct or other appropriate reasons. Generally, our hospital
contracts may be canceled by either party without cause on 90 to
150 days prior written notice. There can be no assurance
that we will be able to continue to renew such contracts or
enter into new contracts enabling us to service our members
profitably. We will be required to establish acceptable provider
networks prior to entering new markets. Although we have
established long-term relationships with many of our providers,
we may be unable to enter into agreements with providers in new
markets on a timely basis or under favorable terms. If we are
unable to retain our current provider contracts or enter into
new provider contracts timely or on favorable terms, our
profitability will be harmed.
On occasion, our members obtain care from providers that are not
in our network and with which we do not have contracts. To the
extent that we know of such instances, we attempt to redirect
their care to a network provider. We have generally reimbursed
non-network providers at the rates paid to comparable network
providers or at the applicable rate that the provider could have
received under the traditional fee-for-service Medicaid program
or at a discount therefrom. In some instances, we pay
non-network providers pursuant to the terms of our contracts
with the state. However, some non-network providers have
requested that we pay them at their highest billing rate, or
full-billed charges. Full-billed charges are
significantly more than the amount the non-network providers
could otherwise receive under the traditional fee-for-service
Medicaid program.
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To the extent that non-network providers are successful in
obtaining payment at rates in excess of the rates that we have
historically paid to non-network providers, our profitability
could be materially adversely affected.
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Negative publicity regarding the managed care industry may
harm our business and operating results. |
In the past, the managed care industry has received negative
publicity. This publicity has led to increased legislation,
regulation, review of industry practices and private litigation
in the commercial sector. These factors may adversely affect our
ability to market our services, require us to change our
services and increase the regulatory burdens under which we
operate, further increasing the costs of doing business and
adversely affecting our operating results.
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We may be subject to claims relating to medical
malpractice, which could cause us to incur significant
expenses. |
Our providers and employees involved in medical care decisions
may be exposed to the risk of medical malpractice claims. Some
states have passed or are considering legislation that permits
managed care organizations to be held liable for negligent
treatment decisions or benefits coverage determinations and or
eliminate the requirement that certain providers carry a minimum
amount of professional liability insurance. This kind of
legislation has the effect of shifting the liability for medical
decisions or adverse outcomes to the managed care organization.
This could result in substantial damage awards against us and
our providers that could exceed the limits of any applicable
insurance coverage. Therefore, successful malpractice or tort
claims asserted against us, our providers or our employees could
adversely affect our financial condition and profitability.
In addition, we may be subject to other litigation that may
adversely affect our business or results of operations. We
maintain errors and omissions insurance and such other lines of
coverage as we believe are reasonable in light of our experience
to date. However, this insurance may not be sufficient or
available at a reasonable cost to protect us from liabilities
that might adversely affect our business or results of
operations. Even if any claims brought against us were
unsuccessful or without merit, we would still have to defend
ourselves against such claims. Any such defenses may be
time-consuming and costly, and may distract our
managements attention. As a result, we may incur
significant expenses and may be unable to effectively operate
our business.
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Changes in the number of Medicaid eligibles, or benefits
provided to Medicaid eligibles or a change in mix of Medicaid
eligibles could cause our operating results to suffer. |
Historically, the number of persons eligible to receive Medicaid
benefits has increased more rapidly during periods of rising
unemployment, corresponding to less favorable general economic
conditions. However, during such economic downturns, state
budgets could decrease, causing states to attempt to cut
healthcare programs, benefits and rates. If this were to happen
while our membership was increasing, our results of operations
could suffer. Conversely, the number of persons eligible to
receive Medicaid benefits may grow more slowly or even decline
if economic conditions improve, thereby causing our operating
results to suffer. In either case, in the event that the Company
experiences a change in product mix to less profitable product
lines, our profitability could be negatively impacted.
|
|
|
Changes in SCHIP rules restricting eligibility could cause
our operating results to suffer. |
The states in which we operate have experienced budget deficits
in the past. In Florida and Texas, the rules governing SCHIP
have either recently changed, or may change in the near future,
to restrict or limit eligibility for benefits through the
imposition of waiting periods, enrollment caps and/or new or
increased co-payments. These changes in SCHIP eligibility could
cause us to experience a net loss in SCHIP membership. If the
states in which we operate continue to restrict or limit SCHIP
eligibility, our operating results could suffer.
32
|
|
|
Our inability to integrate, manage and grow our
information systems effectively could disrupt our
operations. |
Our operations are significantly dependent on effective
information systems. The information gathered and processed by
our information systems assists us in, among other things,
monitoring utilization and other cost factors, processing
provider claims and providing data to our regulators. Our
providers also depend upon our information systems for
membership verifications, claims status and other information.
In November 2003, we signed a software licensing agreement for
FACETS. During 2005, we continued to invest in the
implementation and testing of FACETS with a staggered conversion
to FACETS by health plan beginning in 2005 and continuing
through 2007. As of October 1, 2005, claims payments for
our Texas health plan are processed using FACETS. We estimate
that our current claims payment systems, without FACETS, could
be at full capacity within the next 16 months. We currently
expect that FACETS will meet our software needs and will support
our long-term growth strategies. However, if we cannot execute a
successful system conversion, our operations could be disrupted,
which would have a negative impact on our profitability and our
ability to grow could be harmed.
Our information systems and applications require continual
maintenance, upgrading and enhancement to meet our operational
needs. Moreover, our acquisition activity requires frequent
transitions to or from, and the integration of, various
information systems. We are continually upgrading and expanding
our information systems capabilities. If we experience
difficulties with the transition to or from information systems
or are unable to properly maintain or expand our information
systems, we could suffer, among other things, from operational
disruptions, loss of existing members and difficulty in
attracting new members, regulatory problems and increases in
administrative expenses. For example, we acquired our New York
health plan as of January 1, 2005, that uses TXEN, an
information system that is different from those used by the rest
of our business. We expect to continue using this system
exclusively for our New York plan until such time as the New
York subsidiary can be successfully integrated onto FACETS.
Operating that system as a separate information system can be
expected to increase our costs in the
short-term, and there
is no assurance that we can effect a seamless transition of the
New York plan to our new system. Both the increased operational
costs of this system and any difficulties in conversion to a new
system could have a negative impact on our profitability.
|
|
|
Acts of terrorism, natural disasters and medical epidemics
could cause our business to suffer. |
Our profitability depends, to a significant degree, on our
ability to predict and effectively manage medical costs. If an
act or acts of terrorism or a natural disaster (such as a major
hurricane) or a medical epidemic were to occur in markets in
which we operate, our business could suffer. The results of
terrorist acts or natural disasters could lead to higher than
expected medical costs, network and information technology
disruptions, and other related factors beyond our control, which
would cause our business to suffer. A widespread epidemic in a
market could cause a breakdown in the medical care delivery
system which could cause our business to suffer.
|
|
|
We are currently involved in litigation, and may become
involved in future litigation, which may result in substantial
expense and may divert our attention from our business. |
We are currently involved in certain legal proceedings and, from
time to time, we may be subject to additional legal claims. We
may suffer an unfavorable outcome as a result of one or more
claims, resulting in the depletion of valuable capital to pay
defense costs or the costs associated with any resolution of
such matters. Depending on the costs of litigation and the
amount and timing of any unfavorable resolution of claims
against us, our future results of operations or cash flows could
be materially adversely affected.
In addition, we may be subject to securities class action
litigation. When the market price of a stock has been volatile,
regardless of whether such fluctuations are related to the
operating performance of a particular company, holders of that
stock have sometimes initiated securities class action
litigation against such company. Any class action litigation
against us could cause us to incur substantial costs, divert the
time and attention of our management and other resources, or
otherwise harm our business.
33
|
|
| Item 1B. |
Unresolved Staff Comments |
None.
We do not own any real property. We lease office space in
Virginia Beach, Virginia, where our primary headquarters, call,
claims and data centers are located. We also lease real property
in each of the health plan locations. We are obligated by
various insurance and Medicaid regulatory authorities to have
offices in the service areas where we provide Medicaid benefits.
In September 2005, we entered into a
15-year lease for an
additional 106,000 square-foot building in Virginia Beach,
Virginia to be constructed adjacent to our National Support
Center that houses our primary call and data centers. The new
building, which is expected to be completed in December 2006, is
planned to house our claims processing operations.
|
|
| Item 3. |
Legal Proceedings |
In 2002, Cleveland A. Tyson, a former employee of our Illinois
subsidiary, AMERIGROUP Illinois, Inc., filed a federal and state
Qui Tam or whistleblower action against our Illinois subsidiary.
The complaint was captioned United States of America and the
State of Illinois, ex rel., Cleveland A. Tyson v.
AMERIGROUP Illinois, Inc. The complaint was filed in the
U.S. District Court for the Northern District, Eastern
Division. It alleges that AMERIGROUP Illinois, Inc. submitted
false claims under the Medicaid program. Mr. Tysons
first amended complaint was unsealed and served on AMERIGROUP
Illinois, Inc., in June 2003. Therein, Mr. Tyson alleges
that AMERIGROUP Illinois, Inc. maintained a scheme to discourage
or avoid the enrollment into the health plan of pregnant women
and other recipients with special needs. In his suit,
Mr. Tyson seeks statutory penalties of no less than $5,500
and no more than $11,000 per violation and an unspecified
amount of damages. Mr. Tysons complaint does not
specify the number of alleged violations.
The court denied AMERIGROUP Illinois, Inc.s motion to
dismiss Mr. Tysons second amended complaint on
September 26, 2004. On February 15, 2005, we received
a motion filed by the Office of the Attorney General for the
State of Illinois on February 10, 2005, seeking court
approval to intervene on behalf of the State of Illinois. On
March 2, 2005, the Court granted that motion to intervene.
On March 3, 2005, AMERIGROUP Illinois, Inc. filed a motion
to dismiss for lack of subject matter jurisdiction, based upon a
recent opinion of the United States Court of Appeals for the
District of Columbia Circuit and additional cases that bar
actions under the federal False Claims Act unless there is
direct presentment of allegedly false claims to the federal
government. Also on March 3, 2005, the Office of the
Attorney General of the State of Illinois issued a subpoena to
AMERIGROUP Corporation as part of an investigation pursuant to
the Illinois Whistleblower Reward and Protection Act to
determine whether a violation of the Act has occurred.
AMERIGROUP Corporation filed a motion objecting to the subpoena
of on the grounds, among other things, that the subpoena is
duplicative of one previously served on AMERIGROUP Corporation
in the federal court Tyson litigation with which AMERIGROUP is
complying. The Office of the Attorney General of the State of
Illinois withdrew its state court subpoena in September 2005.
On May 6, 2005, Plaintiffs filed a joint motion for leave
to amend their complaint. At a hearing on June 7, 2005,
Judge David A. Coar indicated that he would grant the motion to
amend. On June 22, 2005, Plaintiffs served AMERIGROUP
Corporation and AMERIGROUP Illinois, Inc. with a third amended
complaint, which includes allegations that AMERIGROUP
Corporation is liable as the alter-ego of AMERIGROUP Illinois,
Inc. and allegations that AMERIGROUP Corporation is liable for
making false claims or causing false claims to be made. On
July 7, 2005, AMERIGROUP Corporation and AMERIGROUP
Illinois, Inc. filed a motion to dismiss the third amended
complaint based on several independent grounds, including lack
of subject matter jurisdiction, which also was raised in the
prior motion to dismiss. In September 2005, Judge David A. Coar
issued an order of recusal. Senior Judge Harry D. Leinenweber is
now the judge for this case. On October 17, 2005, Judge
Leinenweber denied the motion to dismiss for lack of subject
matter jurisdiction. On November 8, 2005, Judge Leinenweber
denied the motion to dismiss the third amended complaint. On
November 23, 2005, AMERIGROUP Illinois, Inc. and AMERIGROUP
Corporation filed their answer and affirmative defenses to the
third
34
amended complaint. The United States Attorneys Office
filed a motion to intervene on behalf of the United States of
America in August 2005. On October 17, 2005, Judge
Leinenweber granted that motion to intervene. Fact discovery is
currently scheduled to end March 31, 2006 and the court has
assigned a trial date of October 4, 2006.
Plaintiffs have proposed a number of damage theories under which
alleged damages range, after trebling, from $60.0 million
to $690.0 million; however, it is unclear which, if any, of
these theories will be relied upon by plaintiffs damage
experts when expert discovery concludes. The damage experts
retained by the Company for this litigation have not reached any
conclusions as to estimates of potential damages, if any.
Although it is possible that the outcome of this case will not
be favorable to us, we cannot with any certainty give a
reasonable estimate of any potential damages. Accordingly, we
have not recorded any liability at December 31, 2005. There
can be no assurance that the ultimate outcome of this matter
will not have a material adverse effect on our financial
position, results of operations or liquidity.
Beginning on October 3, 2005, five purported class action
complaints (the Actions) were filed in the United States
District Court for the Eastern District of Virginia on behalf of
persons who acquired our common stock between April 27,
2005 and September 28, 2005. The actions purported to
allege claims against us and certain of our officers for alleged
violations of Sections 10(b), 20(a), 20(A) and
Rule 10b-5 of the
Securities Exchange Act of 1934. On January 10, 2006, the
Court issued an order (i) consolidating the Actions; (ii)
setting Illinois State Board of Investment v.
AMERIGROUP Corp., et al., Civil Action
No. 2:05-cv-701 as
lead case for purposes of trial and all pretrial proceedings;
(iii) appointing Illinois State Board of Investment (ISBI) as
Lead Plaintiff and its choice of counsel as Lead Counsel; and
(iv) ordering that Lead Plaintiff file a Consolidated Amended
Complaint (CAC) by February 24, 2006. On February 24,
2006, ISBI filed the CAC, which purports to allege claims on
behalf of all persons or entities who purchased our common stock
from February 16, 2005 through September 28, 2005. The
CAC asserts claims for alleged violations of
Sections 10(b), 20(a), 20(A) and
Rule 10b-5 of the
Securities Exchange Act of 1934 against defendants AMERIGROUP
Corporation, Jeffrey L. McWaters, James G. Carlson, E. Paul
Dunn, Jr. and Kathleen K. Toth. Lead Plaintiff alleges that
defendants issued a series of materially false and misleading
statements concerning our financial statements, business, and
prospects. Among other things, the CAC seeks compensatory
damages and attorneys fee and costs. Although we intend to
vigorously contest these allegations, there can be no assurance
that the ultimate outcome of this litigation will not have a
material adverse affect on our financial position, results of
operations or liquidity.
We are from
time-to-time the
subject matter of, or involved in, other legal proceedings
including claims for reimbursement by providers. We believe that
any liability or loss resulting from such other legal matters
will not have a material adverse effect on our financial
position or results of operations.
35
|
|
| Item 4. |
Submission of Matters to a Vote of Security Holders |
None.
Executive Officers of the Company
Our executive officers, their ages and positions as of
February 28, 2006, are as follows:
| |
|
|
|
|
|
|
| Name |
|
Age | |
|
Position |
| |
|
| |
|
|
|
|
|
|
|
|
Jeffrey L. McWaters
|
|
|
49 |
|
|
Chairman and Chief Executive Officer |
|
|
|
|
|
|
James G. Carlson*
|
|
|
53 |
|
|
President and Chief Operating Officer |
|
|
|
|
|
|
Sherri E. Lee**
|
|
|
54 |
|
|
Executive Vice President, Chief Financial Officer and Treasurer |
|
|
|
|
|
|
Stanley F. Baldwin
|
|
|
57 |
|
|
Executive Vice President, General Counsel and Secretary |
|
|
|
|
|
|
Janet M. Brashear
|
|
|
45 |
|
|
Executive Vice President, Strategic Planning |
|
|
|
|
|
|
Catherine S. Callahan
|
|
|
48 |
|
|
Executive Vice President, Associate Services |
|
|
|
|
|
|
Nancy L. Grden
|
|
|
54 |
|
|
Executive Vice President and Chief Marketing Officer |
|
|
|
|
|
|
Steven B. Larsen
|
|
|
46 |
|
|
Executive Vice President, Health Plan Operations |
|
|
|
|
|
|
John E. Littel
|
|
|
41 |
|
|
Executive Vice President, External Affairs |
|
|
|
|
|
|
Leon A. Root, Jr.
|
|
|
52 |
|
|
Executive Vice President and Chief Information Officer |
|
|
|
|
|
|
Kathleen K. Toth
|
|
|
44 |
|
|
Executive Vice President and Chief Accounting Officer |
|
|
|
|
|
|
Eric Yoder, M.D.
|
|
|
53 |
|
|
Executive Vice President and Chief Medical Officer |
|
|
|
|
|
|
Richard C. Zoretic
|
|
|
47 |
|
|
Executive Vice President, Health Plan Operations and Healthcare
Delivery Systems |
|
|
| * |
Effective January 31, 2006 Frederick C. Dunlap resigned
from the position of Executive Vice President, Chief Operating
Officer but remained on the payroll through February 28,
2006. Upon this resignation, James G. Carlson, the
Companys President, reassumed the duties of Chief
Operating Officer previously held by him and transferred to
Mr. Dunlap on October 28, 2005. |
|
|
| ** |
Effective November 7, 2005 E. Paul Dunn, Jr.
resigned from the position of Executive Vice President, Chief
Financial Officer and Treasurer which he held from November
2004. Sherri E. Lee replaced E. Paul Dunn, Jr., as
Executive Vice President, Chief Financial Officer and Treasurer
effective November 7, 2005. Mr. Dunn, who joined us in
November 2004, did not leave as a result of any disagreement
with the Company. From 1998 to November 2004, Mr. Dunn
served as Vice President of Finance and Treasurer for IGM
Global, Inc. |
Jeffrey L. McWaters has been Chairman and Chief
Executive Officer since he founded the Company in December 1994.
Mr. McWaters has more than 27 years of experience in
the managed healthcare industry. From 1991 to 1994, he served as
President and CEO of Options Mental Health (now ValueOptions), a
national managed care company specializing in behavioral health.
Mr. McWaters formerly held senior executive positions with
CIGNA Healthcare and EQUICOR. Mr. McWaters is a member of
the Board of Visitors of the College of William and Mary, a
director of Americas Health Insurance Plans (AHIP), and a
member of the New York Stock Exchange Listed Companies Advisory
Board.
James G. Carlson joined us as our President and
Chief Operating Officer in April 2003. Prior to joining us,
Mr. Carlson co-founded Workscape, Inc. in 1999, a privately
held provider of benefits and workforce management solutions,
for which he also served as Chief Executive Officer and a
Director. From 1995 to 1998, Mr. Carlson served as
Executive Vice President of UnitedHealth Group and President of
the UnitedHealthcare business unit, which served more than
10 million members in HMO and Preferred Provider
Organization plans nationwide.
Sherri E. Lee rejoined us, effective
November 7, 2005, as Executive Vice President, Chief
Financial Officer and Treasurer. Ms. Lee first joined us in
1998 as our Chief Financial Officer and Treasurer. In 2001,
Ms. Lee resigned her position as Senior Vice President and
Chief Financial Officer, but continued to serve as Senior Vice
President and Treasurer through her retirement on April 1,
2005. Prior to joining AMERIGROUP, Ms. Lee
36
served as Executive Vice President Finance of
Pharmacy Corporation of America and as Senior Vice President and
Controller for Beverly Enterprises, Inc. Ms. Lee is a
certified public accountant.
Stanley F. Baldwin joined us in 1997 and serves as
our Executive Vice President, General Counsel and Secretary. He
also serves as our Compliance Officer. Prior to that,
Mr. Baldwin held senior officer and General Counsel
positions with EPIC Healthcare Group, Inc., EQUICOR-Equitable
HCA Corporation and CIGNA Healthplans, Inc. Mr. Baldwin is
licensed to practice law in Virginia, Tennessee and Texas.
Janet M. Brashear joined us in September 2004 as
our Executive Vice President, Strategic Planning. From 1999 to
2004, Ms. Brashear provided consulting and executive
services to new ventures in the hospitality industry.
Previously, she served as Executive Vice President, Strategy for
Marriott International, and Senior Vice President, Strategy and
Operations for Marriott Lodging. She began her career in sales
with Procter and Gamble.
Catherine S. Callahan joined us in 1999 and serves
as our Executive Vice President, Associate Services. From 1991
to 1999, Ms. Callahan was Chief Administrative Officer of
FHC Health Systems.
Nancy L. Grden joined us in 2001 and serves as our
Executive Vice President and Chief Marketing Officer. Prior to
joining us, Ms. Grden served as President and Founder of
Avenir, LLC, a consulting firm specializing in new ventures, and
as Chief Executive Officer for Lifescape, LLC, a web-based
workplace services company, from 1998 to 2000. She previously
served as Executive Vice President and Chief Marketing Officer
for ValueOptions, a national managed behavioral healthcare
company, from 1992 to 1998.
Steven B. Larsen was appointed Senior Vice
President, Health Plan Operations in May 2005 and promoted to
Executive Vice President, Health Plan Operations in February
2006. He also continues to serve as the Chief Executive Officer
of AMERIGROUP Maryland, Inc, our Maryland subsidiary, a position
which he has held since June 2004. From June 2004 through May
2005, he also served as the President of AMERIGROUP Maryland,
Inc. Prior to joining us, Mr. Larsen was a partner with
Saul Ewing, LLP from September 2003 through June 2004. From June
1997 through May 2003, he served as the Insurance Commissioner
for the Maryland Insurance Administration.
John E. Littel joined us in 2001 and serves as our
Executive Vice President, External Affairs. Mr. Littel has
served in a variety of positions in federal and state
governments, including as Deputy Secretary of Health and Human
Resources for the Commonwealth of Virginia, where he was
responsible for the states welfare reform and healthcare
initiatives, and as Director of Intergovernmental Affairs for
the White House Drug Policy Office. Prior to joining the
Company, he served as counsel and deputy director of the
Citizenship Project at the Heritage Foundation and in the
current Bush Administration as senior counselor to the Director
of the Office of Personnel Management. Mr. Littel is
licensed to practice law in the State of Pennsylvania.
Leon A. Root, Jr. joined us in May 2002 as a
Senior Vice President and has served as our Executive Vice
President and Chief Information Officer since June 2003. From
2001 to 2002, Mr. Root served as Senior Vice President and
Chief Information Officer at Medunite, Inc., a private
e-commerce company.
From 1998 to 2001, Mr. Root served as Senior Vice President
of McKessonHBOC Business System Division.
Kathleen K. Toth joined us in 1995 and serves as
our Executive Vice President and Chief Accounting Officer. Prior
to joining us, Ms. Toth was the Vice President of Service
Operations at Options Mental Health from 1992 to 1995.
Ms. Toth also worked for CIGNA Healthplan of Texas, Inc. as
Director of Financial Services and for EQUICOR Health Plan of
Florida as Controller from 1987 to 1992. Ms. Toth is a
certified public accountant.
Eric M. Yoder, M.D. was named Executive Vice
President and Chief Medical Officer in March 2005.
Dr. Yoder joined our Texas health plan subsidiary,
AMERIGROUP Texas, Inc., in 1996 and served there in various
capacities, including Medical Director, Market President and
Chief Executive Officer, until assuming his current position.
Before joining us, he also served as Medical Director for Bell
Textron Employee Health Service and as Medical Director for
(Kaiser) Permanente Medical Group of Texas.
Richard C. Zoretic was named Executive Vice
President, Health Plan Operations in November 2005. He
previously held the position of Chief Marketing Officer with the
Company beginning in September 2003. Before joining us,
Mr. Zoretic served as Senior Vice President of network
operations and distributions at CIGNA Dental Health from
February 2003. From November 2001 to February 2003,
Mr. Zoretic worked as a senior manager for Deloitte
Consultings global management consulting practice,
specializing in the health plan segment. From March 2000 to
October 2001, Mr. Zoretic was an Executive Vice President
and General manager of Workscape, Inc, a privately held provider
of benefits and workforce management solutions.
37
PART II.
|
|
| Item 5. |
Market for Registrants Common Equity, Related
Stockholder Matters and Issuer Purchases of Equity
Securities |
Our common stock has been listed on the New York Stock Exchange
(NYSE) under the symbol AGP since
January 3, 2003. From November 6, 2001 until
January 2, 2003, our common stock was quoted on the NASDAQ
National Market under the symbol AMGP. Prior to
November 6, 2001, there was no public market for our common
stock.
On December 14, 2004, we announced a two-for-one split of
our common stock. The stock split was in the form of a one
hundred percent stock dividend of one share of common stock for
every share of common stock issued and outstanding. The stock
dividend was distributed on January 18, 2005, to our
shareholders of record on December 31, 2004.
The following table sets forth the range of high and low sales
prices for our common stock (after giving retroactive effect to
the two-for-one stock split effective January 18, 2005) for
the period indicated.
| |
|
|
|
|
|
|
|
|
| 2004 |
|
High | |
|
Low | |
| |
|
| |
|
| |
|
First quarter
|
|
$ |
23.08 |
|
|
$ |
18.23 |
|
|
|
|
|
|
|
Second quarter
|
|
|
24.75 |
|
|
|
19.61 |
|
|
|
|
|
|
|
Third quarter
|
|
|
28.46 |
|
|
|
22.03 |
|
|
|
|
|
|
|
Fourth quarter
|
|
|
38.44 |
|
|
|
26.50 |
|
| |
|
|
|
|
|
|
|
|
| 2005 |
|
|
|
|
| |
|
|
|
|
|
First quarter
|
|
$ |
43.16 |
|
|
$ |
35.15 |
|
|
|
|
|
|
|
Second quarter
|
|
|
40.46 |
|
|
|
32.20 |
|
|
|
|
|
|
|
Third quarter
|
|
|
46.92 |
|
|
|
19.12 |
|
|
|
|
|
|
|
Fourth quarter
|
|
|
19.73 |
|
|
|
15.45 |
|
|
|
|
|
|
|
December 31, 2005 Closing Sales Price
|
|
$ |
19.46 |
|
|
|
|
|
February 27, 2006, the last reported sales price of our
common stock was $20.93 per share as reported on the NYSE. As of
February 27, 2006, we had 44 shareholders of record.
We have never declared or paid any cash dividends on our common
stock. We currently anticipate that we will retain any future
earnings for the development and operation of our business.
Also, under the terms of our credit facility, we are limited in
the amount of dividends that we may pay to our stockholders
without the consent of our lenders. Accordingly, we do not
anticipate declaring or paying any cash dividends in the
foreseeable future.
In addition, our ability to pay dividends is dependent on cash
dividends from our subsidiaries. State insurance and Medicaid
regulations limit the ability of our subsidiaries to pay
dividends to us.
38
|
|
| Item 6. |
Selected Financial Data |
The following selected consolidated financial data should be
read in connection with the consolidated financial statements
and related notes and Managements Discussion and Analysis
of Financial Condition and Results of Operations appearing
elsewhere in this
Form 10-K.
Selected financial data as of and for each of the years in the
five-year period ended December 31, 2005 are derived from
our consolidated financial statements, which have been audited
by KPMG LLP, independent registered public accounting firm. All
share and per share amounts included in the following
consolidated financial data have been retroactively adjusted to
reflect the two-for-one stock split effective January 18,
2005.
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Year ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
|
2002 | |
|
2001 | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
| |
|
(Dollars in thousands, except per share data) | |
|
|
|
|
|
|
Income Statement Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Premium
|
|
$ |
2,311,599 |
|
|
$ |
1,813,391 |
|
|
$ |
1,615,508 |
|
|
$ |
1,152,636 |
|
|
$ |
880,510 |
|
|
|
|
|
|
| |
Investment income
|
|
|
18,310 |
|
|
|
10,340 |
|
|
|
6,726 |
|
|
|
8,026 |
|
|
|
10,664 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total revenues
|
|
|
2,329,909 |
|
|
|
1,823,731 |
|
|
|
1,622,234 |
|
|
|
1,160,662 |
|
|
|
891,174 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Health benefits
|
|
|
1,957,196 |
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
933,591 |
|
|
|
709,034 |
|
|
|
|
|
|
| |
Selling, general and administrative
|
|
|
258,446 |
|
|
|
191,915 |
|
|
|
186,856 |
|
|
|
133,409 |
|
|
|
109,822 |
|
|
|
|
|
|
| |
Depreciation and amortization
|
|
|
26,948 |
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
13,149 |
|
|
|
9,348 |
|
|
|
|
|
|
| |
Interest
|
|
|
608 |
|
|
|
731 |
|
|
|
1,913 |
|
|
|
791 |
|
|
|
763 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total expenses
|
|
|
2,243,198 |
|
|
|
1,682,493 |
|
|
|
1,508,319 |
|
|
|
1,080,940 |
|
|
|
828,967 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Income before income taxes
|
|
|
86,711 |
|
|
|
141,238 |
|
|
|
113,915 |
|
|
|
79,722 |
|
|
|
62,207 |
|
|
|
|
|
|
|
Income tax expense
|
|
|
33,060 |
|
|
|
55,224 |
|
|
|
46,591 |
|
|
|
32,686 |
|
|
|
26,127 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Net income
|
|
|
53,651 |
|
|
|
86,014 |
|
|
|
67,324 |
|
|
|
47,036 |
|
|
|
36,080 |
|
|
|
|
|
|
|
Accretion of redeemable preferred stock dividends
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,228 |
) |
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Net income attributable to common stockholders
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
$ |
29,852 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share
|
|
$ |
1.05 |
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
$ |
1.17 |
|
|
$ |
4.04 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares outstanding
|
|
|
51,213,589 |
|
|
|
49,721,945 |
|
|
|
43,245,408 |
|
|
|
40,355,456 |
|
|
|
7,389,688 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
1.02 |
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
$ |
1.10 |
|
|
$ |
1.04 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
52,857,682 |
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
|
|
42,938,844 |
|
|
|
33,299,442 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
|
2002 | |
|
2001 | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
| |
|
(Dollars in thousands) | |
|
|
|
|
|
|
Balance Sheet Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Cash and cash equivalents and short and long-term investments
|
|
$ |
587,106 |
|
|
$ |
612,059 |
|
|
$ |
535,103 |
|
|
$ |
306,935 |
|
|
$ |
301,837 |
|
|
|
|
|
|
| |
Total assets
|
|
|
1,093,588 |
|
|
|
919,850 |
|
|
|
826,021 |
|
|
|
578,484 |
|
|
|
406,942 |
|
|
|
|
|
|
| |
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
50,000 |
|
|
|
|
|
|
|
|
|
|
| |
Total liabilities
|
|
|
452,034 |
|
|
|
351,138 |
|
|
|
364,307 |
|
|
|
339,103 |
|
|
|
223,426 |
|
|
|
|
|
|
| |
Stockholders equity
|
|
|
641,554 |
|
|
|
568,712 |
|
|
|
461,714 |
|
|
|
239,381 |
|
|
|
183,516 |
|
39
|
|
| Item 7. |
Managements Discussion and Analysis of Financial
Condition and Results of Operations |
Overview
We are a multi-state managed healthcare company focused on
serving people who receive healthcare benefits through publicly
sponsored programs, including Medicaid, SCHIP, FamilyCare and
SNP. We were founded in December 1994 with the objective of
becoming the leading managed care organization in the
U.S. focused on serving people who receive these types of
benefits. Having concluded over ten years of operation, we
continue to believe that managed healthcare remains the only
proven mechanism that significantly reduces medical cost trends
and helps our state partners control their costs.
In 2005, we increased our total revenues by 27.8% over 2004.
Total membership increased by 193,000 members, or 20.6%, to
1,129,000 members as of December 2005. Our 2005 revenue growth
came from a number of factors including:
|
|
|
| |
|
Organic growth Our premium revenues for 2005 grew
15.1% over the prior year from membership increases in existing
service areas and new markets, including Ohio and Virginia, and
premium rate increases received. Premium revenues benefited in
2005 from the reversal of a Maryland premium recoupment
previously recorded, totaling $6.1 million, offset by
$6.4 million of anticipated premium recoupments related to
enrollment errors by the States of Florida and Texas due to
eligibility issues related to prior periods. |
| |
| |
|
Growth through acquisitions Effective
January 1, 2005, we completed our stock acquisition of
CarePlus in New York City and Putnam County, New York, pursuant
to the terms of the merger agreement. At the date of the
acquisition, CarePlus served approximately 115,000 members
covered by New York States Medicaid, Child Health Plus and
Family Health Plus programs. CarePlus service areas
include New York City (Brooklyn, Manhattan, Queens and Staten
Island) and Putnam County, New York. CarePlus accounted for
45.1% of the premium revenue growth in 2005. |
As of December 31, 2005, more than 44% of our current
membership has resulted from ten acquisitions. We are also
focused on growth opportunities in new markets and new products.
We will continue to pursue opportunities that we believe meet
our return metrics. We continue to believe acquisitions will be
an important part of our long-term growth strategy.
In 2005, our health benefits ratio (HBR) was 84.7% versus
81.0% in 2004. Our 2005 results have been impacted by an
increase in health benefits expense trend as evidenced by
changes in membership, higher incidence of illness, obstetric
services and related costs such as neonatal intensive care unit
and other services, higher utilization and unit costs for
network changes and provider contract rates and terms, as well
as higher costs associated with entry into new markets. In
addition, due to the impact of the installation of our new
claims processing system, FACETS, on October 1, 2005 in our
Texas market, we enhanced our medical claims estimation process
during the fourth quarter of 2005 and added $15.4 million
to our claims payable balance to compensate for the reduction in
the rate of claims processing. We also added a separate factor
for uncertainty of $5.8 million to cover the impact of
adverse changes in the level and nature of claims inventory
associated with the conversion to FACETS.
Selling, general and administrative expenses (SG&A) were
11.1% of total revenues for the year ended December 31,
2005 compared to 10.5% in 2004. The increase in the SG&A
ratio is primarily a result of increases in premium taxes, legal
fees and experience rebate expenses.
Cash, cash equivalents and investments totaled
$643.8 million at the end of 2005. A significant portion of
our cash, cash equivalents and investments is regulated by state
capital requirements. However, $157.9 million of our cash,
cash equivalents and investments was unregulated and held at the
parent level.
On July 2, 2004, the State of Texas released a Request for
Proposal (RFP) to re-procure its current Medicaid managed
care programs, as well as to expand the current programs. In
July 2005, the State announced the results of this
competitive-bidding process as it relates to the TANF
(STAR) and SCHIP populations. AMERIGROUPs
wholly-owned subsidiary, AMERIGROUP Texas, Inc. was awarded STAR
and SCHIP, or TexCare, contracts in its current service areas of
Houston, Dallas and Fort Worth and contracts in two new
service areas of Corpus
40
Christi and El Paso. AMERIGROUP Texas, Inc. was also
granted a STAR contract for the Austin service area. AMERIGROUP
Texas, Inc. will have one or more competitors in each of its new
and current service areas for the STAR and TexCare programs. The
combined eligibles for these expanded products and markets are
approximately 1,100,000 as compared to the previously existing
eligible population of 735,000. In September 2005, the Company
notified the State of Texas that it had declined the contract
award in El Paso. This decision was reached after the State
of Texas announced the results of the bid, which included
re-awarding contracts to the two existing managed care providers
that currently serve approximately 73% of the eligibles in this
market. This competitive environment would significantly limit
market expansion opportunities. Implementation of the remaining
contracts is expected to be in September 2006. These awards do
not include the expansion of the STAR+PLUS program. The State
announced expansion of STAR+PLUS into all remaining urban areas
under a modified structure which will exclude risk on
hospitalization costs to protect the upper payment limit. This
may reduce premium levels compared to the current STAR+PLUS
reimbursement, but will be offset by an accompanied reduction in
medical risk. The revised program is expected to be finalized in
2006 and implemented by early 2007.
We had an exclusive risk-sharing arrangement with Cook
Childrens Health Care Network (CCHCN) and Cook
Childrens Physician Network (CCPN), which includes Cook
Childrens Medical Center (CCMC), that was terminated as of
August 31, 2005. In its place, we entered into separate
non-exclusive fee-for-service provider agreements with CCPN and
CCMC. On December 27, 2005, CCPN and CCMC each sent notices
indicating their intent to terminate these fee-for-service
agreements as of March 31, 2006. We do not believe that
such terminations are warranted under these agreements. It is
our intent to take appropriate actions to persuade CCPN and CCMC
to rescind their notices of termination. However, there is no
assurance that our efforts will be successful. CCPN and CCMC
control most of the inpatient and specialty pediatric services
available in Fort Worth, Texas. If these agreements
terminate, it would force us to make alternate arrangements for
many services to our pediatric membership, which may adversely
impact our costs and our membership. Therefore, our results from
operations could be harmed as a result of the termination of
these arrangements, and the impact could be material.
As part of the State of Texas re-bidding process, CCHCN obtained
its own contract with the State of Texas to provide healthcare
services to Medicaid recipients effective September 1,
2006. As a result, we may lose members based upon CCHCNs
contract with the State of Texas, and the impact could be
material. In addition, under the risk-sharing arrangement with
CCHCN that terminated as of August 31, 2005, the parties
have an obligation to perform annual reconciliations and
settlements of the risk pool for each contract year. We believe
that CCHCN may owe us substantial payments for the 2004 and 2005
contract years, which we estimate at approximately
$12.5 million as of December 31, 2005. As of this
date, we have not reached an agreement with CCHCN as to the
settlement amounts for the 2004 and 2005 contract years. If we
are unable to agree on a settlement, our health benefits
expenses attributable to these periods may be adversely
affected, and we may incur significant costs in our efforts to
reach a final resolution of this matter.
We announced on June 2, 2005, that the State of Illinois
cut $70 million from its fiscal year 2006 Medicaid managed
care budget. The State of Illinois decision to reduce
spending on its Medicaid managed care program caused AMERIGROUP
Illinois, Inc., to reduce its operations beginning with the
third quarter of 2005. Effective July 1, 2005, AMERIGROUP
Illinois, Inc. entered into a new contract with the State of
Illinois that substantially reduced reimbursement for
administrative, sales and marketing expenses and, accordingly,
AMERIGROUP Illinois, Inc., reduced the size of its organization.
The Illinois Legislature recently passed a bill proposed by the
Governor that would expand coverage for all uninsured children
in Illinois, using savings generated by imposing a statewide
primary care case management program (PCCM). This will allow the
creation of a new entitlement with very limited controls on the
growing costs of Medicaid. According to the State of Illinois,
the current HMO model would
co-exist and provide a
choice for members. This may limit growth opportunities for HMOs
and require us to reconsider our business strategy with respect
to this market in the future.
AMERIGROUP Virginia, Inc. signed a contract with the
Commonwealth of Virginia on July 15, 2005, and began
enrolling members in September 2005. AMERIGROUP Ohio, Inc. also
received an HMO license in and signed a contract with the State
of Ohio on July 25, 2005, and began enrolling members in
September 2005.
41
As a result of a competitive-bidding process, our Georgia
subsidiary, AMGP Georgia Managed Care Company, Inc. (d/b/a
AMERIGROUP Georgia), was chosen in July 2005 to offer healthcare
coverage to low-income residents in four of six regions in the
State of Georgia. Georgia will represent our entry into a tenth
state. AMERIGROUP Georgia will have two competitors in the
Atlanta Region and one competitor in each of the other regions.
The total eligible members in all four regions are approximately
885,000, with 533,000 in the Atlanta Region. We anticipate that
AMERIGROUP Georgia will commence enrollment of members in the
Atlanta Region on June 1, 2006 based on the most recent
communication from the State.
On September 23, 2005, CMS designated AMERIGROUP
Texas, Inc., as a Special Needs Plan. AMERIGROUP Texas, Inc. has
entered into a contract with CMS to offer Medicare benefits to
dual eligibles that live in and surrounding Harris County, Texas
beginning January 1, 2006. AMERIGROUP Texas, Inc. already
served these members through the Texas Medicaid STAR+PLUS
program and will offer them the Medicare and Part D drug
benefit under this new contract. As of January 1, 2006, we
served approximately 8,800 members under this program.
In April 2004, the Maryland Legislature enacted a budget for the
2005 fiscal year beginning July 1, 2004 that included a
provision to reduce the premium paid to managed care
organizations (MCOs) that did not meet certain HEDIS scores and
whose medical loss ratio was below 84% for the calendar year
ended December 31, 2002. In May 2004, the Maryland
Secretary of Health and Mental Hygiene, in consultation with
Marylands legislative leadership, determined our premium
recoupment to be $846,000. A liability for the recoupment was
recorded with a corresponding charge to premium revenue during
the year ended December 31, 2004. Additionally, the
Maryland Legislature directed that the Department of Health and
Mental Hygiene complete a study by September 2004 on the
relevance of the medical loss ratio threshold as an indicator of
quality. The results of this study, which were released in
October 2004, did not directly address what would happen in the
future if an MCO reported a medical loss ratio below 84%. As a
result, we believed the Maryland Legislature could enact similar
legislation in 2005 as part of its fiscal year 2006 budget,
requiring premium recoupment. Accordingly, we recorded a
reduction in premium of $6.1 million in our consolidated
financial statements during the year ended December 31,
2004, which was our best estimate of the possible outcome of
this issue.
The Maryland Legislative Session ended on April 11, 2005
and it addressed the medical loss ratio assessment in the
following manner. First, no budget action was taken to recoup
premium relating to 2003 as it did in the 2004 legislative
session. Second, the Maryland Legislature amended the existing
statute to clarify the process and required that regulations be
promulgated by the Department of Health and Mental Hygiene
before an action could be taken to recoup premium based upon an
MCOs medical loss ratio. Based on this information, we
reversed the reduction in premium that was previously recorded
resulting in $6.1 million of additional premium revenue in
the year ended December 31, 2005.
Discussion of Critical Accounting Policies
In the ordinary course of business, we make a number of
estimates and assumptions relating to the reporting of results
of operations and financial condition in the preparation of our
financial statements in conformity with U.S. generally
accepted accounting principles. We base our estimates on
historical experience and on various other assumptions that we
believe to be reasonable under the circumstances. Actual results
could differ from those estimates and the differences could be
significant. We believe that the following discussion addresses
our critical accounting policies, which are those that are most
important to the portrayal of our financial condition and
results of operations and require managements most
difficult, subjective and complex judgments, often as a result
of the need to make estimates about the effect of matters that
are inherently uncertain.
We generate revenues primarily from premiums we receive from the
states in which we operate to arrange for health benefit
services for our members. In 2006, we will receive premiums from
CMS for the SNP program. We recognize premium revenue during the
period in which we are obligated to provide services to our
members. A fixed premium per member per month is paid to us to
arrange for healthcare benefit services for our members pursuant
to our contracts in each of our markets. These premium payments
are based upon eligibility determined
42
by the state governments with which we have contracted. Errors
in this eligibility determination on which we rely can result in
positive and negative premium adjustments to the extent this
information is adjusted by the state. In all of our states,
except Florida and Virginia, we are eligible to receive
supplemental payments for newborn obstetric deliveries. Each
state contract is specific as to what is required before
payments are generated. Upon delivery of a newborn, each state
is notified according to our contract. Revenue is recognized in
the period that the delivery occurs and the related services are
provided to our member based on our authorization system for
these services. Additionally, in some states we receive
supplemental payments for certain services such as high cost
drugs and early childhood prevention screenings. Any amounts
that have not been received from the state by the end of the
period are recorded on our balance sheet as premium receivables.
We also generate income from investments.
|
|
|
Estimating health benefits expense and claims
payable |
Our results of operations depend on our ability to effectively
manage expenses related to health benefits, as well as our
ability to accurately predict costs incurred in recording the
amounts in our consolidated financial statements. Expenses
related to health benefits have two components: direct medical
expenses and medically related administrative costs. Direct
medical expenses include fees paid to hospitals, physicians and
providers of ancillary medical services, such as pharmacy,
laboratory, radiology, dental and vision. Medically related
administrative costs include expenses related to services such
as health promotion, quality assurance, case management, disease
management and 24-hour
on-call nurses. Direct medical expenses also include estimates
of IBNR. For the year ended December 31, 2005,
approximately 95% of our direct medical payments related to fees
paid on a fee-for-service basis to hospitals, PCPs, specialist
physicians and other providers, including fees paid to
third-party vendors for ancillary services. The balance related
to fees paid on a capitation, or per member, basis. Primary care
and specialist physicians not paid on a capitation basis are
paid on a maximum allowable fee schedule set forth in the
contracts with our providers. We reimburse hospitals on a
negotiated per diem, case rate or an agreed upon percent of
their standard charges. In Maryland, the State sets the amount
reimbursed to hospitals. Fees paid for services provided to our
members by hospitals and providers with whom we have no contract
are paid based upon our usual and customary fee schedules unless
mandated at other levels by state regulation.
We have used a consistent methodology for estimating our medical
expenses and medical liabilities since our inception, and have
refined our assumptions to take into account our maturing
claims, product and market experience. As medical utilization
patterns and cost trends change from
year-to-year, our
underlying claims payments reflect the variations in experience.
Our estimates are revised based upon actual claims payments
using historical per member per month claims cost, including
provider settlements, changes in the age and gender of our
membership, variations in the severity of medical conditions,
high dollar claims and authorization data. Each of these factors
may be considered in determining our current medical liabilities.
There are certain aspects of the managed care business that are
not predictable with consistency. These aspects include the
incidences of illness or disease state (e.g., cardiac heart
failure cases, cases of upper respiratory illness, diabetes, the
number of full-term versus premature births, and the number of
neonatal intensive care babies) as well as non-medical aspects,
such as changes in provider contracting and contractual
benefits. Therefore, we must rely upon our historical
experience, as continually monitored, to reflect the
ever-changing mix and growth of members.
Monthly, we estimate our IBNR based on a number of factors,
including prior claims experience, member mix changes, high
dollar claims, and authorization data. Authorization data is
information captured in our medical management system, which
identifies services requested by providers or members. The
medical cost related to these authorizations is estimated by
pricing the approved services using contractual or historical
amounts adjusted for known variables such as historical claims
trends. These estimated costs are included as a component of
IBNR in the more current months.
We enhanced our estimation processes in the fourth quarter of
2005 to reflect changes in claims payment patterns observed in
2005 and anticipated to continue in the future due to the
conversion to the FACETS system. We considered the typical
reduction in the rate of claims processing due to a decrease in
payment efficiencies
43
associated with the installation of a new medical claims payment
system. As we have discussed previously, we transitioned our
Texas market, which represents 35% of our membership, to FACETS
effective October 1, 2005. To quantify the potential impact
of this conversion on our three claims payment systems, we
reviewed claims payments per member per month, by product and by
health plan, and observed lower than historical payment
patterns, while at the same time we saw an increase in claims
inventory levels for certain markets. Accordingly, we estimated
the value of the increase related to claims on hand at the end
of the period and added $15.4 million to our claims payable
balance for this backlog in our IBNR estimate.
As part of our normal review, we also consider the costs to
process medical claims, and estimates of amounts to cover
uncertainties related to fluctuations in claims payment
patterns, membership, products and authorization trends. These
estimates are adjusted as more information becomes available and
any adjustments are included in current operations. Due to the
uncertainty associated with payment rates and inventory levels,
associated with the FACETS conversion, we established a separate
estimate for this uncertainty to cover the expected adverse
claims development. We will maintain this additional estimate as
long as this uncertainty related to the systems conversion
remains.
We utilize the services of independent actuarial consultants,
who are contracted to review our estimates on a quarterly basis,
as well as the assumptions used in forming these estimates.
Judgments are made based on knowledge and experience about past
and current events. There is a likelihood that actual results
could be materially different than reported if different
assumptions or conditions prevail.
Also included in claims payable are estimates for provider
settlements due to clarification of contract terms,
out-of-network
reimbursement and claims payment differences, as well as amounts
due to or from contracted providers under risk-sharing
arrangements. During 2005, we reclassified certain provider
receivables under our risk-sharing arrangement with CCHCN to
prepaid expenses, provider receivables and other current assets
as a result of the termination of the contract whereby no
liabilities remained in claims payable to offset the
risk-sharing receivable.
The following table shows the components of the change in
medical claims payable for the years ended December 31,
2005, 2004 and 2003 (in thousands):
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
|
Medical claims payable as of January 1
|
|
$ |
241,253 |
|
|
$ |
239,532 |
|
|
$ |
202,430 |
|
|
|
|
|
|
|
Medical claims payable assumed from businesses acquired during
the year
|
|
|
27,424 |
|
|
|
|
|
|
|
20,421 |
|
|
|
|
|
|
|
Health benefits expenses incurred during the year:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Related to current year
|
|
|
1,982,880 |
|
|
|
1,505,482 |
|
|
|
1,355,065 |
|
|
|
|
|
|
| |
Related to prior years
|
|
|
(25,684 |
) |
|
|
(36,385 |
) |
|
|
(59,165 |
) |
| |
|
|
|
|
|
|
|
|
|
| |
|
Total incurred
|
|
|
1,957,196 |
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
|
|
|
|
Health benefits payments during the year:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Related to current year
|
|
|
1,646,664 |
|
|
|
1,274,460 |
|
|
|
1,135,082 |
|
|
|
|
|
|
| |
Related to prior years
|
|
|
230,530 |
|
|
|
192,916 |
|
|
|
144,137 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Total payments
|
|
|
1,877,194 |
|
|
|
1,467,376 |
|
|
|
1,279,219 |
|
| |
|
|
|
|
|
|
|
|
|
|
Medical claims payable as of December 31
|
|
$ |
348,679 |
|
|
$ |
241,253 |
|
|
$ |
239,532 |
|
| |
|
|
|
|
|
|
|
|
|
In the current year, we experienced a reduction in the favorable
prior year development of approximately $10.7 million
related to 2004 and prior which compares to a decrease of
$22.8 million in the prior year related to 2003 and prior.
The current year reduction was primarily the result of continued
tightening of our claims estimates at December 31, 2004.
The Companys methodology includes adding a factor to
compensate for normal claims uncertainty. The more precisely we
have been able to predict claims patterns, the lower the
required factor for uncertainty as a percentage of our medical
liability. Due to the changing mix of members, products and
markets, this factor is a
44
necessary component of our medical liabilities. While our prior
year development historically has been favorable, there is no
guarantee this will continue and the factor for uncertainty
mitigates the risk of emerging claims experience that is
different from historical patterns. The health benefits expenses
incurred during the period related to prior years relate almost
entirely to revisions in estimates for the immediately preceding
year. The application of our methodology has resulted in
reversals of estimated incurred claims related to prior years in
each of the years in the three-year period ended
December 31, 2005. The resulting impact on operations is a
function of the variation of the change in estimate from
year-to-year. Included
in the table above is the negative impact on earnings of the
change in our factor for uncertainty of a total of
$9.2 million in 2005. This change was largely due to
increased uncertainty around the conversion to our new claims
system, FACETS, for which we have added a specific factor for
uncertainty of $5.8 million. We will maintain this specific
factor for claims uncertainty as long as the uncertainty related
to the systems conversion remains. We will review the progress
of the systems conversion and will adjust the related factor for
claims uncertainty as appropriate. Our 2005 unfavorable
development of $9.2 million compares to a favorable
development of $1.5 million in 2004, and an unfavorable
development of $3.5 million in 2003.
Changes in estimates are primarily the result of obtaining more
complete claims information that directly correlates with the
claims and provider reimbursement trends. Since our estimates
are based upon the blended per member per month claims
experience, changes cannot typically be explained by any single
factor, but are the result of a number of interrelated
variables, all influencing the resulting experience. These
variables include fluctuations in claims payment patterns,
changes in membership levels, number and mix of products,
benefit structure, changes in provider networks or contract
terms, severity of illness and utilization levels. We believe
there will be less volatility as we increase in size and gain
more maturity in our markets and successfully convert our
remaining health plans to FACETS.
We believe that the amount of claims payable is adequate to
cover our ultimate liability for unpaid claims as of
December 31, 2005; however, actual claim payments and other
items may differ from established estimates. Assuming a
hypothetical 1% difference between our December 31, 2005
estimates of claims payable and actual claims payable, net
income for the year ended December 31, 2005 would increase
or decrease by approximately $3.5 million and diluted
earnings per share would increase or decrease by approximately
$0.04 per share.
On a quarterly basis, we estimate our required tax liability and
assess the recoverability of our deferred tax assets. Our taxes
payable are estimated based on enacted rates, including
estimated tax rates in states where we do business, applied to
the income expected to be taxed currently. Management assesses
the realizability of our deferred tax assets based on the
availability of carrybacks of future deductible amounts and
managements projections for future taxable income. We
cannot guarantee that we will generate income in future years.
Historically we have not experienced significant differences in
our estimates of our tax accrual.
|
|
|
Goodwill and intangible assets |
As of December 31, 2005 and 2004, we had goodwill and other
intangible assets of $255.1 million and
$140.4 million, respectively, net of accumulated
amortization. We review our intangible assets with defined lives
for impairment whenever events or changes in circumstances
indicate we might not recover their carrying value. We assess
our goodwill for impairment at least annually. In assessing the
recoverability of these assets, we must make assumptions
regarding estimated future utility and cash flows and other
internal and external factors to determine the fair value of the
respective assets. If these estimates or their related
assumptions change in the future, we may be required to record
impairment charges for these assets.
|
|
|
Recent Accounting Standards |
On December 16, 2004, the Financial Accounting Standards
Board (FASB) issued Statement of Financial Accounting
Standard No. 123 (revised 2004)
(SFAS No. 123(R)), Share-Based Payment, which
is a revision of Statement of Financial Accounting Standards
No. 123, Accounting for Stock-Based Compensation
(SFAS No. 123). SFAS No. 123(R)
supersedes Accounting Principles Board (APB) Opinion
No. 25, Accounting
45
for Stock Issued to Employees, and
SFAS No. 148, Accounting for Stock Based
Compensation, and amends FASB Statement of Financial
Accounting Standard No. 95, Statement of Cash Flows.
Generally, the approach in SFAS No. 123(R) is similar
to the approach described in SFAS No. 123. However,
SFAS No. 123(R) requires all share-based payments to
employees, including grants of employee stock options, to be
recognized in the income statement based on their fair values.
Proforma disclosure is no longer an alternative.
Effective January 1, 2006, we adopted
SFAS No. 123(R) applying the modified prospective
method.
Under SFAS No. 123(R), the modified prospective method
permits compensation cost to be recognized beginning with the
effective date (a) based on the requirements of
SFAS No. 123(R) for all share-based payments granted
after the effective date and (b) based on the requirements
of SFAS No. 123 for all awards granted to employees
prior to the effective date of SFAS No. 123(R) that
remain unvested on the effective date.
As permitted by SFAS No. 123, we currently account for
share-based payments to employees using APB Opinion
No. 25s intrinsic value method and, as such,
generally recognize no compensation cost for employee stock
options. Accordingly, the adoption of the fair value method of
SFAS No. 123(R) will have a significant impact on our
results of operations, although it will have no impact on our
overall financial position. The impact of adoption of
SFAS No. 123(R) is estimated to be additional
compensation cost of approximately $4.5 million, net of
tax, or $0.09 per diluted share for the year ended
December 31, 2006. This estimate could differ materially
from actual compensation cost recognized as it depends on levels
of share-based payments granted in the future. Had we adopted
SFAS No. 123(R) in prior periods, the impact of the
standard for prior periods would have approximated the impact of
SFAS No. 123 as described in the disclosure of
proforma net income and earnings per share in Note 2(i) to
our consolidated financial statements. SFAS No. 123(R)
also requires the benefits of tax deductions in excess of
recognized compensation cost to be reported as a financing cash
flow, rather than as an operating cash flow as required under
current literature. This requirement will reduce net operating
cash flows and increase net financing cash flows in periods
after adoption. While we cannot estimate what those amounts will
be in the future (because they depend on, among other things,
when employees exercise stock options), the amount of operating
cash flows recognized in prior periods for such excess tax
deductions were $8.6 million, $8.0 million and
$4.5 million in 2005, 2004 and 2003, respectively.
Results of Operations
The following table sets forth selected operating ratios for the
years ended December 31, 2005, 2004 and 2003. All ratios,
with the exception of the health benefits ratio, are shown as a
percentage of total revenues.
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Year ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
|
Premium revenue
|
|
|
99.2 |
% |
|
|
99.4 |
% |
|
|
99.6 |
% |
|
|
|
|
|
|
Investment income
|
|
|
0.8 |
|
|
|
0.6 |
|
|
|
0.4 |
|
| |
|
|
|
|
|
|
|
|
|
|
Total revenues
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
| |
|
|
|
|
|
|
|
|
|
|
Health benefits(1)
|
|
|
84.7 |
% |
|
|
81.0 |
% |
|
|
80.2 |
% |
|
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
11.1 |
% |
|
|
10.5 |
% |
|
|
11.5 |
% |
|
|
|
|
|
|
Income before income taxes
|
|
|
3.7 |
% |
|
|
7.7 |
% |
|
|
7.0 |
% |
|
|
|
|
|
|
Net income
|
|
|
2.3 |
% |
|
|
4.7 |
% |
|
|
4.2 |
% |
|
|
| (1) |
The health benefits ratio is shown as a percentage of premium
revenue because there is a direct relationship between the
premium received and the health benefits provided. |
46
The following table sets forth the approximate number of our
members in each of our service areas for the periods presented.
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
December 31, | |
| |
|
| |
| Market |
|
2005 | |
|
2004 | |
|
2003 | |
|
2002 | |
|
2001 | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
Texas
|
|
|
399,000 |
|
|
|
394,000 |
|
|
|
343,000 |
|
|
|
296,000 |
|
|
|
214,000 |
|
|
|
|
|
|
|
Florida
|
|
|
219,000 |
|
|
|
229,000 |
|
|
|
221,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Maryland
|
|
|
141,000 |
|
|
|
130,000 |
|
|
|
124,000 |
|
|
|
125,000 |
|
|
|
118,000 |
|
|
|
|
|
|
|
New York
|
|
|
138,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
New Jersey
|
|
|
109,000 |
|
|
|
105,000 |
|
|
|
99,000 |
|
|
|
99,000 |
|
|
|
88,000 |
|
|
|
|
|
|
|
Illinois
|
|
|
41,000 |
|
|
|
37,000 |
|
|
|
32,000 |
|
|
|
34,000 |
|
|
|
39,000 |
|
|
|
|
|
|
|
District of Columbia
|
|
|
41,000 |
|
|
|
41,000 |
|
|
|
38,000 |
|
|
|
37,000 |
|
|
|
13,000 |
|
|
|
|
|
|
|
Ohio
|
|
|
22,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Virginia
|
|
|
19,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
1,129,000 |
|
|
|
936,000 |
|
|
|
857,000 |
|
|
|
591,000 |
|
|
|
472,000 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of December 31, 2005, we served 1,129,000 members, which
reflects an increase of 193,000 members compared to
December 31, 2004. The CarePlus acquisition, effective
January 1, 2005, added the New York market, which has grown
to 138,000 members as of December 31, 2005. The remaining
organic growth occurred in all of our other markets, except the
District of Columbia and Florida, due to new product offerings,
expansion into new service areas, successful marketing
initiatives, and competitors leaving the market. Membership in
the District of Columbia remains constant. The Florida market
decrease of 10,000 members is primarily the result of a decrease
in the SCHIP program, Florida Healthy Kids. This decrease is a
direct result of changes made by the State of Florida during
2004 in the eligibility re-determination process and the
frequency of member enrollment, both of which have negatively
impacted the statewide membership in the Florida Healthy Kids
program. The Florida Legislature enacted legislation in 2005 to
address this problem, which was signed by the Governor,
increasing the frequency of the enrollment period from
semi-annual to monthly. The State of Florida is now in the
process of implementing this enrollment change. Additionally, we
have experienced a backlog in our Texas enrollment due to the
implementation of a new enrollment broker. We anticipate, based
on discussions with the State, that the issues that have caused
this backlog will be corrected in 2006 and the enrollment
backlog will be updated.
On December 14, 2004, we announced a two-for-one split of
our common stock. The stock split was in the form of a one
hundred percent stock dividend of one share of common stock for
every share of common stock issued and outstanding. The stock
dividend was distributed on January 18, 2005, to
shareholders of record on December 31, 2004. All share and
per share data described herein give retroactive effect to the
two-for-one stock split effective January 18, 2005.
Year Ended December 31, 2005 Compared to Year Ended
December 31, 2004
Premium revenue for the year ended December 31, 2005
increased $498.2 million, or 27.5%, to
$2,311.6 million from $1,813.4 million in 2004. The
increase was primarily due to internal growth in membership,
growth through acquisition of CarePlus and premium rate
increases. Total membership increased 20.6% to 1,129,000 as of
December 31, 2005 from 936,000 as of December 31, 2004.
Investment income increased $8.0 million to
$18.3 million for the year ended December 31, 2005.
The increase in investment income is primarily due to increases
in market interest rates.
Expenses relating to health benefits for the year ended
December 31, 2005 increased $488.1 million, or 33.2%,
to $1,957.2 million from $1,469.1 million for the year
ended December 31, 2004. The HBR for the year
47
ended December 31, 2005 was 84.7% compared to 81.0% in
2004. Our 2005 results have been impacted by an increase in
membership, higher incidence of illness, an increase in
obstetric services and related costs such as neonatal intensive
care unit and other services, higher utilization and unit costs
for network changes and provider contract rates and terms, as
well as higher costs associated with entry into new markets. In
addition, due to the impact of the installation of our new
claims processing system, FACETS, on October 1, 2005 in our
Texas market, we enhanced our medical claims estimation process
during the fourth quarter of 2005 and added $15.4 million
to compensate for the reduction in the rate of claims
processing. We also added a separate factor for uncertainty of
$5.8 million to cover the impact of adverse changes in the
level and nature of claims inventory associated with the
conversion.
|
|
|
Selling, general and administrative expenses |
SG&A increased $66.5 million to $258.4 million for
the year ended December 31, 2005 compared to
$191.9 million in 2004. Our SG&A ratio for the year
ended December 31, 2005 was 11.1% compared to 10.5% in
2004. The increase in SG&A ratio was primarily due to:
|
|
|
| |
|
an increase in premium taxes that the States of Texas, New
Jersey and Maryland began assessing in September 2003, July
2004, and April 2005, respectively; |
| |
| |
|
an increase in legal expenses related to the Tyson litigation
and the securities class action complaints; and |
| |
| |
|
an increase in experience rebate expense in our Texas market. |
Interest expense was $0.6 million and $0.7 million for
the years ended December 31, 2005 and 2004, respectively.
|
|
|
Provision for income taxes |
Income tax expense for 2005 was $33.1 million with an
effective tax rate of 38.1% as compared to the
$55.2 million for 2004 with an effective tax rate of 39.1%.
The decrease in the effective tax rate is primarily attributable
to a decrease in the blended state income tax rate reflecting
the profitability by health plan.
Net income for 2005 was $53.7 million, or $1.02 per
diluted share, compared to $86.0 million, or $1.66 per
diluted share in 2004. The decrease in net income is primarily a
result of increased medical costs driven by higher incidence of
illness, an increase in obstetric services and related costs
such as neonatal intensive care unit and other services, higher
utilization and unit costs for network changes and other new
contract terms, as well as higher costs associated with entry
into new markets.
Year Ended December 31, 2004 Compared to Year Ended
December 31, 2003
Premium revenue for the year ended December 31, 2004
increased $197.9 million, or 12.3%, to
$1,813.4 million from $1,615.5 million in 2003. The
increase was primarily due to internal growth in membership as
well as premium rate increases. Total membership increased 9.2%
to 936,000 as of December 31, 2004 from 857,000 as of
December 31, 2003.
Investment income increased $3.6 million to
$10.3 million for the year ended December 31, 2004.
The increase in investment income is primarily due to increased
levels of cash and investments that were a result of having the
proceeds from the secondary offering that occurred in October
2003 available for a full year of investing in 2004 and cash
generated from operations, as well as increases in market
interest rates and a shift in our investment portfolio toward
longer term investments with higher yields.
48
Expenses relating to health benefits for the year ended
December 31, 2004 increased $173.2 million, or 13.4%,
to $1,469.1 million from $1,295.9 million for the year
ended December 31, 2003. The increase was primarily due to
an increase in membership. The HBR for the year ended
December 31, 2004 was 81.0% compared to 80.2% in 2003. The
increase in HBR is driven by less favorable development than in
the prior year due to a combination of more mature claims
patterns in existing products and markets offset by increased
leverage of premium revenue. This had the effect of increasing
the current year HBR even though there was no increase in our
core medical run rates. The underlying medical performance
continues to be stable with trend patterns consistent with those
of the prior year, except for more moderate seasonal respiratory
disorders than in the prior year and continued elevated
obstetric services.
|
|
|
Selling, general and administrative expenses |
SG&A increased $5.0 million to $191.9 million for
the year ended December 31, 2004 compared to
$186.9 million in 2003. The net increase in SG&A was
primarily due to:
|
|
|
| |
|
an increase in premium taxes that the States of Texas and New
Jersey began assessing in September 2003 and July 2004,
respectively; |
| |
| |
|
a decrease in purchased services related to strategic
initiatives in 2003 for operational improvements, including
expenses related to the implementation of the HIPAA
guidelines; and |
| |
| |
|
a decrease in experience rebate expense in our Texas market. |
Our SG&A ratio for the year ended December 31, 2004 was
10.5% compared to 11.5% in 2003. This improvement was achieved
due to increased leverage of premium revenue from successful
rate increases and increased membership levels.
Interest expense was $0.7 million and $1.9 million for
the years ended December 31, 2004 and 2003, respectively.
The decrease primarily relates to the repayment of our
outstanding balance of our credit facility on October 21,
2003, with a portion of the net proceeds from our
October 16, 2003 public offering.
|
|
|
Provision for income taxes |
Income tax expense for 2004 was $55.2 million with an
effective tax rate of 39.1% as compared to the
$46.6 million for 2003 with an effective tax rate of 40.9%.
The decrease in the effective tax rate is primarily attributable
to a decrease in expenses that are not deductible for tax
purposes, an increase in investments in tax advantaged
securities and the resolution of potential tax issues from a
prior year.
Net income for 2004 rose $18.7 million to
$86.0 million, or $1.66 per diluted share, compared to
$67.3 million, or $1.48 per diluted share in 2003.
Diluted earnings per share rose 12.2% as compared to an increase
in net income of 27.8% due to the increase in shares outstanding
primarily resulting from the issuance of 6,325,000 shares
from our October 16, 2003 public offering.
Liquidity and Capital Resources
Our primary sources of liquidity are cash and cash equivalents,
short- and long-term investments, cash flows from operations and
borrowings under our Amended and Restated Credit Agreement. As
of December 31, 2005, we had cash and cash equivalents of
$272.2 million, short and long-term investments of
$314.9 million and restricted investments on deposit for
licensure of $56.7 million. Unregulated cash, cash
equivalents, and investments totaled $157.9 million at
December 31, 2005.
49
On May 10, 2005, we entered into an amendment (Amendment)
to our Amended and Restated Credit Agreement (as amended, the
Credit Agreement), which, among other things, provides for an
increase in the commitments under our Credit Agreement then in
existence to $150.0 million and a five-year extension of
the term from the date of the Amendment. The Credit Agreement
contains a provision which allows us to obtain, subject to
certain conditions, an increase in revolving commitments of up
to an additional $50.0 million. The proceeds of the Credit
Agreement are available for general corporate purposes,
including, without limitation, permitted acquisitions of
businesses, assets and technologies. The borrowings under the
Credit Agreement will accrue interest at one of the following
rates, at our option: Eurodollar plus the applicable margin or
an alternate base rate plus the applicable margin. The
applicable margin for Eurodollar borrowings is between 0.875%
and 1.625% and the applicable margin for alternate base rate
borrowings is between 0.00% and 0.75%. The applicable margin
will vary depending on our leverage ratio. The Credit Agreement
is secured by substantially all of the assets of the Company and
its wholly-owned subsidiary, PHP Holdings, Inc., including the
stock of their respective wholly-owned managed care
subsidiaries. There is a commitment fee on the unused portion of
the Credit Agreement that ranges from 0.20% to 0.325%, depending
on the leverage ratio. The Credit Agreement terminates on
May 10, 2010. As of December 31, 2005, there were no
borrowings outstanding under our Credit Agreement.
Pursuant to the Credit Agreement we must meet certain financial
covenants. These financial covenants include meeting certain
financial ratios and a limit on capital expenditures and
repurchase of our outstanding common stock.
On May 23, 2005, our shelf registration statement was
declared effective with the SEC covering the issuance of up to
$400.0 million of securities including common stock,
preferred stock and debt securities. No securities have been
issued under the shelf registration. Under this shelf
registration, we may publicly offer such registered securities
from time-to-time at
prices and terms to be determined at the time of the offering.
On October 16, 2003, we completed a public offering of
6,325,000 shares of common stock at $23.25 per share,
including an over-allotment issuance of 825,000 shares. Net
proceeds from the offering, after fees and expenses, were
approximately $138.8 million. On October 21, 2003, we
used $30.0 million of proceeds from the offering to repay
the outstanding balance under our revolving credit facility. The
balance of approximately $108.8 million was used to
partially fund the CarePlus acquisition effective
January 1, 2005.
Effective January 1, 2005, we completed our stock
acquisition of CarePlus in New York City, pursuant to the terms
of the merger agreement entered into on October 26, 2004
for $126.8 million in cash, including acquisition costs. On
June 17, 2005, and December 8, 2005, additional
consideration of $4.6 million and $4.0 million was
paid in accordance with the terms of the merger agreement. This
acquisition was funded with unregulated cash. Goodwill and other
intangibles total $122.7 million, which includes
$14.0 million of specifically identifiable intangibles
allocated to the rights to membership, the provider network,
non-compete agreements and trademarks.
Cash from operations was $113.1 million for the year ended
December 31, 2005 compared to $102.1 million for the
year ended December 31, 2004. The increase in cash from
operations is primarily due to the following items:
Increases in cash flows due to:
|
|
|
| |
|
an increase in claims payable primarily as a result of increased
medical costs in 2005 and entry into new markets resulting in a
net increase in cash flow of $78.3 million; |
| |
| |
|
a decrease in the effect of the change in unearned revenue of
$18.4 million; |
Offset by decreases in cash flows due to:
|
|
|
| |
|
a decrease in net income of $32.4 million; |
| |
| |
|
an increase in the effect of the change in premium receivables
of approximately $20.4 million primarily due to the timing
of payment in our new market, New York, where premium is billed
by our New York subsidiary and collected approximately four
weeks later; and |
50
|
|
|
| |
|
a decrease in the change in accounts payable, accrued expenses
and other liabilities of $18.3 million primarily as a
result of the decrease in the contingent liability accrued for
the Maryland market which was accrued 2004 and released in 2005
($12.2 million of the decrease); payment of 2004 incentive
compensation in 2005, with a comparably lower corresponding
accrual in the current period ($12.7 million of the
decrease); payment of premium taxes net of accruals as a result
of timing of payments ($13.6 million of the decrease);
offset by decrease in the change in income taxes payable as a
result of timing of payments ($7.0 million) and decrease in
the change in accounts payable and experience rebate payable of
($5.8 million). |
Cash used in investing activities was $73.9 million for the
year ended December 31, 2005 compared to cash flows
provided by investing activities of $37.9 million for the
year ended December 31, 2004. The decrease in cash provided
by investing activities was primarily due to cash used in the
purchase of CarePlus and additional investments in new markets
requiring purchase of investments on deposit to meet state
regulatory requirements. We currently anticipate that our 2006
capital expenditures will be approximately $45.0 million
related to the expansion of our operations center and
technological infrastructure development.
Our investment policies are designed to provide liquidity,
preserve capital and maximize total return on invested assets.
As of December 31, 2005, our investment portfolio consisted
primarily of fixed-income securities. The weighted average
maturity is less than four months. We utilize investment
vehicles such as money market funds, commercial paper,
certificates of deposit, municipal bonds, debt securities of
government sponsored entities, corporate securities, auction
rate securities and U.S. Treasury instruments. The states
in which we operate prescribe the types of instruments in which
our subsidiaries may invest their cash. The weighted average
taxable equivalent yield on consolidated investments as of
December 31, 2005 was approximately 3.89%.
Cash provided by financing activities was $5.8 million and
$3.1 million for the years ended December 31, 2005 and
2004, respectively. The increase in cash provided by financing
activities primarily related to reductions in cash out flows
from bank overdrafts offset by a decrease in proceeds from the
exercise of stock options.
Our subsidiaries are required to maintain minimum statutory
capital requirements prescribed by various jurisdictions,
including the departments of insurance in each of the states in
which we operate. As of December 31, 2005, our subsidiaries
were in compliance with all minimum statutory capital
requirements. We anticipate the parent company will be required
to fund minimum net worth shortfalls during 2006 using
unregulated cash, cash equivalents and investments. We believe
as a result that we will continue to be in compliance with these
requirements for the next 12 months.
We believe that internally generated funds and available funds
under our Credit Agreement will be sufficient to support
continuing operations, capital expenditures and our growth
strategy for at least 12 months.
The following table summarizes our material contractual
obligations, including both on- and off-balance sheet
arrangements, and our commitments at December 31, 2005 (in
thousands):
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Contractual Obligations |
|
Total | |
|
2006 | |
|
2007 | |
|
2008 | |
|
2009 | |
|
2010 | |
|
Thereafter | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
Lease financing:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Operating lease obligations
|
|
$ |
93,413 |
|
|
$ |
11,327 |
|
|
$ |
11,666 |
|
|
$ |
9,445 |
|
|
$ |
11,019 |
|
|
$ |
8,302 |
|
|
$ |
41,654 |
|
|
|
|
|
|
| |
Capital lease obligations
|
|
|
2,977 |
|
|
|
1,749 |
|
|
|
852 |
|
|
|
376 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total lease financing
|
|
$ |
96,390 |
|
|
$ |
13,076 |
|
|
$ |
12,518 |
|
|
$ |
9,821 |
|
|
$ |
11,019 |
|
|
$ |
8,302 |
|
|
$ |
41,654 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Capital improvement obligations
|
|
$ |
2,360 |
|
|
$ |
2,360 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Lease Financing
Operating Lease Obligations. Our operating lease
obligations are primarily for payments under non-cancelable
office space leases.
Capital Lease Obligations. Our capital lease obligations
are primarily related to leased furniture, fixtures and
equipment. The terms of these leases are normally between three
and five years.
51
Long-term Borrowings
Credit Agreement. On May 10, 2005, we entered into
an amendment (Amendment) to our Amended and Restated Credit
Agreement (as amended, the Credit Agreement), which, among other
things, provides for an increase in the commitments under our
Credit Agreement then in existence to $150.0 million and a
five-year extension of the term from the date of the Amendment.
The Credit Agreement contains a provision which allows us to
obtain, subject to certain conditions, an increase in revolving
commitments of up to an additional $50.0 million. The
proceeds of the Credit Agreement are available for general
corporate purposes, including, without limitation, permitted
acquisitions of businesses, assets and technologies. The
borrowings under the Credit Agreement will accrue interest at
one of the following rates, at our option: Eurodollar plus the
applicable margin or an alternate base rate plus the applicable
margin. The applicable margin for Eurodollar borrowings is
between 0.875% and 1.625% and the applicable margin for
alternate base rate borrowings is between 0.00% and 0.75%. The
applicable margin will vary depending on our leverage ratio. The
Credit Agreement is secured by substantially all of the assets
of the Company and its wholly-owned subsidiary, PHP Holdings,
Inc., including the stock of their respective wholly-owned
managed care subsidiaries. There is a commitment fee on the
unused portion of the Credit Agreement that ranges from 0.20% to
0.325%, depending on the leverage ratio. The Credit Agreement
terminates on May 10, 2010. As of December 31, 2005,
there were no borrowings outstanding under our Credit Agreement.
Commitments
As of December 31, 2005, the Company has a commitment under
the provisions of its lease for the new operations center to
cooperate jointly with the landlord of the property to qualify
for certain grants by satisfying capital investment performance
and employment opportunities criteria totaling
$2.4 million. Upon qualifying for such grants, the Company
is obligated to advance the funds to be received under the grant
to the landlord, unless previously reimbursed by the Company.
Regulatory Capital and Dividend Restrictions
Our operations are conducted through our wholly-owned
subsidiaries, which include HMOs, one MCO and one PHSP. HMOs,
MCOs, and PHSPs are subject to state regulations that, among
other things, require the maintenance of minimum levels of
statutory capital, as defined by each state, and restrict the
timing, payment and amount of dividends and other distributions
that may be paid to their stockholders. Additionally, certain
state regulatory agencies may require individual regulated
entities to maintain statutory capital levels higher than the
state regulations. As of December 31, 2005, we believe our
subsidiaries are in compliance with all minimum statutory
capital requirements. We anticipate the parent company will be
required to fund minimum net worth shortfalls during 2006 using
unregulated cash, cash equivalents and investments. We believe
as a result that we will continue to be in compliance with these
requirements at least through the end of 2006.
As of December 31, 2005, our subsidiaries had aggregate
statutory capital and surplus of approximately
$174.5 million, compared with the recommended minimum
aggregate statutory capital and surplus of approximately
$137.5 million.
The National Association of Insurance Commissioners (NAIC)
utilizes risk-based capital (RBC) standards for HMOs and other
entities bearing risk for healthcare coverage that are designed
to identify weakly capitalized companies by comparing each
companys adjusted surplus to its required surplus (RBC
ratio). The RBC ratio is designed to reflect the risk profile of
HMOs. Within certain ratio ranges, regulators have increasing
authority to take action as the RBC ratio decreases. There are
four levels of regulatory action, ranging from requiring
insurers to submit a comprehensive plan to the state insurance
commissioner to requiring the state insurance commissioner to
place the insurer under regulatory control. At December 31,
2005, the RBC ratio of each of the Companys health plans
was at or above the level that would require regulatory action.
Although not all states had adopted these rules at
December 31, 2005, at that date, each of the Companys
active HMOs had a surplus that exceeded either the applicable
state net worth requirements or, where adopted, the levels that
would require regulatory action under the NAICs RBC rules.
52
Inflation
Although the general rate of inflation has remained relatively
stable and healthcare cost inflation has stabilized in recent
years, the national healthcare cost inflation rate still exceeds
the general inflation rate. We use various strategies to
mitigate the negative effects of healthcare cost inflation.
Specifically, our health plans try to control medical and
hospital costs through contracts with independent providers of
healthcare services. Through these contracted care providers,
our health plans emphasize preventive healthcare and appropriate
use of specialty and hospital services.
While we currently believe our strategies to mitigate healthcare
cost inflation are appropriate, competitive pressures, new
healthcare and pharmaceutical product introductions, demands
from healthcare providers and customers, applicable regulations
or other factors may affect our ability to control the impact of
healthcare cost increases. Our independent actuaries estimate
our health benefits expense trend increase for the year ended
December 31, 2005 compared to the same period in 2004, to
be approximately 10% normalized for underlying membership and
product changes. We anticipate our 2006 health benefits expense
trend increase to be approximately 7.0%. Our inability to reduce
the gap through operational improvements between expected rate
increases of approximately 4.0% and this expected health
benefits expense trend could significantly impact our results of
operations in the future.
Off-Balance Sheet Arrangements
Our off-balance sheet arrangements at December 31, 2005
include future minimum rental commitments of $93.4 million
and capital improvement obligations of $2.4 million. We
have no investments, loans or any other known contractual
arrangements with special-purpose entities, variable interest
entities or financial partnerships.
|
|
| Item 7A. |
Quantitative and Qualitative Disclosures About Market
Risk |
As of December 31, 2005, we had short-term investments of
$130.0 million, long-term investments of
$184.9 million and investments on deposit for licensure of
$56.7 million. These investments consist of highly liquid
investments with maturities between three months and eight
years. These investments are subject to interest rate risk and
will decrease in value if market rates increase. Credit risk is
managed by investing in commercial paper, money market funds,
U.S. Treasury securities, asset-backed securities, debt
securities of government sponsored entities, municipal bonds and
auction rate securities. Our investment policies are subject to
revision based upon market conditions and our cash flow and tax
strategies, among other factors. We have the ability to hold
these investments to maturity, and as a result, we would not
expect the value of these investments to decline significantly
as a result of a sudden change in market interest rates. As of
December 31, 2005, a hypothetical 1% change in interest
rates would result in an approximate $3.7 million change in
our annual investment income or $0.04 per share change in
diluted earnings per share.
53
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation:
We have audited the accompanying consolidated balance sheets of
AMERIGROUP Corporation and subsidiaries as of December 31,
2005 and 2004 and the related consolidated income statements and
consolidated statements of stockholders equity and cash
flows for each of the years in the three-year period ended
December 31, 2005. These consolidated financial statements
are the responsibility of the Companys management. Our
responsibility is to express an opinion on these consolidated
financial statements based on our audits.
We conducted our audits in accordance with the standards of the
Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are
free of material misstatement. An audit includes examining, on a
test basis, evidence supporting the amounts and disclosures in
the financial statements. An audit also includes assessing the
accounting principles used and significant estimates made by
management, as well as evaluating the overall financial
statement presentation. We believe that our audits provide a
reasonable basis for our opinion.
In our opinion, the consolidated financial statements referred
to above present fairly, in all material respects, the financial
position of AMERIGROUP Corporation and subsidiaries as of
December 31, 2005 and 2004 and the results of their
operations and their cash flows for each of the years in the
three-year period ended December 31, 2005 in conformity
with U.S. generally accepted accounting principles.
We also have audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
effectiveness of AMERIGROUP Corporations internal control
over financial reporting as of December 31, 2005, based on
criteria established in Internal Control
Integrated Framework, issued by the Committee of Sponsoring
Organizations of the Treadway Commission (COSO), and our report
dated February 24, 2006 expressed an unqualified opinion on
managements assessment of, and the effective operation of,
internal control over financial reporting.
/s/ KPMG LLP
Norfolk, Virginia
February 24, 2006
54
|
|
| Item 8. |
Financial Statements and Supplementary Data |
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
(Dollars in thousands, except per share data)
| |
|
|
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
| |
|
| |
|
| |
|
|
|
|
|
|
ASSETS |
|
|
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Cash and cash equivalents
|
|
$ |
272,169 |
|
|
$ |
227,130 |
|
|
|
|
|
|
| |
Short-term investments
|
|
|
130,054 |
|
|
|
176,364 |
|
|
|
|
|
|
| |
Premium receivables
|
|
|
76,142 |
|
|
|
44,081 |
|
|
|
|
|
|
| |
Deferred income taxes
|
|
|
11,972 |
|
|
|
11,019 |
|
|
|
|
|
|
| |
Prepaid expenses, provider receivables and other current assets
|
|
|
37,792 |
|
|
|
18,737 |
|
| |
|
|
|
|
|
|
| |
|
Total current assets
|
|
|
528,129 |
|
|
|
477,331 |
|
|
|
|
|
|
|
Long-term investments
|
|
|
184,883 |
|
|
|
208,565 |
|
|
|
|
|
|
|
Investments on deposit for licensure
|
|
|
56,657 |
|
|
|
38,365 |
|
|
|
|
|
|
|
Property and equipment, net
|
|
|
36,967 |
|
|
|
34,030 |
|
|
|
|
|
|
|
Software, net of accumulated amortization of $27,016 and $20,317
at December 31, 2005 and 2004, respectively
|
|
|
24,697 |
|
|
|
16,268 |
|
|
|
|
|
|
|
Other long-term assets
|
|
|
7,140 |
|
|
|
4,909 |
|
|
|
|
|
|
|
Goodwill and other intangible assets, net of accumulated
amortization of $23,166 and $15,226 at December 31, 2005
and 2004, respectively
|
|
|
255,115 |
|
|
|
140,382 |
|
| |
|
|
|
|
|
|
| |
|
$ |
1,093,588 |
|
|
$ |
919,850 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND STOCKHOLDERS EQUITY |
|
|
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Claims payable
|
|
$ |
348,679 |
|
|
$ |
241,253 |
|
|
|
|
|
|
| |
Accounts payable
|
|
|
7,243 |
|
|
|
4,826 |
|
|
|
|
|
|
| |
Unearned revenue
|
|
|
32,598 |
|
|
|
34,228 |
|
|
|
|
|
|
| |
Accrued payroll and related liabilities
|
|
|
17,978 |
|
|
|
19,833 |
|
|
|
|
|
|
| |
Accrued expenses and other current liabilities
|
|
|
26,730 |
|
|
|
33,841 |
|
|
|
|
|
|
| |
Current portion of capital lease obligations
|
|
|
1,642 |
|
|
|
3,168 |
|
| |
|
|
|
|
|
|
| |
|
Total current liabilities
|
|
|
434,870 |
|
|
|
337,149 |
|
|
|
|
|
|
|
Capital lease obligations less current portion
|
|
|
1,175 |
|
|
|
2,878 |
|
|
|
|
|
|
|
Deferred income taxes
|
|
|
10,273 |
|
|
|
4,635 |
|
|
|
|
|
|
|
Other long-term liabilities
|
|
|
5,716 |
|
|
|
6,476 |
|
| |
|
|
|
|
|
|
| |
|
Total liabilities
|
|
|
452,034 |
|
|
|
351,138 |
|
| |
|
|
|
|
|
|
|
Commitments and contingencies (note 11)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Stockholders equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Common stock, $0.01 par value. Authorized
100,000,000 shares; issued and outstanding 51,567,340 and
50,529,724 at December 31, 2005 and 2004, respectively
|
|
|
516 |
|
|
|
505 |
|
|
|
|
|
|
| |
Additional paid-in capital
|
|
|
371,744 |
|
|
|
352,417 |
|
|
|
|
|
|
| |
Retained earnings
|
|
|
269,294 |
|
|
|
215,790 |
|
| |
|
|
|
|
|
|
| |
|
Total stockholders equity
|
|
|
641,554 |
|
|
|
568,712 |
|
| |
|
|
|
|
|
|
| |
|
$ |
1,093,588 |
|
|
$ |
919,850 |
|
| |
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
55
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED INCOME STATEMENTS
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Years Ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
| |
|
(Dollars in thousands, except for per share data) | |
|
|
|
|
|
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Premium
|
|
$ |
2,311,599 |
|
|
$ |
1,813,391 |
|
|
$ |
1,615,508 |
|
|
|
|
|
|
| |
Investment income
|
|
|
18,310 |
|
|
|
10,340 |
|
|
|
6,726 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Total revenues
|
|
|
2,329,909 |
|
|
|
1,823,731 |
|
|
|
1,622,234 |
|
| |
|
|
|
|
|
|
|
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Health benefits
|
|
|
1,957,196 |
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
|
|
|
| |
Selling, general and administrative
|
|
|
258,446 |
|
|
|
191,915 |
|
|
|
186,856 |
|
|
|
|
|
|
| |
Depreciation and amortization
|
|
|
26,948 |
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
|
|
|
| |
Interest
|
|
|
608 |
|
|
|
731 |
|
|
|
1,913 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Total expenses
|
|
|
2,243,198 |
|
|
|
1,682,493 |
|
|
|
1,508,319 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Income before income taxes
|
|
|
86,711 |
|
|
|
141,238 |
|
|
|
113,915 |
|
|
|
|
|
|
|
Income tax expense
|
|
|
33,060 |
|
|
|
55,224 |
|
|
|
46,591 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Net income
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
| |
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Basic net income per share
|
|
$ |
1.05 |
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Weighted average number of common shares outstanding
|
|
|
51,213,589 |
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Diluted net income per share
|
|
$ |
1.02 |
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
52,857,682 |
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
| |
|
|
|
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
56
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF STOCKHOLDERS EQUITY
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Common stock | |
|
Additional | |
|
|
|
|
|
Total | |
| |
|
| |
|
paid-in | |
|
Retained | |
|
Deferred | |
|
stockholders | |
| |
|
Shares | |
|
Amount | |
|
capital | |
|
earnings | |
|
compensation | |
|
equity | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
| |
|
(Dollars in thousands) | |
|
|
|
|
|
|
Balances at January 1, 2003
|
|
|
41,103,888 |
|
|
$ |
411 |
|
|
$ |
176,935 |
|
|
$ |
62,452 |
|
|
$ |
(417 |
) |
|
$ |
239,381 |
|
|
|
|
|
|
|
Common stock issued from public offering, net of expenses of
$8,226
|
|
|
6,325,000 |
|
|
|
63 |
|
|
|
138,766 |
|
|
|
|
|
|
|
|
|
|
|
138,829 |
|
|
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,460,356 |
|
|
|
15 |
|
|
|
11,258 |
|
|
|
|
|
|
|
|
|
|
|
11,273 |
|
|
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
4,547 |
|
|
|
|
|
|
|
|
|
|
|
4,547 |
|
|
|
|
|
|
|
Amortization of deferred compensation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
360 |
|
|
|
360 |
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67,324 |
|
|
|
|
|
|
|
67,324 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2003
|
|
|
48,889,244 |
|
|
|
489 |
|
|
|
331,506 |
|
|
|
129,776 |
|
|
|
(57 |
) |
|
|
461,714 |
|
|
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,640,480 |
|
|
|
16 |
|
|
|
12,902 |
|
|
|
|
|
|
|
|
|
|
|
12,918 |
|
|
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
8,009 |
|
|
|
|
|
|
|
|
|
|
|
8,009 |
|
|
|
|
|
|
|
Amortization of deferred compensation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
57 |
|
|
|
57 |
|
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
86,014 |
|
|
|
|
|
|
|
86,014 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2004
|
|
|
50,529,724 |
|
|
|
505 |
|
|
|
352,417 |
|
|
|
215,790 |
|
|
|
|
|
|
|
568,712 |
|
|
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,037,616 |
|
|
|
11 |
|
|
|
10,756 |
|
|
|
|
|
|
|
|
|
|
|
10,767 |
|
|
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
8,571 |
|
|
|
|
|
|
|
|
|
|
|
8,571 |
|
|
|
|
|
|
|
Other
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(147 |
) |
|
|
|
|
|
|
(147 |
) |
|
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
53,651 |
|
|
|
|
|
|
|
53,651 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2005
|
|
|
51,567,340 |
|
|
$ |
516 |
|
|
$ |
371,744 |
|
|
$ |
269,294 |
|
|
$ |
|
|
|
$ |
641,554 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
57
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Years Ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
| |
|
(Dollars in thousands) | |
|
|
|
|
|
|
Cash flows from operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Net income
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
|
|
|
|
| |
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Depreciation and amortization
|
|
|
26,948 |
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
|
|
|
| |
|
(Gain) loss on disposal or abandonment of property, equipment
and software
|
|
|
(61 |
) |
|
|
971 |
|
|
|
74 |
|
|
|
|
|
|
| |
|
Deferred tax (benefit) expense
|
|
|
(1,247 |
) |
|
|
2,878 |
|
|
|
(3,272 |
) |
|
|
|
|
|
| |
|
Amortization of deferred compensation
|
|
|
|
|
|
|
57 |
|
|
|
360 |
|
|
|
|
|
|
| |
|
Tax benefit related to exercise of stock options
|
|
|
8,571 |
|
|
|
8,009 |
|
|
|
4,547 |
|
|
|
|
|
|
| |
|
Changes in assets and liabilities increasing
(decreasing) cash flows from operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
Premium receivables
|
|
|
(26,234 |
) |
|
|
(5,822 |
) |
|
|
(3,026 |
) |
|
|
|
|
|
| |
|
|
Prepaid expenses, provider receivables and other current assets
|
|
|
(15,919 |
) |
|
|
(2,742 |
) |
|
|
(7,954 |
) |
|
|
|
|
|
| |
|
|
Other assets
|
|
|
(1,074 |
) |
|
|
(941 |
) |
|
|
(750 |
) |
|
|
|
|
|
| |
|
|
Claims payable
|
|
|
80,002 |
|
|
|
1,721 |
|
|
|
16,681 |
|
|
|
|
|
|
| |
|
|
Accounts payable, accrued expenses and other current liabilities
|
|
|
(9,049 |
) |
|
|
9,234 |
|
|
|
(494 |
) |
|
|
|
|
|
| |
|
|
Unearned revenue
|
|
|
(1,723 |
) |
|
|
(20,096 |
) |
|
|
28,806 |
|
|
|
|
|
|
| |
|
|
Other long-term liabilities
|
|
|
(760 |
) |
|
|
2,027 |
|
|
|
2,548 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
|
|
Net cash provided by operating activities
|
|
|
113,105 |
|
|
|
102,060 |
|
|
|
128,494 |
|
| |
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Proceeds from sale of available-for-sale securities
|
|
|
1,120,383 |
|
|
|
5,121,916 |
|
|
|
804,047 |
|
|
|
|
|
|
| |
Purchase of available-for-sale securities
|
|
|
(1,027,478 |
) |
|
|
(4,972,080 |
) |
|
|
(1,034,040 |
) |
|
|
|
|
|
| |
Proceeds from redemption of held-to-maturity securities
|
|
|
214,333 |
|
|
|
74,971 |
|
|
|
190,360 |
|
|
|
|
|
|
| |
Purchase of held-to-maturity securities
|
|
|
(237,393 |
) |
|
|
(158,663 |
) |
|
|
(207,501 |
) |
|
|
|
|
|
| |
Purchase of property and equipment and software
|
|
|
(25,819 |
) |
|
|
(25,727 |
) |
|
|
(13,294 |
) |
|
|
|
|
|
| |
Proceeds from redemption of investments on deposit for licensure
|
|
|
46,064 |
|
|
|
35,525 |
|
|
|
40,009 |
|
|
|
|
|
|
| |
Purchase of investments on deposit for licensure
|
|
|
(56,329 |
) |
|
|
(38,544 |
) |
|
|
(45,496 |
) |
|
|
|
|
|
| |
Stock acquisition, net of cash acquired
|
|
|
(107,645 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Purchase of contract rights and related assets
|
|
|
|
|
|
|
|
|
|
|
(8,581 |
) |
|
|
|
|
|
| |
Purchase price adjustment received
|
|
|
|
|
|
|
512 |
|
|
|
963 |
|
|
|
|
|
|
| |
Cash acquired through stock acquisition
|
|
|
|
|
|
|
|
|
|
|
27,473 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
|
|
Net cash (used in) provided by investing activities
|
|
|
(73,884 |
) |
|
|
37,910 |
|
|
|
(246,060 |
) |
| |
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Net (decrease) increase in bank overdrafts
|
|
|
|
|
|
|
(5,315 |
) |
|
|
4,828 |
|
|
|
|
|
|
| |
Repayments of borrowings under credit facility
|
|
|
|
|
|
|
|
|
|
|
(50,000 |
) |
|
|
|
|
|
| |
Payment of debt issuance costs
|
|
|
(1,626 |
) |
|
|
|
|
|
|
(1,428 |
) |
|
|
|
|
|
| |
Payment of capital lease obligations
|
|
|
(3,323 |
) |
|
|
(4,473 |
) |
|
|
(4,902 |
) |
|
|
|
|
|
| |
Proceeds from exercise of common stock options and employee
stock purchases
|
|
|
10,767 |
|
|
|
12,918 |
|
|
|
11,273 |
|
|
|
|
|
|
| |
Proceeds from issuance of common stock upon the public
offerings, net of issuance costs
|
|
|
|
|
|
|
|
|
|
|
138,829 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
|
|
Net cash provided by financing activities
|
|
|
5,818 |
|
|
|
3,130 |
|
|
|
98,600 |
|
| |
|
|
|
|
|
|
|
|
|
|
Net increase (decrease) in cash and cash equivalents
|
|
|
45,039 |
|
|
|
143,100 |
|
|
|
(18,966 |
) |
|
|
|
|
|
|
Cash and cash equivalents at beginning of year
|
|
|
227,130 |
|
|
|
84,030 |
|
|
|
102,996 |
|
| |
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of year
|
|
$ |
272,169 |
|
|
$ |
227,130 |
|
|
$ |
84,030 |
|
| |
|
|
|
|
|
|
|
|
|
|
Supplemental disclosures of cash flow information:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Cash paid for interest
|
|
$ |
621 |
|
|
$ |
717 |
|
|
$ |
1,755 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Cash paid for income taxes
|
|
$ |
27,494 |
|
|
$ |
53,628 |
|
|
$ |
40,671 |
|
| |
|
|
|
|
|
|
|
|
|
|
Supplemental disclosures of non-cash activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Property and equipment acquired under capital lease
|
|
$ |
|
|
|
$ |
|
|
|
$ |
5,977 |
|
| |
|
|
|
|
|
|
|
|
|
On January 1, 2005, we completed our acquisition of
CarePlus, LLC, which operates as CarePlus Health Plan
(CarePlus). The following summarizes cash paid for this
acquisition:
| |
|
|
|
|
|
|
|
|
|
|
|
Assets acquired, including cash of $27,755
|
|
$ |
172,378 |
|
|
|
|
|
|
|
Liabilities assumed
|
|
|
36,978 |
|
| |
|
|
|
| |
Net assets acquired
|
|
$ |
135,400 |
|
| |
|
|
|
See accompanying notes to consolidated financial statements.
58
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
December 31, 2005, 2004 and 2003
(Dollars in thousands, except for per share data)
|
|
| (1) |
Corporate Organization and Principles of Consolidation |
|
|
| (a) |
Corporate Organization |
AMERIGROUP Corporation (the Company), a Delaware corporation, is
a multi-state managed healthcare company focused on serving
people who receive healthcare benefits through publicly
sponsored programs, including Medicaid, State Childrens
Health Insurance Program (SCHIP) and FamilyCare.
During 1995, we incorporated wholly-owned subsidiaries in New
Jersey, Illinois and Texas to develop, own and operate health
maintenance organizations (HMOs) in those states. During 1996,
we began enrolling Medicaid members in HMOs: AMERIGROUP New
Jersey, Inc., AMERIGROUP Illinois, Inc. and AMERIGROUP Texas,
Inc. During 1999, we incorporated a wholly-owned subsidiary in
Delaware, AMERIGROUP Maryland, Inc., a Managed Care
Organization, to develop, own and operate a managed care
organization (MCO) in Maryland and an HMO in the District of
Columbia. Effective January 1, 2003, AMERIGROUP Maryland
Inc., a Managed Care Organization, changed its domicile of
incorporation to the District of Columbia. During 2001, we
incorporated a wholly-owned subsidiary in Florida, AMERIGROUP
Florida, Inc., an HMO, to develop, own and operate HMOs in
Florida. Effective January 1, 2003, AMERIGROUP Corporation
acquired PHP Holdings, Inc. and its subsidiary, Physicians
Health Plans, Inc., (PHP) and merged it with AMERIGROUP Florida,
Inc. During 2005, we incorporated a wholly-owned subsidiary in
New York, AMERIGROUP Acquisition Corp., to effect the stock
acquisition of CarePlus, LLC (CarePlus). Effective
January 1, 2005, AMERIGROUP Corporation acquired CarePlus
and merged it with AMERIGROUP Acquisition Corp. with CarePlus
being the surviving corporation (note 5). In September
2005, we began enrolling Medicaid members in two HMOs,
AMERIGROUP Ohio, Inc. and AMERIGROUP Virginia, Inc., which were
incorporated in 2002 and 2004, respectively. Additionally, AMGP
Georgia Managed Care Company, Inc. and AMERIGROUP New Mexico,
Inc. were incorporated in November 2002 and December 2004,
respectively, in anticipation of new development in those
markets.
On October 16, 2003, we completed a public offering of
6,325,000 shares of common stock, including an
over-allotment issuance of 825,000 shares at a price of
$23.25 per share. We received net proceeds from the
offering of $138,829. On October 21, 2003, we used $30,000
of proceeds from the offering to repay the outstanding balance
of our credit facility.
On December 14, 2004, our Board of Directors approved a
two-for-one split of our common stock effected in the form of a
one hundred percent stock dividend. As a result of the stock
split, our stockholders received one additional share of our
common stock for each share of common stock held of record on
December 31, 2004. The additional shares of our common
stock were distributed on January 18, 2005. All share and
per share amounts in these consolidated financial statements and
related notes have been retroactively adjusted to reflect this
stock split for all periods presented.
|
|
| (b) |
Principles of Consolidation |
The consolidated financial statements include the financial
statements of AMERIGROUP Corporation and our eleven wholly-owned
subsidiaries: AMERIGROUP Florida, Inc., AMGP Georgia Managed
Care Company, Inc. (d/b/a AMERIGROUP Georgia), AMERIGROUP
Illinois, Inc., AMERIGROUP New Jersey, Inc., AMERIGROUP Ohio,
Inc., AMERIGROUP New Mexico, Inc., AMERIGROUP Texas, Inc., and
AMERIGROUP Virginia, Inc. each an HMO; AMERIGROUP Maryland,
Inc., a Managed Care Organization, CarePlus LLC, a Prepaid
Health Services Plan, and PHP Holdings, Inc., a holding company
that is the parent company of AMERIGROUP Florida, Inc. All
significant intercompany balances and transactions have been
eliminated in consolidation.
59
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
| (2) |
Summary of Significant Accounting Policies and Practices |
We consider all highly liquid temporary investments with
original maturities of three months or less to be cash
equivalents. We had cash equivalents of $126,404 and $2,513 at
December 31, 2005 and 2004, respectively, which consist of
commercial paper and municipal bonds.
|
|
|
(b) Short and Long-Term Investments and Investments
on Deposit for Licensure |
Short and long-term investments and investments on deposit for
licensure at December 31, 2005 and 2004 consist of
certificates of deposit, commercial paper, money market funds,
U.S. Treasury securities, corporate securities, debt
securities of government sponsored entities, municipal bonds and
auction rate securities. We consider all investments with
original maturities greater than three months but less than or
equal to twelve months to be short-term investments. We classify
our debt and equity securities in one of three categories:
trading, available-for-sale or
held-to-maturity.
Trading securities are bought and held principally for the
purpose of selling them in the near term.
Held-to-maturity
securities are those securities in which we have the ability and
intent to hold the security until maturity. All other securities
not included in trading or
held-to-maturity are
classified as available-for-sale. At December 31, 2005 and
2004, our auction rate securities are classified as
available-for-sale. All other securities are classified as
held-to-maturity.
Available-for-sale securities are recorded at fair value.
Changes in fair value are reported in other comprehensive income
until realized through the sale or maturity of the security.
Held-to-maturity
securities are recorded at amortized cost, adjusted for the
amortization or accretion of premiums or discounts. A decline in
the market value of any
held-to-maturity
security below cost that is deemed other than temporary results
in a reduction in carrying amount to fair value. The impairment
is charged to earnings and a new cost basis for the security is
established. Premiums and discounts are amortized or accreted
over the life of the related
held-to-maturity
security as an adjustment to yield using the effective-interest
method. Dividend and interest income is recognized when earned.
Included in short-term and long-term investments are auction
rate securities totaling $94,105 and $187,157 at
December 31, 2005 and 2004, respectively. Auction rate
securities are securities with an underlying component of a
long-term debt or an equity instrument. These auction rate
securities trade or mature on a shorter term than the underlying
instrument based on an auction bid that resets the interest rate
of the security. The auction or reset dates occur at intervals
that are typically less than three months providing high
liquidity to otherwise longer term investments. The Company had
previously classified its auction rate securities as
held-to-maturity and as
cash equivalents, short-term investments or long-term
investments based on the period from the purchase date to the
first reset date. In 2004, the Company reclassified auction rate
securities from cash equivalents to short-term investments
because the underlying instruments had maturity dates exceeding
3 months. Additionally, the Company reclassified these
securities to available-for-sale as the securities are not held
to the maturity date of the underlying security. Prior periods
have been reclassified to provide consistent presentation.
|
|
|
(c) Property and Equipment |
Property and equipment are stated at cost less accumulated
depreciation and amortization. Depreciation and amortization
expense on property and equipment is calculated on the
straight-line method over the estimated useful lives of the
assets. Property and equipment held under capital leases and
leasehold improvements are amortized on the straight-line method
over the shorter of the lease term or estimated useful life of
the asset.
60
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Depreciation and amortization expense on property and equipment
was $12,978, $12,495 and $14,389 for the years ended
December 31, 2005, 2004 and 2003, respectively. The
estimated useful lives are as follows:
| |
|
|
|
|
|
|
|
|
|
|
Leasehold improvements
|
|
|
3-15 years |
|
|
|
|
|
|
|
Furniture and fixtures
|
|
|
5-7 years |
|
|
|
|
|
|
|
Equipment
|
|
|
3-5 years |
|
Software is stated at cost less accumulated amortization in
accordance with Statement of
Position 98-1,
Accounting for the Costs of Software Developed or Obtained
for Internal Use. Software is amortized over its estimated
useful life of three to ten years, using the straight-line
method. Amortization expense on software was $5,477, $4,121 and
$2,972 for the years ended December 31, 2005, 2004 and
2003, respectively.
|
|
|
(e) Goodwill and Other Intangibles |
Goodwill represents the excess of cost over fair value of
businesses acquired. In accordance with Statement of Financial
Accounting Standards No. 142, Goodwill and Other
Intangible Assets (SFAS No. 142), goodwill and
intangible assets acquired in a purchase business combination
and determined to have an indefinite useful life are not
amortized, but instead tested for impairment at least annually.
SFAS No. 142 also requires that intangible assets with
estimable useful lives be amortized over their respective
estimated useful lives to their estimated residual values, and
reviewed for impairment in accordance with Statement of
Financial Accounting Standards No. 144, Accounting for
Impairment or Disposal of Long-Lived Assets.
Other assets include deposits, debt issuance costs and cash
surrender value of life insurance policies.
Income taxes are accounted for under the asset and liability
method as mandated by Statement of Financial Accounting
Standards No. 109, Accounting for Income Taxes
(SFAS No. 109). SFAS No. 109 requires
recognition of deferred tax assets and liabilities for the
expected future tax consequences of events that have been
recognized in our financial statements or tax returns. Deferred
tax assets and liabilities are measured using enacted tax rates.
The effect on deferred tax assets and liabilities of a change in
tax rates is recognized in income in the period that includes
the enactment date.
Taxes based on premium revenues are currently paid by our plans
in the States of Texas, New Jersey, Maryland (beginning
April 1, 2005) and Ohio (beginning December 1, 2005).
Premium tax expense totaled $23,473, $14,066 and $3,913 in 2005,
2004 and 2003, respectively, and is included in selling, general
and administrative expenses. Premium taxes range from 1% to 4.5%
of premium revenues.
|
|
|
(i) Stock-Based Compensation |
As permitted under Statement of Financial Accounting Standards
No. 123, Accounting for Stock-Based Compensation
(SFAS No. 123), we have chosen to account for
stock-based compensation using the intrinsic value method
prescribed in Accounting Principles Board Opinion No. 25,
Accounting for Stock Issued to Employees (APB Opinion
No. 25), and related interpretations. Accordingly,
compensation cost for stock options is measured as the excess,
if any, of the estimated fair value of our stock at the date of
grant over the amount an employee must pay to acquire the stock.
In December 2002, Statement of Financial Accounting Standards
61
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
No. 148, Accounting for Stock-Based Compensation
(SFAS No. 148), was issued which requires that we
illustrate the effect on net income and net income per share as
if we had applied the fair value principles included in
SFAS No. 123 for both annual and interim financial
statements. The following table illustrates the effect on net
income and earnings per share as if the Company had applied the
fair value recognition.
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
|
Net income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Reported net income
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
|
|
|
|
| |
Deduct: Total stock-based employee compensation expense
determined under fair value based method for all awards, net of
related tax effects
|
|
|
16,563 |
|
|
|
9,321 |
|
|
|
9,577 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Proforma net income
|
|
$ |
37,088 |
|
|
$ |
76,693 |
|
|
$ |
57,747 |
|
| |
|
|
|
|
|
|
|
|
|
|
Basic net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Reported basic net income per share
|
|
$ |
1.05 |
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
|
|
|
|
| |
Proforma basic net income per share
|
|
|
0.72 |
|
|
|
1.54 |
|
|
|
1.34 |
|
|
|
|
|
|
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Reported diluted net income per share
|
|
$ |
1.02 |
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
|
|
|
|
| |
Proforma diluted net income per share
|
|
|
0.70 |
|
|
|
1.49 |
|
|
|
1.28 |
|
On August 10, 2005, the Compensation Committee approved the
immediate and full acceleration of vesting of approximately
909,000
out-of-the-money
stock options awarded on February 9, 2005 to employees,
including its executive officers, under the Companys
annual bonus program pursuant to its 2003 Equity Incentive Plan
(the Grant). No other option grants were affected.
Each stock option issued as a part of the Grant has an exercise
price which is greater than the closing price per share on the
date of the Compensation Committees action. The purpose of
the acceleration was to enable the Company to avoid recognizing
compensation expense associated with these options in future
periods in its consolidated income statements, as a result of
Statement of Financial Accounting Standards No. 123
(revised 2004) (SFAS No. 123(R)). The pre-tax charge
avoided totals approximately $8,900 which would have been
recognized over the years 2006 and 2007. This amount has been
reflected in the proforma disclosures of the 2005 consolidated
year-end financial statements. Because the options that were
accelerated had a per share exercise price in excess of the
market value of a share of the Companys common stock on
the date of acceleration, the Compensation Committee determined
that the expense savings outweighs the objective of incentive
compensation and retention.
We record premium revenue based on membership and premium
information from each state. Premiums are due monthly and are
recognized as revenue during the period in which we are
obligated to provide services to members. In all of our states
except Florida and Virginia, we are eligible to receive
supplemental payments for newborns and/or obstetric deliveries.
Each state contract is specific as to what is required before
payments are generated. Upon delivery of a newborn, each state
is notified according to our contract. Revenue is recognized in
the period that the delivery occurs and the related services are
provided to our member. Additionally, in some states we receive
supplemental payments for certain services such as high cost
drugs and early childhood prevention screenings. Any amounts
that have been earned and have not been received from the state
by the end of the period are recorded on our balance sheet as
premium receivables.
|
|
|
(k) Experience Rebate Payable |
Experience rebate payable, included in accrued expenses, capital
leases and other current liabilities, consists of estimates of
amounts due under contracts with a state government. These
amounts are computed based on a
62
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
percentage of the contract profits as defined in the contract
with the state. The profitability computation includes premium
revenue earned from the state less actual medical and
administrative costs incurred and paid and less estimated unpaid
claims payable for the applicable membership. The unpaid claims
payable estimates are based on historical payment patterns using
actuarial techniques. A final settlement is generally made
334 days after the contract period ends using paid claims
data and is subject to audit by the State any time thereafter.
Any adjustment made to the experience rebate payable as a result
of final settlement is included in current operations.
Accrued medical expenses for inpatient, outpatient surgery,
emergency room, specialist, pharmacy and ancillary medical
claims include amounts billed and not paid and an estimate of
costs incurred for unbilled services provided. These liabilities
are principally based on historical payment patterns while
taking into consideration variability in those patterns using
actuarial techniques. In addition, claims processing costs are
accrued based on an estimate of the costs necessary to process
unpaid claims. Claims payable are reviewed and adjusted
periodically and, as adjustments are made, differences are
included in current operations.
Stop-loss premiums, net of recoveries, are included in health
benefits expense in the accompanying consolidated income
statements.
|
|
|
(n) Impairment of Long-Lived Assets |
Long-lived assets, such as property and equipment and purchased
intangibles subject to amortization, are reviewed for impairment
whenever events or changes in circumstances indicate that the
carrying amount of an asset may not be recoverable.
Recoverability of assets to be held and used is measured by a
comparison of the carrying amount of an asset to estimated
undiscounted future cash flows expected to be generated by the
asset. If the carrying amount of an asset exceeds its estimated
future cash flows and the assets could not be used within the
Company, an impairment charge is recognized by the amount by
which the carrying amount of the asset exceeds the fair value of
the asset. Assets to be disposed of would be separately
presented in the consolidated balance sheet and reported at the
lower of the carrying amount or fair value less costs to sell,
and are no longer depreciated. The assets and liabilities of a
group classified as held for sale would be presented separately
in the appropriate asset and liability sections of the
consolidated balance sheet. No impairment of long-lived assets
was recorded in 2005, 2004 or 2003.
Goodwill is tested annually for impairment, and is tested for
impairment more frequently if events and circumstances indicate
that the asset might be impaired. An impairment loss is
recognized to the extent that the carrying amount exceeds the
assets fair value. This determination is made at the
reporting unit level and consists of two steps. First, we
determine the fair value of a reporting unit and compare it to
its carrying amount. Second, if the carrying amount of a
reporting unit exceeds its fair value, an impairment loss is
recognized for any excess of the carrying amount of the
reporting units goodwill over the implied fair value of
that goodwill. The implied fair value of goodwill is determined
by allocating the fair value of the reporting unit in a manner
similar to a purchase price allocation, in accordance with
SFAS No. 141, Business Combinations. The
residual fair value after this allocation is the implied fair
value of the reporting unit goodwill. No impairment of goodwill
was recorded in 2005, 2004 or 2003.
Basic net income per share has been computed by dividing net
income by the weighted average number of common shares
outstanding. Diluted net income per share reflects the potential
dilution that could occur assuming the inclusion of dilutive
potential common shares and has been computed by dividing net
income by the weighted average number of common shares and
dilutive potential common shares outstanding. Dilutive potential
63
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
common shares include all outstanding stock options after
applying the treasury stock method to the extent the options are
dilutive.
Our management has made a number of estimates and assumptions
relating to the reporting of assets and liabilities and the
disclosure of contingent assets and liabilities at the date of
the consolidated financial statements and the reported amounts
of revenues and expenses during the reporting period to prepare
these consolidated financial statements in conformity with
U.S. generally accepted accounting principles. Actual
results could differ from those estimates.
Certain reclassifications have been made to prior year amounts
to conform to the current year presentation.
|
|
|
(r) Recent Accounting Standards |
On December 16, 2004, the Financial Accounting Standards
Board (FASB) issued SFAS No. 123(R), which is a
revision of SFAS No. 123. SFAS No. 123(R)
supersedes APB Opinion No. 25, and SFAS No. 148
and amends SFAS No. 95, Statement of Cash
Flows. Generally, the approach in SFAS No. 123(R)
is similar to the approach described in SFAS No. 123.
However, SFAS No. 123(R) requires all share-based
payments to employees, including grants of employee stock
options, to be recognized in the income statement based on their
fair values. Proforma disclosure is no longer an alternative.
Effective January 1, 2006, we adopted
SFAS No. 123(R) applying the modified prospective
method.
Under SFAS No. 123(R), the modified prospective method
permits compensation cost to be recognized beginning with the
effective date (a) based on the requirements of
SFAS No. 123(R) for all share-based payments granted
after the effective date and (b) based on the requirements
of SFAS No. 123 for all awards granted to employees
prior to the effective date of SFAS No. 123(R) that
remain unvested on the effective date.
As permitted by SFAS No. 123, the Company currently
accounts for share-based payments to employees using APB Opinion
No. 25s intrinsic value method and, as such,
generally recognizes no compensation cost for employee stock
options. Accordingly, the adoption of the fair value method of
SFAS No. 123(R) will have a significant impact on our
results of operations, although it will have no impact on our
overall financial position. The impact of adoption of
SFAS No. 123(R) is estimated to be additional
compensation cost of approximately $4,500, net of tax, or
$0.09 per diluted share for the year ended
December 31, 2006. This estimate could differ materially
from actual compensation cost recognized as it depends on levels
of share-based payments granted in the future. Had we adopted
SFAS No. 123(R) in prior periods, the impact of the
standard would have approximated the impact of
SFAS No. 123 as described in the disclosure of
proforma net income and earnings per share in Note 2(i) to
our consolidated financial statements. SFAS No. 123(R)
also requires the benefits of tax deductions in excess of
recognized compensation cost to be reported as a financing cash
flow, rather than as an operating cash flow as required under
current literature. This requirement will reduce net operating
cash flows and increase net financing cash flows in periods
after adoption. While the company cannot estimate what those
amounts will be in the future (because they depend on, among
other things, when employees exercise stock options), the amount
of operating cash flows recognized in prior periods for such
excess tax deductions were $8,571, $8,009 and $4,547 in 2005,
2004 and 2003, respectively.
|
|
|
(s) Risks and Uncertainties |
Our profitability depends in large part on accurately predicting
and effectively managing health benefits expense. We continually
review our premium and benefit structure to reflect its
underlying claims experience and revised actuarial data;
however, several factors could adversely affect the health
benefits expense. Certain of these
64
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
factors, which include changes in healthcare practices, cost
trends, inflation, new technologies, major epidemics, natural
disasters and malpractice litigation, are beyond any health
plans control and could adversely affect our ability to
accurately predict and effectively control healthcare costs.
Costs in excess of those anticipated could have a material
adverse effect on our results of operations.
At December 31, 2005, we served members who received
healthcare benefits through 20 contracts with the regulatory
entities in the jurisdictions in which we operate. Five of these
contracts individually accounted for 10% or more of our revenues
for the year ended December 31, 2005, with the largest of
these contracts representing approximately 18% of our revenues.
Our state contracts have terms that are generally one- to
two-years in length, some of which contain optional renewal
periods at the discretion of the individual state. Some
contracts also contain a termination clause with notification
periods ranging from 30 to 180 days. At the termination of
these contracts, re-negotiation of terms or the requirement to
enter into a re-bidding or re-procurement process is required to
execute a new contract.
|
|
| (3) |
Short and Long-Term Investments and Investments on Deposit
for Licensure |
The carrying amount, gross unrealized holding gains, gross
unrealized holding losses and fair value for available-for-sale
and held-to-maturity
short-term investments are as follows at December 31, 2005
and 2004:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Gross | |
|
Gross | |
|
|
| |
|
|
|
unrealized | |
|
unrealized | |
|
|
| |
|
Amortized | |
|
holding | |
|
holding | |
|
Fair | |
| |
|
Cost | |
|
gains | |
|
losses | |
|
value | |
| |
|
| |
|
| |
|
| |
|
| |
|
2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Auction rate securities available-for-sale (carried
at fair value)
|
|
$ |
59,500 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
59,500 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
Held-to-maturity (carried at amortized cost):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Commercial paper
|
|
$ |
5,382 |
|
|
$ |
|
|
|
$ |
5 |
|
|
$ |
5,377 |
|
|
|
|
|
|
| |
|
Certificates of deposit
|
|
|
513 |
|
|
|
|
|
|
|
|
|
|
|
513 |
|
|
|
|
|
|
| |
|
Corporate securities
|
|
|
1,500 |
|
|
|
|
|
|
|
|
|
|
|
1,500 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities
|
|
|
52,681 |
|
|
|
1 |
|
|
|
50 |
|
|
|
52,632 |
|
|
|
|
|
|
| |
Municipal bonds
|
|
|
10,478 |
|
|
|
|
|
|
|
6 |
|
|
|
10,472 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
70,554 |
|
|
$ |
1 |
|
|
$ |
61 |
|
|
$ |
70,494 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Auction rate securities available-for-sale (carried
at fair value)
|
|
$ |
150,401 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
150,401 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
Held-to-maturity (carried at amortized cost):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Commercial paper
|
|
$ |
18,476 |
|
|
$ |
|
|
|
$ |
6 |
|
|
$ |
18,470 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities
|
|
|
7,487 |
|
|
|
|
|
|
|
12 |
|
|
|
7,475 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
25,963 |
|
|
$ |
|
|
|
$ |
18 |
|
|
$ |
25,945 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
65
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The carrying amount, gross unrealized holding gains, gross
unrealized holding losses and fair value for available-for-sale
and held-to-maturity
long-term investments are as follows at December 31, 2005
and 2004:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Gross | |
|
Gross | |
|
|
| |
|
|
|
unrealized | |
|
unrealized | |
|
|
| |
|
Amortized | |
|
holding | |
|
holding | |
|
Fair | |
| |
|
Cost | |
|
gains | |
|
losses | |
|
value | |
| |
|
| |
|
| |
|
| |
|
| |
|
2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Auction rate securities available-for-sale (carried
at fair value)
|
|
$ |
34,752 |
|
|
$ |
|
|
|
$ |
147 |
|
|
$ |
34,605 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
Held-to-maturity (carried at amortized cost):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Municipal bonds, maturing within one year
|
|
$ |
6,400 |
|
|
$ |
|
|
|
$ |
29 |
|
|
$ |
6,371 |
|
|
|
|
|
|
| |
|
Corporate securities, maturing within one year
|
|
|
2,000 |
|
|
|
|
|
|
|
10 |
|
|
|
1,990 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities, maturing
within one year
|
|
|
114,384 |
|
|
|
|
|
|
|
645 |
|
|
|
113,739 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
27,494 |
|
|
|
1 |
|
|
|
32 |
|
|
|
27,463 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
150,278 |
|
|
$ |
1 |
|
|
$ |
716 |
|
|
$ |
149,563 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Auction rate securities available-for-sale (carried
at fair value)
|
|
$ |
36,756 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
36,756 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
Held-to-maturity (carried at amortized cost):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Municipal bonds, maturing within one year
|
|
$ |
9,908 |
|
|
$ |
|
|
|
$ |
39 |
|
|
$ |
9,869 |
|
|
|
|
|
|
| |
|
Municipal bonds, maturing between one and five years
|
|
|
6,528 |
|
|
|
|
|
|
|
21 |
|
|
|
6,507 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities, maturing
within one year
|
|
|
46,993 |
|
|
|
|
|
|
|
313 |
|
|
|
46,680 |
|
|
|
|
|
|
| |
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
108,380 |
|
|
|
|
|
|
|
1,074 |
|
|
|
107,306 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
171,809 |
|
|
$ |
|
|
|
$ |
1,447 |
|
|
$ |
170,362 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
66
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
As a condition for licensure by various state governments to
operate HMOs, MCOs, or PHSPs we are required to maintain certain
funds on deposit with or under the control of the various
departments of insurance. Accordingly, at December 31, 2005
and 2004, the amortized cost, gross unrealized holding gains,
gross unrealized holding losses and fair value for these
held-to-maturity
securities are summarized as follows:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Gross | |
|
Gross | |
|
|
| |
|
|
|
unrealized | |
|
unrealized | |
|
|
| |
|
Amortized | |
|
holding | |
|
holding | |
|
|
| |
|
Cost | |
|
gains | |
|
losses | |
|
Fair value | |
| |
|
| |
|
| |
|
| |
|
| |
|
2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Money market funds
|
|
$ |
4,984 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,984 |
|
|
|
|
|
|
| |
Commercial paper
|
|
|
422 |
|
|
|
|
|
|
|
15 |
|
|
|
407 |
|
|
|
|
|
|
| |
Certificates of deposit
|
|
|
303 |
|
|
|
|
|
|
|
3 |
|
|
|
300 |
|
|
|
|
|
|
| |
U.S. Treasury securities, maturing within one year
|
|
|
13,791 |
|
|
|
|
|
|
|
53 |
|
|
|
13,738 |
|
|
|
|
|
|
| |
U.S. Treasury securities, maturing between one year and
five years
|
|
|
503 |
|
|
|
|
|
|
|
11 |
|
|
|
492 |
|
|
|
|
|
|
| |
U.S. Treasury securities, maturing between five years and
ten years
|
|
|
2,456 |
|
|
|
50 |
|
|
|
45 |
|
|
|
2,461 |
|
|
|
|
|
|
| |
Debt securities of government sponsored entities, maturing
within one year
|
|
|
23,415 |
|
|
|
1 |
|
|
|
213 |
|
|
|
23,203 |
|
|
|
|
|
|
| |
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
10,368 |
|
|
|
|
|
|
|
24 |
|
|
|
10,344 |
|
|
|
|
|
|
| |
Debt securities of government sponsored entities, maturing
between five and ten years
|
|
|
415 |
|
|
|
|
|
|
|
74 |
|
|
|
341 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
56,657 |
|
|
$ |
51 |
|
|
$ |
438 |
|
|
$ |
56,270 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Money market funds
|
|
$ |
3,452 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
3,452 |
|
|
|
|
|
|
| |
U.S. Treasury securities, maturing within one year
|
|
|
5,933 |
|
|
|
|
|
|
|
7 |
|
|
|
5,926 |
|
|
|
|
|
|
| |
Debt securities of government sponsored entities, maturing
within one year
|
|
|
11,373 |
|
|
|
|
|
|
|
69 |
|
|
|
11,304 |
|
|
|
|
|
|
| |
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
17,607 |
|
|
|
|
|
|
|
137 |
|
|
|
17,470 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total
|
|
$ |
38,365 |
|
|
$ |
|
|
|
$ |
213 |
|
|
$ |
38,152 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
The state governments in which we operate require us to maintain
investments on deposit in specific dollar amounts based on
either formulas or set amounts as determined by state
regulations. We purchase interest-based investments with a fair
value equal to or greater than the required dollar amount. The
interest that accrues on these investments is not restricted and
is available for withdrawal.
67
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table shows the fair value of our
held-to-maturity
investments with unrealized losses that are not deemed to be
other-than-temporarily impaired, aggregated by investment
category and length of time that individual securities have been
in a continuous unrealized loss position, at December 31,
2005:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Less than 12 Months | |
|
12 months or greater | |
| |
|
| |
|
| |
| |
|
|
|
Gross | |
|
|
|
|
|
Gross | |
|
|
| |
|
|
|
unrealized | |
|
Total | |
|
|
|
unrealized | |
|
Total | |
| |
|
Fair | |
|
holding | |
|
number of | |
|
Fair | |
|
holding | |
|
number of | |
| |
|
value | |
|
losses | |
|
securities | |
|
value | |
|
losses | |
|
securities | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Commercial paper
|
|
$ |
4,383 |
|
|
$ |
20 |
|
|
|
3 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
Certificates of deposit
|
|
|
300 |
|
|
|
3 |
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Corporate securities
|
|
|
1,990 |
|
|
|
10 |
|
|
|
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
|
94,801 |
|
|
|
260 |
|
|
|
66 |
|
|
|
118,899 |
|
|
|
778 |
|
|
|
60 |
|
|
|
|
|
|
|
Municipal bonds
|
|
|
5,972 |
|
|
|
6 |
|
|
|
3 |
|
|
|
6,371 |
|
|
|
29 |
|
|
|
5 |
|
|
|
|
|
|
|
U.S. Treasury securities
|
|
|
9,082 |
|
|
|
109 |
|
|
|
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Total temporarily impaired securities
|
|
$ |
116,528 |
|
|
$ |
408 |
|
|
|
89 |
|
|
$ |
125,270 |
|
|
$ |
807 |
|
|
|
65 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following table shows the fair value of our
held-to-maturity
investments with unrealized losses that are not deemed to be
other-than-temporarily impaired, aggregated by investment
category and length of time that individual securities have been
in a continuous unrealized loss position, at December 31,
2004:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Less than 12 Months | |
|
12 months or greater | |
| |
|
| |
|
| |
| |
|
|
|
Gross | |
|
|
|
|
|
Gross | |
|
|
| |
|
|
|
unrealized | |
|
Total | |
|
|
|
unrealized | |
|
Total | |
| |
|
Fair | |
|
holding | |
|
number of | |
|
Fair | |
|
holding | |
|
number of | |
| |
|
value | |
|
losses | |
|
securities | |
|
value | |
|
losses | |
|
securities | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Commercial paper
|
|
$ |
14,970 |
|
|
$ |
6 |
|
|
|
10 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
|
179,771 |
|
|
|
1,567 |
|
|
|
91 |
|
|
|
5,962 |
|
|
|
38 |
|
|
|
3 |
|
|
|
|
|
|
|
Municipal bonds
|
|
|
16,376 |
|
|
|
60 |
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
U.S. Treasury securities
|
|
|
5,926 |
|
|
|
7 |
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Total temporarily impaired securities
|
|
$ |
217,043 |
|
|
$ |
1,640 |
|
|
|
116 |
|
|
$ |
5,962 |
|
|
$ |
38 |
|
|
|
3 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The temporary declines in value as of December 31, 2005 and
2004, are primarily due to fluctuations in short-term market
interest rates.
68
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
| (4) |
Property and Equipment, Net |
Property and equipment, net at December 31, 2005 and 2004
is summarized as follows:
| |
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
| |
|
| |
|
| |
|
Leasehold improvements
|
|
$ |
20,110 |
|
|
$ |
17,506 |
|
|
|
|
|
|
|
Furniture and fixtures
|
|
|
14,683 |
|
|
|
11,918 |
|
|
|
|
|
|
|
Equipment
|
|
|
57,583 |
|
|
|
43,551 |
|
| |
|
|
|
|
|
|
| |
|
|
92,376 |
|
|
|
72,975 |
|
|
|
|
|
|
|
Less accumulated depreciation and amortization
|
|
|
(55,409 |
) |
|
|
(38,945 |
) |
| |
|
|
|
|
|
|
| |
|
$ |
36,967 |
|
|
$ |
34,030 |
|
| |
|
|
|
|
|
|
Effective January 1, 2005, we completed our stock
acquisition of CarePlus, LLC (CarePlus), in New York City, New
York for $126,781 in cash, including acquisition costs, pursuant
to the terms of the merger agreement entered into on
October 26, 2004. On June 17, 2005, in accordance with
the terms of the merger agreement, additional consideration was
paid in the amount of $4,619 for meeting agreed upon revenue
targets for the month ended December 31, 2004. On
December 8, 2005, in accordance with the terms of the
merger agreement, additional consideration was paid in the
amount of $4,000 upon the approval from and execution of a
contract with the State of New York to conduct a long-term care
business in that state and enrollment of long-term care
membership in December 2005. Both payments were accounted for as
additional costs of the acquisition. In accordance with the
terms of the merger agreement, additional consideration of up to
$10,000 may be paid contingent upon the achievement of certain
earnings thresholds by CarePlus during the twelve months ended
December 31, 2005. The calculation of this earnings
threshold is expected to be determined and agreed upon during
2006. If the earnings threshold is met and additional payment
becomes due, it will be accounted for as an additional cost of
the acquisition. Beginning January 1, 2005, the results of
operations of CarePlus have been included in the accompanying
Consolidated Income Statements.
As of December 31, 2004, CarePlus served approximately
115,000 New York State Medicaid, Child Health Plus and Family
Health Plus members in New York City (Brooklyn, Manhattan,
Queens and Staten Island) and Putnam County providing us with an
entry into the New York market. CarePlus is also authorized to
offer a managed long-term care program in New York City
effective December 1, 2005.
This acquisition was funded with unregulated cash. Goodwill and
other intangibles total $122,673, which includes $13,980 of
specifically identifiable intangibles allocated to the rights to
membership, the provider network, non-compete agreements and
trademarks. Intangible assets related to the rights to
membership are being amortized based on the timing of the
related cash flows with an expected amortization of ten years.
Intangible assets related to the provider network are being
amortized over ten years on a straight-line basis. Intangible
assets related to the trademarks and non-compete agreements are
being amortized over 12 to 36 months on a straight-line
basis. The merger agreement provides for purchase price
adjustments related to the future settlement of certain assumed
liabilities. Therefore, the purchase price is subject to
adjustment.
69
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table summarizes the fair values of the assets
acquired and liabilities assumed of CarePlus at the date of the
acquisition.
| |
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
27,755 |
|
|
|
|
|
|
|
Investments on deposit for licensure
|
|
|
8,027 |
|
|
|
|
|
|
|
Goodwill and other intangible assets
|
|
|
122,673 |
|
|
|
|
|
|
|
Property, equipment and software
|
|
|
3,941 |
|
|
|
|
|
|
|
Other assets
|
|
|
9,982 |
|
| |
|
|
|
| |
Total assets acquired
|
|
|
172,378 |
|
| |
|
|
|
|
Claims payable
|
|
|
27,424 |
|
|
|
|
|
|
|
Other liabilities
|
|
|
9,554 |
|
| |
|
|
|
| |
Total liabilities assumed
|
|
|
36,978 |
|
| |
|
|
|
| |
Net assets acquired
|
|
$ |
135,400 |
|
| |
|
|
|
The following table summarizes identifiable intangible assets
resulting from the CarePlus transaction:
| |
|
|
|
|
|
|
|
|
| |
|
|
|
Amortization period | |
| |
|
|
|
| |
|
Membership rights and provider network
|
|
$ |
12,900 |
|
|
|
10 years |
|
|
|
|
|
|
|
Non-compete agreement and trademarks
|
|
|
1,080 |
|
|
|
1-3 years |
|
| |
|
|
|
|
|
|
| |
|
$ |
13,980 |
|
|
|
|
|
| |
|
|
|
|
|
|
The following are the proforma results of operations for the
year ended December 31, 2004 as if the acquisition had been
completed on January 1, 2004:
| |
|
|
|
|
|
|
|
|
|
|
|
Premium revenue
|
|
$ |
2,008,319 |
|
|
|
|
|
|
|
Investment income and other
|
|
|
9,030 |
|
| |
|
|
|
| |
Total revenues
|
|
|
2,017,349 |
|
| |
|
|
|
|
Health benefits expenses
|
|
|
1,608,656 |
|
|
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
229,812 |
|
|
|
|
|
|
|
Depreciation and amortization expenses
|
|
|
28,734 |
|
|
|
|
|
|
|
Interest expense
|
|
|
731 |
|
| |
|
|
|
| |
Income before income taxes
|
|
|
149,416 |
|
|
|
|
|
|
|
Provision for income taxes
|
|
|
59,093 |
|
| |
|
|
|
| |
Net income
|
|
$ |
90,323 |
|
| |
|
|
|
| |
Diluted net income per share
|
|
$ |
1.74 |
|
| |
|
|
|
Effective July 1, 2003, we purchased the Medicaid contracts
and related assets known as St. Augustine for $8,581. The assets
purchased consisted primarily of St. Augustines rights to
provide managed care services to its 26,000 Medicaid members who
receive healthcare benefits under Floridas Medicaid
program in nine counties in the Miami/ Ft. Lauderdale,
Orlando and Tampa markets. Goodwill and other intangibles
totaling $8,581 includes $2,151 for identifiable intangibles
allocated to a non-compete agreement and the rights to the
membership, all of which is deductible for income tax purposes.
Intangible assets related to the non-compete agreement and the
rights to the membership are being amortized based on the timing
of related cash flows.
70
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table summarizes intangible assets resulting from
the St. Augustine transaction:
| |
|
|
|
|
|
|
|
|
| |
|
|
|
Amortization | |
| |
|
|
|
period | |
| |
|
|
|
| |
|
Membership rights
|
|
$ |
2,143 |
|
|
|
8 years |
|
|
|
|
|
|
|
Non-compete agreement
|
|
|
8 |
|
|
|
3 years |
|
| |
|
|
|
|
|
|
| |
|
$ |
2,151 |
|
|
|
|
|
| |
|
|
|
|
|
|
Effective January 1, 2003, we completed our acquisition of
PHP pursuant to the terms of a merger agreement entered into on
August 22, 2002 for $124,260, including acquisition costs
of $1,260.
Established in 1992, PHP served 193,000 Medicaid and SCHIP
members at December 31, 2002 in 12 counties, including the
metropolitan areas of Orlando, Tampa and Ft. Lauderdale/
Miami. PHP also served Medicare and commercial members which
were spun off from PHP prior to December 31, 2002 and not
acquired by us.
Of the $124,260 acquisition cost which includes transaction
costs, approximately $50,000 was financed through our credit
facility with the balance funded through unregulated cash.
Goodwill and other intangibles totaling $116,075 includes $8,990
of identifiable intangibles allocated to the rights to
membership and a non-compete agreement, none of which is
deductible for tax purposes. Intangible assets related to the
non-compete agreement and rights to membership are being
amortized based on the timing of related cash flows. A portion
of the purchase price remains in escrow pending various
settlement provisions between us and the former shareholders of
PHP Holdings, Inc. During 2004, $512 of the escrow was returned
to us as part of an interim settlement provision and goodwill
was reduced by the same amount. During 2003, as part of the
finalization of our fair value analysis, purchase price
adjustments totaling $127 were recorded and reflected as a
reduction in goodwill in the period. Further, purchase price
adjustments may arise in the future as a result of the
settlement provisions.
The following table summarizes the fair values of the assets
acquired and liabilities assumed of PHP at the date of
acquisition.
| |
|
|
|
|
|
|
|
|
|
|
|
Current assets, including cash and cash equivalents
|
|
$ |
31,668 |
|
|
|
|
|
|
|
Intangible assets
|
|
|
8,990 |
|
|
|
|
|
|
|
Goodwill
|
|
|
107,085 |
|
|
|
|
|
|
|
Other assets
|
|
|
2,482 |
|
| |
|
|
|
| |
Total assets acquired
|
|
|
150,225 |
|
| |
|
|
|
|
Claims payable
|
|
|
20,574 |
|
|
|
|
|
|
|
Other liabilities
|
|
|
6,030 |
|
| |
|
|
|
| |
Total liabilities assumed
|
|
|
26,604 |
|
| |
|
|
|
| |
Net assets acquired
|
|
$ |
123,621 |
|
| |
|
|
|
71
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table summarizes intangible assets resulting from
the PHP transaction:
| |
|
|
|
|
|
|
|
|
| |
|
|
|
Amortization | |
| |
|
|
|
period | |
| |
|
|
|
| |
|
Membership rights
|
|
$ |
8,650 |
|
|
|
10 years |
|
|
|
|
|
|
|
Non-compete agreement
|
|
|
340 |
|
|
|
5 years |
|
| |
|
|
|
|
|
|
| |
|
$ |
8,990 |
|
|
|
|
|
| |
|
|
|
|
|
|
Beginning January 1, 2003, all results of operations of PHP
have been included in the accompanying Consolidated Income
Statements.
|
|
| (d) |
Summary of Goodwill and Acquired Intangible Assets |
Goodwill and acquired intangible assets for the years ended
December 31, 2005 and 2004 are as follows:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
|
|
2004 | |
|
|
| |
|
| |
|
Weighted | |
|
| |
|
|
| |
|
Gross carrying | |
|
Accumulated | |
|
average | |
|
Gross carrying | |
|
Accumulated | |
|
Weighted | |
| |
|
amount | |
|
amortization | |
|
life | |
|
amount | |
|
amortization | |
|
average life | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
Goodwill
|
|
$ |
252,637 |
|
|
$ |
(5,773 |
) |
|
|
n/a |
|
|
$ |
143,944 |
|
|
$ |
(5,773 |
) |
|
|
n/a |
|
|
|
|
|
|
|
Membership rights and provider contracts
|
|
|
24,116 |
|
|
|
(16,252 |
) |
|
|
10 |
|
|
|
11,216 |
|
|
|
(9,213 |
) |
|
|
10 |
|
|
|
|
|
|
|
Non-compete agreements and trademarks
|
|
|
1,528 |
|
|
|
(1,141 |
) |
|
|
2 |
|
|
|
448 |
|
|
|
(240 |
) |
|
|
4 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
$ |
278,281 |
|
|
$ |
(23,166 |
) |
|
|
|
|
|
$ |
155,608 |
|
|
$ |
(15,226 |
) |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortization expense for the years ended December 31, 2005,
2004 and 2003 was $7,940, $3,504 and $5,849, respectively, and
the estimated aggregate amortization expense for the five
succeeding years is as follows:
| |
|
|
|
|
| |
|
Estimated | |
| |
|
amortization | |
| |
|
expense | |
| |
|
| |
|
2006
|
|
$ |
4,541 |
|
|
|
|
|
|
|
2007
|
|
|
2,047 |
|
|
|
|
|
|
|
2008
|
|
|
804 |
|
|
|
|
|
|
|
2009
|
|
|
404 |
|
|
|
|
|
|
|
2010
|
|
|
197 |
|
Total income taxes for the years ended December 31, 2005,
2004 and 2003 were allocated as follows:
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Years Ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
|
Income taxes from continuing operations
|
|
$ |
33,060 |
|
|
$ |
55,224 |
|
|
$ |
46,591 |
|
|
|
|
|
|
|
Stockholders equity, tax benefit on exercise of stock
options
|
|
|
(8,571 |
) |
|
|
(8,009 |
) |
|
|
(4,547 |
) |
| |
|
|
|
|
|
|
|
|
|
| |
|
$ |
24,489 |
|
|
$ |
47,215 |
|
|
$ |
42,044 |
|
| |
|
|
|
|
|
|
|
|
|
72
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
Income tax expense (benefit) for the years ended
December 31, 2005, 2004 and 2003 consists of the following:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Current | |
|
Deferred | |
|
Total | |
| |
|
| |
|
| |
|
| |
|
Year ended December 31, 2005:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
U.S. federal
|
|
$ |
29,911 |
|
|
$ |
292 |
|
|
$ |
30,203 |
|
|
|
|
|
|
| |
State and local
|
|
|
4,396 |
|
|
|
(1,539 |
) |
|
|
2,857 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
$ |
34,307 |
|
|
$ |
(1,247 |
) |
|
$ |
33,060 |
|
| |
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
U.S. federal
|
|
$ |
44,235 |
|
|
$ |
2,335 |
|
|
$ |
46,570 |
|
|
|
|
|
|
| |
State and local
|
|
|
8,111 |
|
|
|
543 |
|
|
|
8,654 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
$ |
52,346 |
|
|
$ |
2,878 |
|
|
$ |
55,224 |
|
| |
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
U.S. federal
|
|
$ |
42,238 |
|
|
$ |
(2,409 |
) |
|
$ |
39,829 |
|
|
|
|
|
|
| |
State and local
|
|
|
7,625 |
|
|
|
(863 |
) |
|
|
6,762 |
|
| |
|
|
|
|
|
|
|
|
|
| |
|
$ |
49,863 |
|
|
$ |
(3,272 |
) |
|
$ |
46,591 |
|
| |
|
|
|
|
|
|
|
|
|
Income tax expense differed from the amounts computed by
applying the statutory U.S. federal income tax rate to
income before income taxes as a result of the following:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Years Ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
| |
|
Amount | |
|
% | |
|
Amount | |
|
% | |
|
Amount | |
|
% | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
Tax expense at statutory rate
|
|
$ |
30,349 |
|
|
|
35.0 |
|
|
$ |
49,434 |
|
|
|
35.0 |
|
|
$ |
39,870 |
|
|
|
35.0 |
|
|
|
|
|
|
|
Increase in income taxes resulting from:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
State and local income taxes, net of federal income tax effect
|
|
|
1,857 |
|
|
|
2.1 |
|
|
|
5,625 |
|
|
|
4.0 |
|
|
|
4,395 |
|
|
|
3.9 |
|
|
|
|
|
|
| |
Effect of nondeductible expenses and other, net
|
|
|
854 |
|
|
|
1.0 |
|
|
|
165 |
|
|
|
0.1 |
|
|
|
2,326 |
|
|
|
2.0 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Total income tax expense
|
|
$ |
33,060 |
|
|
|
38.1 |
|
|
$ |
55,224 |
|
|
|
39.1 |
|
|
$ |
46,591 |
|
|
|
40.9 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The effective tax rate is based on expected taxable income,
statutory tax rates, and estimated permanent book to tax
differences. Income tax returns that we file are periodically
audited by federal or state authorities for compliance with
applicable federal and state tax laws. Our effective tax rate is
computed taking into account changes in facts and circumstances,
including progress of audits, developments in case law and other
applicable authority, and emerging legislation.
73
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The tax effects of temporary differences that give rise to
significant portions of the deferred tax assets and deferred tax
liabilities at December 31, 2005 and 2004 are presented
below:
| |
|
|
|
|
|
|
|
|
|
|
| |
|
December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
| |
|
| |
|
| |
|
Deferred tax assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Estimated claims incurred but not reported, a portion of which
is deductible as paid for tax purposes
|
|
$ |
3,034 |
|
|
$ |
2,160 |
|
|
|
|
|
|
| |
Vacation, bonus and other accruals, deductible as paid for tax
purposes
|
|
|
9,272 |
|
|
|
10,343 |
|
|
|
|
|
|
| |
Accounts receivable allowances, deductible as written off for
tax purposes
|
|
|
1,846 |
|
|
|
590 |
|
|
|
|
|
|
| |
Start-up costs, deductible in future periods for tax purposes
|
|
|
284 |
|
|
|
552 |
|
|
|
|
|
|
| |
Unearned revenue, a portion of which is includible in income as
received for tax purposes
|
|
|
2,570 |
|
|
|
2,636 |
|
|
|
|
|
|
| |
State net operating loss/credit carryforwards, deductible in
future periods for tax purposes
|
|
|
2,066 |
|
|
|
1,616 |
|
| |
|
|
|
|
|
|
| |
|
Gross deferred tax asset
|
|
|
19,072 |
|
|
|
17,897 |
|
|
|
|
|
|
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Goodwill, due to timing differences in book and tax amortization
|
|
|
(4,449 |
) |
|
|
(474 |
) |
|
|
|
|
|
| |
Property and equipment, due to timing differences in book and
tax depreciation
|
|
|
(10,387 |
) |
|
|
(8,822 |
) |
|
|
|
|
|
| |
Deductible prepaid expenses and other
|
|
|
(2,537 |
) |
|
|
(2,217 |
) |
| |
|
|
|
|
|
|
| |
|
Gross deferred tax liabilities
|
|
|
(17,373 |
) |
|
|
(11,513 |
) |
| |
|
|
|
|
|
|
| |
|
Net deferred tax asset
|
|
$ |
1,699 |
|
|
$ |
6,384 |
|
| |
|
|
|
|
|
|
To assess the recoverability of deferred tax assets, we consider
whether it is more likely than not that deferred tax assets will
be realized. In making this determination, we take into account
the scheduled reversal of deferred tax liabilities and whether
projected future taxable income is sufficient to permit
deduction of the deferred tax assets. Based on the level of
historical taxable income and projections for future taxable
income, we believe it is more likely than not that we will fully
realize the benefits of the gross deferred tax assets of
$19,072. State net operating loss carryforwards that expire in
2012 and 2023 through 2025 comprise $129 and $1,937,
respectively, of the gross deferred tax assets.
Prepaid income tax was $3,719 and $2,287 at December 31,
2005 and December 31, 2004, respectively, and is included
in prepaid expenses, provider receivables and other current
assets.
On May 10, 2005, we entered into an amendment (Amendment)
to our Amended and Restated Credit Agreement (as amended, the
Credit Agreement), which, among other things, provides for an
increase in the commitments under our Credit Agreement then in
existence to $150,000 and a five-year extension of the term from
the date of the Amendment. The Credit Agreement, contains a
provision which allows us to obtain, subject to certain
conditions, an increase in revolving commitments of up to an
additional $50,000. The proceeds of the Credit Agreement are
available for general corporate purposes, including, without
limitation, permitted acquisitions of businesses, assets and
technologies. The borrowings under the Credit Agreement will
accrue interest at one of the following rates, at our option:
Eurodollar plus the applicable margin or an alternate base rate
plus the applicable margin. The applicable margin for Eurodollar
borrowings is between 0.875% and 1.625% and the applicable
margin for alternate base rate borrowings is between 0.00% and
0.75%. The applicable margin will vary depending on our leverage
ratio. The Credit Agreement is secured by substantially all
74
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
of the assets of the Company and its wholly-owned subsidiary,
PHP Holdings, Inc., including the stock of their respective
wholly-owned managed care subsidiaries. There is a commitment
fee on the unused portion of the Credit Agreement that ranges
from 0.20% to 0.325%, depending on the leverage ratio. The
Credit Agreement terminates on May 10, 2010. As of
December 31, 2005, there were no borrowings outstanding
under our Credit Agreement.
Pursuant to the Credit Agreement, we must meet certain financial
covenants. These financial covenants include meeting certain
financial ratios and limits on capital expenditures and
repurchase of our outstanding common stock.
In May 2005, our shareholders adopted and approved our 2005
Equity Incentive Plan (2005 Plan), which provides for the
granting of stock options, restricted stock, restricted stock
units, stock appreciation rights, stock bonuses and other
stock-based awards to employees and directors. We reserved for
issuance a maximum of 3,750,000 shares of common stock
under the 2005 Plan. In addition, shares remaining available for
issuance under our 2003 Stock Plan (described below), our 2000
Stock Plan (described below) and our 1994 Stock Plan (described
below) will be available for issuance under the 2005 Plan. Under
all plans, an options maximum term is ten years. As of
December 31, 2005, we had a total of 3,936,071 shares
available for issuance under our 2005 Plan.
In May 2003, our shareholders approved and we adopted the 2003
Equity Incentive Plan (2003 Plan), which provides for the
granting of stock options, restricted stock, phantom stock and
stock bonuses to employees and directors. We reserved for
issuance a maximum of 3,300,000 shares of common stock
under the 2003 Plan.
In July 2000, we adopted the 2000 Equity Incentive Plan (2000
Plan), which provides for the granting of stock options,
restricted stock, phantom stock and stock bonuses to employees,
directors and consultants. We reserved for issuance a maximum of
4,128,000 shares of common stock under the 2000 Plan at
inception.
In 1994, we established the 1994 Stock Plan (1994 Plan), which
provides for the granting of either incentive stock options or
non-qualified options to purchase shares of our common stock by
employees, directors and consultants of the Company for up to
4,199,000 shares of common stock as of December 31,
1999. On February 9, 2000, we increased the number of
options available for grant to 4,499,000.
Stock option activity during the years indicated is as follows:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
| |
|
|
|
Weighted- | |
|
|
|
Weighted- | |
|
|
|
Weighted- | |
| |
|
|
|
average | |
|
|
|
average | |
|
|
|
average | |
| |
|
Shares | |
|
exercise price | |
|
Shares | |
|
exercise price | |
|
Shares | |
|
exercise price | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
Outstanding at beginning of year
|
|
|
4,808,872 |
|
|
$ |
14.73 |
|
|
|
5,365,464 |
|
|
$ |
10.50 |
|
|
|
4,829,868 |
|
|
$ |
7.20 |
|
|
|
|
|
|
|
Granted
|
|
|
2,035,748 |
|
|
|
39.74 |
|
|
|
1,534,076 |
|
|
|
21.71 |
|
|
|
2,297,346 |
|
|
|
15.43 |
|
|
|
|
|
|
|
Exercised
|
|
|
957,276 |
|
|
|
9.34 |
|
|
|
1,578,796 |
|
|
|
7.46 |
|
|
|
1,390,278 |
|
|
|
7.39 |
|
|
|
|
|
|
|
Forfeited
|
|
|
620,267 |
|
|
|
29.27 |
|
|
|
511,872 |
|
|
|
15.84 |
|
|
|
371,472 |
|
|
|
10.26 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at end of year
|
|
|
5,267,077 |
|
|
|
23.67 |
|
|
|
4,808,872 |
|
|
|
14.73 |
|
|
|
5,365,464 |
|
|
|
10.50 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
75
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table summarizes information related to the stock
options outstanding at December 31, 2005:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Weighted- | |
|
|
|
|
|
|
| |
|
|
|
average | |
|
|
|
|
|
|
| |
|
|
|
remaining | |
|
Weighted- | |
|
|
|
Weighted- | |
| |
|
Options | |
|
contractual | |
|
average | |
|
Options | |
|
average | |
| Range of exercise prices |
|
outstanding | |
|
life (years) | |
|
exercise price | |
|
exercisable | |
|
exercise price | |
| |
|
| |
|
| |
|
| |
|
| |
|
| |
|
$0.01 $4.16
|
|
|
45,806 |
|
|
|
2.9 |
|
|
$ |
1.36 |
|
|
|
45,806 |
|
|
$ |
1.36 |
|
|
|
|
|
|
|
$4.17 $8.32
|
|
|
258,042 |
|
|
|
4.7 |
|
|
|
7.17 |
|
|
|
258,042 |
|
|
|
7.17 |
|
|
|
|
|
|
|
$8.33 $12.48
|
|
|
839,586 |
|
|
|
6.1 |
|
|
|
10.75 |
|
|
|
714,391 |
|
|
|
10.77 |
|
|
|
|
|
|
|
$12.49 $16.64
|
|
|
1,120,085 |
|
|
|
7.3 |
|
|
|
14.71 |
|
|
|
915,880 |
|
|
|
14.61 |
|
|
|
|
|
|
|
$16.65 $20.80
|
|
|
933,397 |
|
|
|
7.9 |
|
|
|
18.78 |
|
|
|
590,752 |
|
|
|
18.84 |
|
|
|
|
|
|
|
$20.81 $24.96
|
|
|
210,876 |
|
|
|
7.8 |
|
|
|
22.11 |
|
|
|
129,459 |
|
|
|
21.99 |
|
|
|
|
|
|
|
$24.97 $33.28
|
|
|
85,000 |
|
|
|
0.1 |
|
|
|
30.51 |
|
|
|
85,000 |
|
|
|
30.51 |
|
|
|
|
|
|
|
$33.29 $37.44
|
|
|
30,000 |
|
|
|
9.7 |
|
|
|
33.74 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$37.45 $41.60
|
|
|
1,744,285 |
|
|
|
8.2 |
|
|
|
40.98 |
|
|
|
1,395,285 |
|
|
|
41.60 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
5,267,077 |
|
|
|
7.3 |
|
|
$ |
23.67 |
|
|
|
4,134,615 |
|
|
$ |
23.61 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
We apply APB Opinion No. 25 and related interpretations in
accounting for our stock plans. Accordingly, compensation cost
related to stock options issued to employees would be recorded
on the date of grant only if the current market price of the
underlying stock exceeded the exercise price. During 2000, we
recorded deferred charges of $1,833, representing the difference
between the exercise price and the deemed fair value of our
common stock for the options granted in 2000. The deferred
compensation has been amortized to expense over the period the
options vested, generally four to five years. We recognized $57
and $360 in non-cash compensation expense related to the
amortization of deferred compensation during 2004 and 2003. At
December 31, 2004 the deferred compensation was fully
amortized.
The fair value of each option grant is estimated on the date of
grant using an option pricing model with the following
assumptions: no dividend yield for all years, risk-free interest
rate of 4.2%, 3.1% and 3.2%, expected life of 6.1, 5.4 and
6.7 years and volatility of 28.6%, 29.5% and 44.6%, for the
years ended December 31, 2005, 2004 and 2003, respectively.
On August 10, 2005, the Compensation Committee approved the
immediate and full acceleration of vesting of approximately
909,000
out-of-the-money
stock options awarded on February 9, 2005 to employees,
including its executive officers, under the Companys
annual bonus program pursuant to its 2003 Equity Incentive Plan
(the Grant). No other option grants were affected.
Each stock option issued as a part of the Grant has an exercise
price which is greater than the closing price per share on the
date of the Compensation Committees action. The purpose of
the acceleration was to enable the Company to avoid recognizing
compensation expense associated with these options in future
periods in its consolidated income statements, as a result of
SFAS No. 123(R). The pre-tax charge avoided totals
approximately $8,900 which would have been recognized over the
years 2006 and 2007. This amount has been reflected in the
proforma disclosures of the 2005 consolidated year-end financial
statements. Because the options that were accelerated had a per
share exercise price in excess of the market value of a share of
the Companys common stock on the date of acceleration, the
Compensation Committee determined that the expense savings
outweighs the objective of incentive compensation and retention.
76
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
The following table sets forth the calculation of basic and
diluted net income per share:
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Years Ended December 31, | |
| |
|
| |
| |
|
2005 | |
|
2004 | |
|
2003 | |
| |
|
| |
|
| |
|
| |
|
Basic net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Net income
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Weighted average number of common shares outstanding
|
|
|
51,213,589 |
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Basic net income per share
|
|
$ |
1.05 |
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
| |
|
|
|
|
|
|
|
|
|
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Net income
|
|
$ |
53,651 |
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Weighted average number of common shares outstanding
|
|
|
51,213,589 |
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
|
|
|
|
|
| |
Dilutive effect of stock options (as determined by applying the
treasury stock method)
|
|
|
1,644,093 |
|
|
|
2,115,634 |
|
|
|
2,357,891 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
52,857,682 |
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
| |
|
|
|
|
|
|
|
|
|
| |
Diluted net income per share
|
|
$ |
1.02 |
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
| |
|
|
|
|
|
|
|
|
|
Options to purchase 1,774,285, 185,000 and
501,000 shares of common stock were outstanding during the
years ended December 31, 2005, 2004 and 2003, respectively,
and were not included in the computation of diluted net income
per share because the option exercise price was greater than the
average market price; and therefore, including such shares would
have been antidilutive.
|
|
| (10) |
Fair Value of Financial Instruments |
The fair value of a financial instrument is the amount at which
the instrument could be exchanged in a current transaction
between willing parties. The following methods and assumptions
were used to estimate the fair value of each class of financial
instruments:
Cash and cash equivalents, premium receivables, prepaid
expenses, provider receivables and other current assets,
deposits, accounts payable, unearned revenue, accrued payroll
and related liabilities, accrued expenses and other current
liabilities and claims payable: The carrying amounts approximate
fair value because of the short maturity of these items.
Short-term investments, long-term investments and investments on
deposit for licensure: The carrying amounts approximate their
fair values, which were determined based upon quoted market
prices (note 3).
Cash surrender value of life insurance policies: The carrying
amount approximates fair value.
|
|
| (11) |
Commitments and Contingencies |
|
|
| (a) |
Minimum Reserve Requirements |
Regulations governing our managed care operations in the
District of Columbia, Florida, Georgia, Illinois, Maryland, New
Jersey, New Mexico, New York, Ohio, Texas and Virginia require
the applicable subsidiaries to meet certain minimum net worth
requirements. Each subsidiary was in compliance with its
requirements at December 31, 2005.
77
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
We maintain professional liability coverage for certain claims
which is provided by independent carriers and is subject to
annual coverage limits. Professional liability policies are on a
claims-made basis and must be renewed or replaced with
equivalent insurance if claims incurred during its term, but
asserted after its expiration, are to be insured.
We are obligated under capital leases covering certain office
equipment that expires at various dates during the next three
years. At December 31, 2005 and 2004, the gross amount of
office equipment and related accumulated amortization recorded
under capital leases was as follows:
| |
|
|
|
|
|
|
|
|
| |
|
2005 | |
|
2004 | |
| |
|
| |
|
| |
|
Equipment
|
|
$ |
17,247 |
|
|
$ |
17,247 |
|
|
|
|
|
|
|
Accumulated amortization
|
|
|
(14,561 |
) |
|
|
(11,781 |
) |
| |
|
|
|
|
|
|
| |
|
$ |
2,686 |
|
|
$ |
5,466 |
|
| |
|
|
|
|
|
|
Amortization of assets held under capital leases is included
with depreciation and amortization expense.
We also lease office space under operating leases which expire
at various dates through 2019. Future minimum payments by year
and in the aggregate under all non-cancelable leases are as
follows at December 31, 2005:
| |
|
|
|
|
|
|
|
|
|
| |
|
Capital | |
|
Operating | |
| |
|
Leases | |
|
Leases | |
| |
|
| |
|
| |
|
2006
|
|
$ |
1,749 |
|
|
$ |
11,327 |
|
|
|
|
|
|
|
2007
|
|
|
852 |
|
|
|
11,666 |
|
|
|
|
|
|
|
2008
|
|
|
376 |
|
|
|
9,445 |
|
|
|
|
|
|
|
2009
|
|
|
|
|
|
|
11,019 |
|
|
|
|
|
|
|
2010
|
|
|
|
|
|
|
8,302 |
|
|
|
|
|
|
|
Thereafter
|
|
|
|
|
|
|
41,654 |
|
| |
|
|
|
|
|
|
| |
Total minimum lease payments
|
|
|
2,977 |
|
|
$ |
93,413 |
|
| |
|
|
|
|
|
|
|
Amount representing interest
|
|
|
(160 |
) |
|
|
|
|
| |
|
|
|
|
|
|
| |
Present value of minimum lease payments
|
|
|
2,817 |
|
|
|
|
|
|
|
|
|
|
|
Current installments of obligations under capital leases
|
|
|
(1,642 |
) |
|
|
|
|
| |
|
|
|
|
|
|
| |
Obligations under capital leases, excluding current installments
|
|
$ |
1,175 |
|
|
|
|
|
| |
|
|
|
|
|
|
These leases have various escalations, abatements and tenant
improvement allowances that have been included in the total cost
of each lease and amortized on a straight-line basis. Total rent
expense for all office space and office equipment under
non-cancelable operating leases was $11,362, $8,704 and $8,187
in 2005, 2004 and 2003, respectively, and is included in
selling, general and administrative expenses in the accompanying
consolidated income statements.
As of December 31, 2005, the Company has a commitment under
the provisions of its lease for a new operations center to
cooperate jointly with the landlord of the property to qualify
for certain grants by satisfying capital investment performance
criteria and employment opportunities criteria totaling $2,360.
Upon qualifying for such grants, the Company is obligated to
advance the funds to be received under the grant to the
landlord, unless previously reimbursed by the Company.
78
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
|
|
| (d) |
Deferred Compensation Plans |
Our employees have the option to participate in a deferred
compensation plan sponsored by the Company. All full-time and
most part-time employees of AMERIGROUP Corporation and
subsidiaries may elect to participate in this plan. This plan is
exempt from income taxes under Section 401(k) of the
Internal Revenue Code. Participants may contribute a certain
percentage of their compensation subject to maximum federal and
plan limits. We may elect to match a certain percentage of each
employees contributions up to specified limits. For the
years ended December 31, 2005, 2004 and 2003, the matching
contributions under the plan were $1,700, $1,227, and $720,
respectively.
During 2003, we added a long-term cash incentive award designed
to retain certain key executives. Each eligible participant is
assigned a cash target, the payment of which is deferred for
three years. The amount of the target is dependent upon the
participants performance against individual major job
objectives in the first year of the program. The target award
amount is funded over the three-year period, with the funding
being dependent upon the Company meeting its financial goals
each year. An executive is eligible for payment of a long-term
incentive earned in any one year only if the executive remains
employed with the Company and is in good standing at the
beginning of the third following year. The expense recorded for
the long-term cash incentive awards was $1,754 and $1,326 in
2004 and 2003, respectively. No expense was recorded in 2005 as
the Company did not meet its financial goals required for the
long-term cash incentive award to be awarded for the current
year. The related current portion of the liability of $1,742 at
December 31, 2005 was included in accrued payroll and
related liabilities. There was no current portion of the
liability at December 31, 2004. The related long-term
portion of the liability of $1,320 and $3,385 at
December 31, 2005 and 2004, respectively, was included in
other long-term liabilities.
In 2002, Cleveland A. Tyson, a former employee of our Illinois
subsidiary, AMERIGROUP Illinois, Inc., filed a federal and state
Qui Tam or whistleblower action against our Illinois subsidiary.
The complaint was captioned the United States of America and the
State of Illinois, ex rel., Cleveland A. Tyson v.
AMERIGROUP Illinois, Inc. The complaint was filed in the
U.S. District Court for the Northern District, Eastern
Division. It alleges that AMERIGROUP Illinois, Inc. submitted
false claims under the Medicaid program. Mr. Tysons
first amended complaint was unsealed and served on AMERIGROUP
Illinois, Inc., in June 2003. Therein, Mr. Tyson alleges
that AMERIGROUP Illinois, Inc. maintained a scheme to discourage
or avoid the enrollment into the health plan of pregnant women
and other recipients with special needs. In his suit,
Mr. Tyson seeks statutory penalties of no less than $5.5
and no more than $11.0 per violation and an unspecified
amount of damages. Mr. Tysons complaint does not
specify the number of alleged violations.
The court denied AMERIGROUP Illinois, Inc.s motion to
dismiss Mr. Tysons second amended complaint on
September 26, 2004. On February 15, 2005, we received
a motion filed by the Office of the Attorney General for the
State of Illinois on February 10, 2005, seeking court
approval to intervene on behalf of the State of Illinois. On
March 2, 2005, the Court granted that motion to intervene.
On March 3, 2005, AMERIGROUP Illinois, Inc. filed a motion
to dismiss for lack of subject matter jurisdiction, based upon a
recent opinion of the United States Court of Appeals for the
District of Columbia Circuit and additional cases that bar
actions under the federal False Claims Act unless there is
direct presentment of allegedly false claims to the federal
government. Also on March 3, 2005, the Office of the
Attorney General of the State of Illinois issued a subpoena to
AMERIGROUP Corporation as part of an investigation pursuant to
the Illinois Whistleblower Reward and Protection Act to
determine whether a violation of the Act has occurred.
AMERIGROUP Corporation filed a motion objecting to the subpoena
on the grounds, among other things, that the subpoena is
duplicative of one previously served on AMERIGROUP Corporation
in the federal court Tyson litigation with which AMERIGROUP is
complying. The Office of the Attorney General of the State of
Illinois withdrew its state court subpoena in September 2005.
79
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
On May 6, 2005, Plaintiffs filed a joint motion for leave
to amend their complaint. At a hearing on June 7, 2005,
Judge David A. Coar indicated that he would grant the motion to
amend. On June 22, 2005, Plaintiffs served AMERIGROUP
Corporation and AMERIGROUP Illinois, Inc. with a third amended
complaint, which includes allegations that AMERIGROUP
Corporation is liable as the alter-ego of AMERIGROUP Illinois,
Inc. and allegations that AMERIGROUP Corporation is liable for
making false claims or causing false claims to be made. On
July 7, 2005, AMERIGROUP Corporation and AMERIGROUP
Illinois, Inc. filed a motion to dismiss the third amended
complaint based on several independent grounds, including lack
of subject matter jurisdiction, which also was raised in the
prior motion to dismiss. In September 2005, Judge David A. Coar
issued an order of recusal. Senior Judge Harry D. Leinenweber is
now the judge for this case. On October 17, 2005, Judge
Leinenweber denied the motion to dismiss for lack of subject
matter jurisdiction. On November 8, 2005, Judge Leinenweber
denied the motion to dismiss the third amended complaint. On
November 23, 2005, AMERIGROUP Illinois, Inc. and AMERIGROUP
Corporation filed their answer and affirmative defenses to the
third amended complaint. The United States Attorneys
Office filed a motion to intervene on behalf of the United
States of America in August 2005. On October 17, 2005,
Judge Leinenweber granted that motion to intervene. Fact
discovery is currently scheduled to end March 31, 2006 and
the court has assigned a trial date of October 4, 2006.
Plaintiffs have proposed a number of damage theories under which
alleged damages range, after trebling, from $60,000 to $690,000;
however, it is unclear which, if any, of these theories will be
relied upon by plaintiffs damage experts when expert
discovery concludes. The damage experts retained by the Company
for this litigation have not reached any conclusions as to
estimates of potential damages, if any. Although it is possible
that the outcome of this case will not be favorable to us, we
cannot with any certainty give a reasonable estimate of any
potential damages. Accordingly, we have not recorded any
liability at December 31, 2005. There can be no assurance
that the ultimate outcome of this matter will not have a
material adverse effect on our financial position, results of
operations or liquidity.
Beginning on October 3, 2005, five purported class action
complaints (the Actions) were filed in the United States
District Court for the Eastern District of Virginia on behalf of
persons who acquired our common stock between April 27,
2005 and September 28, 2005. The Actions purported to
allege claims against us and certain of our officers for alleged
violations of Sections 10(b), 20(a), 20(A) and
Rule 10b-5 of the Securities Exchange Act of 1934. On
January 10, 2006, the Court issued an order
(i) consolidating the Actions; (ii) settingIllinois
State Board of Investment v. AMERIGROUP Corp., et al., Civil
Action No. 2:05-cv-701 as lead case for purposes of trial
and all pretrial proceedings; (iii) appointing Illinois
State Board of Investment (ISBI) as Lead Plaintiff and its
choice of counsel as Lead Counsel; and (iv) ordering that
Lead Plaintiff file a Consolidated Amended Complaint (CAC) by
February 24, 2006. On February 24, 2006, ISBI filed
the CAC, which purports to allege claims on behalf of all
persons or entities who purchased our common stock from
February 16, 2005 through September 28, 2005. The CAC
asserts claims for alleged violations of Sections 10(b),
20(a), 20(A) and Rule 10b-5 of the Securities Exchange Act
of 1934 against defendants AMERIGROUP Corporation, Jeffrey L.
McWaters, James G. Carlson, E. Paul Dunn, Jr. and Kathleen K.
Toth. Lead Plaintiff alleges that defendants issued a series of
materially false and misleading statements concerning our
financial statements, business and prospects. Among other
things, the CAC seeks compensatory damages and attorneys
fee and costs. Although we intend to vigorously contest these
allegations, there can be no assurance that the ultimate outcome
of this litigation will not have a material adverse affect on
our financial position, results of operations or liquidity.
In April 2004, the Maryland Legislature enacted a budget for the
2005 fiscal year beginning July 1, 2004 that included a
provision to reduce the premium paid to managed care
organizations that did not meet certain HEDIS scores and whose
medical loss ratio was below 84% for the calendar year ended
December 31, 2002. In May 2004, the Maryland Secretary of
Health and Mental Hygiene, in consultation with Marylands
legislative leadership, determined our premium recoupment to be
$846. A liability for the recoupment was recorded with a
80
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
corresponding charge to premium revenue during the year ended
December 31, 2004. Additionally, the Legislature directed
that the Department of Health and Mental Hygiene complete a
study by September 2004 on the relevance of the medical loss
ratio threshold as an indicator of quality. The results of this,
which were released in October 2004, did not directly address
what would happen in the future if a managed care organization
reported a medical loss ratio below 84%. As a result, we
believed the Maryland Legislature could enact similar
legislation in 2005 as part of its fiscal year 2006 budget,
requiring premium recoupment. Accordingly, we recorded a
reduction in premium of $6,100 in our consolidated financial
statements during the year ended December 31, 2004.
The Maryland Legislative Session ended on April 11, 2005
and it addressed the medical loss ratio assessment in the
following manner. First, no budget action was taken to recoup
premium relating to 2003 as it did in the 2004 legislative
session. Second, the Legislature amended the existing statue to
clarify the process and required that regulations be promulgated
by the Department of Health and Mental Hygiene before an action
could be taken to recoup premium based upon an MCOs
medical loss ratio. Based on this information, we reversed the
reduction in premium that was previously recorded resulting in
approximately $6,100 of additional premium revenue during the
year ended December 31, 2005. net of the related tax
effect, net income increased approximately $3,800 or
$0.07 per share for the year ended December 31, 2005
as a result of this reversal.
Our Texas health plan is required to pay a rebate to the State
of Texas in the event profits exceed established levels. The
rebate calculation reports that we filed for the contract years
ended August 31, 2000 through 2004 are currently being
audited by a contracted auditing firm. In a preliminary report,
the auditor has challenged inclusion in the rebate calculation
certain expenses incurred by the Company in providing services
to the health plan under the administrative services agreement.
Although we believe that the rebate calculations were done
appropriately, if the regulators were ultimately to disallow
certain of these expenses in the rebate calculation, it could
result in the requirement that we pay the State of Texas
additional amounts for these prior periods and it could reduce
our profitability in future periods.
|
|
| (12) |
Employee Stock Purchase Plan |
On February 15, 2001, the Board of Directors approved and
we adopted an Employee Stock Purchase Plan. All employees are
eligible to participate except those employees who have been
employed by us less than 90 days, whose customary
employment is less than 20 hours per week or any employee
who owns five percent or more of our common stock. Eligible
employees may join the plan every six months. Purchases of
common stock are priced at the lower of the stock price less 15%
on the first day or the last day of the six-month period. We
have reserved for issuance 1,200,000 shares of common
stock. We issued 80,340 and 61,684 shares under the
Employee Stock Purchase Plan in 2005 and 2004, respectively.
|
|
| (13) |
Quarterly Financial Data (unaudited) |
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Three months ended | |
| |
|
| |
| 2005 |
|
March 31 | |
|
June 30 | |
|
September 30 | |
|
December 31 | |
| |
|
| |
|
| |
|
| |
|
| |
|
Premium revenues
|
|
$ |
553,888 |
|
|
$ |
560,731 |
|
|
$ |
582,784 |
|
|
$ |
614,196 |
|
|
|
|
|
|
|
Health benefits expenses
|
|
|
454,404 |
|
|
|
463,071 |
|
|
|
520,243 |
|
|
|
519,478 |
|
|
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
62,041 |
|
|
|
57,745 |
|
|
|
63,596 |
|
|
|
75,064 |
|
|
|
|
|
|
|
Income (loss) before income taxes
|
|
|
33,816 |
|
|
|
37,085 |
|
|
|
(3,110 |
) |
|
|
18,920 |
|
|
|
|
|
|
|
Net income (loss)
|
|
|
20,443 |
|
|
|
22,548 |
|
|
|
(2,260 |
) |
|
|
12,920 |
|
|
|
|
|
|
|
Diluted net income (loss) per share
|
|
|
0.39 |
|
|
|
0.43 |
|
|
|
(0.04 |
) |
|
|
0.25 |
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
shares outstanding
|
|
|
52,961,652 |
|
|
|
53,053,949 |
|
|
|
51,420,856 |
|
|
|
52,148,265 |
|
81
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL
STATEMENTS (Continued)
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Three months ended | |
| |
|
| |
| 2004 |
|
March 31 | |
|
June 30 | |
|
September 30 | |
|
December 31 | |
| |
|
| |
|
| |
|
| |
|
| |
|
Premium revenues
|
|
$ |
422,335 |
|
|
$ |
435,918 |
|
|
$ |
468,156 |
|
|
$ |
486,982 |
|
|
|
|
|
|
|
Health benefits expenses
|
|
|
342,247 |
|
|
|
354,415 |
|
|
|
374,085 |
|
|
|
398,350 |
|
|
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
45,487 |
|
|
|
43,728 |
|
|
|
52,124 |
|
|
|
50,576 |
|
|
|
|
|
|
|
Income before income taxes
|
|
|
30,756 |
|
|
|
34,532 |
|
|
|
39,669 |
|
|
|
36,281 |
|
|
|
|
|
|
|
Net income
|
|
|
18,438 |
|
|
|
20,846 |
|
|
|
24,333 |
|
|
|
22,397 |
|
|
|
|
|
|
|
Diluted net income per share
|
|
|
0.36 |
|
|
|
0.40 |
|
|
|
0.47 |
|
|
|
0.43 |
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
shares outstanding
|
|
|
51,258,930 |
|
|
|
51,582,960 |
|
|
|
51,955,940 |
|
|
|
52,552,486 |
|
82
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation:
Under date of February 24, 2006, we reported on the
consolidated balance sheets of AMERIGROUP Corporation and
subsidiaries as of December 31, 2005 and 2004 and the
related consolidated income statements and consolidated
statements of stockholders equity and cash flows for each
of the years in the three-year period ended December 31,
2005, which are included herein. In connection with our audits
of the aforementioned consolidated financial statements, we also
audited the related financial statement schedule,
Schedule II Schedule of Valuation and
Qualifying Accounts, which is also included herein. This
financial statement schedule is the responsibility of the
Companys management. Our responsibility is to express an
opinion on the financial statement schedule based on our audits.
In our opinion, the financial statement schedule,
Schedule II Schedule of Valuation and
Qualifying Accounts, when considered in relation to the basic
consolidated financial statements taken as a whole, presents
fairly, in all material respects, the information set forth
therein.
/s/ KPMG LLP
Norfolk, Virginia
February 24, 2006
83
SCHEDULE OF VALUATION AND QUALIFYING ACCOUNTS
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
Additions- |
|
Deductions- | |
|
|
| |
|
Balance | |
|
Amounts |
|
Amounts | |
|
|
| |
|
Beginning | |
|
Charged to |
|
Credited to | |
|
Balance End |
| Valuation Allowance on Deferred Tax Assets |
|
of Year | |
|
Expense |
|
Expense | |
|
of Year |
| |
|
| |
|
|
|
| |
|
|
|
Year Ended December 31, 2005
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
Year Ended December 31, 2004
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, 2003
|
|
|
785 |
|
|
|
|
|
|
|
785 |
|
|
|
|
|
84
|
|
| Item 9. |
Changes in and Disagreements with Accountants on
Accounting and Financial Disclosure |
None.
Item 9A. Controls and Procedures
|
|
|
| |
(a) |
Evaluation of Disclosure Controls and Procedures. |
Our management, with the participation of our Chief Executive
Officer and Chief Financial Officer, has evaluated the
effectiveness of our disclosure controls and procedures (as such
term is defined in
Rules 13a-15(e)
and 15d-15(e) under the
Securities Exchange Act of 1934, as amended (the Exchange
Act)) as of the end of the period covered by this report.
Based on such evaluation, our Chief Executive Officer and Chief
Financial Officer have concluded that, as of the end of such
period, our disclosure controls and procedures are effective in
recording, processing, summarizing and reporting, on a timely
basis, information required to be disclosed by us in the reports
that we file or submit under the Exchange Act and are effective
in ensuring that information required to be disclosed by us in
the reports that we file or submit under the Exchange Act is
accumulated and communicated to management, including our Chief
Executive Officer and Chief Financial Officer, as appropriate,
to allow timely decisions regarding required disclosure.
|
|
|
| |
(b) |
Internal Control over Financial Reporting. |
MANAGEMENTS REPORT ON INTERNAL CONTROL OVER FINANCIAL
REPORTING
The management of AMERIGROUP Corporation is responsible for
establishing and maintaining adequate internal control over
financial reporting. Internal control over financial reporting
is defined in
Rules 13a-15(f)
and 15d-15(f) under the
Securities Exchange Act of 1934 as a process designed by, or
under the supervision of, the Companys principal executive
and principal financial officers and effected by the
Companys board of directors, management and other
personnel to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with
U.S. generally accepted accounting principles.
The management of AMERIGROUP Corporation assessed the
effectiveness of the Companys internal control over
financial reporting as of December 31, 2005. In making this
assessment, it used the criteria established in Internal
ControlIntegrated Framework set forth by the Committee
of Sponsoring Organizations of the Treadway Commission (COSO).
Based on our assessment, we believe that, as of
December 31, 2005, the Companys internal control over
financial reporting was effective based on those criteria.
Managements assessment of the effectiveness of internal
control over financial reporting as of December 31, 2005
has been audited by KPMG LLP, an independent registered public
accounting firm, as stated in their report, which is included
herein.
|
|
|
| |
(c) |
Changes in Internal Controls. |
During the fourth quarter of 2005, in connection with our
evaluation of internal control over financial reporting in
accordance with Section 404 of the Sarbanes-Oxley Act of
2002, the Company implemented or revised certain internal
control procedures which affect financial reporting. The most
significant change made was the transition of our Texas market
to a new medical claims payment system, FACETS. FACETS was
implemented to provide for future growth, consolidate our
medical claims payment systems onto one common platform and
improve operating efficiencies. It is expected to take twelve to
eighteen months to complete this transition for our other
markets.
While we did not identify any material weaknesses in our
financial reporting controls that would cause us to consider
them ineffective, we did identify three significant
deficiencies. First, operational challenges during the year and
especially in the fourth quarter including the implementation of
the FACETS medical claims payment system, the integration of
CarePlus and operational improvement initiatives resulted in
limitations of our resources to provide adequate and timely
oversight of process monitoring, documentation and testing
controls.
85
Second, due to the smaller scale of our acquired CarePlus claims
operations, we have inappropriate system configuration access
and segregation of duties controls for the manager and trainer,
who under certain circumstances, also adjudicate claims. Third,
information technology account management controls, including
periodic access reviews, were not always conducted on a timely
basis resulting in some undocumented access authorizations and
departed users whose access had not been terminated. To
compensate for these significant deficiencies and their impact
on preventative controls, the Company performed additional
analysis, increased detective control monitoring, testing and
other pre and post closing procedures. The results of these
additional efforts contribute to managements belief that
our financial statements and related disclosures present fairly,
in all material respects, our financial condition and results of
operations. Further, the Company has communicated the importance
of timely execution of financial reporting controls and
implemented enhancements to business processes and additional
controls to prevent the problems we encountered from occurring
in the future.
Our internal control over financial reporting includes policies
and procedures that:
|
|
|
| |
|
pertain to the maintenance of records that in reasonable detail
accurately and fairly reflect the transactions and dispositions
of the assets of the Company; |
| |
| |
|
provide reasonable assurance that transactions are recorded as
necessary to permit preparation of financial statements in
accordance with U.S. generally accepted accounting
principles, and that receipts and expenditures of the Company
are being made only in accordance with authorizations of
management and directors of the Company; and |
| |
| |
|
provide reasonable assurance regarding prevention or timely
detection of unauthorized acquisition, use, or disposition of
the Companys assets that could have a material effect on
the consolidated financial statements. |
Because of its inherent limitations, internal control over
financial reporting may not prevent or detect misstatements.
Projections of any evaluation of effectiveness to future periods
are subject to the risks that controls may become inadequate
because of changes in conditions, or that the degree of
compliance with the policies or procedures may deteriorate.
|
|
| Item 9B. |
Other Information |
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR program in the Dallas Service
Delivery Area effectively extending the contract through August
31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR program in the Harris Service
Delivery Area effectively extending the contract through August
31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR program in the Tarrant Service
Delivery Area effectively extending the contract through August
31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR program in the Travis Service
Delivery Area effectively extending the contract through August
31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR+PLUS program in the Harris Service
Delivery Area effectively extending the contract through
August 31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective January 1, 2006, to
the Health & Human Services Commission Agreement for Health
Services to the Medicaid STAR+PLUS program in the Harris County
Service Delivery Area whereby provisions for covered services
and payments related to Special Needs Plan members were
incorporated into the agreement.
86
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into an amendment, effective September 1, 2005, to
the Health & Human Services Commission Agreement for Health
Services to the Childrens Health Insurance Program
effectively extending the contract through August 31, 2006.
The Company, through its subsidiary AMERIGROUP Texas, Inc.,
entered into the Health & Human Services Commission Uniform
Managed Care Contract covering all service areas and products in
which the subsidiary has agreed to participate effective
September 1, 2006.
87
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation:
We have audited managements assessment, included in the
accompanying Managements Report on Internal Control Over
Financial Reporting, that AMERIGROUP Corporation maintained
effective internal control over financial reporting as of
December 31, 2005, based on criteria established in
Internal Control Integrated Framework, issued
by the Committee of Sponsoring Organizations of the Treadway
Commission (COSO). AMERIGROUP Corporations management is
responsible for maintaining effective internal control over
financial reporting and for its assessment of the effectiveness
of internal control over financial reporting. Our responsibility
is to express an opinion on managements assessment and an
opinion on the effectiveness of AMERIGROUP Corporations
internal control over financial reporting based on our audit.
We conducted our audit in accordance with the standards of the
Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether effective internal control
over financial reporting was maintained in all material
respects. Our audit included obtaining an understanding of
internal control over financial reporting, evaluating
managements assessment, testing and evaluating the design
and operating effectiveness of internal control, and performing
such other procedures as we considered necessary in the
circumstances. We believe that our audit provides a reasonable
basis for our opinion.
A companys internal control over financial reporting is a
process designed to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with
U.S. generally accepted accounting principles. A
companys internal control over financial reporting
includes those policies and procedures that (1) pertain to
the maintenance of records that, in reasonable detail,
accurately and fairly reflect the transactions and dispositions
of the assets of the company; (2) provide reasonable
assurance that transactions are recorded as necessary to permit
preparation of financial statements in accordance with
U.S. generally accepted accounting principles and that
receipts and expenditures of the company are being made only in
accordance with authorizations of management and directors of
the company; and (3) provide reasonable assurance regarding
prevention or timely detection of unauthorized acquisition, use
or disposition of the companys assets that could have a
material effect on the financial statements.
Because of its inherent limitations, internal control over
financial reporting may not prevent or detect misstatements.
Also, projections of any evaluation of effectiveness to future
periods are subject to the risk that controls may become
inadequate because of changes in conditions, or that the degree
of compliance with the policies or procedures may deteriorate.
In our opinion, managements assessment that AMERIGROUP
Corporation maintained effective internal control over financial
reporting as of December 31, 2005, is fairly stated, in all
material respects, based on criteria established in Internal
Control Integrated Framework, issued by the
Committee of Sponsoring Organizations of the Treadway Commission
(COSO). Also, in our opinion, AMERIGROUP Corporation maintained,
in all material respects, effective internal control over
financial reporting as of December 31, 2005 based on
criteria established in Internal Control
Integrated Framework, issued by the Committee of Sponsoring
Organizations of the Treadway Commission (COSO).
We also have audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
consolidated balance sheets of AMERIGROUP Corporation and
subsidiaries as of December 31, 2005 and 2004 and the
related consolidated income statements and consolidated
statements of stockholders equity and cash flows for each
of the years in the three-year period ended December 31,
2005 and our report dated February 24, 2006 expressed an
unqualified opinion on those consolidated financial statements.
/s/ KPMG LLP
Norfolk, Virginia
February 24, 2006
88
PART III.
|
|
| Item 10. |
Directors and Executive Officers of the Company |
The information regarding compliance with Section 16(a) of
the Securities and Exchange Act of 1934 is incorporated herein
by reference from the section entitled Section 16(a)
Beneficial Ownership Reporting Compliance of our
definitive Proxy Statement (the Proxy Statement) to
be filed pursuant to Regulation 14A of the Securities
Exchange Act of 1934, as amended, for our Annual Meeting of
Stockholders to be held on Wednesday, May 10, 2006. The
Proxy Statement will be filed within 120 days after the end
of our fiscal year ended December 31, 2005.
The information regarding Executive Officers is contained in
Part I of this Report under the caption Executive
Officers of the Company.
The information regarding directors is incorporated herein by
reference from the section entitled PROPOSAL #1:
ELECTION OF DIRECTORS in the Proxy Statement.
The information regarding the Companys code of business
conduct and ethics is incorporated herein by reference from the
section entitled Corporate Governance in the Proxy
Statement.
|
|
| Item 11. |
Executive Compensation |
Information regarding executive compensation is incorporated
herein by reference from the section entitled Executive
Officer Compensation in the Proxy Statement.
|
|
| Item 12. |
Security Ownership of Certain Beneficial Owners and
Management and Related Stockholder Matters |
| |
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
Number of Securities | |
| |
|
Number of | |
|
Weighted- | |
|
Remaining Available | |
| |
|
Securities to be | |
|
average Exercise | |
|
for Future Issuance | |
| |
|
Issued Upon | |
|
Price of | |
|
Under Equity | |
| |
|
Exercise of | |
|
Outstanding | |
|
Compensation Plans | |
| |
|
Outstanding | |
|
Options, | |
|
(excluding securities | |
| |
|
Options, Warrants | |
|
Warrants and | |
|
reflected in the first | |
| |
|
and Rights | |
|
Rights | |
|
column)(1) | |
| |
|
| |
|
| |
|
| |
|
Equity compensation plans approved by security holders
|
|
|
5,267,077 |
|
|
$ |
23.67 |
|
|
|
4,817,557 |
|
|
|
|
|
|
|
Equity compensation plans not approved by security holders
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
5,267,077 |
|
|
$ |
23.67 |
|
|
|
4,817,557 |
|
| |
|
|
|
|
|
|
|
|
|
|
|
| (1) |
Includes a total of 3,936,071 shares not yet issued as of
December 31, 2005 under the 1994 Stock Plan and the 2000,
2003, and 2005 Equity Incentive Plans and 882,486 shares
not yet issued under the Employee Stock Purchase Plan. |
In 2005, we issued options to
purchase 2,035,748 shares of common stock to
associates. All of these options were granted under
AMERIGROUPs 2005 Equity Incentive Plan.
|
|
| Item 13. |
Certain Relationships and Related Transactions |
Information regarding certain relationships and related
transactions is incorporated herein by reference from the
section entitled Certain Relationships and Related
Transactions in the Proxy Statement.
|
|
| Item 14. |
Principal Accountant Fees and Services |
Information regarding principal accountant fees and services is
incorporated herein by reference from the section entitled
Proposal #2: APPOINTMENT OF INDEPENDENT REGISTERED
PUBLIC ACCOUNTING FIRM in the Proxy Statement.
89
PART IV.
|
|
| Item 15. |
Exhibits and Financial Statement Schedules |
|
|
|
| |
(a)(1) |
Financial Statements. |
The following financial statements are filed: Independent
Auditors Report, Consolidated Balance Sheets, Consolidated
Income Statements, Consolidated Statements of Stockholders
Equity, Consolidated Statements of Cash Flows, and Notes to
Consolidated Financial Statements.
|
|
|
| |
(a)(2) |
Financial Statement Schedules. |
The following financial statement schedule is filed: Schedule of
Valuation and Qualifying Accounts
The following exhibits, which are furnished with this annual
report or incorporated herein by reference, are filed as part of
this annual report.
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
3 |
.1 |
|
Amended and Restated Certificate of Incorporation of the Company
(incorporated by reference to exhibit 3.1 to our Registration
Statement on Form S-3 (No. 333-108831)). |
| |
3 |
.2 |
|
By-Laws of the Company (incorporated by reference to exhibit 3.2
to our Registration Statement on Form S-3 (No. 333-108831)). |
| |
4 |
.1 |
|
Form of share certificate for common stock (incorporated by
reference to exhibit 4.1 to our Registration Statement on Form
S-1 (No. 333-347410)). |
| |
4 |
.2 |
|
AMERIGROUP Corporation Second Restated Investor Rights
Agreement, dated July 28, 1998 (incorporated by reference to
exhibit 4.2 to our Registration Statement on Form S-1 (No.
333-37410)). |
| |
10 |
.6.9 |
|
Amendment to Amended and Restated Contract between State of New
Jersey, Department of Human Services, Division of Medical
Assistance and Health Services and AMERIGROUP New Jersey, Inc.
dated July 1, 2005 (incorporated by reference to our Quarterly
Report on Form 10-Q filed on August 3, 2005). |
| |
10 |
.6.10 |
|
Amendment to Amended and Restated Contract between State of New
Jersey, Department of Human Services, Division of Medical
Assistance and Health Services and AMERIGROUP New Jersey, Inc.
dated July 1, 2005 (incorporated by reference to our Quarterly
Report on Form 10-Q filed on August 3, 2005). |
| |
10 |
.7.8 |
|
Amendment 2, dated August 1, 2005, to the State of Illinois
Department of Healthcare and Family Services Contract for
Furnishing Health Services by a Health Maintenance Organization
(incorporated by reference to our Quarterly Report on Form 10-Q
filed on August 3, 2005). |
| |
10 |
.8 |
|
Form 2003 Cash Incentive Plan of the Company (incorporated by
reference to exhibit 10.38 to our Quarterly Report of Form 10-Q
for the last quarter ended June 30, 2003, filed on August 11,
2003). |
| |
10 |
.9 |
|
Form 2005 Equity Incentive Plan (incorporated by reference to
our Definitive Proxy Statement Pursuant to Schedule 14a of the
Securities Exchange Act of 1934, filed on April 4, 2005). |
| |
10 |
.10 |
|
Definitive Agreement dated October 26, 2004, between CarePlus,
LLC and AMERIGROUP Corporation (incorporated by reference to our
Current Report on Form 8-K, filed on November 1, 2004). |
| |
10 |
.11 |
|
Closing Agreement dated January 3, 2005, between CarePlus, LLC
and AMERIGROUP Corporation (incorporated by reference to exhibit
10.47 to our Current Report on Form 8-K, filed on January 6,
2005). |
| |
10 |
.12 |
|
Separation Agreement and General Release with E. Paul Dunn, Jr.
former Executive Vice President and Chief Financial Officer
effective December 2, 2005 (incorporated by reference to our
Current Report on Form 8-K, filed on December 6, 2005). |
| |
10 |
.13 |
|
Form the Officer and Director Indemnification Agreement
(incorporated by reference to exhibit 10.16 to our Registration
Statement on Form S-1 (No. 333-37410). |
90
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
10 |
.14 |
|
Form of Employee Noncompete, Nondisclosure and Developments
Agreement (incorporated by reference to exhibit 10.1 to our
Current Report on Form 8-K, filed on February 23, 2005). |
| |
10 |
.15 |
|
Form of Incentive Stock Option Agreement (incorporated by
reference to exhibit 10.1 to our Current Report of Form 8-K,
filed on May 13, 2005). |
| |
10 |
.16 |
|
Form of Nonqualified Stock Option Agreement (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed on May 13, 2005). |
| |
10 |
.17 |
|
Form of Stock Appreciation Rights Agreement (incorporated by
reference to exhibit 10.3 to our Current Form 8-K filed on May
13, 2005). |
| |
10 |
.18 |
|
Form of AMERIGROUP Corporation Nonqualified Stock Option
Agreement (incorporated by reference to exhibit 10.1 to our
Current Form 8-K filed on November 3, 2005). |
| |
10 |
.19 |
|
The Board of Directors approved and adopted a resolution for
director compensation practices on February 10, 2005
(incorporated by reference to our Current Report on Form 8-K,
filed on February 15, 2005). |
| |
10 |
.20 |
|
Form of Separation Agreement between AMERIGROUP Corporation and
Lorenzo Childress, Jr., M.D. (incorporated by reference to
exhibit 10.1 to our Current Report on Form 8-K filed March 4,
2005). |
| |
10 |
.21 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed March 4, 2005). |
| |
10 |
.22 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed March 4, 2005). |
| |
10 |
.23 |
|
Amendment No. 00017, dated March 1, 2005, to the District of
Columbia Healthy Families Programs, Department of Health Medical
Assistance Administration, Prepaid, Capital Risk Contract
(POHC-2002-D-2003) (incorporated by reference to our Current
Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.2 |
|
Amendment No. 2, dated November 19, 2004, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 10.25 to our
Quarterly Report on Form 10-Q, filed on November 5, 2004). |
| |
10 |
.25.3 |
|
Amendment No. 4, dated February 28, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 25.3 to our
Current Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.4 |
|
Amendment No. 5, dated March 31, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 25.4 to our
Current Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.5 |
|
Amendment No. 6, dated May 1, 2005, to the June 28, 2002 Medical
Contract between the State of Florida, Agency for Health Care
Administration and AMERIGROUP Florida Inc. (AHCA Contract No.
FA523) (incorporated by reference to Exhibit 10.1 to our Current
Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.6 |
|
Amendment No. 7, dated June 1, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 10.1 to our
Current Report on Form 8-K, filed on June 15, 2005). |
| |
10 |
.25.7 |
|
Amendment No. 8, dated July 1, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 10.2 to our
Current Report on Form 8-K, filed on July 26, 2005). |
91
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
10 |
.25.8 |
|
Amendment No. 9, dated July 1, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 10.3 to our
Current Report on Form 8-K, filed on July 26, 2005). |
| |
10 |
.25.9 |
|
Medical Services Contract by and between Florida Healthy Kids
Corporation and AMERIGROUP Florida, Inc., dated October 1, 2005
(incorporated by reference to exhibit 10.5 to our Quarterly
Report on Form 10-Q filed on November 4, 2005). |
| |
10 |
.26 |
|
Medicaid Contract between New York City Department of Health and
Mental Hygiene and CarePlus, L.L.C. date October 1, 2004
(incorporated by reference to Exhibit 10.48 to our Current
Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.26.1 |
|
Contract Amendment, dated January 1, 2005, to the Medicaid
Managed Care Model Contract between New York City Department of
Health and Mental Hygiene and CarePlus LLC. Dated October 1,
2004 (incorporated by reference to Exhibit 10.48.1 to our
Current Report on Form 8-K, filed on May 5, 2005.) |
| |
10 |
.27 |
|
Child Health Plus by and between The State of New York
Department of Health and Care Plus Health Plan is effective for
the period July 1, 1998 through June 30, 2005 (Contract No.
C-015473) (incorporated by reference to Exhibit 10.49 to our
Current Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.27.1 |
|
Contract Amendment - Appendix X, dated September 10, 2005, to
the Child Health Plus Contract by and between The State of New
York Department of Health and Care Plus Health Plan is effective
for the period June 30, 2005 through December 31, 2005
((Contract No. C-015473) (incorporated by reference to our
Quarterly Report on Form 10-Q, filed on November 4, 2005)). |
| |
10 |
.27.2 |
|
Contract Amendment - Appendix X, dated September 10, 2005, to
the Child Health Plus by and between The State of New York
Department of Health and Care Plus Health Plan is effective for
the period January 1, 2006 through December 31, 2006 ((Contract
No. C-015473) (incorporated by reference to our Quarterly Report
on Form 10-Q, filed on November 4, 2005)). |
| |
10 |
.28 |
|
Family Health Plus Model Contract by and between The City of New
York through the State Department of Health and CarePlus LLC is
effective for the period October 1, 2005 through September 30,
2007 (incorporate by reference to our Quarterly Report filed on
Form 10-Q, filed on November 4, 2005). |
| |
10 |
.29 |
|
Medicaid Managed Care Model Contract by The State of New York
Department of Health and CarePlus LLC effective for the period
October 1, 2005 through September 30, 2007 (incorporated by
reference to our Quarterly Report on Form 10-Q, filed on
November 4, 2005). |
| |
10 |
.30 |
|
Contract dated July 19, 2005 between Georgia Department of
Community Health and AMGP Georgia Managed Care Company, Inc. for
the period from July 1, 2005 through June 30, 2006 with six
optional renewal periods (incorporated by reference to Exhibit
10.1 to our Current Report on Form 8-K, filed on July 26, 2005). |
| |
10 |
.30.1 |
|
Contract rates to contract dated July 19, 2005 between Georgia
Department of Community Health and AMGP Georgia Managed Care
Company, Inc. for the period from July 1, 2005 through June 30,
2006 with six optional renewal periods (incorporated by
reference to Exhibit 10.1.1 to our Current Report on Form 8-K,
filed on July 26, 2005). |
| |
10 |
.31 |
|
Contract with Eligible Medicare Advantage (MA) Organization
Pursuant to Sections 1851 through 1859 of the Social Security
Act for the Operation of a Medicare Advantage Coordinated Care
Plan(s) (incorporated by reference to Exhibit 10.1 to our
Current Report on Form 8-K, filed September 29, 2005). |
| |
10 |
.31.1 |
|
Addendum To Medicare Managed Care Contract Pursuant To Sections
1860D-1 Through 1860D-42 Of The Social Security Act For The
Operation of a Voluntary Medicare Prescription Drug Plan
(incorporated by reference to Exhibit 10.2 to our Current Report
on Form 8-K, filed September 29, 2005). |
92
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
10 |
.32.1 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR program in the Dallas Service Delivery Area
effectively extending the contract through August 31, 2006. |
| |
10 |
.32.2 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR program in the Harris Service Delivery Area
effectively extending the contract through August 31, 2006. |
| |
10 |
.32.3 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR program in the Tarrant Service Delivery Area
effectively extending the contract through August 31, 2006. |
| |
10 |
.32.4 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR program in the Travis Service Delivery Area
effectively extending the contract through August 31, 2006. |
| |
10 |
.32.5 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR+PLUS program in the Harris Service Delivery Area
effectively extending the contract through August 31, 2006. |
| |
10 |
.32.6 |
|
Amendment, effective January 1, 2006, to the Health &
Human Services Commission Agreement for Health Services to the
Medicaid STAR+PLUS program in the Harris County Service Delivery
Area. |
| |
10 |
.32.8 |
|
Amendment, effective September 1, 2005, to the Health &
Human Services Commission Agreement for Health Services to the
Childrens Health Insurance Program effectively extending
the contract through August 31, 2006. |
| |
10 |
.32.9 |
|
Health & Human Services Commission Uniform Managed Care
Contract covering all service areas and products in which the
subsidiary has agreed to participate, effective
September 1, 2006. |
| |
21 |
.1 |
|
List of Subsidiaries |
| |
23 |
.1 |
|
Consent of KPMG LLP, Independent Registered Public Accounting
Firm, with respect to financial statements of the registrant. |
| |
31 |
.1 |
|
Certification of Chief Executive Officer pursuant to Section 302
of Sarbanes-Oxley Act of 2002, dated March 1, 2006. |
| |
31 |
.2 |
|
Certification of Chief Financial Officer pursuant to Section 302
of Sarbanes-Oxley Act of 2002, dated March 1, 2006. |
| |
32 |
|
|
Certification of Chief Executive Officer and Chief Financial
Officer pursuant to Section 906 of Sarbanes-Oxley Act of 2002,
dated March 1, 2006. |
93
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the
Securities Act of 1934, the registrant has duly caused this
report to be signed on its behalf by the undersigned, thereunto
duly authorized, in the City of Virginia Beach, Commonwealth of
Virginia, on March 1, 2006.
|
|
| |
|
| |
Name: Sherri E. Lee |
| |
Title: Executive Vice President, Chief Financial
Officer and Treasurer |
Pursuant to the requirements of the Securities Exchange Act of
1934, this report has been signed below by the following persons
on behalf of the registrant and in the capacities and on the
dates indicated.
| |
|
|
|
|
|
|
| Signatures |
|
Title |
|
Date |
| |
|
|
|
|
| |
/s/ Jeffrey L. McWaters
Jeffrey L. McWaters |
|
Chairman and Chief Executive Officer |
|
March 1, 2006 |
| |
/s/ Sherri E. Lee
Sherri E. Lee |
|
Executive Vice President, Chief Financial Officer and Treasurer |
|
March 1, 2006 |
| |
/s/ Kathleen K. Toth
Kathleen K. Toth |
|
Executive Vice President and Chief Accounting Officer |
|
March 1, 2006 |
| |
/s/ Thomas E. Capps
Thomas E. Capps |
|
Director |
|
March 1, 2006 |
| |
/s/ Jeffrey B. Child
Jeffrey B. Child |
|
Director |
|
March 1, 2006 |
| |
/s/ Kay Coles James
Kay Coles James |
|
Director |
|
March 1, 2006 |
| |
/s/ William J. Mcbride
William J. McBride |
|
Director |
|
March 1, 2006 |
| |
/s/ Uwe E.
Reinhardt, Ph.D.
Uwe E. Reinhardt, Ph.D. |
|
Director |
|
March 1, 2006 |
| |
/s/ Richard D. Shirk
Richard D. Shirk |
|
Director |
|
March 1, 2006 |
94
EXHIBIT INDEX
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
3 |
.1 |
|
Amended and Restated Certificate of Incorporation of the Company
(incorporated by reference to exhibit 3.1 to our Registration
Statement on Form S-3 (No. 333-108831)). |
| |
3 |
.2 |
|
By-Laws of the Company (incorporated by reference to exhibit 3.2
to our Registration Statement on Form S-3 (No. 333-108831)). |
| |
4 |
.1 |
|
Form of share certificate for common stock (incorporated by
reference to exhibit 4.1 to our Registration Statement on Form
S-1 (No. 333-347410)). |
| |
4 |
.2 |
|
AMERIGROUP Corporation Second Restated Investor Rights
Agreement, dated July 28, 1998 (incorporated by reference to
exhibit 4.2 to our Registration Statement on Form S-1 (No.
333-37410)). |
| |
10 |
.6.9 |
|
Amendment to Amended and Restated Contract between State of New
Jersey, Department of Human Services, Division of Medical
Assistance and Health Services and AMERIGROUP New Jersey, Inc.
dated July 1, 2005 (incorporated by reference to our Quarterly
Report on Form 10-Q filed on August 3, 2005). |
| |
10 |
.6.10 |
|
Amendment to Amended and Restated Contract between State of New
Jersey, Department of Human Services, Division of Medical
Assistance and Health Services and AMERIGROUP New Jersey, Inc.
dated July 1, 2005 (incorporated by reference to our Quarterly
Report on Form 10-Q filed on August 3, 2005). |
| |
10 |
.7.8 |
|
Amendment 2, dated August 1, 2005, to the State of Illinois
Department of Healthcare and Family Services Contract for
Furnishing Health Services by a Health Maintenance Organization
(incorporated by reference to our Quarterly Report on Form 10-Q
filed on August 3, 2005). |
| |
10 |
.8 |
|
Form 2003 Cash Incentive Plan of the Company (incorporated by
reference to exhibit 10.38 to our Quarterly Report of Form 10-Q
for the last quarter ended June 30, 2003, filed on August 11,
2003). |
| |
10 |
.9 |
|
Form 2005 Equity Incentive Plan (incorporated by reference to
our Definitive Proxy Statement Pursuant to Schedule 14a of the
Securities Exchange Act of 1934, filed on April 4, 2005). |
| |
10 |
.10 |
|
Definitive Agreement dated October 26, 2004, between CarePlus,
LLC and AMERIGROUP Corporation (incorporated by reference to our
Current Report on Form 8-K, filed on November 1, 2004). |
| |
10 |
.11 |
|
Closing Agreement dated January 3, 2005, between CarePlus, LLC
and AMERIGROUP Corporation (incorporated by reference to exhibit
10.47 to our Current Report on Form 8-K, filed on January 6,
2005). |
| |
10 |
.12 |
|
Separation Agreement and General Release with E. Paul Dunn, Jr.
former Executive Vice President and Chief Financial Officer
effective December 2, 2005 (incorporated by reference to our
Current Report on Form 8-K, filed on December 6, 2005). |
| |
10 |
.13 |
|
Form the Officer and Director Indemnification Agreement
(incorporated by reference to exhibit 10.16 to our Registration
Statement on Form S-1 (No. 333-37410). |
| |
10 |
.14 |
|
Form of Employee Noncompete, Nondisclosure and Developments
Agreement (incorporated by reference to exhibit 10.1 to our
Current Report on Form 8-K, filed on February 23, 2005). |
| |
10 |
.15 |
|
Form of Incentive Stock Option Agreement (incorporated by
reference to exhibit 10.1 to our Current Report of Form 8-K,
filed on May 13, 2005). |
| |
10 |
.16 |
|
Form of Nonqualified Stock Option Agreement (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed on May 13, 2005). |
| |
10 |
.17 |
|
Form of Stock Appreciation Rights Agreement (incorporated by
reference to exhibit 10.3 to our Current Form 8-K filed on May
13, 2005). |
| |
10 |
.18 |
|
Form of AMERIGROUP Corporation Nonqualified Stock Option
Agreement (incorporated by reference to exhibit 10.1 to our
Current Form 8-K filed on November 3, 2005). |
| |
10 |
.19 |
|
The Board of Directors approved and adopted a resolution for
director compensation practices on February 10, 2005
(incorporated by reference to our Current Report on Form 8-K,
filed on February 15, 2005). |
| |
10 |
.20 |
|
Form of Separation Agreement between AMERIGROUP Corporation and
Lorenzo Childress, Jr., M.D. (incorporated by reference to
exhibit 10.1 to our Current Report on Form 8-K filed March 4,
2005). |
| |
|
|
|
|
| Exhibit | |
|
|
| Number | |
|
Description |
| | |
|
|
| |
10 |
.21 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed March 4, 2005). |
| |
10 |
.22 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on Form 8-K
filed March 4, 2005). |
| |
10 |
.23 |
|
Amendment No. 00017, dated March 1, 2005, to the District of
Columbia Healthy Families Programs, Department of Health Medical
Assistance Administration, Prepaid, Capital Risk Contract
(POHC-2002-D-2003) (incorporated by reference to our Current
Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.2 |
|
Amendment No. 2, dated November 19, 2004, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 10.25 to our
Quarterly Report on Form 10-Q, filed on November 5, 2004). |
| |
10 |
.25.3 |
|
Amendment No. 4, dated February 28, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 25.3 to our
Current Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.4 |
|
Amendment No. 5, dated March 31, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHCA Contract
No. FA523) (incorporated by reference to Exhibit 25.4 to our
Current Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.5 |
|
Amendment No. 6, dated May 1, 2005, to the June 28, 2002 Medical
Contract between the State of Florida, Agency for Health Care
Administration and AMERIGROUP Florida Inc. (AHCA Contract No.
FA523) (incorporated by reference to Exhibit 10.1 to our Current
Report on Form 8-K, filed on May 5, 2005). |
| |
10 |
.25.6 |
|
Amendment No. 7, dated June 1, 2005, to the June 28, 2002
Medical Contract between the State of Florida, Agency for Health
Care Administration and AMERIGROUP Florida Inc. (AHC |