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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

[X] QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended June 30, 2003

OR

[ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 (d) OF THE
SECURITIES EXCHANGE ACT OF 1934

For the transition period from _____ to _____

Commission file number 1-5975


HUMANA INC.
(Exact name of registrant as specified in its charter)

Delaware

61-0647538

(State or other jurisdiction of
incorporation or organization)

(I.R.S. Employer
Identification Number)

500 West Main Street
Louisville, Kentucky 40202

(Address of principal executive offices, including zip code)

(502) 580-1000
(Registrant's telephone number, including area code)

    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, and (2) has been subject to such filing requirements for the past 90 days. Yes X No ______

    
Indicate by check mark whether the registrant is an accelerated filer (as defined in Rule 12b-2 of the Act). Yes X No ____

    
Indicate the number of shares outstanding of each of the issuer's classes of common stock as of the latest practicable date.

Class of Common Stock
$0.16 2/3 par value

Outstanding at
June 30, 2003
161,657,618 shares

 

 


Humana Inc.

FORM 10-Q

JUNE 30, 2003

INDEX

Part I: Financial Information

Page

Item 1.

Financial Statements (Unaudited)

Condensed Consolidated Balance Sheets at June 30, 2003 and December 31, 2002

3

Condensed Consolidated Statements of Income for the three and six months ended
June 30, 2003 and 2002

4

Condensed Consolidated Statements of Cash Flows for the six months ended June 30, 2003 and 2002

5

Notes to Condensed Consolidated Financial Statements

6

Item 2.

Management's Discussion and Analysis of Financial Condition and Results of Operations

19

Item 3.

Quantitative and Qualitative Disclosures about Market Risk

35

Item 4.

Controls and Procedures

35

Part II: Other Information

Item 1.

Legal Proceedings

36

Item 4.

Submission of Matters to a Vote of Security Holders

39

Item 5.

Other Information

39

Item 6.

Exhibits and Reports on Form 8-K

40

Signatures

41

 

 

 

 

 

Humana Inc.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)

 

 

June 30,

 

 

December 31,

 

 

 

2003

 

 

2002

 

 

 

(in thousands, except share amounts)

 

Assets

Current assets:

   Cash and cash equivalents

 

$

754,942

 

 

$

721,357

 

   Investment securities

 

 

1,399,220

 

 

 

1,405,833

 

   Receivables, less allowance for doubtful accounts of $32,956
     at June 30, 2003 and $30,178 at December 31, 2002:

 

 

 

 

 

 

 

 

      Premiums

 

 

402,821

 

 

 

348,562

 

      Administrative services fees

 

 

36,688

 

 

 

68,316

 

   Other

 

 

223,800

 

 

 

250,857

 

      Total current assets

 

 

2,817,471

 

 

 

2,794,925

 

Property and equipment, net

 

 

417,446

 

 

 

459,842

 

Other assets:

 

 

 

 

 

 

 

 

   Long-term investment securities

 

 

329,178

 

 

 

288,724

 

   Goodwill

 

 

776,874

 

 

 

776,874

 

   Other

 

 

152,885

 

 

 

279,665

 

      Total other assets

 

 

1,258,937

 

 

 

1,345,263

 

      Total assets

 

$

4,493,854

 

 

$

4,600,030

 

Liabilities and Stockholders' Equity

Current liabilities:

   Medical and other expenses payable

 

$

1,287,364

 

 

$

1,142,131

 

   Trade accounts payable and accrued expenses

 

 

455,541

 

 

 

552,689

 

   Book overdraft

 

 

79,536

 

 

 

94,882

 

   Unearned revenues

 

 

100,445

 

 

 

335,757

 

   Short-term debt

 

 

265,000

 

 

 

265,000

 

      Total current liabilities

 

 

2,187,886

 

 

 

2,390,459

 

Long-term debt

 

 

334,610

 

 

 

339,913

 

Other long-term obligations

 

 

265,098

 

 

 

263,184

 

      Total liabilities

 

 

2,787,594

 

 

 

2,993,556

 

Commitments and contingencies

Stockholders' equity:

   Preferred stock, $1 par; 10,000,000 shares authorized, none issued

 

 

--

 

 

 

--

 

   Common stock, $0.16 2/3 par; 300,000,000 shares authorized;
      172,263,921 shares issued at June 30, 2003 and 171,334,893
      shares issued at December 31, 2002

 

 

28,708

 

 

 

28,556

 

   Capital in excess of par value

 

 

938,648

 

 

 

931,089

 

   Retained earnings

 

 

821,383

 

 

 

720,877

 

   Accumulated other comprehensive income

 

 

29,839

 

 

 

22,455

 

   Unearned restricted stock compensation

 

 

(1,469

)

 

 

(6,516

)

   Treasury stock, at cost, 10,606,303 shares at June 30, 2003 and
      8,362,537 shares at December 31, 2002

 

 

(110,849

)

 

 

(89,987

)

      Total stockholders' equity

 

 

1,706,260

 

 

 

1,606,474

 

      Total liabilities and stockholders' equity

 

$

4,493,854

 

 

$

4,600,030

 

See accompanying notes to condensed consolidated financial statements.

Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(Unaudited)

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands, except per share results)

Revenues:

   Premiums

$

2,913,405

$

2,743,739

$

5,756,354

$

5,385,551

   Administrative services fees

71,668

63,831

132,804

128,844

   Investment and other income

44,885

24,370

72,516

50,127

      Total revenues

3,029,958

2,831,940

5,961,674

5,564,522

Operating expenses:

   Medical

2,444,977

2,316,188

4,816,411

4,510,727

   Selling, general and administrative

448,537

414,433

895,582

849,497

   Depreciation and amortization

28,453

30,237

59,593

60,033

   Restructuring charge

--

--

30,760

--

      Total operating expenses

2,921,967

2,760,858

5,802,346

5,420,257

Income from operations

107,991

71,082

159,328

144,265

Interest expense

3,801

4,377

7,736

8,781

Income before income taxes

104,190

66,705

151,592

135,484

Provision for income taxes

34,914

21,346

51,086

43,355

Net income

$

69,276

$

45,359

$

100,506

$

92,129

Basic earnings per common share

$

0.44

$

0.28

$

0.64

$

0.56

Diluted earnings per common share

$

0.43

$

0.27

$

0.62

$

0.55

See accompanying notes to condensed consolidated financial statements.

 

 

 

Humana Inc.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)

Six months ended
June 30,

2003

2002

(in thousands)

Cash flows from operating activities

  Net income

$

100,506

$

92,129

  Adjustments to reconcile net income
    to net cash provided by (used in) operating activities:

      Non-cash restructuring charge

30,760

--

      Depreciation and amortization

59,593

60,033

      Provision for deferred income taxes

11,054

23,038

      Changes in operating assets and liabilities:

        Receivables

40,636

(191,193

)

        Other assets

(22,627

)

(27,728

)

        Medical and other expenses payable

145,233

108,303

        Other liabilities

(60,069

)

(16,682

)

        Unearned revenues

(235,312

)

(242,078

)

      Other

(16,508

)

10,263

          Net cash provided by (used in) operating activities

53,266

(183,915

)

Cash flows from investing activities

  Purchases of property and equipment

(42,477

)

(56,730

)

  Divestiture

--

1,109

  Purchases of investment securities

(2,261,276

)

(998,097

)

  Maturities of investment securities

384,926

177,971

  Proceeds from sales of investment securities

1,897,174

869,436

    Net cash used in investing activities

(21,653

)

(6,311

)

Cash flows from financing activities

  Common stock repurchases

(21,020

)

--

  Proceeds from swap exchange

31,556

--

  Net commercial paper conduit borrowings

--

2,000

  Change in book overdraft

(15,346

)

(19,478

)

  Other

6,782

6,984

    Net cash provided by (used in) financing activities

1,972

(10,494

)

Increase (decrease) in cash and cash equivalents

33,585

(200,720

)

Cash and cash equivalents at beginning of period

721,357

651,420

Cash and cash equivalents at end of period

$

754,942

$

450,700

Supplemental cash flow disclosures:

  Interest payments

$

398

$

7,535

  Income tax payments, net

$

27,210

$

9,084

 

 

 

 

See accompanying notes to condensed consolidated financial statements.

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

(1)   Basis of Presentation

       The accompanying condensed consolidated financial statements are presented in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the disclosures normally required by accounting principles generally accepted in the United States of America, or those normally made in an Annual Report on Form 10-K. References throughout this document to "we," "us," "our," the "Company," and "Humana," mean Humana Inc. and all entities we own. For further information, the reader of this Form 10-Q should refer to our Form 10-K for the year ended December 31, 2002, that was filed with the Securities and Exchange Commission, or the SEC, on March 21, 2003.

       The preparation of our condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America requires us to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. The areas involving the most significant use of estimates are the estimation of medical expenses payable, the recognition of revenue related to our TRICARE contracts, the valuation and related impairment recognition of investment securities, and the valuation and related impairment recognition of long-lived assets, including goodwill. Although our estimates are based on knowledge of current events and anticipated future events, actual results may ultimately differ materially from those estimates. Refer to "Critical Accounting Policies and Estimates" in Humana's 2002 Annual Report on Form 10-K for information on accounting policies that the Company considers critical in preparing its Consolidated Financial Statements.

       The financial information has been prepared in accordance with our customary accounting practices and has not been audited. In our opinion, the information presented reflects all adjustments necessary for a fair statement of interim results. All such adjustments are of a normal and recurring nature.

(2)   Significant Accounting Policies

       New Accounting Standards

       On January 1, 2003, we adopted Statement of Financial Accounting Standards No. 146, Accounting for Exit or Disposal Activities, or Statement 146. Statement 146 addresses the recognition, measurement, and reporting of costs that are associated with exit and disposal activities, including certain lease termination costs and severance-type costs under a one-time benefit arrangement rather than an ongoing benefit arrangement or an individual deferred-compensation contract. Statement 146 requires liabilities associated with exit and disposal activities to be expensed as incurred and impacts the timing of recognition for exit or disposal activities that were initiated after December 31, 2002. The adoption of Statement 146 did not have a material impact on our consolidated financial position or results of operations.

       In November 2002, the Financial Accounting Standards Board, or FASB, issued FASB Interpretation No. 45, Guarantor's Accounting and Disclosure Requirements for Guarantees, Including Indirect Guarantees of Indebtedness of Others, an interpretation of FASB Statements No. 5, 57, and 107 and Rescission of FASB Interpretation No. 34, or FIN 45. FIN 45 requires that upon issuance of a guarantee, the entity must recognize a liability for the fair value of the obligation it assumes under that guarantee. FIN 45 requires disclosure about each guarantee even if the likelihood of the guarantors having to make any payments under the guarantee is remote. The provisions for initial recognition and measurement are effective on a prospective basis for guarantees that are issued or modified after December 31, 2002. Refer to Note 8 for guarantee disclosures. The adoption of the recognition provision of FIN 45 did not have a material impact on our financial position, res ults of operations or cash flows.

       In January 2003, the FASB issued Interpretation No. 46, Consolidation of Variable Interest Entities, an Interpretation of ARB 51, or FIN 46. The primary objectives of FIN 46 are to provide guidance on the identification of entities for which control is achieved through means other than through voting rights (variable interest entities, or VIEs) and how to determine when and which business enterprise should consolidate the VIE (the primary

 

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

beneficiary). The provisions of FIN 46 are effective immediately for VIEs created after January 31, 2003 and no later than July 1, 2003 for VIEs created before February 1, 2003. In addition, FIN 46 requires that both the primary beneficiary and all other enterprises with a significant variable interest make additional disclosure in filings issued after January 31, 2003. The adoption of FIN 46 did not have a material impact on our financial position, results of operations or cash flows.

       Stock-Based Compensation

       We have stock-based employee compensation plans, including stock options and restricted stock awards, which are described more fully in Note 9 to the consolidated financial statements in Humana's 2002 Annual Report on Form 10-K. On August 7, 2003, approximately 3.9 million shares of restricted stock will vest which represents approximately 96% of all restricted shares outstanding.

       We account for our stock option plans under Accounting Principles Board Opinion No. 25, Accounting for Stock Issued to Employees and related interpretations, or APB No. 25. No compensation cost is reflected in net income related to fixed-based stock option awards to employees when the option has an exercise price equal to the market value of the underlying common stock on the date of grant. Compensation expense is recorded for restricted stock grants over their vesting periods based on fair value, which is equal to the market price of Humana common stock on the date of the grant. The following table illustrates the effects on net income and earnings per share if we had applied the fair value recognition provisions of FASB Statement No. 123, Accounting for Stock-Based Compensation, to our stock-based awards.

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands, except per share results)

Net income, as reported

$

69,276

$

45,359

$

100,506

$

92,129

Add: Restricted stock compensation expense included in reported net income, net of related tax

 

1,401

 

 

1,494

 

 

2,804

 

 

3,066

Deduct: Total stock-based employee compensation
expense determined under fair value based method
for all fixed-based options and restricted stock
awards, net of related tax

 

(2,764

)

 

(2,563

)

 

(5,160

)

 

(4,829)

Adjusted net income

$

67,913

 

$

44,290

 

$

98,150

 

$

90,366

Earnings per share:

 

 

 

 

 

 

 

 

 

 

 

     Basic, as reported

$

0.44

 

$

0.28

 

$

0.64

 

$

     0.56

     Basic, pro forma

$

0.43

 

$

0.27

 

$

0.62

 

$

     0.55

     Diluted, as reported

$

0.43

$

0.27

$

0.62

$

     0.55

     Diluted, pro forma

$

0.42

 

$

0.26

 

$

0.61

 

$

     0.54

 

  Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

(3)   Restructuring Charge

       During the fourth quarter of 2002, we finalized a plan to realign our administrative cost structure with the consolidation of seven customer service centers into four and an enterprise-wide workforce reduction.

       The following table presents a rollforward of the restructuring charge for the year ended December 31, 2002 and the six months ended June 30, 2003:

Severance

 

No. of Employees

 

Cost

 

Long-lived Assets

 

Lease Discontinuance

 

Total

 

Year ended December 31, 2002

(dollars in thousands)

Provision

2,600

$

32,105

$

2,448

$

1,324

$

35,877

Cash payments

 

(500

)

 

(910

)

 

--

 

 

--

 

 

(910

)

Non-cash

 

--

 

 

--

 

 

(2,448

)

 

--

 

 

(2,448

)

Balance at December 31, 2002

 

2,100

 

 

31,195

 

 

--

 

 

1,324

 

 

32,519

 

Six months ended June 30, 2003

Provision

 

--

 

 

--

 

 

30,760

 

 

--

 

 

30,760

 

Cash payments

 

(1,410

)

 

(9,323

)

 

--

 

 

(455

)

 

(9,778

)

Non-cash

 

--

 

 

--

 

 

(30,760

)

 

--

 

 

(30,760

)

Balance at June 30, 2003

 

690

 

$

21,872

 

$

--

 

$

869

 

$

22,741

 

       Severance

       During the fourth quarter of 2002, we recorded severance and related employee benefit costs of $32.1 million ($19.6 million after tax) in connection with the customer service center consolidation and an enterprise-wide workforce reduction. Severance costs were estimated based upon the provisions of the Company's existing employee benefit plans and policies. The plan to reduce our administrative cost structure is expected to ultimately affect approximately 2,600 positions throughout the entire organization, including customer service, claim administration, clinical operations, provider network administration, as well as other corporate and field-based positions. As of June 30, 2003, approximately 1,910 positions had been eliminated. We expect the remaining positions to be eliminated by December 31, 2003, with most of the severance being paid in 2003.

       Long-lived Asset Impairment

       Our decision to eliminate three customer service centers prompted a review during the fourth quarter of 2002 for the possible impairment of long-lived assets used in these operations. We continued to use some long-lived assets associated with these customer service center operations until June 2003, the completion date for consolidating these operations.

       Our fourth quarter of 2002 impairment review indicated that estimated future undiscounted cash flows attributable to our business supported by our San Antonio, Texas customer service operations were insufficient to recover the carrying value of certain long-lived assets, primarily buildings used in these operations. Accordingly, we adjusted the carrying value of these long-lived assets to their estimated fair value resulting in a non-cash impairment charge of $2.4 million ($1.5 million after tax). Estimated fair value was based on an independent third party appraisal of the buildings.

       Our first quarter of 2003 impairment review indicated that estimated future undiscounted cash flows attributable to our business supported by our Jacksonville, Florida customer service operations were insufficient to recover the carrying value of certain long-lived assets, primarily a building used in our Florida operations. Accordingly, we recorded a non-cash impairment charge of approximately $17.2 million ($10.5 million after tax) during the first quarter of 2003. Estimated fair value was based on an independent third party appraisal of the buildings. Additionally, we recorded a non-cash impairment charge of approximately $13.5 million ($8.3 million after tax) during the first quarter of 2003 related to accelerated depreciation of software we ceased using in the first quarter of 2003.

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

       We are in the process of selling the buildings previously used in our Jacksonville and San Antonio customer service operations and have classified them as held for sale. The carrying amount of the buildings approximated $27.6 million at June 30, 2003 based on their fair value less estimated costs to sell the buildings. We are no longer depreciating these buildings effective July 1, 2003. The impact of ceasing depreciation of the buildings will not be material to our results of operations.

(4)   Other Intangible Assets

       Other intangible assets primarily relate to acquired subscriber, provider, and government contracts, and the cost of acquired licenses and are included with other long-term assets on the condensed consolidated balance sheets. Amortization expense for other intangible assets was approximately $6.8 million for the six months ended June 30, 2003, and $7.9 million for the six months ended June 30, 2002. The following table presents our estimate of amortization expense for the remaining six months of 2003, and for each of the five succeeding fiscal years:

(in thousands)

For the six month period ending December 31, 2003

$

4,778

For the years ending December 31,:

  2004

$

9,060

  2005

$

5,440

  2006

$

352

  2007

$

352

  2008

$

227

       The following table presents details of our other intangible assets at June 30, 2003 and December 31, 2002:

 

June 30, 2003

 

December 31, 2002

 

 

 

 

Accumulated

 

 

 

 

 

 

 

Accumulated

 

 

 

 

Cost

 

Amortization

 

Net

 

Cost

 

Amortization

 

Net

 

(in thousands)

Other intangible assets:

  Subscriber contracts

$

85,496

 

$

71,739

 

$

13,757

 

$

85,496

 

$

68,284

 

$

17,212

  Provider contracts

 

12,128

 

 

6,860

 

 

5,268

 

 

12,128

 

 

5,644

 

 

6,484

  Government contracts

 

11,820

 

 

11,820

 

 

--

 

 

11,820

 

 

9,764

 

 

2,056

  Licenses and other

 

5,065

 

 

1,268

 

 

3,797

 

 

5,065

 

 

1,161

 

 

3,904

   Total other intangible assets

$

114,509

$

91,687

$

22,822

$

114,509

$

84,853

$

29,656

(5)   Comprehensive Income

       The following table presents details supporting the computation of comprehensive income for the three and six months ended June 30, 2003 and 2002:

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands)

Net income

$

69,276

$

45,359

$

100,506

$

92,129

Net unrealized investment gains,
  net of tax

6,582

15,332

7,384

6,965

Comprehensive income, net of tax

$

75,858

$

60,691

$

107,890

$

99,094

 

 Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

(6)   Earnings Per Common Share

       We compute basic earnings per common share on the basis of the weighted average number of unrestricted common shares outstanding. Diluted earnings per common share is computed on the basis of the weighted average number of unrestricted common shares outstanding plus the dilutive effect of outstanding employee stock options and restricted shares using the treasury stock method. There were no adjustments required to be made to net income for purposes of computing basic or diluted earnings per common share.

       The following table presents details supporting the computation of basic and diluted earnings per common share for the three and six months ended June 30, 2003 and 2002:

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands, except per share results)

Net income available for common stockholders

$

69,276

$

45,359

$

100,506

$

92,129

Weighted average outstanding shares of common stock
used to compute basic earnings per common share

 

157,395

 

 

164,853

 

 

157,565

 

 

164,555

Dilutive effect of:

 

 

 

 

 

 

 

 

 

 

 

   Stock options

 

813

 

 

1,342

 

 

607

 

 

1,208

   Restricted stock

 

2,941

 

 

2,665

 

 

2,810

 

 

2,511

Shares used to compute diluted earnings per common share

 

161,149

 

 

168,860

 

 

160,982

 

 

168,274

 

 

 

 

 

 

 

 

 

 

 

 

Basic earnings per common share

$

0.44

 

$

0.28

 

$

0.64

 

$

0.56

 

 

 

 

 

 

 

 

 

 

 

 

Diluted earnings per common share

$

0.43

 

$

0.27

 

$

0.62

 

$

0.55

Number of antidilutive stock options excluded from
computation

6,033

4,787

6,549

4,988

(7)   Stock Repurchase Plan

       In July 2002, the Board of Directors authorized the use of up to $100 million for the repurchase of our common shares. For the six months ended June 30, 2003, we purchased in the open market 2.2 million shares at a cost of $20.8 million, or an average of $9.31 per share. Cumulatively, through June 30, 2003, we purchased in the open market 8.6 million shares at a cost of $94.9 million, or an average of $10.98 per share. In July 2003, the Board of Directors authorized an additional use of up to $100 million for the repurchase of our common shares. The $5.1 million remaining share repurchase under the July 2002 authorization expired with this replacement. The shares may be purchased from time to time at prevailing prices in the open market or in privately negotiated transactions.

(8)   Guarantees and Contingencies

       Guarantees

       Our 5-year and 7-year airplane operating leases provide for a residual value guarantee of no more than $13.6 million at the end of the lease terms which expire December 29, 2004 for the 5-year leases and January 1, 2010 for the 7-year lease. We have the right to exercise a purchase option with respect to the leased equipment or the equipment can be sold to a third party. If we decide not to exercise our purchase option at the end of the lease, we must pay the lessor a maximum amount of $8.8 million related to the 5-year leases and $4.8 million related to the 7-year lease. The amount will be reduced by the net sales proceeds of the airplanes to a third party. A $1.7 million

 Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

gain in connection with a 1999 sale/leaseback transaction is being deferred until the residual value guarantee is resolved at the end of the lease. After considering the current fair value of the airplanes and any deferred gain, we do not believe that we will have any exposure from the residual value guarantee at the end of the lease because we will exercise the purchase obligation, or the net proceeds from the sale of the airplanes will exceed the maximum amount payable to the lessor. During the second quarter of 2003, we terminated one 5-year airplane lease early. The impact of this transaction was not material.

       We have $19.2 million in undrawn letters of credit outstanding at June 30, 2003. Letters of credit totaling $13.7 million have been issued to ensure our payment to a beneficiary for assumed obligations of our wholly owned captive insurance subsidiary related to pre-1993 professional liability risks for which the beneficiary remains directly liable. Other letters of credit totaling $5.5 million were issued to ensure our payment to various beneficiaries for miscellaneous contractual obligations. These letters of credit are required to be renewed automatically on an annual basis unless the beneficiary otherwise notifies us. Over the past 10 years, we have not had to fund any letters of credit.

       Through indemnity agreements approved by the state regulatory authorities, certain of our regulated subsidiaries generally are guaranteed by Humana Inc., our parent company, in the event of insolvency for (1) member coverage for which premium payment has been made prior to insolvency; (2) benefits for members then hospitalized until discharged; and (3) payment to providers for services rendered prior to insolvency.

       Government Contracts

       Our Medicare+Choice contracts with the federal government are renewed for a one-year term each December 31 unless notice of termination is received at least 90 days prior thereto. Legislative proposals have recently been passed by both houses under separate bills to add a prescription drug benefit to Medicare and increase private competition for the program. Each proposal is projected to cost approximately $400 billion over ten years and, as proposed, would subsidize prescription medications for beneficiaries beginning in 2006. The two houses must now negotiate their differences in a conference committee. The House version includes upfront Medicare+Choice (M+C) stabilization funding provisions for plans in 2004 and 2005. In addition to improving M+C funding in the short-term, these provisions will improve the benchmark for government payment for PPOs that bid under the new program proposed for 2006. The Senate bill includes some stabilization funds for 2005. T here is substantial uncertainty regarding the passage of a final bill and we are unable to predict the provisions of any final bill which would emerge from the Conference Committee or its impact on our financial position, results of operations or cash flows.

       We have extended our current TRICARE contracts with the Department of Defense. The contract for Regions 2 and 5 was extended to April 30, 2004 and the contract for Regions 3 and 4 was extended to June 30, 2004, each subject to a one year renewal at the Government's option. We believe these extensions should continue our contracts until the new TRICARE Next Generation, or T-Nex, transition, described below.

       The Department of Defense announced a plan to consolidate the total number of prime contracts from seven to three under the new T-Nex program. The Department of Defense has stated that a bidder can be awarded only one prime contract, although a bidder would be allowed to secondarily participate in another contract. We submitted a bid in January 2003 to participate as a prime contractor for the South region. Additionally, we partnered with Aetna Government Health Plans, LLC, a subsidiary of Aetna, Inc., to participate as a subcontractor should Aetna Government Health Plans, LLC be awarded the North region. With the January 2003 bid for the South region set to expire on July 28, 2003, we extended the terms of this bid for an additional 30 days at the Department of Defense's request. The bid for the North region was similarly extended. We expect an announcement of the awards by the end of August 2003. However, it is possible that the Department of Defense could reque st another extension for either or both of these regions. The transition to the new regions is not expected until at least mid to late 2004. In addition, under the new T-Rex program, we submitted a bid in June 2003 to provide retail pharmacy support for all TRICARE beneficiaries. We expect an announcement of this award by the Department of Defense by the end of August 2003, although there is no assurance the Department of Defense will meet that schedule. At this time we are unable to predict whether we will be awarded a contract under any of these bids, or the effective dates of the contracts.

       We currently have Medicaid contracts with the Health Insurance Administration in Puerto Rico through June 30, 2005, subject to each party agreeing upon annual rates. In July 2003, we signed amendments to the Puerto Rico

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

Medicaid contracts for the East and Southeast regions of Puerto Rico which extended our contracts until June 30, 2004. Both contracts contain provisions for premium increases. Our other Medicaid contracts in Florida and Illinois generally are annual contracts. As of June 30, 2003, Puerto Rico accounted for approximately 85% of our total Medicaid membership.

       The loss of any of these government contracts or significant changes in these programs as a result of legislative action, including reductions in premium payments to us, or increases in member benefits without corresponding increases in premium payments to us, may have a material adverse effect on our financial position, results of operations and cash flows.

Legal Proceedings

       Securities Litigation

       In late 1997, three purported class action complaints were filed in the United States District Court for the Southern District of Florida by former stockholders of Physician Corporation of America, or PCA, against PCA and certain of its former directors and officers. We acquired PCA by a merger that became effective on September 8, 1997. The three actions were consolidated into a single action entitled In re Physician Corporation of America Securities Litigation. The consolidated complaint alleges that PCA and the individual defendants knowingly or recklessly made false and misleading statements in press releases and public filings with respect to the financial and regulatory difficulties of PCA's workers' compensation business. On July 24, 2002, the Court denied the defendants' motion for summary judgement. On May 20, 2003, the Court granted the plaintiffs' motion for class certification. On June 4, 2003, the defendants requested the Court of Appeals f or the Eleventh Circuit to grant permission to appeal the class certification order. Thereafter, the parties reached agreement to settle the case for the amount of $10.2 million. The settlement has been reflected in our financial statements as of June 30, 2003. The settlement agreement is subject to notice to the class and approval by the Court. The Company has pursued insurance coverage for this matter from two insurers, each of which has denied coverage. On April 23, 2003, one of the insurers filed a complaint in the United States District Court for the Southern District of Florida seeking, in effect, a declaration of the responsibilities of the two insurers. The Company intends to continue to pursue the insurance proceeds.

       Managed Care Industry Purported Class Action Litigation

       We have been involved in several purported class action lawsuits that are part of a wave of generally similar actions that target the health care payer industry and particularly target managed care companies. As a result of action by the Judicial Panel on Multi District Litigation, most of the cases against us, as well as similar cases against other companies in the industry, were consolidated in the United States District Court for the Southern District of Florida, and have been styled In re Managed Care Litigation. The cases included separate suits against us and five other managed care companies that purported to have been brought on behalf of members, which have been referred to as the subscriber track cases, and a single action against us and nine other companies that purports to have been brought on behalf of providers, which is referred to as the provider track case.

       In the subscriber track cases, the plaintiffs sought a recovery under the Racketeer Influenced and Corrupt Organizations Act, or RICO, for all persons who were subscribers at any time during the four-year period prior to the filing of the complaints. Plaintiffs also sought to represent a subclass of policyholders who purchased insurance through their employers' health benefit plans governed by ERISA, and who were subscribers at any time during the six-year period prior to the filing of the complaints. The complaints allege, among other things, that we intentionally concealed from members certain information concerning the way in which we conduct business, including the methods by which we pay providers. The plaintiffs did not allege that any of the purported practices resulted in denial of any claim for a particular benefit, but instead, claimed that we provided the purported class with health insurance benefits of lesser value than promised. The complaints also a llege an industry-wide conspiracy to engage in the various alleged improper practices.

       On September 26, 2002, the Court denied the plaintiffs' request for class certification. On October 9, 2002, the plaintiffs asked the Court to reconsider its ruling on that issue. The Court denied the motion on November 25, 2002.

 Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

Thereafter, we entered into a settlement arrangement with the two named plaintiffs pursuant to which we paid each $8,000. The Court entered an order dismissing the subscriber track cases with prejudice on May 19, 2003.

       In the provider track case, the plaintiffs assert that we and other defendants improperly paid providers' claims and "downcoded" their claims by paying lesser amounts than they submitted. The complaint alleges, among other things, multiple violations under RICO as well as various breaches of contract and violations of regulations governing the timeliness of claim payments. We moved to dismiss the provider track complaint on September 8, 2000, and the other defendants filed similar motions thereafter. On March 2, 2001, the Court dismissed certain of the plaintiffs' claims pursuant to the defendants' several motions to dismiss. However, the Court allowed the plaintiffs to attempt to correct the deficiencies in their complaint with an amended pleading with respect to all of the allegations except a claim under the federal Medicare regulations, which was dismissed with prejudice. The Court also left undisturbed the plaintiffs' claims for breach of contract. On March 2 6, 2001, the plaintiffs filed their amended complaint, which, among other things, added four state or county medical associations as additional plaintiffs. Two of those, the Denton County Medical Society and the Texas Medical Association, purport to bring their actions against us, as well as against several other defendant companies. The Medical Association of Georgia and the California Medical Association purport to bring their actions against various other defendant companies. The associations seek injunctive relief only. The defendants filed a motion to dismiss the amended complaint on April 30, 2001.

       On September 26, 2002, the Court granted the plaintiffs' request to file a second amended complaint, adding additional plaintiffs, including the Florida Medical Association, which purports to bring its action against all defendants. On October 21, 2002, the defendants moved to dismiss the second amended complaint. The Court has not yet ruled on that motion.

       Also on September 26, 2002, the Court certified a global class consisting of all medical doctors who provided services to any person insured by any defendant from August 4, 1990, to September 30, 2002. The class includes two subclasses. A national subclass consists of medical doctors who provided services to any person insured by a defendant when the doctor has a claim against such defendant and is not required to arbitrate that claim. A California subclass consists of medical doctors who provided services to any person insured in California by any defendant when the doctor was not bound to arbitrate the claim. On October 10, 2002, the defendants asked the Court of Appeals for the Eleventh Circuit to review the class certification decision. On November 20, 2002, the Court of Appeals agreed to review the class issue. Oral argument has been scheduled before the appellate court on September 11, 2003. The District Court has ruled that discovery can proceed during the pendency of the request to the Eleventh Circuit, and the Eleventh Circuit rejected a request to halt discovery.

       The Court has set a trial date of June 30, 2004. In the meantime, one of the defendants, Aetna Inc., announced on May 22, 2003, that it has entered into a settlement agreement with the plaintiffs. The agreement has been filed with the Court and is subject to approval by the Court.

       Other

       The Academy of Medicine of Cincinnati, the Butler County Medical Society, the Northern Kentucky Medical Society and several physicians have filed antitrust suits in state courts in Ohio and Kentucky against Aetna Health, Inc., Humana Health Plan of Ohio, Inc., Anthem Blue Cross Blue Shield, and United Healthcare of Ohio, Inc., alleging that the defendants have violated the Ohio and Kentucky antitrust laws by conspiring to fix the reimbursement rates paid to physicians in the Greater Cincinnati and Northern Kentucky region. Each suit seeks class certification, damages and injunctive relief. Plaintiffs cite no evidence that any such conspiracy existed, but base their allegations on assertions that physicians in the Greater Cincinnati region are paid less than physicians in other major cities in Ohio and Kentucky.

       The state courts in Ohio and Kentucky each have denied motions by the defendants to compel arbitration or alternatively to dismiss. Defendants have filed notices of appeal with respect to the orders denying arbitration. The Ohio court has agreed to stay proceedings pending resolution of the appeal. The Kentucky court granted a similar request with respect to the physician plaintiffs who are subject to arbitration agreements, but denied the requested stay with respect to the association plaintiffs and any physician plaintiffs whose contracts do not contain arbitration provisions. The plaintiffs have filed motions to certify a class in each case. The purported classes allegedly consist

  Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

of all physicians who have practiced medicine at any time since January 1, 1992, in a four county region in Southwestern Ohio or a three county region in Northern Kentucky.

       We intend to continue to defend these actions vigorously.

       Government Audits and Other Litigation and Proceedings

       In July 2000, the Office of the Florida Attorney General initiated an investigation, apparently relating to some of the same matters that are involved in the managed care industry purported class action litigation described above. On September 21, 2001, the Texas Attorney General initiated a similar investigation. No actions have been filed against us by either state. These investigations are ongoing, and we have cooperated with the regulators in both states.

       On May 31, 2000, we entered into a five-year Corporate Integrity Agreement, or CIA, with the Office of Inspector General, or OIG, of the Department of Health and Human Services. Under the CIA, we are obligated to, among other things, provide training, conduct periodic audits and make periodic reports to the OIG.

       In addition, our business practices are subject to review by various state insurance and health care regulatory authorities and federal regulatory authorities. There has been increased scrutiny by these regulators of the managed health care companies' business practices, including claims payment practices and utilization management practices. We have been and continue to be subject to such reviews. Some of these have resulted in fines and could require changes in some of our practices and could also result in additional fines or other sanctions.

       We also are involved in other lawsuits that arise in the ordinary course of our business operations, including claims of medical malpractice, bad faith, nonacceptance or termination of providers, failure to disclose network discounts and various other provider arrangements, and challenges to subrogation practices. We also are subject to claims relating to performance of contractual obligations to providers, members, and others, including failure to properly pay claims and challenges to the use of certain software products in processing claims. Pending state and federal legislative activity may increase our exposure for any of these types of claims.

       In addition, some courts recently have issued decisions which could have the effect of eroding the scope of ERISA preemption for employer-sponsored health plans, thereby exposing us to greater liability for medical negligence claims. This includes decisions which hold that plans may be liable for medical negligence claims in some situations based solely on medical necessity decisions made in the course of adjudicating claims. In addition, some courts have issued rulings which make it easier to hold plans liable for medical negligence on the part of network providers on the theory that providers are agents of the plans and that the plans are therefore vicariously liable for the injuries to members by providers.

       Personal injury claims and claims for extracontractual damages arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future. On January 1, 2002, and again on January 1, 2003, we reduced the amount of coverage purchased from third party insurance carriers and increased the amount of risk we retain due to substantially higher insurance rates.

       We do not believe that any pending or threatened legal actions against us or any pending or threatened audits or investigations by state or federal regulatory agencies will have a material adverse effect on our financial position, results of operations, or cash flows. However, the likelihood or outcome of current or future suits, like the purported class action lawsuits described above, or governmental investigations, cannot be accurately predicted with certainty. In addition, the increased litigation, which has accompanied the negative publicity and public perception of our industry, adds to this uncertainty. Therefore, such legal actions and government audits and investigations could have a material adverse effect on our financial position, results of operations and cash flows.

  Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

 

(9)   Segment Information

       We manage our business with two segments: Commercial and Government. The Commercial segment consists of members enrolled in products marketed to employer groups and individuals, and includes three lines of business: fully insured medical, administrative services only, or ASO, and specialty. The Government segment consists of members enrolled in government-sponsored programs, and includes three lines of business: Medicare+Choice, Medicaid, and TRICARE. We identified our segments in accordance with the aggregation provisions of Statement of Financial Accounting Standards No. 131, Disclosures About Segments of an Enterprise and Related Information, which is consistent with information used by our Chief Executive Officer in managing our business. The segment information aggregates products with similar economic characteristics. These characteristics include the nature of customer groups and pricing, benefits and underwriting requirements.

       The results of each segment are measured by income before income taxes. We allocate all selling, general and administrative expenses, investment and other income, interest expense, and goodwill, but no other assets or liabilities, to our segments. Members served by our two segments generally utilize the same medical provider networks, enabling us to obtain more favorable contract terms with providers. Our segments also share overhead costs and assets. As a result, the profitability of each segment is interdependent.

Our segment results for the three and six months ended June 30, 2003 and 2002 are as follows:

Commercial Segment

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands)

Revenues:

  Premiums:

    Fully insured

        HMO

$

728,458

$

643,852

$

1,464,048

$

1,279,669

        PPO

823,161

709,421

1,624,524

1,416,865

            Total fully insured

1,551,619

1,353,273

3,088,572

2,696,534

    Specialty

78,935

83,814

157,538

166,541

      Total premiums

1,630,554

1,437,087

3,246,110

2,863,075

  Administrative services fees

30,356

25,576

59,946

50,723

  Investment and other income

36,898

18,236

58,751

36,551

      Total revenues

1,697,808

1,480,899

3,364,807

2,950,349

Operating expenses:

  Medical

1,353,484

1,205,997

2,667,064

2,373,521

  Selling, general and administrative

279,718

239,349

555,755

494,954

  Depreciation and amortization

17,744

17,463

36,972

34,630

  Restructuring charge

--

--

17,852

--

      Total operating expenses

1,650,946

1,462,809

3,277,643

2,903,105

Income from operations

46,862

18,090

87,164

47,244

Interest expense

3,105

3,197

6,168

6,256

Income before income taxes

$

43,757

$

14,893

$

80,996

$

40,988

 

 

 

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

Government Segment

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands)

Revenues:

  Premiums:

    Medicare+Choice

$

630,432

$

662,480

$

1,266,274

$

1,334,666

    TRICARE

536,414

530,938

1,006,735

963,323

    Medicaid

116,005

113,234

237,235

224,487

      Total premiums

1,282,851

1,306,652

2,510,244

2,522,476

  Administrative services fees

41,312

38,255

72,858

78,121

  Investment and other income

7,987

6,134

13,765

13,576

      Total revenues

1,332,150

1,351,041

2,596,867

2,614,173

Operating expenses:

  Medical

1,091,493

1,110,191

2,149,347

2,137,206

  Selling, general and administrative

168,819

175,084

339,827

354,543

  Depreciation and amortization

10,709

12,774

22,621

25,403

  Restructuring charge

--

--

12,908

--

      Total operating expenses

1,271,021

1,298,049

2,524,703

2,517,152

Income from operations

61,129

52,992

72,164

97,021

Interest expense

696

1,180

1,568

2,525

Income before income taxes

$

60,433

$

51,812

$

70,596

$

94,496

 Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

(10)   Debt

       The following table presents our short-term and long-term debt outstanding at June 30, 2003 and December 31, 2002:

 

June 30,

 

 

December 31,

 

 

2003

 

 

2002

 

 

(in thousands)

 

Short-term debt:

  Conduit commercial paper financing program

$

265,000

 

 

$

265,000

 

 

 

 

 

 

 

 

 

Long-term debt:

 

 

 

 

 

 

 

  Senior notes

$

299,552

 

 

$

299,479

 

  Fair value of swap

 

(1,136

)

 

 

34,889

 

  Deferred gain from swap exchange

 

30,959

 

 

 

--

 

    Total senior notes

 

329,375

 

 

 

334,368

 

  Other long-term borrowings

 

5,235

 

 

 

5,545

 

    Total long-term debt

$

334,610

 

 

$

339,913

 

       Senior Notes

       The $300 million 71/4% senior, unsecured notes are due August 1, 2006.

       The 71/4% senior notes were issued with original issue discount. The principal amount outstanding on the 71/4% senior notes is $300 million. The $299.6 million amount shown reflects the remaining original discount to be expensed over the life of the 71/4% senior notes.

       In order to hedge the risk of changes in the fair value of our $300 million 71/4% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. Changes in the fair value of the 71/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness. Our swap agreements are recognized in our consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. The fair value of our swap agreements are estimated based on quoted market prices of comparable agreements and reflect the amounts we would receive (or pay) to terminate the agreements at the reporting date.

       Our interest rate swap agreements exchange the 71/4% fixed interest rate under our senior notes for a variable interest rate, which was 6.23% at June 30, 2003. The $300 million swap agreements mature on August 1, 2006, and have the same critical terms as our senior notes.

       In June 2003, we realized a deferred gain and proceeds of $31.6 million in exchange for new swap agreements having current market terms. The new swap agreements have the same critical terms as our senior notes. The corresponding deferred swap gain of $31.6 million is being amortized to reduce interest expense over the remaining term of the senior notes. The carrying value of our senior notes has been increased $31.0 million by the remaining deferred swap gain balance at June 30, 2003.

       At June 30, 2003, the $1.1 million fair value of our swap agreements is included in other long-term liabilities. Likewise, the carrying value of our senior notes has been decreased $1.1 million to its fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

       Credit Agreements

       We maintain two unsecured revolving credit agreements consisting of a $265 million, 4-year revolving credit agreement and a $265 million, 364-day revolving credit agreement with a one-year term out option. A one year term out option converts the outstanding borrowings, if any, under the credit agreement to a one year term loan upon

Humana Inc.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)

expiration. The 4-year revolving credit agreement expires in October 2005. In October 2002, we renewed the 364-day revolving credit agreement which expires in October 2003, unless extended.

       There were no balances outstanding under either agreement at June 30, 2003. Under these agreements, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of both agreements bear interest at either a fixed rate or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 80 to 125 basis points for our 4-year agreement, and 85 to 137.5 basis points for our 364-day agreement. We also pay an annual facility fee regardless of utilization. This facility fee, currently 25 basis points, may fluctuate between 15 and 50 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings under either credit agreement will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

       These credit agreements , and the agreement relating to the conduit commerical paper program described below, contain customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of net worth, and minimum interest coverage and maximum leverage ratios. At June 30, 2003, we were in compliance with all applicable financial covenant requirements. The terms of each of these credit agreements also include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow. We have not experienced a material adverse effect and we know of no circumstances or events which would be reasonably likely to result in a material adverse effect. We do not believe the material adverse effect clause poses a material funding risk to Humana in the future.

       Commercial Paper Programs

       We maintain indirect access to the commercial paper market through our conduit commercial paper financing program. Under this program, a third party issues commercial paper and loans the proceeds of those issuances to us so that the interest and principal payments on the loans match those on the underlying commercial paper. The $265 million, 364-day revolving credit agreement supports the conduit commercial paper financing program of up to $265 million. At June 30, 2003, we had $265 million of conduit commercial paper borrowings outstanding and the weighted average interest rate on these conduit commercial paper borrowings was 1.48%. The carrying value of these borrowings approximates fair value as the interest rate on the borrowings varies at market rates.

       We also maintain and may issue short-term debt securities under a commercial paper program when market conditions allow. The program is backed by our credit agreements described above. Under the terms of our credit agreements, aggregate borrowings under both the credit agreements and commercial paper program cannot exceed $530 million.

       Other Borrowings

       Other borrowings of $5.2 million at June 30, 2003 represent financing for the renovation of a building, bear interest at 2%, are secured by the building and are payable in various installments through 2014.

 

Humana Inc.
MANAGEMENT'S DISCUSSION AND ANALYSIS OF
FINANCIAL CONDITION AND RESULTS OF OPERATIONS

 

The consolidated financial statements of Humana Inc. in this document present the Company's financial position, results of operations and cash flows, and should be read in conjunction with the following discussion and analysis. References to "we," "us," "our," "Company," and "Humana" mean Humana Inc. and its subsidiaries. This discussion includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in this filing and in future filings with the Securities and Exchange Commission, in our press releases, investor presentations, and in oral statements made by or with the approval of one of our executive officers, the words or phrases like "expects," "anticipates," "intends," "likely will result," "estimates," "projects" or variations of such words and similar expressions are intended to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties and assump tions, including, among other things, information set forth in the "Cautionary Statements" section of this document. In light of these risks, uncertainties and assumptions, the forward-looking events discussed in this document might not occur. There may also be other risks that we are unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.

       Introduction

       Headquartered in Louisville, Kentucky, Humana is one of the nation's largest publicly traded health benefits companies, based on our 2002 revenues of $11.3 billion. We offer coordinated health insurance coverage and related services through a variety of traditional and Internet-based plans for employer groups, government-sponsored programs, and individuals. As of June 30, 2003, we had approximately 6.6 million members in our medical insurance programs, as well as approximately 1.6 million members in our specialty products programs.

       We manage our business with two segments: Commercial and Government. The Commercial segment consists of members enrolled in products marketed to employer groups and individuals, and includes three lines of business: fully insured medical, administrative services only, or ASO, and specialty. The Government segment consists of members enrolled in government-sponsored programs, and includes three lines of business: Medicare+Choice, Medicaid, and TRICARE. We identified our segments in accordance with the aggregation provisions of Statement of Financial Accounting Standards No. 131, Disclosures About Segments of an Enterprise and Related Information, which is consistent with information used by our Chief Executive Officer in managing our business. The segment information aggregates products with similar economic characteristics. These characteristics include the nature of customer groups and pricing, benefits and underwriting requirements.

       The results of each segment are measured by income before income taxes. We allocate all selling, general and administrative expenses, investment and other income, interest expense, and goodwill, but no other assets or liabilities, to our segments. Members served by our two segments generally utilize the same medical provider networks, enabling us to obtain more favorable contract terms with providers. Our segments also share overhead costs and assets. As a result, the profitability of each segment is interdependent.

       Our business strategy centers on increasing Commercial segment profitability while maintaining our existing strength in the Government segment. Our strategy to increase Commercial segment profitability focuses on providing solutions for employers to the rising cost of health care through the use of innovative and consumer-driven product designs which are supported by service excellence and advanced electronic capabilities, including education, tools and technologies for our members provided primarily through the Internet. The intent of our Commercial segment strategy is to enable us to further penetrate commercial markets with potential for profitable growth and to transform the traditional consumer experience for both employers and members to result in a high degree of consumer satisfaction, loyalty and brand awareness.

       Restructuring Charge

       During the fourth quarter of 2002, we finalized a plan to realign our administrative cost structure with the consolidation of seven customer service centers into four and an enterprise-wide workforce reduction.

       The following table presents a rollforward of the restructuring charge for the year ended December 31, 2002 and the six months ended June 30, 2003:

 

Severance

 

 

 

 

 

 

 

 

No. of Employees

 

Cost

 

Long-lived Assets

 

Lease Discontinuance

 

Total

 

Year ended December 31, 2002

(dollars in thousands)

Provision

2,600

$

32,105

$

2,448

$

1,324

$

35,877

Cash payments

 

(500

)

 

(910

)

 

--

 

 

--

 

 

(910

)

Non-cash

 

--

 

 

--

 

 

(2,448

)

 

--

 

 

(2,448

)

Balance at December 31, 2002

 

2,100

 

 

31,195

 

 

--

 

 

1,324

 

 

32,519

 

Six months ended June 30, 2003

Provision

 

--

 

 

--

 

 

30,760

 

 

--

 

 

30,760

 

Cash payments

 

(1,410

)

 

(9,323

)

 

--

 

 

(455

)

 

(9,778

)

Non-cash

 

--

 

 

--

 

 

(30,760

)

 

--

 

 

(30,760

)

Balance at June 30, 2003

 

690

 

$

21,872

 

$

--

 

$

869

 

$

22,741

 

       Severance

       During the fourth quarter of 2002, we recorded severance and related employee benefit costs of $32.1 million ($19.6 million after tax) in connection with the customer service center consolidation and an enterprise-wide workforce reduction. Severance costs were estimated based upon the provisions of the Company's existing employee benefit plans and policies. The plan to reduce our administrative cost structure is expected to ultimately affect approximately 2,600 positions throughout the entire organization, including customer service, claim administration, clinical operations, provider network administration, as well as other corporate and field-based positions. As of June 30, 2003, approximately 1,910 positions had been eliminated. We expect the remaining positions to be eliminated by December 31, 2003, with most of the severance being paid in 2003.

       Long-lived Asset Impairment

       Our decision to eliminate three customer service centers prompted a review during the fourth quarter of 2002 for the possible impairment of long-lived assets used in these operations. We continued to use some long-lived assets associated with these customer service center operations until June 2003, the completion date for consolidating these operations.

       Our fourth quarter of 2002 impairment review indicated that estimated future undiscounted cash flows attributable to our business supported by our San Antonio, Texas customer service operations were insufficient to recover the carrying value of certain long-lived assets, primarily buildings used in these operations. Accordingly, we adjusted the carrying value of these long-lived assets to their estimated fair value resulting in a non-cash impairment charge of $2.4 million ($1.5 million after tax). Estimated fair value was based on an independent third party appraisal of the buildings.

       Our first quarter of 2003 impairment review indicated that estimated future undiscounted cash flows attributable to our business supported by our Jacksonville, Florida customer service operations were insufficient to recover the carrying value of certain long-lived assets, primarily a building used in our Florida operations. Accordingly, we recorded a non-cash impairment charge of approximately $17.2 million ($10.5 million after tax) during the first quarter of 2003. Estimated fair value was based on an independent third party appraisal of the buildings. Additionally, we recorded a non-cash impairment charge of approximately $13.5 million ($8.3 million after tax) during the first quarter of 2003 related to accelerated depreciation of software we ceased using in the first quarter of 2003.

       We are in the process of selling the buildings previously used in our Jacksonville and San Antonio customer service operations and have classified them as held for sale. The carrying amount of the buildings approximated $27.6 million at June 30, 2003 based on their fair value less estimated costs to sell the buildings. We are no longer depreciating these buildings effective July 1, 2003. The impact of ceasing depreciation of the buildings will not be material to our results of operations.

 

Comparison of Results of Operations

       The following table presents certain consolidated financial data for our two segments for the three and six months ended June 30, 2003 and 2002:

Three months ended
June 30,

Six months ended
June 30,

2003

2002

2003

2002

(in thousands, except ratios)

Premium revenues:

  Fully insured

$

1,551,619

$

1,353,273

$

3,088,572

$

2,696,534

  Specialty

78,935

83,814

157,538

166,541

    Total Commercial

1,630,554

1,437,087

3,246,110

2,863,075

  Medicare+Choice

630,432

662,480

1,266,274

1,334,666

  TRICARE

536,414

530,938

1,006,735

963,323

  Medicaid

116,005

113,234

237,235

224,487

    Total Government

1,282,851

1,306,652

2,510,244

2,522,476

      Total

$

2,913,405

$

2,743,739

$

5,756,354

$

5,385,551

Administrative services fees:

  Commercial

$

30,356

$

25,576

$

59,946

$

50,723

  Government

41,312

38,255

72,858

78,121

    Total

$

71,668

$

63,831

$

132,804

$

128,844

Medical expense ratios:

  Commercial

83.0

%

83.9

%

82.2

%

82.9

%

  Government

85.1

%

85.0

%

85.6

%

84.7

%

    Total

83.9

%

84.4

%

83.7

%

83.8

%

SG&A expense ratios:

  Commercial

16.8

%

16.4

%

16.8

%

17.0

%

  Government

12.7

%

13.0

%

13.2

%

13.6

%

    Total

15.0

%

14.8

%

15.2

%

15.4

%

Income before income taxes:

   Commercial

$

43,757

$

14,893

$

80,996

$

40,988

   Government

60,433

51,812

70,596

94,496

     Total

$

104,190

$

66,705

$

151,592

$

135,484

       The following table presents a comparison of our medical membership at June 30, 2003 and 2002:

 

 

June 30,

 

Change

 

 

 

2003

 

2002

 

Members

 

Percentage

 

Commercial segment medical members:

 

 

 

 

 

 

 

 

 

   Fully insured

 

2,350,400

 

2,319,600

 

30,800

 

1.3

%

   ASO

 

670,300

 

627,500

 

42,800

 

6.8

%

      Total Commercial

 

3,020,700

 

2,947,100

 

73,600

 

2.5

%

 

 

 

 

 

 

 

 

 

 

Government segment medical members:

 

 

 

 

 

 

 

 

 

   Medicare+Choice

 

324,200

 

354,100

 

(29,900

)

(8.4

)%

   Medicaid

 

492,700

 

487,900

 

4,800

 

1.0

%

   TRICARE

 

1,750,800

 

1,761,000

 

(10,200

)

(0.6

)%

   TRICARE ASO

 

1,052,500

 

1,021,900

 

30,600

 

3.0

%

      Total Government

 

3,620,200

 

3,624,900

 

(4,700

)

(0.1

)%

Total medical membership

6,640,900

6,572,000

68,900

1.0

%

       The following discussion deals with our results of operations for the three months ended June 30, 2003, or the 2003 quarter, and the three months ended June 30, 2002, or the 2002 quarter, as well as the six months ended June 30, 2003, or the 2003 period, and the six months ended June 30, 2002, or the 2002 period.

       Overview

       Net income was $69.3 million, or $0.43 per diluted share in the 2003 quarter compared to $45.4 million, or $0.27 per diluted share in the 2002 quarter. Net income was $100.5 million, or $0.62 per diluted share in the 2003 period compared to $92.1 million, or $0.55 per diluted share in the 2002 period. Included in net income for the 2003 quarter and period was a $10.1 million after tax gain, or $0.06 per diluted share, from the sale of an interest in a privately held venture capital investment. As previously discussed, the 2003 period also included an $18.8 million after tax, or $0.12 per diluted share, non-cash, restructuring charge.

       Premium Revenues and Medical Membership

       Premium revenues increased 6.2% to $2.91 billion for the 2003 quarter, compared to $2.74 billion for the 2002 quarter. For the 2003 period, premium revenues were $5.76 billion, an increase of 6.9% compared to $5.39 billion for the 2002 period. Higher premium revenues resulted primarily from increasing fully insured commercial premium yields. Premium yield represents the percentage increase in the average premium per member over the comparable period in the prior year. Items impacting premium yield include changes in premium rates, changes in government reimbursement rates, changes in the geographic mix of membership, and changes in the mix of benefit plans selected by our membership.

       Commercial segment premium revenues increased 13.5% to $1.63 billion for the 2003 quarter, compared to $1.44 billion for the 2002 quarter. For the 2003 period, commercial segment premium revenues were $3.25 billion, an increase of 13.4% compared to $2.86 billion for the 2002 period. These increases resulted from higher premium yields on our fully insured commercial business, which were in the 13% to 15% range, and slightly higher membership levels. Our fully insured commercial medical membership increased 1.3%, or 30,800 members, to 2,350,400 at June 30, 2003 compared to 2,319,600 at June 30, 2002.

       We expect Commercial fully insured and ASO medical membership to achieve a combined increase for all of 2003 in the range of 2% to 3%. We also expect Commercial fully insured premium yields to continue in the 13% to 15% range for 2003.

       Government segment premium revenues decreased 1.8% to $1.28 billion for the 2003 quarter, compared to $1.31 billion for the 2002 quarter. For the 2003 period, government segment premium revenues were $2.51 billion, a decrease of 0.5% compared to $2.52 billion for the 2002 period. These decreases were primarily attributable to a reduction in our Medicare+Choice membership, partially offset by increases in our TRICARE and, to a lesser extent, our Medicaid businesses. Medicare+Choice membership was 324,200 at June 30, 2003, compared to 354,100 at June 30, 2002, a decline of 29,900 members, or 8.4%. This decline was due to our exit of various counties on January 1, 2003, as well as attrition of some members leaving our plans in certain markets as a result of new benefit designs. Premium yield on our Medicare+Choice business was in the 4% to 6% range. We expect Medicare+Choice premium yield to continue in the 4% to 6% range for 2003 with membership falling to between 310,000 to 320,000 by December 31, 2003. TRICARE premium revenues grew primarily as a result of the annual increase in our contractually determined base revenues.

       Administrative Services Fees

       Our administrative services fees for the 2003 quarter were $71.7 million, an increase of $7.9 million, or 12.3%, from $63.8 million for the 2002 quarter. For the 2003 period, our administrative services fees were $132.8 million, an increase of $4.0 million, or 3.1%, compared to the 2002 period. For the Commercial segment, administrative services fees increased $4.8 million, or 18.7%, from $25.6 million for the 2002 quarter to $30.4 million for the 2003 quarter, and increased $9.2 million, or 18.2%, from $50.7 million to $59.9 million when comparing the 2003 period with the 2002 period. These increases reflect a higher average fee per member and growth in ASO membership of 6.8%, which was 670,300 members at June 30, 2003, compared to 627,500 members at June 30, 2002. Administrative services fees for the Government segment increased $3.1 million, or 8.0%, when comparing the 2003 quarter with the 2002 quarter, and decreased $5.3 million, or 6.7%, when comparing the 2003 period with the 2002 period. The changes in Government segment administrative services fees primarily were due to the timing of contractual adjustments related to TRICARE for Life, a program for seniors where we provide medical benefit administrative services.

       Investment and Other Income

       Investment and other income totaled $44.9 million for the 2003 quarter, an increase of $20.5 million from $24.4 million for the 2002 quarter. For the 2003 period, investment and other income totaled $72.5 million, an increase of $22.4 million from $50.1 million for the 2002 period. This increase in the 2003 quarter and period primarily resulted from an increase in capital gains consisting primarily of the $15.2 million pretax gain from the sale of an interest in a privately held venture capital investment.

       Medical Expense

       The medical expense ratio, or MER, is computed by taking total medical expenses as a percentage of premium revenues. MER for the 2003 quarter was 83.9%, decreasing 50 basis points from the 2002 quarter of 84.4%. For the 2003 period, our medical expense ratio was 83.7%, decreasing 10 basis points from the 2002 period of 83.8%.

       The Commercial segment's MER for the 2003 quarter was 83.0%, decreasing 90 basis points from the 2002 quarter of 83.9%, and a decrease of 70 basis points from 82.9% to 82.2% was experienced comparing the 2003 period with the 2002 period. The level of improvement in both the 2003 quarter and period was achieved even with a slight shift to more large group fully insured membership, which traditionally experience a higher medical expense ratio and lower selling, general and administrative expense ratio than small group membership. Large group commercial membership represented 65% of our fully insured commercial membership at June 30, 2003 compared to 64% at June 30, 2002. The improvement in MER primarily resulted from pricing discipline and attrition of groups with a high medical expense ratio. Pricing discipline produces the delivery of premium rate increases commensurate with underlying claims costs to ensure margins.

       The Government segment's 85.1% MER for the 2003 quarter was comparable to the 2002 quarter, increasing 10 basis points compared to 85.0% in the 2002 quarter. For the 2003 period, the ratio was 85.6%, increasing 90 basis points when compared to the 2002 period of 84.7%. The 2003 period MER increase was due to TRICARE. Our MER for TRICARE for that period was higher than the prior year period due primarily to increases in utilization of services. The increase in utilization was largely attributable to decreases in the availability of lower-cost military treatment facilities resulting from activity and deployments surrounding the military conflicts in the Middle East.

       SG&A Expense

       Total selling, general and administrative, or SG&A, expenses as a percentage of premium revenues and administrative services fees, or SG&A expense ratio, for the 2003 quarter was 15.0%, increasing 20 basis points from the 2002 quarter of 14.8%. For the 2003 period, the SG&A expense ratio was 15.2%, decreasing 20 basis points when compared to the 2002 period of 15.4%. As indicated in the preceding table, the SG&A expense ratio for the Commercial segment increased 40 basis points from 16.4% to 16.8% while the Government segment decreased 30 basis points from 13.0% to 12.7% for the 2003 quarter versus the 2002 quarter. For the 2003 period compared to the 2002 period, the Commercial SG&A expense ratio decreased 20 basis points from 17.0% to 16.8% while the Government SG&A expense ratio decreased 40 basis points from 13.6% to 13.2%.

       The Commercial SG&A expense ratio of 16.8% for the 2003 quarter and period includes temporary, redundant personnel costs during the training and transition period of our service center operations in Jacksonville, Florida, San Antonio, Texas, and Madison, Wisconsin. The service center consolidations were completed during the 2003 quarter. Also included during the 2003 quarter and period are advertising and marketing costs associated with our new commercial branding campaign, which were not incurred in the prior year and will decline during the remainder of 2003. Accordingly, we expect our commercial SG&A expense ratio to decline during the second half of 2003, resulting in a ratio of 16.3% to 16.5% for the full year 2003.

       The Government SG&A ratio of 12.7% for the 2003 quarter and 13.2% for the 2003 period represented declines of 30 basis points and 40 basis points respectively, versus the prior year, as a result of administrative spending growing at a slower pace than premium revenues and administrative services fees. We expect the Government SG&A expense ratio for the full 2003 year to remain close to the 13.2% experienced for the 2003 period.

       Depreciation and amortization for the 2003 quarter totaled $28.5 million compared to $30.2 million for the 2002 quarter, a decrease of $1.7 million, or 5.9%. For the 2003 period, depreciation and amortization totaled $59.6 million compared to $60.0 million for the 2002 period, a decrease of $0.4 million, or 0.7%. These decreases primarily were due to lower other intangible amortization as costs associated with an acquired government contract became fully amortized in the 2003 quarter.

       Interest Expense

       Interest expense was $3.8 million for the 2003 quarter, compared to $4.4 million for the 2002 quarter, a decrease of $0.6 million, or 13.2%. For the 2003 period, interest expense was $7.7 million, compared to $8.8 million for the 2002 period, a decrease of $1.1 million, or 11.9%. These decreases primarily resulted from lower interest rates.

       Income Taxes

       Our effective tax rate for the 2003 quarter and period was approximately 34% compared to 32% for the 2002 quarter and period. The higher effective tax rate in the 2003 quarter and period resulted primarily from a lower proportion of tax-exempt investment income to pretax income.

       Membership

       The following table presents our medical and specialty membership at June 30, 2003, March 31, 2003, and at the end of each quarter in 2002:

 

2003

 

2002

 

June 30

 

March 31

 

Dec. 31

 

Sept. 30

 

June 30

 

March 31

Medical Membership:

 

 

 

 

 

 

 

 

 

 

 

Commercial segment:

 

 

 

 

 

 

 

 

 

 

 

   Fully insured

2,350,400

 

2,348,800

 

2,340,300

 

2,323,600

 

2,319,600

 

2,332,400

   ASO

670,300

 

654,600

 

652,200

 

658,600

 

627,500

 

621,800

     Total Commercial

3,020,700

 

3,003,400

 

2,992,500

 

2,982,200

 

2,947,100

 

2,954,200

Government segment:

 

 

 

 

 

 

 

 

 

 

 

   Medicare+Choice

324,200

 

327,100

 

344,100

 

349,000

 

354,100

 

363,700

   Medicaid

492,700

 

491,400

 

506,000

 

506,100

 

487,900

 

476,800

   TRICARE

1,750,800

 

1,752,500

 

1,755,800

 

1,755,700

 

1,761,000

 

1,742,300

   TRICARE ASO

1,052,500

 

1,050,800

 

1,048,700

 

1,038,400

 

1,021,900

 

997,900

     Total Government

3,620,200

 

3,621,800

 

3,654,600

 

3,649,200

 

3,624,900

 

3,580,700

       Total medical members

6,640,900

 

6,625,200

 

6,647,100

 

6,631,400

 

6,572,000

 

6,534,900

Specialty Membership:

Commercial segment

1,642,000

 

1,650,100

 

1,640,000

 

1,629,400

 

1,638,200

 

1,659,300

Liquidity

       Cash flows provided by operating activities of $53.3 million for the 2003 period improved from cash flows used in operating activities of $183.9 million for the 2002 period by $237.2 million. This increase primarily was attributable to an improvement in earnings and collections of receivables primarily associated with our TRICARE business.

       The timing of Medicare+Choice premium receipts significantly impacts cash flows from operations. This timing resulted in only five monthly Medicare+Choice premium receipts during the 2003 and 2002 periods rather than a normal six. The Medicare+Choice premium receipt is payable to us on the first day of each month. When the first day of a month falls on a weekend or holiday, we receive this payment at the end of the previous month. This receipt is significant, the timing of which causes material fluctuation in operating cash flows. The Medicare+Choice premium receipts for January 2003 of $205.8 million and for January 2002 of $216.6 million were received early in December 2002 and December 2001, respectively, because January 1 is always a holiday.

       Medical and other expenses payable increased $145.2 million from $1,142.1 million at December 31, 2002 to $1,287.4 million at June 30, 2003 primarily due to higher medical claims trend and membership levels.

       Total net premium and ASO receivables increased $22.6 million, or 5.4%, from $416.9 million at December 31, 2002 to $439.5 million at June 30, 2003, as presented in the following table:

 

 

 

June 30,

 

 

December 31,

 

Change

 

 

 

 

2003

 

 

2002

 

 

Dollars

 

Percentage

 

 

 

(in thousands)

 

 

 

TRICARE:

 

 

 

 

 

 

 

 

 

 

 

 

Base receivable

 

$

234,053

 

$

197,544

 

$

36,509

 

18.5

%

Bid price adjustments (BPAs)

 

 

53,663

 

 

104,044

 

 

(50,381

)

(48.4

)%

Change orders

 

 

21,733

 

 

57,630

 

 

(35,897

)

(62.3

)%

 

 

 

309,449

 

 

359,218

 

 

(49,769

)

(13.9

)%

Less: long-term portion of BPAs

 

 

--

 

 

(86,471

)

 

86,471

 

100.0

%

TRICARE subtotal

 

 

309,449

 

 

272,747

 

 

36,702

 

13.5

%

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial

 

 

163,016

 

 

174,309

 

 

(11,293

)

(6.5

)%

Allowance for doubtful accounts

 

 

(32,956

)

 

(30,178

)

 

(2,778

)

(9.2

)%

      Total net receivables

 

$

439,509

 

$

416,878

 

$

22,631

 

5.4

%

       TRICARE base receivables are collected monthly in the ordinary course of business. The timing of BPA collections occurs at contractually specified intervals, typically in excess of 6 months after the end of a contract year. At December 31, 2002, we classified $86.5 million of the BPA receivables associated with our Regions 3 and 4 TRICARE contract as long-term because the federal government was not contractually obligated to pay us the amounts until January 2004. As of June 30, 2003, since the receivable was due within 12 months, these amounts were classified into current assets and included with premium receivables at June 30, 2003. We also had a net BPA amount, payable within one year under the Regions 3 and 4 contract, of $23.3 million at December 31, 2002, which required classification in trade accounts payable and accrued expenses in our consolidated balance sheet. As of June 30, 2003, we had a net BPA receivable, rather than payable, under the R egions 3 and 4 contract. Thus, excluding the impact of changes in balance sheet classifications, TRICARE receivables decreased $26.5 million and total receivables decreased $40.6 million. Collections of BPA and change order receivables during the 2003 period contributed to the reduction. We are projecting our TRICARE receivables to remain in the $300 million to $325 million range for the remainder of 2003.

       Capital Expenditures

       Our ongoing capital expenditures relate primarily to our technology initiatives and administrative facilities necessary for activities such as claims processing, billing and collections, medical utilization review and customer service. Total capital expenditures were $42.5 million for the 2003 period, compared to $56.7 million for the 2002 period. We expect our total capital expenditures for the full 2003 year to be approximately $95 million, most of which will be used for our technology initiatives and improvement of administrative facilities.

       Stock Repurchase Plan

       In July 2002, the Board of Directors authorized the use of up to $100 million for the repurchase of our common shares. For the six months ended June 30, 2003, we purchased in the open market 2.2 million shares at a cost of $20.8 million, or an average of $9.31 per share. Cumulatively, through June 30, 2003, we purchased in the open market 8.6 million shares at a cost of $94.9 million, or an average of $10.98 per share. In July 2003, the Board of Directors authorized an additional use of up to $100 million for the repurchase of our common shares. The $5.1 million remaining share repurchase under the July 2002 authorization expired with this replacement. The shares may be purchased from time to time at prevailing prices in the open market or in privately negotiated transactions.

       Debt

       The following table presents our short-term and long-term debt outstanding at June 30, 2003 and December 31, 2002:

 

June 30,

 

 

December 31,

 

 

2003

 

 

2002

 

 

(in thousands)

 

Short-term debt:

  Conduit commercial paper financing program

$

265,000

 

 

$

265,000

 

 

 

 

 

 

 

 

 

Long-term debt:

 

 

 

 

 

 

 

  Senior notes

$

299,552

 

 

$

299,479

 

  Fair value of swap

 

(1,136

)

 

 

34,889

 

  Deferred gain from swap exchange

 

30,959

 

 

 

--

 

    Total senior notes

 

329,375

 

 

 

334,368

 

  Other long-term borrowings

 

5,235

 

 

 

5,545

 

    Total long-term debt

$

334,610

 

 

$

339,913

 

       Senior Notes

       The $300 million 71/4% senior, unsecured notes are due August 1, 2006.

       The 71/4% senior notes were issued with original issue discount. The principal amount outstanding on the 71/4% senior notes is $300 million. The $299.6 million amount shown reflects the remaining original discount to be expensed over the life of the 71/4% senior notes.

       In order to hedge the risk of changes in the fair value of our $300 million 71/4% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. Changes in the fair value of the 71/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness. Our swap agreements are recognized in our consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. The fair value of our swap agreements are estimated based on quoted market prices of comparable agreements and reflect the amounts we would receive (or pay) to terminate the agreements at the reporting date.

       Our interest rate swap agreements exchange the 71/4% fixed interest rate under our senior notes for a variable interest rate, which was 6.23% at June 30, 2003. The $300 million swap agreements mature on August 1, 2006, and have the same critical terms as our senior notes.

       In June 2003, we realized a deferred gain and proceeds of $31.6 million in exchange for new swap agreements having current market terms. The new swap agreements have the same critical terms as our senior notes. The corresponding deferred swap gain of $31.6 million is being amortized to reduce interest expense over the remaining term of the senior notes. The carrying value of our senior notes has been increased $31.0 million by the remaining deferred swap gain balance at June 30, 2003.

       At June 30, 2003, the $1.1 million fair value of our swap agreements is included in other long-term liabilities. Likewise, the carrying value of our senior notes has been decreased $1.1 million to its fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

       Credit Agreements

       We maintain two unsecured revolving credit agreements consisting of a $265 million, 4-year revolving credit agreement and a $265 million, 364-day revolving credit agreement with a one-year term out option. A one year term out option converts the outstanding borrowings, if any, under the credit agreement to a one year term loan upon expiration. The 4-year revolving credit agreement expires in October 2005. In October 2002, we renewed the 364-day revolving credit agreement which expires in October 2003, unless extended.

       There were no balances outstanding under either agreement at June 30, 2003. Under these agreements, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of both agreements bear interest at either a fixed rate or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 80 to 125 basis points for our 4-year agreement, and 85 to 137.5 basis points for our 364-day agreement. We also pay an annual facility fee regardless of utilization. This facility fee, currently 25 basis points, may fluctuate between 15 and 50 basis points, depending upon our credit ratings. The competitive advance portion of any borrowings under either credit agreement will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

       These credit agreements, and the agreement relating to the conduit commercial paper program described below, contain customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of net worth, and minimum interest coverage and maximum leverage ratios. At June 30, 2003, we were in compliance with all applicable financial covenant requirements. The terms of each of these credit agreements also include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow. We have not experienced a material adverse effect and we know of no circumstances or events which would be reasonably likely to result in a material adverse effect. We do not believe the material adverse effect clause poses a material funding risk to Humana in the future.

       Commercial Paper Programs

       We maintain indirect access to the commercial paper market through our conduit commercial paper financing program. Under this program, a third party issues commercial paper and loans the proceeds of those issuances to us so that the interest and principal payments on the loans match those on the underlying commercial paper. The $265 million, 364-day revolving credit agreement supports the conduit commercial paper financing program of up to $265 million. At June 30, 2003, we had $265 million of conduit commercial paper borrowings outstanding and the weighted average interest rate on these conduit commercial paper borrowings was 1.48%. The carrying value of these borrowings approximates fair value as the interest rate on the borrowings varies at market rates.

       We also maintain and may issue short-term debt securities under a commercial paper program when market conditions allow. The program is backed by our credit agreements described above. Under the terms of our credit agreements, aggregate borrowings under both the credit agreements and commercial paper program cannot exceed $530 million.

       Other Borrowings

       Other borrowings of $5.2 million at June 30, 2003 represent financing for the renovation of a building, bear interest at 2%, are secured by the building and are payable in various installments through 2014.

       Shelf Registration

       On April 1, 2003, our universal shelf registration became effective with the SEC. This allows us to register debt or equity securities, from time to time, up to a total of $600 million, with the amount, price and terms to be determined at the time of the sale. The universal shelf registration allows us to use the net proceeds from any future sales of our securities for our operations and for other general corporate purposes, including repayment or refinancing of borrowings, working capital, capital expenditures, investments, acquisitions, or the repurchase of our outstanding securities.

       Regulatory Requirements

       Certain of our subsidiaries operate in states that regulate the payment of dividends, loans or other cash transfers to Humana Inc., our parent company, require minimum levels of equity, and limit investments to approved securities. The amount of dividends that may be paid to Humana Inc. by these subsidiaries, without prior approval by state regulatory authorities, is limited based on the entity's level of statutory income and statutory capital and surplus. In most states, prior notification is provided before paying a dividend even if approval is not required. During the 2003 period, dividends of $121.0 million were paid to Humana Inc. by these subsidiaries.

       As of June 30, 2003, we maintained aggregate statutory capital and surplus of an estimated $1,044.4 million in our state regulated health insurance subsidiaries. Each of these subsidiaries was in compliance with applicable statutory requirements which aggregated $602.9 million. Although the minimum required levels of equity are largely based on premium volume, product mix, and the quality of assets held, minimum requirements can vary significantly at the state level. Certain states rely on risk-based capital requirements, or RBC, to define the required levels of equity. RBC is a model developed by the National Association of Insurance Commissioners to monitor an entity's solvency. This calculation indicates recommended minimum levels of required capital and surplus and signals regulatory measures should actual surplus fall below these recommended levels. Some states are in the process of phasing in these RBC requirements over a number of years. If RBC were fully i mplemented by all states at June 30, 2003, each of our subsidiaries would be in compliance, and we would have an estimated $372.8 million of aggregate capital and surplus above any of the levels that require corrective action under RBC.

       One TRICARE subsidiary under the Regions 3 and 4 contract with the Department of Defense is required to maintain current assets at least equivalent to its current liabilities. We were in compliance with this requirement at June 30, 2003.

       Future Liquidity Needs

       We believe that funds from future operating cash flows and funds available under our credit agreements and commercial paper program are sufficient to meet future liquidity needs. We also believe these sources of funds together with the ability to issue securities under the shelf registration statement are adequate to allow us to fund selected expansion opportunities, as well as to fund capital requirements.

       Cautionary Statements

       This document includes both historical and forward-looking statements. The forward-looking statements are made within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. We intend such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995, and we are including this statement for purposes of complying with these safe harbor provisions. We have based these forward-looking statements on our current expectations and projections about future events. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions, including, among other things, the information discussed below. In making these statements, we are not undertaking to address or update each factor in future filings or communications regarding our business or results. Our business is highly complicated, regulated and competitive with many different factors affecting results.

       If the premiums we charge are insufficient to cover the cost of health care services delivered to our members, or if our estimates of medical claim reserves based upon our estimates of future medical claims are inadequate, our profitability could decline.

       We use a significant portion of our revenues to pay the costs of health care services delivered to our members. These costs include claims payments, capitation payments, allocations of some centralized expenses and various other costs incurred to provide health insurance coverage to our members. These costs also include estimates of future payments to hospitals and others for medical care provided to our members. Generally, premiums in the health care business are fixed for one-year periods. Accordingly, costs we incur in excess of our medical cost projections generally are not recovered in the contract year through higher premiums. We estimate the costs of our future medical claims and other expenses using actuarial methods and assumptions based upon claim payment patterns, medical inflation, historical developments, including claim inventory levels and claim receipt patterns, and other relevant factors. We also record medical claims reserves for future p ayments. We continually review estimates of future payments relating to medical claims costs for services incurred in the current and prior periods and make necessary adjustments to our reserves. However, increases in the use or cost of services by our members, competition, government regulations and many other factors may and often do cause actual health care costs to exceed what was estimated and reflected in premiums.

       These factors may include:

       Failure to adequately price our products or estimate sufficient medical claim reserves may result in a material adverse effect on our financial position, results of operations and cash flows.

       If we fail to effectively implement our operational and strategic initiatives, our business could be materially adversely affected.

       Our future performance depends in large part upon our management team's ability to execute our strategy to position the company for the future. This strategy includes the growth of our Commercial segment business, introduction of new products and benefit designs, the successful implementation of our e-business initiatives and the selection and adoption of new technologies. We believe that the adoption of new technologies will contribute toward a reduction in administrative costs as we more closely align our workforce with our membership. Additionally, we have consolidated our service centers and their related systems as part of our operational initiatives. There can be no assurance that we will be able to successfully implement our operational and strategic initiatives that are intended to position the company for future growth. Failure to implement this strategy may result in a material adverse effect on our financial position, results of operations and c ash flows.

       If we fail to continue to properly maintain the integrity of our data or to strategically implement new information systems, our business could be materially adversely affected.

       Our business depends significantly on effective information systems and the integrity and timeliness of the data we use to run our business. Our business strategy involves providing members and providers with easy to use products that leverage our information to meet their needs. Our ability to adequately price our products and services, provide effective and efficient service to our customers, and to accurately report our financial results depends significantly on the integrity of the data in our information systems. As a result of our past acquisition activities, we have acquired additional systems. We have been taking steps to reduce the number of systems we operate and have upgraded and expanded our information systems capabilities. If the information we rely upon to run our businesses was found to be inaccurate or unreliable or if we fail to maintain effectively our information systems and data integrity, we could have operational disruptions, have pr oblems in determining medical cost estimates and establishing appropriate pricing, have customer and physician and other health care provider disputes, have regulatory problems, have increases in operating expenses, lose existing customers, have difficulty in attracting new customers, or suffer other adverse consequences. Our information systems require an ongoing commitment of significant resources to maintain and enhance existing systems and develop new systems to keep pace with continuing changes in information processing technology, evolving industry and regulatory standards, and changing customer preferences. For example, the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, or HIPAA, requires changes to our current systems.

       We depend on independent third parties for significant portions of our systems-related support, equipment, facilities, and certain data, including data center operations, data network, voice communication services and pharmacy data processing. This dependence makes our operations vulnerable to such third parties' failure to perform adequately under the contract, due to internal or external factors. Although there are a limited number of service organizations with the size, scale and capabilities to effectively provide certain of these services, especially with regard to pharmacy benefits processing and management, we believe that other organizations could provide similar services on comparable terms. A change in service providers, however, could result in a decline in service quality and effectiveness or less favorable contract terms which could adversely affect our operating results.

       There can be no assurance that our process of improving existing systems, developing new systems to support our operations and improving service levels will not be delayed or that additional systems issues will not arise in the future. Failure to adequately maintain the integrity of our information systems and data may result in a material adverse effect on our financial positions, results of operations and cash flows.

       If we do not design and price our products properly and competitively, our membership and profitability could decline.

       We are in a highly competitive industry. Many of our competitors are more established in the health care industry and have a larger market share and greater financial resources than we do in some markets. In addition, other companies may enter our markets in the future. Contracts for the sale of commercial products are generally bid upon or renewed annually. While health plans compete on the basis of many factors, including service and the quality and depth of provider networks, we expect that price will continue to be a significant basis of competition. In addition to the challenge of controlling health care costs, we face competitive pressure to contain premium prices.

       Premium increases, introduction of new product designs, and our relationship with our providers in various markets, among others, could affect our membership levels. Other actions that could affect membership levels include the possible exit of Medicare+Choice service and the exit of commercial products in some markets. If we do not compete effectively in our markets, if membership does not increase as we expect, or if it declines, or if we lose accounts with favorable medical cost experience while retaining accounts with unfavorable medical cost experience, our business and results of operations could be materially adversely affected.

       If we fail to manage prescription drug costs successfully, our financial results could suffer.

       In general, prescription drug costs have been rising over the past few years. These increases are due to the introduction of new drugs costing significantly more than existing drugs, direct consumer advertising by the pharmaceutical industry that creates consumer demand for particular brand-name drugs, and members seeking medications to address lifestyle changes. In order to control prescription drug costs, we have implemented multi-tiered copayment benefit designs for prescription drugs, including our four-tiered copayment benefit design, Rx4. We are also evaluating other multi-tiered designs. We cannot assure that these efforts will be successful in controlling costs. Failure to control these costs could have a material adverse effect on our financial position, results of operations and cash flows.

       We are involved in various legal actions, which, if resolved unfavorably to us, could result in substantial monetary damages.

       We are a party to a variety of legal actions that affect our business, including employment and employment discrimination-related suits, employee benefit claims, breach of contract actions, tort claims and shareholder suits involving alleged securities fraud.

       We and some of our competitors in the health benefits business are defendants in a number of purported class action lawsuits. These include an action against us and nine of our competitors that purports to be brought on behalf of health care providers. This suit alleges breaches of federal statutes, including ERISA and RICO.

       In addition, because of the nature of the health care business, we are subject to a variety of legal actions relating to our business operations, including the design, management and offering of products and services. These include and could include in the future:

       In some cases, substantial non-economic or punitive damages as well as treble damages under the federal False Claims Act, RICO and other statutes may be sought. While we currently have insurance coverage for some of these potential liabilities, other potential liabilities may not be covered by insurance, insurers may dispute coverage or the amount of insurance may not be enough to cover the damages awarded.

       In addition, some types of damages, like punitive damages, may not be covered by insurance, particularly in those jurisdictions in which coverage of punitive damages is prohibited. Insurance coverage for all or some forms of liability may become unavailable or prohibitively expensive in the future.

       A description of material legal actions in which we are currently involved is included under "Legal Proceedings" of Item 1 in Part II. We cannot predict the outcome of these suits with certainty, and we are incurring expenses in the defense of these matters. In addition, recent court decisions, including some that may erode protections under the Employee Retirement Income Security Act, or ERISA, and legislative activity may increase our exposure for any of these types of claims. Therefore, these legal actions could have a material adverse effect on our financial position, results of operations and cash flows.

       Increased litigation and negative publicity could increase our cost of doing business.

       The managed care industry continues to receive significant negative publicity reflecting the public perception of the industry. This publicity and perception have been accompanied by increased litigation, including some large jury awards, legislative activity, regulation and governmental review of industry practices. These factors may adversely affect our ability to market our products or services, may require us to change our products or services, may increase the regulatory burdens under which we operate and may require us to pay large judgments or fines. Any combination of these factors could further increase our cost of doing business and adversely affect our financial position, results of operations and cash flows.

       As a government contractor, we are exposed to additional risks that could adversely affect our business or our willingness to participate in government health care programs.

       A significant portion of our revenues relates to federal, state and local government health care coverage programs, including the TRICARE, Medicare+Choice, and Medicaid programs. These programs involve various risks, including:

       Our industry is currently subject to substantial government regulation, which, along with possible increased governmental regulation or legislative reform, increases our costs of doing business and could adversely affect our profitability.

       The health care industry in general, and health management organizations, or HMOs, and preferred provider organizations, or PPOs, in particular, are subject to substantial federal and state government regulation, including:

       State regulations require our licensed, operating subsidiaries to maintain minimum net worth requirements and restrict some investment activities. Additionally, those regulations restrict the ability of our subsidiaries to make dividend payments, loans, loan repayments or other payments to us.

       In recent years, significant federal and state legislation affecting our business has been enacted. State and federal governmental authorities are continually considering changes to laws and regulations applicable to us and are currently considering regulations relating to:

       All of these proposals could apply to us.

       There can be no assurance that we will be able to continue to obtain or maintain required governmental approvals or licenses or that legislative or regulatory changes will not have a material adverse effect on our business. Delays in obtaining or failure to obtain or maintain required approvals, or moratoria imposed by regulatory authorities, could adversely affect our revenue or the number of our members, increase costs or adversely affect our ability to bring new products to market as forecasted.

       The National Association of Insurance Commissioners, or NAIC, has adopted risk-based capital requirements, also known as RBC, which is subject to state-by-state adoption and to the extent implemented, sets minimum capitalization requirements for insurance and HMO companies. The NAIC recommendations for life insurance companies were adopted in all states and the prescribed calculation for HMOs has been adopted in most states in which we operate. The HMO rules may increase the minimum capital required for some of our subsidiaries.

       The Health Insurance Portability and Accountability Act of 1996, or HIPAA, includes administrative provisions directed at simplifying electronic data interchange through standardizing transactions, establishing uniform health care provider, payer and employer identifiers and seeking protections for confidentiality and security of patient data. Under the new HIPAA standard transactions and code sets rules, we must make significant systems enhancements and invest in new technological solutions. The compliance date for standard transactions and code sets rules has been extended to October 17, 2003 based on our submission of a compliance plan, including work plan and implementation strategy to the Secretary of Health and Human Services. If entities with which we do business do not timely comply with HIPAA's transactions and code set standards, it could result in disruptions of certain of our business operations. Under the new HIPAA privacy rules, which became effectiv e on April 14, 2003 we must now comply with a variety of requirements concerning the use and disclosure of individuals' protected health information, establish rigorous internal procedures to protect health information and enter into business associate contracts with those companies to whom protected health information is disclosed. Regulations issued in February 2003 set standards for the security of electronic health information requiring compliance by April 21, 2005. Violations of these rules will subject us to significant penalties. Compliance with HIPAA regulations requires significant systems enhancements, training and administrative effort. The final rules do not provide for complete federal preemption of state laws, but rather preempt all inconsistent state laws unless the state law is more stringent. HIPAA could also expose us to additional liability for violations by our business associates.

       Another area receiving increased focus is the time in which various laws require the payment of health care claims. Many states already have legislation in place covering payment of claims within a specific number of days. However, due to provider groups advocating for laws or regulations establishing even stricter standards, procedures and penalties, we expect additional regulatory scrutiny and supplemental legislation with respect to claims payment practices. The provider-sponsored bills are characterized by stiff penalties for late payment, including high interest rates payable to providers and costly fines levied by state insurance departments and attorneys general. This legislation and possible future regulation and oversight could expose our Company to additional liability and penalties.

       On November 21, 2000, the Department of Labor published its final regulation on claims and appeals review procedures under ERISA. The claims procedure regulation applies to all employee benefit plans governed by ERISA, whether benefits are provided through insurance products or are self-funded. As a result, the new claims and appeals review regulation impacts nearly all employer and union-sponsored health and disability plans, except church and government plans. Similar to legislation recently passed by many states, the new ERISA claims and appeals procedures impose shorter and more detailed procedures for processing and reviewing claims and appeals. According to the Department of Labor, however, its ERISA claims and appeals regulation does not preempt state insurance and utilization review laws that impose different procedures or time lines, unless complying with the state law would make compliance with the new ERISA regulation impossible. Unlike its state counte rparts, the ERISA claims and appeals rules do not provide for independent external review to decide disputed medical questions. Instead, the federal regulation will generally make it easier for claimants to avoid state-mandated internal and external review processes and to file suit in federal court. Health plans have been subject to the new rules with respect to all claims filed on or after January 1, 2003.

       Legislative proposals have recently been passed by both houses under separate bills to add a prescription drug benefit to Medicare and increase private competition for the program. Each proposal is projected to cost approximately $400 billion over ten years and, as proposed, would subsidize prescription medications for beneficiaries beginning in 2006. The two houses must now negotiate their differences in a conference committee. The House version includes upfront Medicare+Choice (M+C) stabilization funding provisions for plans in 2004 and 2005. In addition to improving M+C funding in the short-term, these provisions will improve the benchmark for government payment for PPOs that bid under the new program proposed for 2006. The Senate bill includes some stabilization funds for 2005. There is substantial uncertainty regarding the passage of a final bill and we are unable to predict the provisions of any final bill which would emerge from the Conference Committee or its impact on our financial position, results of operations or cash flows.

       We are also subject to various governmental audits and investigations. These can include audits and investigations by state attorneys general, CMS, the Office of the Inspector General of Health and Human Services, the Office of Personnel Management, the Department of Justice and state Departments of Insurance and Departments of Health. These activities could result in the loss of licensure or the right to participate in various programs, or the imposition of fines, penalties and other sanctions. In addition, disclosure of any adverse investigation or audit results or sanctions could negatively affect our reputation in various markets and make it more difficult for us to sell our products and services.

       If we fail to maintain satisfactory relationships with the providers of care to our members, our business could be adversely affected.

       We contract with physicians, hospitals and other providers to deliver health care to our members. Our products encourage or require our customers to use these contracted providers. These providers may share medical cost risk with us or have financial incentives to deliver quality medical services in a cost-effective manner.

       In any particular market, providers could refuse to contract with us, demand higher payments, or take other actions that could result in higher health care costs for us, less desirable products for customers and members or difficulty meeting regulatory or accreditation requirements. In some markets, some providers, particularly hospitals, physician/hospital organizations or multi-specialty physician groups, may have significant market positions and negotiating power. In addition, physician or practice management companies, which aggregate physician practices for administrative efficiency and marketing leverage, may, in some cases, compete directly with us. If these providers refuse to contract with us, use their market position to negotiate favorable contracts or place us at a competitive disadvantage, our ability to market products or to be profitable in those areas could be adversely affected.

       In some situations, we have contracts with individual or groups of primary care physicians for an actuarially determined, fixed, per-member-per-month fee under which physicians are paid an amount to provide all required medical services to our members (i.e. capitation). The inability of providers to properly manage costs under these capitation arrangements can result in the financial instability of these providers and the termination of their relationship with us. In addition, payment or other disputes between a primary care provider and specialists with whom the primary care provider contracts can result in a disruption in the provision of services to our members or a reduction in the services available to our members. The financial instability or failure of a primary care provider to pay other providers for services rendered could lead those other providers to demand payment from us, even though we have made our regular fixed payments to the primary provider. Th ere can be no assurance that providers with whom we contract will properly manage the costs of services, maintain financial solvency or avoid disputes with other providers. Any of these events could have an adverse effect on the provision of services to our members and our operations.

       Our ability to obtain funds from our subsidiaries is restricted.

       Because we operate as a holding company, we are dependent upon dividends and administrative expense reimbursements from our subsidiaries to fund the obligations of Humana Inc., the parent company. These subsidiaries generally are regulated by state Departments of Insurance. In most states, we are required to seek prior approval by these state regulatory authorities before we transfer money or pay dividends from these subsidiaries that exceed specified amounts, or, in some states, any amount. In addition, we normally notify the state Departments of Insurance prior to making payments that do not require approval. We are also required by law to maintain specific prescribed minimum amounts of capital in these subsidiaries. One TRICARE subsidiary under the Regions 3 and 4 contract with the Department of Defense is required to maintain assets at least equivalent to its current liabilities.

 

 

Item 3. Quantitative and Qualitative Disclosure about Market Risk

 

       We are exposed to market risks, such as changes in interest rates. To manage the volatility relating to these exposures, we net the exposures on a consolidated basis to take advantage of natural offsets. A portion of our natural offsets changed when we issued $300 million 71/4% senior notes during 2001. This change was mitigated when we entered into interest rate swap agreements as discussed in Management's Discussion and Analysis herein. Changes in the fair value of the 71/4% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness.

       No material changes have occurred in our exposures to market risk since the date of our Annual Report on Form 10-K for the fiscal year ended December 31, 2002.

 

Item 4. Controls and Procedures

       We carried out an evaluation, under the supervision and with the participation of our Chief Executive Officer, or CEO, and Chief Financial Officer, or CFO, of the effectiveness of the design and operation of our disclosure controls and procedures including our internal controls over financial reporting for the quarter ended June 30, 2003.

       The company's management, including the CEO and CFO, does not expect that our disclosure controls and procedures including our internal controls over financial reporting will prevent all error and all fraud. However, they have been designed to give reasonable assurance about the effectiveness of the design and operation of our disclosure controls and procedures including our internal controls over financial reporting. A control system, no matter how well conceived and operated, can provide only reasonable, not absolute assurance that the objectives of the control system are met. Further, the design of a control system must reflect the fact that there are resource constraints, and the benefits of controls must be considered relative to their costs. Control system limitations include the realities that judgments in decision-making can be faulty, and that breakdowns can occur because of simple error or mistake. Additionally, controls can be circumvented by the indiv idual acts of some persons, by collusion of two or more people, or by management override of the control. The design of any system of controls also is based in part upon certain assumptions about the likelihood of future events. Over time, control may become inadequate because of changes in conditions, or the degree of compliance with the policies or procedures may deteriorate. Because of the inherent limitations in a cost-effective control system, misstatements due to error or fraud may occur and not be detected.

       Based on this evaluation, our CEO and CFO concluded that our disclosure controls and procedures including our internal controls over financial reporting are effective in timely alerting them to material information required to be included in our periodic SEC reports. There have been no significant changes in our internal controls over financial reporting or in other factors that are reasonably likely to affect those controls over financial reporting during the Company's quarter ended June 30, 2003.

 

 

 

Part II. Other Information

 

Item 1: Legal Proceedings

       Securities Litigation

       In late 1997, three purported class action complaints were filed in the United States District Court for the Southern District of Florida by former stockholders of Physician Corporation of America, or PCA, against PCA and certain of its former directors and officers. We acquired PCA by a merger that became effective on September 8, 1997. The three actions were consolidated into a single action entitled In re Physician Corporation of America Securities Litigation. The consolidated complaint alleges that PCA and the individual defendants knowingly or recklessly made false and misleading statements in press releases and public filings with respect to the financial and regulatory difficulties of PCA's workers' compensation business. On July 24, 2002, the Court denied the defendants' motion for summary judgement. On May 20, 2003, the Court granted the plaintiffs' motion for class certification. On June 4, 2003, the defendants requested the Court of Appeals f or the Eleventh Circuit to grant permission to appeal the class certification order. Thereafter, the parties reached agreement to settle the case for the amount of $10.2 million. The settlement has been reflected in our financial statements as of June 30, 2003. The settlement agreement is subject to notice to the class and approval by the Court. The Company has pursued insurance coverage for this matter from two insurers, each of which has denied coverage. On April 23, 2003, one of the insurers filed a complaint in the United States District Court for the Southern District of Florida seeking, in effect, a declaration of the responsibilities of the two insurers. The Company intends to continue to pursue the insurance proceeds.

       Managed Care Industry Purported Class Action Litigation

       We have been involved in several purported class action lawsuits that are part of a wave of generally similar actions that target the health care payer industry and particularly target managed care companies. As a result of action by the Judicial Panel on Multi District Litigation, most of the cases against us, as well as similar cases against other companies in the industry, were consolidated in the United States District Court for the Southern District of Florida, and have been styled In re Managed Care Litigation. The cases included separate suits against us and five other managed care companies that purported to have been brought on behalf of members, which have been referred to as the subscriber track cases, and a single action against us and nine other companies that purports to have been brought on behalf of providers, which is referred to as the provider track case.

       In the subscriber track cases, the plaintiffs sought a recovery under the Racketeer Influenced and Corrupt Organizations Act, or RICO, for all persons who were subscribers at any time during the four-year period prior to the filing of the complaints. Plaintiffs also sought to represent a subclass of policyholders who purchased insurance through their employers' health benefit plans governed by ERISA, and who were subscribers at any time during the six-year period prior to the filing of the complaints. The complaints allege, among other things, that we intentionally concealed from members certain information concerning the way in which we conduct business, including the methods by which we pay providers. The plaintiffs did not allege that any of the purported practices resulted in denial of any claim for a particular benefit, but instead, claimed that we provided the purported class with health insurance benefits of lesser value than promised. The complaints also a llege an industry-wide conspiracy to engage in the various alleged improper practices.

       On September 26, 2002, the Court denied the plaintiffs' request for class certification. On October 9, 2002, the plaintiffs asked the Court to reconsider its ruling on that issue. The Court denied the motion on November 25, 2002. Thereafter, we entered into a settlement arrangement with the two named plaintiffs pursuant to which we paid each $8,000. The Court entered an order dismissing the subscriber track cases with prejudice on May 19, 2003.

       In the provider track case, the plaintiffs assert that we and other defendants improperly paid providers' claims and "downcoded" their claims by paying lesser amounts than they submitted. The complaint alleges, among other things, multiple violations under RICO as well as various breaches of contract and violations of regulations governing the timeliness of claim payments. We moved to dismiss the provider track complaint on September 8, 2000, and the other defendants filed similar motions thereafter. On March 2, 2001, the Court dismissed certain of the plaintiffs' claims pursuant to the defendants' several motions to dismiss. However, the Court allowed the plaintiffs to attempt to correct the deficiencies in their complaint with an amended pleading with respect to all of the allegations except a claim under the federal Medicare regulations, which was dismissed with prejudice. The Court also left undisturbed the plaintiffs' claims for breach of contract. On March 2 6, 2001, the plaintiffs filed their amended complaint, which, among other things, added four state or county medical associations as additional plaintiffs. Two of those, the Denton County Medical Society and the Texas Medical Association, purport to bring their actions against us, as well as against several other defendant companies. The Medical Association of Georgia and the California Medical Association purport to bring their actions against various other defendant companies. The associations seek injunctive relief only. The defendants filed a motion to dismiss the amended complaint on April 30, 2001.

       On September 26, 2002, the Court granted the plaintiffs' request to file a second amended complaint, adding additional plaintiffs, including the Florida Medical Association, which purports to bring its action against all defendants. On October 21, 2002, the defendants moved to dismiss the second amended complaint. The Court has not yet ruled on that motion.

       Also on September 26, 2002, the Court certified a global class consisting of all medical doctors who provided services to any person insured by any defendant from August 4, 1990, to September 30, 2002. The class includes two subclasses. A national subclass consists of medical doctors who provided services to any person insured by a defendant when the doctor has a claim against such defendant and is not required to arbitrate that claim. A California subclass consists of medical doctors who provided services to any person insured in California by any defendant when the doctor was not bound to arbitrate the claim. On October 10, 2002, the defendants asked the Court of Appeals for the Eleventh Circuit to review the class certification decision. On November 20, 2002, the Court of Appeals agreed to review the class issue. Oral argument has been scheduled before the appellate court on September 11, 2003. The District Court has ruled that discovery can proceed during the pendency of the request to the Eleventh Circuit, and the Eleventh Circuit rejected a request to halt discovery.

       The Court has set a trial date of June 30, 2004. In the meantime, one of the defendants, Aetna Inc., announced on May 22, 2003, that it has entered into a settlement agreement with the plaintiffs. The agreement has been filed with the Court and is subject to approval by the Court.

       Other

       The Academy of Medicine of Cincinnati, the Butler County Medical Society, the Northern Kentucky Medical Society and several physicians have filed antitrust suits in state courts in Ohio and Kentucky against Aetna Health, Inc., Humana Health Plan of Ohio, Inc., Anthem Blue Cross Blue Shield, and United Healthcare of Ohio, Inc., alleging that the defendants have violated the Ohio and Kentucky antitrust laws by conspiring to fix the reimbursement rates paid to physicians in the Greater Cincinnati and Northern Kentucky region. Each suit seeks class certification, damages and injunctive relief. Plaintiffs cite no evidence that any such conspiracy existed, but base their allegations on assertions that physicians in the Greater Cincinnati region are paid less than physicians in other major cities in Ohio and Kentucky.

       The state courts in Ohio and Kentucky each have denied motions by the defendants to compel arbitration or alternatively to dismiss. Defendants have filed notices of appeal with respect to the orders denying arbitration. The Ohio court has agreed to stay proceedings pending resolution of the appeal. The Kentucky court granted a similar request with respect to the physician plaintiffs who are subject to arbitration agreements, but denied the requested stay with respect to the association plaintiffs and any physician plaintiffs whose contracts do not contain arbitration provisions. Defendants requested a stay from the Kentucky Court of Appeals pending appeal of the arbitration issue. The Court of Appeals denied the stay, and discovery has begun in the Kentucky action. The plaintiffs have filed motions to certify a class in each case. The purported classes allegedly consist of all physicians who have practiced medicine at any time since January 1, 1992, in a four coun ty region in Southwestern Ohio or a three county region in Northern Kentucky.

       We intend to continue to defend these actions vigorously.

       Government Audits and Other Litigation and Proceedings

       In July 2000, the Office of the Florida Attorney General initiated an investigation, apparently relating to some of the same matters that are involved in the managed care industry purported class action litigation described above. On September 21, 2001, the Texas Attorney General initiated a similar investigation. No actions have been filed against us by either state. These investigations are ongoing, and we have cooperated with the regulators in both states.

       On May 31, 2000, we entered into a five-year Corporate Integrity Agreement, or CIA, with the Office of Inspector General, or OIG, of the Department of Health and Human Services. Under the CIA, we are obligated to, among other things, provide training, conduct periodic audits and make periodic reports to the OIG.

       In addition, our business practices are subject to review by various state insurance and health care regulatory authorities and federal regulatory authorities. There has been increased scrutiny by these regulators of the managed health care companies' business practices, including claims payment practices and utilization management practices. We have been and continue to be subject to such reviews. Some of these have resulted in fines and could require changes in some of our practices and could also result in additional fines or other sanctions.

       We also are involved in other lawsuits that arise in the ordinary course of our business operations, including claims of medical malpractice, bad faith, nonacceptance or termination of providers, failure to disclose network discounts and various other provider arrangements, and challenges to subrogation practices. We also are subject to claims relating to performance of contractual obligations to providers, members, and others, including failure to properly pay claims and challenges to the use of certain software products in processing claims. Pending state and federal legislative activity may increase our exposure for any of these types of claims.

       In addition, some courts recently have issued decisions which could have the effect of eroding the scope of ERISA preemption for employer-sponsored health plans, thereby exposing us to greater liability for medical negligence claims. This includes decisions which hold that plans may be liable for medical negligence claims in some situations based solely on medical necessity decisions made in the course of adjudicating claims. In addition, some courts have issued rulings which make it easier to hold plans liable for medical negligence on the part of network providers on the theory that providers are agents of the plans and that the plans are therefore vicariously liable for the injuries to members by providers.

       Personal injury claims and claims for extracontractual damages arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future. On January 1, 2002, and again on January 1, 2003, we reduced the amount of coverage purchased from third party insurance carriers and increased the amount of risk we retain due to substantially higher insurance rates.

       We do not believe that any pending or threatened legal actions against us or any pending or threatened audits or investigations by state or federal regulatory agencies will have a material adverse effect on our financial position, results of operations, or cash flows. However, the likelihood or outcome of current or future suits, like the purported class action lawsuits described above, or governmental investigations, cannot be accurately predicted with certainty. In addition, the increased litigation, which has accompanied the negative publicity and public perception of our industry, adds to this uncertainty. Therefore, such legal actions and governments audits and investigations could have a material adverse effect on our financial position, results of operations and cash flows.

 

Part II. Other Information, continued

 

Item 2:

 

Changes in securities

None.

Item 3:

Defaults Upon Senior Securities

None.

Item 4:

Submission of Matters to a Vote of Security Holders

(a)

The regular annual meeting of the stockholders of Humana Inc. was held in Louisville, Kentucky on May 15, 2003, for the purpose of voting on the proposals described below.

(b)

Proxies for the meeting were solicited pursuant to Section 14(a) of the Securities Exchange Act of 1934 and there was no solicitation in opposition to management's nominees for directors. All of management's nominees for directors were elected as set forth in clause (c) below.

(c)

Three proposals were submitted to a vote of security holders as follows:

(1)

The stockholders approved the election of the following persons as directors of the Company:

Name

For

Withheld

David A. Jones

138,252,796

5,136,942

David A. Jones, Jr.

95,408,922

47,980,816

Michael E. Gellert

138,326,316

5,063,422

John R. Hall

138,330,327

5,059,411

Irwin Lerner

138,411,554

4,978,184

Michael B. McCallister

139,990,080

3,399,658

W. Ann Reynolds, Ph.D.

139,997,514

3,392,224

(2)

The Company's 2003 Stock Incentive Plan was approved by the affirmative votes of shareholders:

For

Against

Abstain

126,212,176

16,051,396

1,126,166

(3)

The Company's 2003 Executive Management Incentive Compensation Plan was approved by the affirmative votes of shareholders:

For

Against

Abstain

132,505,687

9,632,727

1,251,324

 

 

 

Item 5:

 

Other Information

In July 2003, the Company appointed Kurt J. Hilzinger to its Board of Directors.

 

Part II. Other Information, continued

 

 

 

 

Item 6:

 

Exhibits and Reports on Form 8-K

(a)

Exhibit Index:

   12

Computation of ratio of earnings to fixed charges.

 

 

   31.1

CEO certification pursuant to Section 302 of Sarbanes - Oxley Act of 2002.

 

 

   31.2

CFO certification pursuant to Section 302 of Sarbanes - Oxley Act of 2002.

 

 

   32

CEO and CFO certification pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes - Oxley Act of 2002.

 

 

(b)

For the quarter ended June 30, 2003, and through the date of this report, we furnished reports on Form 8-K on April 28, 2003 regarding our first quarter's earnings release and on July 28, 2003 regarding our second quarter's earnings release.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

Humana Inc.

 

(Registrant)

Date:

July 28, 2003

By:

/s/ James H. Bloem

 

 

 

James H. Bloem

 

 

 

Senior Vice President

 

 

 

And Chief Financial Officer

 

 

 

(Principal Accounting Officer)

Date:

July 28, 2003

By:

/s/ Arthur P. Hipwell

 

 

 

Arthur P. Hipwell

 

 

 

Senior Vice President and

 

 

 

General Counsel