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UNITED
STATES
SECURITIES AND
EXCHANGE COMMISSION
Washington, D.C.
20549
Form
10-K
þ ANNUAL REPORT
PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES
EXCHANGE ACT OF 1934
For the fiscal
year ended December 31, 1999
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 of
incorporation) |
|
(I.R.S.
Employer |
|
|
Identification
Number) |
500 West Main
Street |
|
|
Louisville,
Kentucky |
|
40202 |
(Address of
principal executive offices) |
|
(Zip
Code) |
Registrants
telephone number, including area code: 502-580-1000
Securities
registered pursuant to Section 12(b) of the Act:
Title of each
class
|
|
Name of each
exchange on which registered
|
Common Stock,
$0.16 2
/3 par value
|
|
New York Stock
Exchange |
Securities
registered pursuant to Section 12(g) of the Act:
None
Indicate by check mark whether the
registrant (1) has filed all reports required to be filed by Section 13 or
15(d) of the Securities Exchange Act of 1934 during the preceding 12 months
(or for such shorter period that the Registrant was required to file such
reports), and (2) has been subject to such filing requirements for the past
90 days. Yes þ
No ¨
Indicate by check mark if
disclosure of delinquent filers pursuant to Item 405 of the Regulation S-K
is not contained herein, and will not be contained, to the best of Registrant
s knowledge, in the Registrants definitive proxy or information
statements incorporated by reference in Part III of this Form 10-K or any
amendment to this Form 10-K.
The aggregate market value of
voting stock held by non-affiliates of the Registrant as of March 1, 2000
was $1,145,376,612 calculated using the average price on such date of $7.25.
The number of shares outstanding of the Registrants Common Stock as of
March 1, 2000 was 167,752,710.
DOCUMENTS
INCORPORATED BY REFERENCE
Portions of Part II and Part IV
incorporate herein by reference the Registrants 1999 Annual Report to
Stockholders; Part III incorporates herein by reference portions of the
Registrants Proxy Statement filed pursuant to Regulation 14A covering
the Annual Meeting of Stockholders scheduled to be held May 18,
2000.
HUMANA
INC.
INDEX TO ANNUAL
REPORT ON FORM 10-K
For the Year Ended
December 31, 1999
PART
I
General
Humana Inc. is a Delaware
corporation organized in 1961. Its principal executive offices are located
at 500 West Main Street, Louisville, Kentucky 40202 and its telephone number
at that address is (502) 580-1000. As used herein, the terms the
Company or Humana include Humana Inc. and its
subsidiaries. This Annual Report on Form 10-K contains both historical and
forward-looking information. The forward-looking statements may be
significantly impacted by risks and uncertainties and are made pursuant to
the safe harbor provisions of the Private Securities Litigation Reform Act
of 1995. There can be no assurance that anticipated future results will be
achieved because actual results may differ materially from those projected
in the forward-looking statements. Readers are cautioned that a number of
factors, which are described herein, could adversely affect the Company
s ability to obtain these results. These include the effects of either
federal or state health care reform or other legislation, including the
Patients Bill of Rights Act, any changes in the Medicare
reimbursement system, the ability of health care providers (including
physician practice management companies) to comply with current contract
terms, renewal of the Companys Medicare contracts with the federal
government, renewal of the Companys contract with the federal
government to administer the TRICARE program and renewal of the Company
s Medicaid contracts with various state governments and the Health
Insurance Administration in Puerto Rico. Such factors also include the
effects of other general business conditions, including but not limited to,
the success of the Companys improvement initiatives including its
electronic business strategies, premium rate and yield changes,
retrospective premium adjustments relating to federal government contracts,
changes in commercial and Medicare HMO membership, medical and pharmacy cost
trends, compliance with debt covenants, changes in the Companys debt
rating and its ability to borrow under its commercial paper program,
operating subsidiary capital requirements, competition, general economic
conditions and the retention of key employees. In addition, the Company and
the managed care industry as a whole are experiencing increased litigation,
including alleged class action suits challenging various managed care
practices and suits seeking significant punitive damages awards. (See
Legal Proceedings section for a description of the Companys
significant litigation.) Past financial performance is not necessarily a
reliable indicator of future performance and investors should not use
historical performance to anticipate results or future period
trends.
Since 1983, the Company has been a
health services company that facilitates the delivery of health care
services through networks of providers to its approximately 5.9 million
medical members. The Companys products are marketed primarily through
health maintenance organizations (HMOs) and preferred provider
organizations (PPOs) that encourage or require the use of
contracted providers. HMOs and PPOs control health care costs by various
means, including pre-admission approval for hospital inpatient services,
pre-authorization of outpatient surgical procedures and risk-sharing
arrangements with providers. These providers may share medical cost risk or
have incentives to deliver quality medical services in a cost-effective
manner. The Company also offers various specialty products to employers,
including dental, group life and workers compensation, and
administrative services (ASO) to those who self-insure their
employee health plans. The Company has entered into a definitive agreement
to sell its workers compensation business. In total, the Company
s products are licensed in 49 states, the District of Columbia and
Puerto Rico, with approximately 20 percent of its membership in the state of
Florida.
Acquisitions and
Dispositions
Between December 30, 1999 and
February 4, 2000, the Company entered into definitive agreements to sell its
workers compensation, Medicare supplement and North Florida Medicaid
businesses for proceeds of approximately $115 million. The Company recorded
a $118 million loss in 1999 related to these sale transactions.
On January 31, 2000, the Company
acquired the Memorial Sisters of Charity Health Network (MSCHN),
a Houston based health plan for approximately $50 million in
cash.
On June 1, 1999, the Company
reached an agreement with FPA Medical Management, Inc. (FPA), FPA
s lenders and a federal bankruptcy court under which the Company
acquired the operations of 50 medical centers from FPA for approximately $14
million in cash. The Company has subsequently reached agreements with 14
provider groups to assume operating responsibility for 38 of the 50 acquired
FPA medical centers under long-term provider agreements with the
Company.
On October 17, 1997, the Company
acquired ChoiceCare Corporation (ChoiceCare) for approximately
$250 million in cash. The purchase was funded with borrowings under the
Companys commercial paper program. ChoiceCare provided health services
products to members in the Greater Cincinnati, Ohio, area.
On September 8, 1997, the Company
acquired Physician Corporation of America (PCA) for total
consideration of $411 million in cash, consisting primarily of $7 per share
for PCAs outstanding common stock and the assumption of $121 million
in debt. The purchase was funded with borrowings under the Companys
commercial paper program. PCA provided comprehensive health services through
its HMOs in Florida, Texas and Puerto Rico. In addition, PCA provided workers
compensation third-party administrative management services. Prior to
November 1996, PCA also was a direct writer of workers compensation
insurance in Florida. Long-term medical and other expenses payable in the
accompanying Consolidated Balance Sheets includes the long-term portion of
workers compensation liabilities related to this business.
On February 28, 1997, the Company
acquired Health Direct, Inc. (Health Direct) from Advocate
Health Care for approximately $23 million in cash.
Business
Segments
During 1999, the Company realigned
its organization to achieve greater accountability in its lines of business.
As a result of this realignment, the Company organized into two business
units: the Health Plan segment and the Small Group segment. The Health Plan
segment includes the Companys large group commercial (100 employees
and over), Medicare, Medicaid, ASO, workers compensation and military
or TRICARE business. The Company has entered into a definitive agreement to
sell its workers compensation business. The Small Group segment
includes small group commercial (under 100 employees) and specialty benefit
lines, including dental, life and short-term disability. Results of each
segment are measured based upon results of operations before income taxes.
The Company allocates administrative expenses, interest income and interest
expense, but no assets, to the segments. Members served by the two segments
generally utilize the same medical provider networks, enabling the Company
to obtain more favorable contract terms with providers. As a result, the
profitability of each segment is somewhat interdependent. In addition,
premium revenue pricing to large group commercial employers has historically
been more competitive than that to small group commercial employers,
resulting in less favorable underwriting margins for the large group
commercial line of business. Costs to distribute and administer products to
small group commercial employers are higher compared to large group
commercial employers resulting in small groups higher administrative
expense ratio.
The following table presents the
Companys segment membership and premium revenues by product for the
year ended December 31, 1999:
(Dollars in
millions) |
|
Ending
Medical
Membership
|
|
Ending
Specialty
Membership
|
|
Premium
Revenues
|
|
Percent of
Total
Premium
Revenues
|
Health
Plan: |
Large group
commercial |
|
1,420,500 |
|
|
|
$2,348 |
|
23.6 |
% |
Medicare HMO |
|
488,500 |
|
|
|
2,920 |
|
29.3 |
|
Medicaid |
|
616,600 |
|
|
|
603 |
|
6.1 |
|
TRICARE |
|
1,058,000 |
|
29,800 |
|
866 |
|
8.7 |
|
ASO, workers compensation
and Medicare supplement |
|
692,500 |
|
447,100 |
|
90 |
|
0.9 |
|
|
|
|
|
|
|
|
|
|
|
Total Health Plan |
|
4,276,100 |
|
476,900 |
|
6,827 |
|
68.6 |
|
|
|
|
|
|
|
|
|
|
|
Small
Group: |
Small group
commercial |
|
1,663,100 |
|
|
|
2,882 |
|
28.9 |
|
Specialty |
|
|
|
2,484,400 |
|
250 |
|
2.5 |
|
|
|
|
|
|
|
|
|
|
|
Total Small Group |
|
1,663,100 |
|
2,484,400 |
|
3,132 |
|
31.4 |
|
|
|
|
|
|
|
|
|
|
|
Total |
|
5,939,200 |
|
2,961,300 |
|
$9,959 |
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
Large and Small
Group Commercial HMO and PPO Products
An HMO facilitates the delivery of
prepaid health care services to its members through a network of independent
primary care physicians, specialty physicians and other health care
providers who contract with the HMO to furnish such services. Primary care
physicians generally include internists, family practitioners and
pediatricians. Generally, access to specialty physicians and other health
care providers must be approved by the members primary care physician.
These other health care providers include, among others, hospitals, nursing
homes, home health agencies, pharmacies, mental health and substance abuse
centers, diagnostic centers, optometrists, outpatient surgery centers,
dentists, urgent care centers and durable medical equipment suppliers.
Because access to these specialty physicians and other health care providers
must generally be approved by the primary care physician, the HMO product is
the most restrictive form of managed care.
As of March 1, 2000, the Company
owned and operated 13 licensed and active HMOs, which contracted with
approximately 62,600 physicians (including approximately 21,100 primary care
physicians) and approximately 940 hospitals. In addition, the Company had
approximately 5,100 contracts with other health care providers to provide
services to HMO members.
An HMO member, typically through
the members employer, pays a monthly fee which generally covers, with
minimal co-payments, health care services received from or approved by the
members primary care physician. For the year ended December 31, 1999,
commercial HMO premium revenues totaled approximately $2.2 billion or 23
percent of the Companys total premium revenues. Approximately $234
million of the Companys commercial HMO premium revenues for the year
ended December 31, 1999 were derived from contracts with the United States
Office of Personnel Management (OPM), under which the Company
facilitates the delivery of health care services through the Federal
Employee Health Benefit Plan (FEHBP) to approximately 135,200
federal civilian employees and their dependents. Pursuant to these
contracts, payments made by OPM may be retrospectively adjusted downward by
OPM if an audit discloses that a comparable product was offered by the
Company to a similar size subscriber group at a lower premium rate than that
offered to OPM. Management believes that any retrospective adjustments as a
result of OPM audits will not have a material impact on the Companys
financial position, results of operations or cash flows.
PPO products include many elements
of managed health care. PPOs are also similar to traditional health
insurance because they provide a member with the freedom to choose a
physician or other health care provider. In a PPO, the member is encouraged,
through financial incentives, to use participating health care providers
which have contracted with the PPO to provide services at favorable rates.
In the event a member chooses not to use a participating health care
provider, the member may be required to pay a greater portion of the provider
s fees.
As of March 1, 2000, approximately
397,000 physicians and approximately 3,400 hospitals contracted directly
with the Company to provide services to PPO members (including the
ChoiceCare Network described below). The Company also had approximately
5,000 contracts (including certain contracts which also service the Company
s HMOs) with other providers to provide services to PPO members. In
addition, the Company had access to 24 leased provider networks throughout
the country. During 1999, the Company assumed the operational control of a
previously leased provider network. This new provider network called the
ChoiceCare Network added approximately 330,000 physicians and other
providers as well as 2,500 hospitals to the Companys PPO
networks.
For the year ended December 31,
1999, commercial PPO premium revenues totaled approximately $3.0 billion or
30 percent of the Companys total premium revenues.
The Company expects that 2000
commercial HMO and PPO premium rates will increase by approximately 10 to 12
percent. Over the last five years, changes in the Companys commercial
HMO and PPO premium rates have ranged between an approximate two percent
decrease for the year ended December 31, 1995, to an approximate six percent
increase for the year ended December 31, 1999, with an average increase of
approximately three percent.
Medicare
Products
Medicare is a federal program that
provides persons age 65 and over and some disabled persons certain hospital
and medical insurance benefits, which include hospitalization benefits for
up to 90 days per incident of illness plus a lifetime reserve aggregating 60
days. Each Medicare-eligible individual is entitled to receive inpatient
hospital care (Part A) without the payment of any premium, but
is required to pay a premium to the federal government, which is adjusted
annually, to be eligible for physician care and other services (Part B
).
Even though participating in both
Part A and Part B of the traditional Medicare program, beneficiaries are
still required to pay certain deductible and coinsurance amounts. They may,
if they choose, supplement their Medicare coverage by purchasing Medicare
supplement policies which pay these deductibles and coinsurance amounts.
Many of these policies also cover other services (such as prescription
drugs) which are not included in Medicare coverage.
Humana contracts with the federal
governments Health Care Financing Administration (HCFA)
under the Medicare+Choice (M+C) program, to facilitate the
delivery of medical benefits in exchange for a fixed monthly payment per
member for Medicare-eligible individuals residing in the geographic areas in
which its HMOs operate. Individuals who elect to participate in these
Medicare programs are relieved of the obligation to pay some or all of the
deductible or coinsurance amounts but are generally required to use
exclusively the services provided by the HMO and are required to pay a Part
B premium to the Medicare program. Generally, the enrollee pays the HMO a
premium only in cases where the HMO provides additional benefits and where
competitive market conditions permit. At December 31, 1999, approximately
48,000 members in six markets were paying premiums, which totaled
approximately $30 million for the year ended December 31, 1999. In January
2000, the Company instituted member premiums in additional markets to offset
the effect of lower HCFA reimbursement rates. During 2000, approximately
229,000 Medicare HMO members in ten markets, or approximately one-half of
the Companys entire Medicare HMO membership, will be paying premiums
totaling approximately $73 million.
A Medicare HMO product involves
a contract between an HMO and HCFA pursuant to which HCFA makes a fixed
monthly payment to the HMO on behalf of each Medicare-eligible individual
who chooses to enroll for coverage in the HMO. Membership may be terminated
by the member at any time during the month. The fixed monthly payment is
determined by formula established by federal law.
As of March 1, 2000, the Company
facilitates the delivery of Medicare HMO services under eight contracts with
HCFA in nine states. HCFA contracts covered approximately 488,500 Medicare
HMO members for which the Company received premium revenues of approximately
$2.9 billion or 29 percent of the Companys total premium revenues for
1999. At December 31, 1999, one such HCFA contract covered approximately
250,000 members in Florida and accounted for premium revenues of
approximately $1.5 billion, which represented 51 percent of the Company
s HCFA premium revenues or 15 percent of the Companys total
premium revenues for the year ended December 31, 1999. HCFA contracts are
renewed for a one-year term each January 1 unless terminated 90 days prior
thereto. Management believes termination of the HCFA contract covering the
members in Florida would have a material adverse effect on the Company
s financial position, results of operations or cash flows.
Future premiums from HCFA will be
impacted by new payment methods being developed by HCFA as more fully
discussed in the Health Care ReformNational section. The Company
s 2000 average rate of statutory increase under the HCFA contracts is
approximately two percent. Over the last five years, annual increases have
ranged from as low as the January 1999 increase of two percent to as high as
nine percent in January 1996, with an average of approximately five percent.
On January 1, 2000, the Company exited 31 counties affecting approximately
46,000 members resulting, in part, from lower HCFA reimbursement rates. The
Company intends to offset the effect of lower HCFA reimbursement rates with
the introduction of member premiums, benefit changes and pursue expansion
opportunities only in markets that meet the Companys long-term growth
strategies.
The loss of the Companys
HCFA contracts or significant changes in the Medicare HMO program as a
result of legislative action, including reductions in payments or increases
in benefits without corresponding increases in payments, would have a
material adverse effect on the Companys financial position, results of
operations or cash flows.
On December 30, 1999, the Company
reached agreement, subject to regulatory approvals, to transfer
substantially all of the Companys 44,500 Medicare supplement policies
to United Teachers Associates Insurance Company. These policies paid for
hospital deductibles, co-payments and coinsurance for which an individual
enrolled in the traditional Medicare program is responsible. For the year
ended December 31, 1999, Medicare supplement premium revenues totaled
approximately $60 million or 1 percent of the Companys total premium
revenues.
Medicaid
Product
Medicaid is a federal program that
is state-operated to facilitate the delivery of health care services to
low-income residents. Each state which chooses to do so develops, through a
state specific regulatory agency, a Medicaid managed care initiative which
must be approved by HCFA. HCFA requires that Medicaid managed care plans
meet federal standards and cost no more than the amount that would have been
spent on a comparable fee-for-service basis. States currently use either a
formal proposal process reviewing many bidders or award individual contracts
to qualified bidders, which apply for entry to the program. In either case,
the contractual relationship with the state is generally for a one-year
period. Management believes that the risks associated with participation in
a state Medicaid managed care program are similar to the risks associated
with the Medicare HMO product discussed previously. In both instances, the
Company receives a fixed monthly payment from a government agency for which
it is required to facilitate the delivery of managed health care services to
enrolled members. Due to the increased emphasis on state health care reform
and budgetary constraints, more states are utilizing a managed care product
in their Medicaid programs.
In 1999, the Company renewed a
two-year contract with the Health Insurance Administration of Puerto Rico to
facilitate the delivery of health care to Medicaid-eligible individuals. On
February 4, 2000, the Company entered into a definitive agreement, subject
to regulatory approvals, to sell its North Florida Medicaid business
covering approximately 94,000 Medicaid members to Well Care HMO, Inc. For
the year ended December 31, 1999, premium revenues from the Companys
Medicaid products totaled approximately $603 million or 6 percent of the
Companys total premium revenues. At December 31, 1999, the Company had
approximately 410,400 and 206,200 Medicaid members in the Commonwealth of
Puerto Rico and in four states, respectively.
TRICARE
In 1993, the Company established
Humana Military Healthcare Services, Inc. (a wholly owned subsidiary of the
Company), to enter into contracts to facilitate the delivery of managed care
services to the dependents of active duty military personnel and retired
military personnel and their dependents. In November 1995, the United States
Department of Defense awarded the Company its first TRICARE contract
covering approximately 1.1 million eligible beneficiaries in Florida,
Georgia, South Carolina, Mississippi, Alabama, Tennessee and Eastern
Louisiana.
On July 1, 1996, the Company began
facilitating the delivery of managed health care services to these
approximate 1.1 million eligible beneficiaries under a potential five-year
contract (a one-year contract renewable annually for one additional year).
The government exercised its option to renew the contract for the year
beginning July 1, 1999. The Company anticipates the government exercising
its option for the year beginning July 1, 2000 which will be the fifth year
of the five-year contract period. The Company is in discussion with the
government concerning two additional one-year renewal periods, however, the
Company is unable to predict if such an extension will be granted. The
Company has subcontracted with third parties to provide certain
administration and specialty services under the contract. Three health
benefit options are available to TRICARE beneficiaries. In addition to a
traditional indemnity option, participants may enroll in an HMO-like plan
with a point-of-service option or take advantage of reduced co-payments by
using a network of preferred providers. TRICARE premium revenues were
approximately $866 million or 9 percent of the Companys total premium
revenues for the year ended December 31, 1999.
The Company will actively seek
opportunities to facilitate the delivery of managed care services to
beneficiaries of federal and state programs, including other TRICARE
contracts.
Other Related
Products
The Company offers various
specialty products to employers, including dental, group life and workers
compensation, and administrative services (ASO) to those
who self-insure their employee health plans. The Company has entered into a
definitive agreement to sell its workers compensation business.
Specialty and ASO membership at December 31, 1999 totaled approximately 3.0
million members and 648,100 members, respectively. Specialty product premium
revenues were approximately $277 million or 3 percent of the Companys
total premiums for the year ended December 31, 1999.
Provider
Arrangements
In certain situations, the Company
s HMOs contract with individual or groups of primary care physicians,
generally for an actuarially determined, fixed, per-member-per-month fee
referred to as a capitation payment. Under these arrangements,
physicians are paid a fixed amount to provide services to their members.
These contracts typically obligate primary care physicians to provide or
make referrals to specialty physicians and other providers for the provision
of all covered managed health care services to HMO members. The capitation
payment does not vary with the nature or extent of services to the member
and is generally designed to shift a portion of the HMOs financial risk to
the primary care physician. The degree to which the Company uses capitation
arrangements varies by provider.
The Company also contracts with
medical specialists and other providers to which a primary care physician
may refer a member. The contracts with specialists may be capitation
arrangements or may provide
for payment on a fee-for-service basis based on negotiated fees. Typically,
payments by the Company to these specialists and other providers reduce the
ultimate payment that otherwise would be made to primary care physicians.
The Companys HMOs also have arrangements under which physicians can
earn bonuses when certain target goals relating to quality and cost
effectiveness in the provision of patient care are met. The Companys
contracts with capitated physicians generally provide for stop-loss coverage
so that a physicians financial risk for any single member is limited
to a certain amount on an annual basis.
The focal point for cost control
in the Companys HMOs is the primary care physician who, under
contract, provides services and controls utilization of appropriate services
by directing or approving hospitalization and referrals to specialists and
other providers. In addition, the Companys Hospital Inpatient
Management System (HIMS) controls costs by allowing specially
trained physicians to manage the entire range of medical care while an HMO
member is in the hospital, and coordinate the members discharge and
care after discharge. Cost control is further achieved by directly
negotiating provider discounts. Cost control in the Companys PPOs is
achieved primarily by establishing a cost-effective network of participating
health care providers and providing incentives for members to use such
providers. These providers are generally paid on a negotiated
fee-for-service basis. With respect to both HMO and PPO products, cost
control is further achieved through the use of a utilization review system
designed to allow only necessary hospital admissions, lengths of stay and
necessary or appropriate medical procedures. The Companys HMOs and
PPOs generally contract for hospital services under per-diem arrangements
for inpatient hospital services and discounted fee-for-service arrangements
for outpatient services. During the year ended December 31, 1999,
approximately 41 percent of the Companys total medical costs were for
services provided to its members in hospitals or related
facilities.
The Company has certain
risk-sharing contracts whereby providers also assume a specified level of
risk for covered managed care services to its members. Under these
risk-sharing arrangements, referred to as global capitation contracts,
providers are paid a monthly capitation payment per covered member to assume
risk for all managed care services including professional and institutional
(i.e. hospital) costs. The capitation payments are based on a specified
percentage of premiums (typically 78 to 88 percent). The Company continually
monitors the financial viability and/or effectiveness of these risk-sharing
arrangements. At December 31, 1999, approximately 30 percent and 45 percent
of the Companys commercial and Medicare HMO membership, respectively,
were under some form of risk-sharing arrangement deemed financially viable
and/or effective. Under all of its arrangements, the Company remains
financially responsible for the provision of covered medical services if its
contractors fail to perform their obligations under the
contract.
The Company continually contracts
and seeks to renew contracts with providers at rates designed to ensure
adequate profitability. To the extent the Company is unable to obtain such
rates, its financial position, results of operations and cash flows could be
adversely impacted.
The Company continues to implement
several disease management programs in various markets. Under these
arrangements, the Company provides financial incentives for contractors to
provide the full range of care to members with respect to a particular high
risk or chronic disease in a quality, cost-effective manner. These programs
include congestive heart failure, prenatal and premature infant care, asthma
related illness, end stage renal disease, diabetes and breast cancer
screening.
Quality
Assessment
The Companys quality
assessment program under its managed care products consists of several
internal programs such as those that credential providers, and those
designed to meet the standards of audits by federal and state agencies and
external accreditation standards. The Company also offers quality and
outcome measurement and improvement programs such as the Health Plan
Employer Data Information Sets or HEDIS.
Physicians participating in the
Companys HMO networks must satisfy specific criteria, including
licensing, hospital admission privileges, patient access, office standards,
after-hours coverage and many other factors. Participating hospitals must
also meet accreditation criteria established by HCFA and/or the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO
).
Participating physicians are
recredentialed regularly. Recredentialing of primary care physicians (
PCP) covers many aspects of patient care such as an analysis of
member grievances filed with the Company, the transfer and termination rate
of members from a physician practice, analysis of utilization patterns, and
member surveys. Committees, each composed of a peer group of physicians,
review participating PCPs being considered for credentialing and
recredentialing.
The Company pursues accreditation
for certain of its HMO plans from JCAHO, the National Committee for Quality
Assurance (NCQA) and the American Accreditation Healthcare
Commission/URAC (AAHC/URAC). Accreditation or external review by
an approved organization is mandatory in the states of Florida and Kansas
for licensure as an HMO.
JCAHO performs reviews of
standards for rights, responsibilities and ethics, continuum of care,
education and communication, health promotion and disease prevention,
management of human resource information and improving network performance.
Humana Medical Plan, Inc. in Ft. Walton Beach, Florida received a three-year
accreditation from JCAHO in 1998.
NCQA performs reviews for quality
improvement, credentialing, utilization management, preventative health
member rights and responsibilities and medical records. As of January 31,
2000, eight of Humanas markets have received commendable accreditation
status from NCQA for all HMO product lines. Humana Medical Plan, Inc. in
Central Florida (which includes Daytona Beach and Orlando), Humana Medical
Plan, Inc. in North Florida (Jacksonville), Humana Medical Plan, Inc. in
South Florida, Humana Medical Plan, Inc. in Tampa Bay, Florida, Humana
Health Plan, Inc. in Chicago, Illinois, Humana Health Plan, Inc. and Humana
Kansas City, Inc. in Kansas City, Missouri, Humana Health Plan, Inc. in
Louisville, Kentucky and Humana Health Plan of Ohio, Inc. d/b/a ChoiceCare
in Cincinnati, Ohio.
AAHC/URAC performs reviews of
standards for confidentiality, staff qualifications and credentials, program
qualifications, quality improvement programs, accessibility and on site
review procedures, information requirements, utilization review procedures
and appeals. AAHC/URAC accreditation was received for all Humana HMO markets
which have utilization management functions performed in the Green Bay,
Wisconsin or Louisville, Kentucky service centers.
The Companys
Year 2000 Disclosure Statement
The Company commenced its
assessment of Year 2000 exposures in early 1996. In December 1998, the
Company was 100 percent complete with the remediation of its core business
systems and by December 1999 had remediated 100 percent of its business
application systems. As of December 31, 1999, the Company had completed all
Year 2000 initiatives.
To date, the Company has
experienced no outages or problems related to the Year 2000 date rollover.
All business systems are functioning normally and the Company has not
experienced any disruptions in service with third party organizations with
which it interacts related to the century change.
The Companys application
systems are largely developed and maintained in-house by a staff of 400
application programmers who are versed in the utilization of
state-of-the-art technology. All application systems are fully integrated
and automatically pass data through various system processes. The Company
s primary data center and the majority of its programming and support
staff are located at the Companys corporate offices in Louisville,
Kentucky. In order to create the necessary internal focus surrounding the
Year 2000 issue, the Company established a centralized Year 2000 Program
Management Office (PMO) which is charged with overall
coordination of enterprise wide Year 2000 initiatives and regular progress
reporting to the Companys senior management.
The Year 2000 project is currently
estimated to have a minimum total cost of approximately $30 million of which
approximately $10 million was spent during 1999. Year 2000 expenses
represented less than ten
percent of the Information Systems budget during 1999. Year 2000 costs are
expensed as incurred and funded with cash flows from operations. The Company
does not expect to incur significant Year 2000 project costs in the year
2000.
The extent and magnitude of the
Year 2000 project, as it will affect the Company for some period after
January 1, 2000, is difficult to predict or quantify. In order to mitigate
these risks, the Company developed business continuity and contingency plans
which were finalized in the second quarter of 1999. These plans would be
enacted if Year 2000 problems were to occur within the Company, or if third
party constituents have failures due to the millennium change. Contingency
plans were developed for six major functional areas encompassing 22
operational subdivisions that require contingency plan development. The six
major functional areas are: providers, service centers, suppliers and
vendors, customers and brokers, banking and finance and legal
services.
While the Company presently
believes that the timely completion of its Year 2000 project limited the
exposure, so that the Year 2000 issue has not posed material operational
problems, the Company recognizes that it does not control third party
constituents. If these third party organizations have failures related to
the Year 2000 century change and/or fail to properly implement appropriate
contingency plans, Year 2000 failures may result. These failures could
potentially have a material adverse impact on the Companys financial
position, results of operations and cash flows.
Sales and
Marketing
Individuals become members of the
Companys commercial HMOs and PPOs through their employer or other
groups which typically offer employees or members a selection of managed
health care products, pay for all or part of the premiums and make payroll
deductions for any premiums payable by the employees. The Company attempts
to become an employers or groups exclusive source of managed
health care benefits by offering HMO and PPO products that facilitate the
delivery of cost-effective quality care consistent with the needs and
expectations of the employees or members.
The Company uses various methods
to market its commercial, Medicare HMO and Medicaid products, including
television, radio, the Internet, telemarketing and mailings. At December 31,
1999, the Company used approximately 40,300 licensed independent brokers and
agents and approximately 510 licensed employees to sell the Companys
commercial products. Many of the Companys employer group customers are
represented by insurance brokers and consultants who assist these groups in
the design and purchase of health care products. The Company generally pays
brokers a commission based on premiums, with commissions varying by market
and premium volume.
At December 31, 1999, the Company
used approximately 950 employed sales representatives, who are each paid a
salary and/or per member commission, to market the Companys Medicare
HMO and Medicaid products. The Company also used approximately 370
telemarketing representatives who assisted in the marketing of Medicare HMO
and Medicaid products by making appointments for sales representatives with
prospective members.
The following table lists the
Companys medical membership at December 31, 1999, by market and
product:
MEDICAL
MEMBERSHIP
(In
thousands)
|
|
Commercial
|
|
Medicaid
|
|
Medicare
HMO
|
|
Medicare
Supplement
|
|
ASO
|
|
TRICARE
|
|
Total
|
|
Percent
of
Total
|
|
|
HMO
|
|
PPO
|
Florida |
|
219.3 |
|
151.7 |
|
138.6 |
|
250.5 |
|
4.0 |
|
7.3 |
|
404.8 |
|
1,176.2 |
|
19.8 |
% |
Texas |
|
258.1 |
|
319.4 |
|
29.3 |
|
68.9 |
|
3.8 |
|
11.2 |
|
|
|
690.7 |
|
11.6 |
|
Illinois |
|
294.0 |
|
239.7 |
|
15.2 |
|
82.6 |
|
|
|
89.4 |
|
|
|
720.9 |
|
12.1 |
|
Puerto
Rico |
|
20.8 |
|
33.4 |
|
410.4 |
|
|
|
|
|
|
|
|
|
464.6 |
|
7.8 |
|
Wisconsin |
|
110.4 |
|
66.6 |
|
23.1 |
|
3.3 |
|
|
|
310.6 |
|
|
|
514.0 |
|
8.7 |
|
Kentucky |
|
99.4 |
|
177.3 |
|
|
|
19.8 |
|
22.9 |
|
55.2 |
|
|
|
374.6 |
|
6.3 |
|
Georgia |
|
9.1 |
|
88.9 |
|
|
|
|
|
3.0 |
|
2.9 |
|
252.9 |
|
356.8 |
|
6.0 |
|
Ohio |
|
206.1 |
|
104.4 |
|
|
|
11.2 |
|
|
|
50.2 |
|
|
|
371.9 |
|
6.3 |
|
Missouri/Kansas |
|
75.3 |
|
37.3 |
|
|
|
24.3 |
|
4.5 |
|
14.6 |
|
|
|
156.0 |
|
2.6 |
|
Indiana |
|
16.1 |
|
94.3 |
|
|
|
3.5 |
|
1.1 |
|
33.8 |
|
|
|
148.8 |
|
2.5 |
|
South
Carolina |
|
|
|
16.4 |
|
|
|
|
|
|
|
0.4 |
|
129.6 |
|
146.4 |
|
2.5 |
|
Tennessee |
|
|
|
55.9 |
|
|
|
|
|
|
|
18.3 |
|
70.9 |
|
145.1 |
|
2.4 |
|
Colorado |
|
|
|
147.4 |
|
|
|
|
|
0.9 |
|
0.2 |
|
|
|
148.5 |
|
2.5 |
|
Other |
|
|
|
242.3 |
|
|
|
24.4 |
|
4.3 |
|
53.9 |
|
199.8 |
|
524.7 |
|
8.9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
1,308.6 |
|
1,775.0 |
|
616.6 |
|
488.5 |
|
44.5 |
|
648.0 |
|
1,058.0 |
|
5,939.2 |
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Risk
Management
Through the use of internally
developed underwriting criteria, the Company determines the risk it is
willing to assume and the amount of premium to charge for its commercial
products. In most instances, employer and other groups must meet the Company
s underwriting standards in order to qualify to contract with the
Company for coverage. Small group reform laws in some states have imposed
regulations which provide for guaranteed issue of certain health insurance
products and prescribe certain limitations on the variation in rates charged
based upon assessment of health conditions.
Underwriting techniques are not
employed in connection with Medicare HMO products because HCFA regulations
require the Company to accept all eligible Medicare applicants regardless of
their health or prior medical history. The Company also is not permitted to
employ underwriting criteria for the Medicaid product but rather follows
HCFA and state requirements. In addition, with respect to the TRICARE
contract, no underwriting techniques are employed because the Company must
accept all eligible beneficiaries who choose to participate.
Competition
The managed health care industry
is highly competitive and contracts for the sale of commercial products are
generally bid or renewed annually. The Companys competitors vary by
local market and include other publicly traded managed care companies,
national insurance companies and other HMOs and PPOs, including HMOs and
PPOs owned by Blue Cross/Blue Shield plans. Many of the Companys
competitors have more membership and/or greater financial resources than the
Companys health plans in those markets. The Companys ability to
sell its products and to retain customers is or may be influenced by such
factors as benefits, pricing, contract terms, number and quality of
participating physicians and other managed health care providers,
utilization review, claims processing, administrative efficiency,
relationships with agents, quality of customer service and accreditation
results.
Government
Regulation
Government regulation of health
care products and services is a changing area of law that varies from
jurisdiction to jurisdiction. Regulatory agencies generally have broad
discretion to issue regulations and interpret and enforce laws and rules.
Changes in applicable laws and regulations are continually being considered,
and the interpretation of existing laws and rules also may change
periodically. These regulatory revisions could affect the Companys
operations and financial results. Also, it may become increasingly difficult
to control medical costs if federal and state bodies continue to consider
and enact significant and sometimes onerous managed care laws and
regulations.
Enforcement of health care fraud
and abuse laws has become a top priority for the nations law
enforcement entities. The funding of such law enforcement efforts has
increased dramatically in the past few years and is expected to continue.
The focus of these efforts has been directed at participants in federal
government health care programs such as Medicare, Medicaid and FEHBP. The
Company participates extensively in these programs and has enhanced its
regulatory compliance efforts for these programs. The programs are subject
to very technical rules. When combined with law enforcement intolerance for
any level of noncompliance, these rules mean that compliance efforts in this
area continue to be challenging.
The Company is subject to various
governmental audits, investigations and enforcement actions. These include
possible government actions relating to the Employee Retirement Income
Security Act (ERISA), FEHBP, federal and state fraud and abuse
laws, and laws relating to Medicare, including adjusted community rating
development, special payment status, payments for emergency room visits, and
various other areas. Any such government actions could result in assessment
of damages, civil or criminal fines or penalties, or other sanctions,
including exclusion from participation in government programs. The Company
is currently involved in various government investigations, audits and
reviews, some of which are under ERISA, and the authority of state
departments of insurance. The Company does not believe the results of
current audits or investigations, individually or in the aggregate, will
have a material adverse effect on its financial position and results of
operations.
Of the Companys 13 licensed
and active HMO subsidiaries as of March 1, 2000, nine are qualified under
the Federal Health Maintenance Organization Act of 1973, as amended. To
obtain federal qualification, an HMO must meet certain requirements,
including conformance with benefit, rating and financial reporting
standards. In certain markets, and for certain products, the Company
operates HMOs that are not federally qualified because this provides greater
flexibility with respect to product design and pricing than is possible for
federally qualified HMOs.
Six subsidiaries (Humana Medical
Plan, Inc., Humana Health Plan of Texas, Inc., Humana Health Plan, Inc.,
Humana Kansas City, Inc., Humana Health Plan of Ohio, Inc., and Memorial
Sisters of Charity HMO, L.L.C.) hold HCFA contracts under the M+C program to
sell Medicare HMO products in nine states.
HCFA conducts audits of HMOs
qualified under its M+C program at least biannually and may perform other
reviews more frequently to determine compliance with federal regulations and
contractual obligations. These audits include review of the HMOs
administration and management (including management information and data
collection systems), fiscal stability, utilization management and physician
incentive arrangements, health services delivery, quality assurance,
marketing, enrollment and disenrollment activity, claims processing, and
complaint systems.
HCFA regulations require quarterly
and annual submission of financial statements. In addition, HCFA requires
certain disclosures to HCFA and to Medicare beneficiaries concerning
operations of a health plan qualified under the M+C program. HCFAs
rules require disclosure to members upon request of information concerning
financial arrangements and incentive plans between an HMO and physicians in
the HMOs networks. These rules also require certain levels of
stop-loss coverage to protect contracted physicians against major losses
relating to patient care, depending on the amount of financial risk they
assume. The reporting of certain health care data contained in HEDIS is
another important HCFA disclosure requirement.
The Companys Medicaid
products are regulated by the applicable state agency in the state in which
the Company sells a Medicaid product and the Health Insurance Administration
in Puerto Rico, in conformance with federal approval of the applicable state
plan, and are subject to periodic reviews by these agencies. The reviews are
similar in nature to those performed by HCFA.
Laws in each of the states and the
Commonwealth of Puerto Rico in which the Company operates its HMOs, PPOs and
other health insurance-related services regulate the Companys
operations, including the scope of benefits, rate formulas, delivery
systems, utilization review procedures, quality assurance, complaint
systems, enrollment requirements, claim payments, marketing and advertising.
The HMO, PPO and other health insurance-related products offered by the
Company are sold under licenses issued by the applicable insurance
regulators and the entities selling these products are required to be in
compliance with certain minimum capital requirements. These requirements
must be satisfied by investing in approved investments that generally cannot
be used for other purposes. Under state laws, the Companys HMOs and
health insurance companies are audited by state departments of insurance for
financial and contractual compliance, and its HMOs are audited for
compliance with health services standards by respective state departments of
health. Most states laws require such audits to be performed at least
triennially.
The Company and its licensed
subsidiaries are subject to regulation under state insurance holding company
and Commonwealth of Puerto Rico regulations. These regulations require,
among other things, prior approval and/or notice of certain material
transactions, including dividend payments, intercompany agreements and the
filing of various financial and operational reports.
The National Association of
Insurance Commissioners has recommended that states adopt a risk-based
capital (RBC) formula for companies established as HMO entities,
similar to the current requirement for insurance companies. The RBC
provisions may require new minimum capital and surplus levels for some of
the Companys HMO subsidiaries. Many states have not yet determined
when they will adopt the RBC formula or if they will allow a phase-in to the
required levels of capital and surplus.
The Company currently maintains
approximately $768 million of capital and surplus in its health insurance
and HMO entities, compared to the minimum statutory required capital and
surplus levels of approximately $569 million. If the states in which the
Company conducts business adopt the proposed RBC formula, without a phase-in
provision, the Company estimates it would be required to fund additional
capital into certain of its subsidiaries of approximately $45 million. After
this capital infusion, the Company would have $138 million of capital and
surplus above the required RBC level in its entities as a whole.
Management works proactively to
ensure compliance with all governmental laws and regulations affecting the
Companys business.
Health Care
Reform
There continue to be diverse
legislative and regulatory initiatives at both the federal and state levels
to address aspects of the nations health care system.
In 1999, Congress passed the
Medicare, Medicaid and State Childrens Health Insurance Program
Balanced Budget Refinement Act of 1999 (BBRA) amending certain
provisions of the Balanced Budget Act of 1997 (BBA). The BBA
revised the structure of and payment for private health plan options for
Medicare enrollees under the M+C program. The BBRA improved reimbursement to
M+C contracting organizations, made certain other technical corrections to
ease administrative burdens and required that the Medicare Payment Advisory
Commission issue a report on the impact of risk-adjusted
payment.
Under the health risk-adjusted
payment mechanism for M+C plans, health plan payments are adjusted based on
the likelihood (or risk) that enrollees will use health care services. The
BBRA slowed the phase-in
period of the risk-adjustment payment mechanism to 10 percent in 2000, 10
percent in 2001 and 20 percent in 2002. The Company believes that Congress
may again consider modifications to the payment formula during the
intervening years.
The BBRA also increased future
health plan payments by reducing from 0.5 percent to 0.3 percent, the
difference in the annual growth rate allowed for M+C plans and traditional
Medicare in 2002. Further, effective January 1, 2001, Congress changed the
formula by which health plans pay for the national Medicare education
campaign from one where M+C plans pay the entire amount based on number of
plan enrollees to one based on a ratio of plan enrollees to the total
Medicare population. Organizations that offer M+C plans in areas without
such plans since 1997 will receive bonus payments in their first two
years.
While the Company believes that
these adjustments modestly restore some Medicare reimbursement, pending
legislative and regulatory initiatives could cause the Company to again
consider increasing enrollee out-of-pocket costs, modifying benefits or
exiting markets in 2001. On January 1, 2000, the Company exited 31 M+C
counties and raised or established premiums and reduced benefits in others.
The Company is working with HCFA on modifications to the risk adjuster
payment method.
The Health Insurance Portability
and Accountability Act (HIPAA) was enacted in 1996. The
provisions of HIPAA that have already been implemented govern rules related
to portability and guarantee issue requirements. Final rules mandated by
HIPAA on privacy standards, administrative simplification of employer,
provider and health plan identification information, claims transaction
codes, security and electronic signatures will be proposed or promulgated in
2000. The Company is taking administrative steps to be in full compliance
with the rules once finalized.
There are several other
legislative proposals under consideration that include, among other things,
a patient bill of rights, expansion of a patients right to sue,
protecting patient medical information, greater access to health insurance
for the uninsured, provisions that seek to reduce the number of uninsured by
expanding medical savings accounts, the acceleration of the self-employed
tax deduction, collective bargaining rights for independent physicians, and
provisions to permit employers to pool at the federal or state level. Many
of these proposals may require additional administrative costs to ensure
compliance and the Company is currently assessing their cost and impact on
premiums for the future.
A number of states continue to
enact some form of managed care reform. Issues relating to managed care
consumer protection standards, including increased plan information
disclosure, expedited appeals and grievance procedures, third party review
of certain medical decisions, health plan liability, access to specialists,
clean claim payment timing, physician collective bargaining rights and
confidentiality of medical records continue to be under discussion. Further,
proposals that place restrictions on the selection and termination of
participating health care providers also are receiving review. A few states
are also expected to consider small group purchasing alliance and small
group rating legislation.
Management believes that managed
care and health care in general will continue to be scrutinized and may lead
to additional legislative health care reform initiatives. Management is
unable to predict how existing federal or state laws and regulations may be
changed or interpreted, what additional laws or regulations affecting the
Companys businesses may be enacted or proposed, when and which of the
proposed laws will be adopted or what effect any such new laws and
regulations will have on its financial position, results of operations or
cash flows.
Other
|
Captive
Insurance Company
|
The Company insures substantially
all professional liability risks through a wholly owned subsidiary (the
Subsidiary). The annual premiums paid to the Subsidiary are
determined by independent actuaries. The Subsidiary reinsures levels of
coverage for losses in excess of its retained limits with unrelated
insurance carriers.
|
Centralized
Management Services
|
Centralized management services
are provided to each health plan from the Companys headquarters and
service centers. These services include management information systems,
product administration, financing, personnel, development, accounting, legal
advice, public relations, marketing, insurance, purchasing, risk management,
actuarial, underwriting and claims processing.
Employees
As of December 31, 1999, the
Company had approximately 17,300 employees, including approximately 330
employees covered by collective bargaining agreements. The Company has not
experienced any work stoppages and believes it has good relations with its
employees.
The Company owns its principal
executive office, which is located in the Humana Building, 500 West Main
Street, Louisville, Kentucky 40202. In addition, the Company owns buildings
in Louisville, Kentucky, San Antonio, Texas and Green Bay, Wisconsin and
Jacksonville, Florida and leases facilities in Madison, Wisconsin, all of
which are used for customer service and claims processing. The Louisville
and Green Bay facilities also perform enrollment processing and other
corporate functions.
The Company also owns or leases
medical centers ranging in size from approximately 1,500 to 80,000 square
feet. The Companys administrative market offices are generally leased,
with square footage ranging from approximately 700 to 89,000. The following
chart lists the location of properties used in the operation of the Company
at December 31, 1999:
|
|
Medical
Centers
|
|
Administrative
Offices
|
|
|
Owned
|
|
Leased
|
|
Owned
|
|
Leased
|
|
Total
|
Florida |
|
6 |
|
78 |
|
3 |
|
49 |
|
136 |
Illinois |
|
7 |
|
17 |
|
|
|
8 |
|
32 |
Texas |
|
5 |
|
5 |
|
3 |
|
3 |
|
16 |
Puerto
Rico |
|
|
|
|
|
|
|
23 |
|
23 |
Kentucky |
|
9 |
|
4 |
|
3 |
|
2 |
|
18 |
Missouri/Kansas |
|
3 |
|
5 |
|
|
|
4 |
|
12 |
California |
|
|
|
|
|
|
|
3 |
|
3 |
Wisconsin |
|
|
|
|
|
1 |
|
11 |
|
12 |
Ohio |
|
|
|
|
|
|
|
6 |
|
6 |
Other |
|
1 |
|
3 |
|
1 |
|
48 |
|
53 |
|
|
|
|
|
|
|
|
|
|
|
Total |
|
31 |
|
112 |
|
11 |
|
157 |
|
311 |
|
|
|
|
|
|
|
|
|
|
|
ITEM 3. LEGAL PROCEEDINGS
Six purported class action
complaints have been filed in the United States District Court for the
Western District of Kentucky at Louisville, by purported stockholders of the
Company against the Company and certain of its current and former directors
and officers. The six complaints contain the same or substantially similar
allegations; namely, that the Company and the individual defendants
knowingly or recklessly made false or misleading statements in press
releases and public filings concerning the Companys financial
condition, primarily with respect to the impact of the negotiations over
renewal of the Companys contract with Columbia/HCA which took effect
April 1, 1999. The complaints allege violations of Section 10(b) of the
Securities Exchange Act of 1934 (the 1934 Act) and SEC Rule 10b-5,
and Section 20(a) of the 1934 Act and seek certification of a class of
stockholders who purchased shares of Humana common stock starting either (in
four complaints) in late October 1998 or (in two complaints) on February 9,
1999 and ending (in all six complaints) on April 8, 1999. All seek money
damages in unspecified amounts, plus (in certain of the complaints)
pre-judgment and post-judgment interest, and costs and expenses including
attorney and expert fees. Plaintiffs moved for consolidation of the actions,
now styled In re Humana Inc. Securities Litigation, and have filed a
Consolidated Complaint.
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 (PCA) against PCA and certain of its
former directors and officers. The three actions were consolidated into a
single action entitled In re Physician Corporation of America Securities
Litigation, Civil Action No. 97-3678 (S.D. Fla.). 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. Count I alleges violations of
Section 10(b) of the 1934 Act and SEC Rule 10b-5, and Count II alleges
violations of Section 20(a) of the 1934 Act. Plaintiffs have moved for
certification of a class of stockholders who purchased shares of PCA common
stock from March 31, 1996 through March 31, 1997, as well as money damages
plus prejudgment interest in an unspecified amount, and costs and expenses
including attorneys fees. On February 19, 1999, the U.S. District Court
denied PCAs motion to dismiss. On May 5, 1999, plaintiffs moved for
certification of the purported class. On June 28, 1999, defendants moved for
partial summary judgment and filed papers opposing the motion for class
certification. Both motions are currently pending. Discovery is proceeding
and the action has been set for trial beginning January 2001.
The Company believes that the
above allegations are without merit and intends to pursue the defense of the
actions vigorously.
|
Managed Care
Industry Litigation
|
Since October 1999, the Company
has received twelve purported class action complaints filed on behalf of
various named plaintiffs who seek to represent a class consisting of present
and former Humana subscribers but excluding persons insured by Medicare or
Medicaid. All of the cases have been filed in federal courts, ten in the
Southern District of Florida, one in the Southern District of Mississippi
and one in the Northern District of Alabama. In each case, the plaintiffs
seek a recovery (including statutory treble damages) under the Racketeer
Influenced and Corrupt Organizations Act (RICO) for all persons
who are or were Humana subscribers at any time during the four-year period
prior to the filing of the complaints. In addition, plaintiffs seek to
represent a subclass of policyholders who purchased their Humana coverage
through their employers health benefits plans governed by ERISA, and
who are or were Humana subscribers at any time during the six-year period
prior to filing the complaints.
The plaintiffs complaints,
which are generally the same, allege, among other things, that Humana
intentionally concealed from its members information concerning the various
ways Humana decides what claims will be paid, what procedures will be deemed
medically necessary, and what criteria and procedures are used to determine
the extent and type of their coverage. Plaintiffs also allege that Humana
concealed from members the existence of direct financial incentives to
treating physicians and other health care providers to deny coverage. The
plaintiffs generally do not allege that any of the alleged practices
resulted in any named plaintiff, or any other specific member, being denied
coverage for services that should have been covered but, instead, claim that
Humana provided the purported class with health insurance benefits of lesser
value than promised. Humana has asked the Federal Judicial Panel on
Multidistrict Litigation (MDL Panel) to consolidate the
management of all of these cases in a single court.
Humana has also received a class
action suit filed in state court in Louisville, Kentucky, by named
plaintiffs who seek to represent a purported nationwide class of providers
who allege that the Company has
improperly paid them and has downcoded their claims by paying
lesser amounts than they billed for. The Company has removed the case to
federal court and has asked the MDL Panel to consolidate that case with the
ones described above as well as with another case brought by a physician
plaintiff in Alabama and two others brought by physicians in South
Florida.
The Company believes these actions
are without merit and intends to pursue the defense of these actions
vigorously.
|
Mary Forsyth, et al. V. Humana Inc., et al.
|
A class action lawsuit styled
Mary Forsyth, et al. V. Humana Inc., et al., Case No.
CV-5-89-249-PMP, was filed on March 29, 1989, in the United States District
Court for the District of Nevada involving claims arising out of the method
of calculation of coinsurance for Nevada insureds prior to 1988, and an
antitrust claim. The District Court granted the Companys motion for
summary judgment on most of the claims on July 22, 1993. The District Court
granted summary judgment in favor of plaintiffs on the claims under ERISA.
On appeal, the Court of Appeals for the Ninth Circuit reinstated certain
claims, including the claim under RICO on behalf of a class of insureds who
paid coinsurance at Humana hospitals (the Co-Payer Class), and
the antitrust claim. On August 18, 1997, the Company filed a Petition for
Writ of Certiorari in the United States Supreme Court requesting the Supreme
Court to reverse the part of the Ninth Circuit ruling reinstating the RICO
claim of the Co-Payer Class. In January 1999, the Supreme Court ruled that
the plaintiffs could pursue their RICO claim. The parties subsequently
entered into a settlement agreement on July 16, 1999 resolving all
outstanding claims. The District Court entered its final approval of the
settlement agreement on November 30, 1999. The Companys portion of the
settlement which was paid in 1999 was $11.2 million and since it had
previously established adequate liabilities for the resolution of this
matter, the settlement did not have a material impact on the Companys
financial position or its results of operations.
|
Chipps v. Humana Health Insurance Company of Florida,
Inc.
|
On January 4, 2000, a jury in Palm
Beach County, Florida issued a verdict against Humana Health Insurance
Company of Florida, Inc., a subsidiary of the Company, awarding
approximately $80 million to Mark Chipps, an insured who had sued
individually and on behalf of his minor daughter. The claim arose from the
removal of the child from a case management program which had provided her
with benefits in excess of those available under her policy. The award
included $78.5 million for punitive damages, $1 million for emotional
distress and $29,000 for contractual benefits. On March 13, 2000, the Humana
Health Insurance Company of Florida, Inc., filed its notice of appeal to the
Fourth District Court of Appeals in Florida.
|
Government
Audits and Other
|
During 1999, the Company reached
agreement in principle with the United States Department of Justice and the
Department of Health and Human Services (HHS) on a $15 million
settlement relating to Medicare premium overpayments. The overpayments
resulted from the erroneous designation of certain Medicare enrollees as
also eligible for Medicaid. In conjunction with the settlement, the Company
is also negotiating with the Office of the Inspector General of HHS with
respect to the terms of a corporate integrity agreement which is expected to
be finalized during the second quarter of 2000. The settlement amount is
expected to be paid sometime during 2000. The Company previously established
adequate liabilities for the resolution of these issues and, therefore, the
settlement will not have a material impact on the Companys financial
position or results of operations.
Damages for claims for personal
injuries and medical benefit denials are usual in the Companys
business. Personal injury and medical benefit denial claims are covered by
insurance from the Companys wholly-owned captive insurance subsidiary
and excess carriers, except to the extent that claimants seek punitive
damages, which may not be covered by insurance if awarded in states in which
insurance coverage for punitive damages is not permitted. In connection with
the case of Chipps v. Humana Health Insurance Company of Florida,
Inc., the Companys insurance carriers have preliminarily indicated
that they believe no coverage may be available
for a punitive damages award. 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, insurance coverage
for all or certain forms of liability may become unavailable or
prohibitively expensive in the future.
Due to the nature of its business,
the Company is or may become subject to pending or threatened litigation or
other legal actions relating to the failure to provide or pay for health
care or other benefits, poor outcomes for care delivered or arranged under
the Companys programs, nonacceptance or termination of providers,
failure to return withheld amounts from provider compensation, and failure
to disclose network discounts and various provider payment arrangements and
claims relating to contract performance. Recent court decisions and
legislative activity may increase our exposure for any of these types of
claims.
Management does not believe that
any pending or threatened legal actions against the Company or audits by
agencies will have a material adverse effect on the Companys financial
position or results of operations. However, the likelihood or outcome of
current or future suits cannot be accurately predicted, and they could
adversely affect the Companys financial position, results of
operations or cash flows.
ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY
HOLDERS
Not applicable.
EXECUTIVE
OFFICERS OF THE COMPANY
Set forth below are names and ages
of all of the current executive officers of the Company as of March 9, 2000,
their positions, date of election to such position and the date first
elected an officer of the Company:
Name
|
|
Age
|
|
Position
|
|
First
Elected
Officer
|
Michael B.
McCallister |
|
47 |
|
President and Chief
Executive Officer |
|
09/89 |
(1) |
Kenneth J.
Fasola |
|
40 |
|
Chief Operating
OfficerSmall Group Division |
|
05/96 |
(2) |
James E.
Murray |
|
46 |
|
Chief Operating
OfficerHealth Plan Division and Chief
Financial Officer |
|
08/90 |
(3) |
John M.
Bertko |
|
50 |
|
Vice President
Actuarial Consulting |
|
03/00 |
(4) |
Douglas R.
Carlisle |
|
49 |
|
Senior Vice
PresidentMarket Operations |
|
05/86 |
(5) |
Bruce J.
Goodman |
|
58 |
|
Senior Vice
President and Chief Information Officer |
|
04/99 |
(6) |
Bonita C.
Hathcock |
|
51 |
|
Senior Vice
PresidentHuman Resources |
|
05/99 |
(7) |
Arthur P.
Hipwell |
|
51 |
|
Senior Vice
President and General Counsel |
|
08/90 |
(8) |
Heidi S.
Margulis |
|
46 |
|
Senior Vice
PresidentGovernment Affairs |
|
12/95 |
(9) |
Sheri E.
Mitchell |
|
52 |
|
Senior Vice
President and Chief Compliance Officer |
|
09/94 |
(10) |
Thomas T. Noland,
Jr. |
|
46 |
|
Senior Vice
PresidentCorporate Communications |
|
01/92 |
(11) |
Bruce D.
Perkins |
|
46 |
|
Senior Vice
PresidentNational Networks |
|
05/95 |
(12) |
L. Bryan
Shaul |
|
55 |
|
Vice President
Finance and Controller |
|
03/00 |
(13) |
George W. Vieth,
Jr. |
|
44 |
|
Senior Vice
PresidentLarge Group Commercial |
|
12/95 |
(14) |
(1)
|
Mr. McCallister was
elected President, Chief Executive Officer and a member of the Board of
Directors in February 2000. Prior to that, Mr. McCallister served as
Senior Vice PresidentHealth System Management from January 1998 to
February 2000. Prior to that, Mr. McCallister served as Division I
President from July 1996 to January 1998. Mr. McCallister joined the
Company in June 1974.
|
(2)
|
Mr. Fasola
currently serves as Chief Operating OfficerSmall Group Division
having held this position since February 2000. Prior to that, Mr. Fasola
served as Senior Vice PresidentSales, Marketing and Business
Development from November 1998 to February 2000 and as Vice President
Sales & Marketing from May 1996 to November 1998. Mr. Fasola
served in a similar capacity as Vice President and National Sales Manager
of Employers Health Insurance Company since 1989.
|
(3)
|
Mr. Murray
currently serves as Chief Operating OfficerHealth Plan Division
having held this position since February 2000. Mr. Murray will continue to
serve as Chief Financial Officer until his replacement is selected. Prior
to that, Mr. Murray served as Senior Vice President and Chief Financial
Officer from November 1998 to February 2000, Chief Financial Officer from
January 1997 to November 1998 and Vice PresidentFinance from August
1990 to January 1997. Mr. Murray joined the Company as Controller in
October 1989.
|
(4)
|
Mr. Bertko joined
the Company in October 1999 as Vice PresidentActuarial Consulting.
Prior to joining the Company, Mr. Bertko was a Principal with Reden &
Anders/PM Squared in San Francisco, California from September 1996 to
October 1999 and a consultant with Coopers & Lybrand in San Francisco,
California from April 1980 to 1995, then a Principal with the firm through
August 1996. From 1976 to 1980, Mr. Bertko served as an Actuarial
Assistant with Metropolitan Life Insurance Company in San Francisco,
California and New York, New York.
|
(5)
|
Mr. Carlisle
currently serves as Senior Vice PresidentMarket Operations having
held this position since February 2000. Prior to that, Mr. Carlisle served
as Senior Vice PresidentHealth System Management from September 1999
to February 2000. Mr. Carlisle also served as Regional Vice President
Health System Management (Central Region) from January 1998 to
September 1999 and held various positions with the Company from May 1986
to December 1997.
|
(6)
|
Mr. Goodman joined
the Company in April 1999 as Senior Vice President and Chief Information
Officer. Prior to joining the Company, Mr. Goodman served as Chief
Executive Officer of C2K Technology
Partners, Inc. in Livingston, New Jersey from 1998 to April 1999. From 1993
to 1998, Mr. Goodman served as Chief Executive OfficerPrudential
Service Co. for Prudential Insurance Co. in Roseland, New Jersey, and as
Senior Vice President, Chief Information Officer of Metropolitan Life
Insurance Co. in New York, New York from 1970 to 1993.
|
(7)
|
Ms. Hathcock joined
the Company in May 1999 as Senior Vice PresidentHuman Resources.
Prior to joining the Company, Ms. Hathcock served as Vice President of
Human Resources & Development for US Airways Group in Crystal City,
Virginia from 1997 to 1999. From 1990 to 1997, Ms. Hathcock served as Vice
President of Human Resources for Siemens AG/Siemens Rolm Communications,
Inc. in Santa Clara, California.
|
(8)
|
Mr. Hipwell was
initially elected an officer of the Company in 1990 and served as Senior
Vice President and General Counsel from July 1992 until the spinoff of
Galen Health Care Inc. (Galen), when he became Senior Vice
President and General Counsel of Galen. Mr. Hipwell returned to the
Company in January 1994 and was named Senior Vice President and General
Counsel of the Company in June 1994. Mr. Hipwell retired from the Company
in January 1999. He returned as Senior Vice President and General Counsel
in September 1999.
|
(9)
|
Ms. Margulis
currently serves as Senior Vice PresidentGovernment Affairs and was
elected to that position in January 2000. Prior to that, Ms. Margulis
served as Vice PresidentGovernment Affairs from December 1995 to
January 2000. Ms. Margulis has been with the Company since November
1985.
|
(10)
|
Ms. Mitchell
currently serves as Senior Vice President and Chief Compliance Officer and
was elected to this position in July 1999. Prior to that, Ms. Mitchell
served as Vice PresidentAccreditation & Compliance from January
1998 to July 1999 and Vice PresidentQuality & Service Excellence
from September 1994 to January 1998. Ms. Mitchell joined the Company in
1972.
|
(11)
|
Mr. Noland
currently serves as Senior Vice PresidentCorporate Communications
and was elected to this position in September 1999. Prior to that, Mr.
Noland served as Vice PresidentCorporate Communications from July
1997 to September 1999. Mr. Noland previously worked for the Company from
1984 to 1993 in various Vice President and Director positions in the
Communications, Public Affairs and Hospital Public Relations areas. Prior
to returning to the Company, Mr. Noland was a Publisher for The Cobb Group
in Louisville, Kentucky from 1993 to 1997.
|
(12)
|
Mr. Perkins
currently serves as Senior Vice PresidentNational Networks having
held this position since February 2000. Prior to that, Mr. Perkins served
as Senior Vice PresidentNational Contracting from May 1998 to
February 2000; as Senior Vice PresidentProvider Affairs and
Reengineering from December 1996 to May 1998; as Vice President
OperationsRegion II during the month of May 1996, then elected
to the position of President of the South/West Division from May 1996 to
December 1996 and Vice PresidentRegion II from May 1995 to May 1996.
Mr. Perkins joined the Company in May 1976.
|
(13)
|
Mr. Shaul currently
serves as Vice PresidentFinance and Controller and has held that
position since March 2000. Prior to that, Mr. Shaul served as Vice
PresidentMergers and Acquisitions from March 1999 to March 2000.
Prior to joining the Company, Mr. Shaul was Chief Financial Officer of
Primary Health, Inc. in Boise, Idaho from February 1997 to February 1999;
Chief Financial Officer of Pacific EyeNet, Inc. in Los Angeles, California
from August 1996 to February 1997; and Chief Financial Officer of Right
CHOICE Managed Care, Inc. from March 1994 to December 1995.
|
(14)
|
Mr. Vieth currently
serves as Senior Vice PresidentLarge Group Commercial having held
this position since August 1999. Prior to that, Mr. Vieth served as Senior
Vice PresidentMarket Segment Management from November 1998 to August
1999 and as Vice PresidentStrategy and Systems Development from
January 1998 through November 1998. Mr. Vieth also served as Vice President
Development and Planning from December 1995 through January 1998.
Mr. Vieth joined the Company in November 1992 as Director of Development
and Planning.
|
Executive officers are elected
annually by the Companys Board of Directors and serve until their
successors are elected or until resignation or removal. There are no family
relationships among any of the executive officers of the
Company.
PART
II
ITEM 5. MARKET FOR REGISTRANTS COMMON
EQUITY AND RELATED STOCKHOLDER MATTERS
The Companys common stock
trades on the New York Stock Exchange under the symbol HUM. The following
table shows the range of high and low closing sales prices as reported on
the New York Stock Exchange Composite Tape:
|
|
High
|
|
Low
|
Year Ended
December 31, 1999 |
|
|
First
quarter |
|
20-3/4 |
|
16-15/16 |
Second
quarter |
|
16-7/16 |
|
11 |
Third
quarter |
|
13-1/8 |
|
6-7/8 |
Fourth
quarter |
|
8-1/4 |
|
5-7/8 |
|
|
Year Ended
December 31, 1998 |
First
quarter |
|
26-3/8 |
|
19-1/2 |
Second
quarter |
|
31-11/16 |
|
24-15/16 |
Third
quarter |
|
31-7/8 |
|
12-7/8 |
Fourth
quarter |
|
21-9/16 |
|
14-3/8 |
As of March 1, 2000, there were
approximately 7,700 holders of record of the Companys common
stock.
Since 1992, the Company has
historically not declared or paid any cash dividends on its common stock.
The Company does not presently intend to pay dividends on its common stock
in the future and will retain all of its earnings for future operations and
growth of its businesses.
Information for Items 6 through 8
of this report, which appears in the 1999 Annual Report to Stockholders as
indicated on the following table, is incorporated by reference herein in
this report and filed as an exhibit hereto:
|
|
|
|
Annual
Report to
Stockholders
Page
|
ITEM 6. |
|
SELECTED
FINANCIAL DATA |
|
23 |
|
ITEM 7. |
|
MANAGEMENT
S DISCUSSION AND ANALYSIS OF FINANCIAL
CONDITION AND RESULTS OF OPERATIONS |
|
24 |
|
ITEM 7a. |
|
QUANTITATIVE
AND QUALITATIVE DISCLOSURES ABOUT MARKET
RISK |
|
32 |
|
ITEM 8. |
|
FINANCIAL
STATEMENTS AND SUPPLEMENTARY DATA |
|
|
|
|
Consolidated
financial statements |
|
35 |
|
|
Report of
independent accountants |
|
51 |
|
|
Quarterly
financial information (unaudited) |
|
52 |
|
ITEM 9. |
|
CHANGES IN AND
DISAGREEMENTS WITH ACCOUNTANTS ON
ACCOUNTING AND FINANCIAL DISCLOSURE |
|
|
PART
III
ITEM 10. DIRECTORS AND EXECUTIVE OFFICERS OF
THE REGISTRANT
The information required by this
Item other than the information set forth in Part I under the Section
entitled Executive Officers of the Company, is herein
incorporated by reference from the Registrants Proxy Statement for
the Annual Meeting of Stockholders scheduled to be held on May 18, 2000
appearing under the caption Election of Directors of
such Proxy Statement.
ITEM 11. EXECUTIVE COMPENSATION
The information required by this
Item is incorporated herein by reference from the Registrants Proxy
Statement for the Annual Meeting of Stockholders scheduled to be held on
May 18, 2000 appearing under the caption Executive Compensation of
the Company of such Proxy Statement.
ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL
OWNERS AND MANAGEMENT
The information required by this
Item is herein incorporated by reference from the Registrants Proxy
Statement for the Annual Meeting of Stockholders scheduled to be held on
May 18, 2000 appearing under the caption Security Ownership of
Certain Beneficial Owners of Company Common Stock of such Proxy
Statement.
ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS
The information required by this
Item is herein incorporated by reference from the Registrants Proxy
Statement for the Annual Meeting of Stockholders scheduled to be held on
May 18, 2000 appearing under the caption Certain Transactions with
Management and Others of such Proxy Statement.
PART
IV
ITEM 14. EXHIBITS, FINANCIAL STATEMENT SCHEDULES AND
REPORTS ON FORM 8-K
(a)
|
The financial
statements, financial statement schedules and exhibits set forth below
are filed as part of this report.
|
(1) Financial
StatementsThe response to this portion of Item 14 is submitted as
Item 8 of this report.
(2) Index to
Consolidated Financial Statement Schedules:
|
I Parent Company Financial
Information
|
|
II Valuation and Qualifying
Accounts
|
|
All other schedules have been
omitted because they are not applicable.
|
(3)
Exhibits:
3(a) |
|
Restated
Certificate of Incorporation filed with the Secretary of State of
Delaware on November 9,
1989, as restated to incorporate the amendment of January 9, 1992, and the
correction of March 23,
1992. Exhibit 4(i) to the Companys Post-Effective Amendment to the
Registration Statement on Form
S-8 (Reg. No. 33-49305) filed February 2, 1994, is incorporated by
reference herein. |
|
(b)
|
|
By-laws, as
amended. Exhibit 3(b) to the Companys Annual Report for the fiscal
year ended
December 31, 1997, is incorporated by reference herein. |
|
4(a) |
|
Form of Amended
and Restated Rights Agreement dated February 14, 1996, between Humana Inc.
and Mid-America Bank of Louisville and Trust Company. Exhibit 1.3 to the
Registration Statement
(File No. 1-5975) on Form 8-A/A dated February 14, 1996, is incorporated by
reference herein. |
|
(b) |
|
Amendment No. 2 to
the Amended and Restated Rights Agreement. Exhibit 4.3 to the Registration
Statement (File No. 1-5975) on Form 8-A/A dated March 1, 1999, is
incorporated by reference herein. |
|
(c) |
|
There are no
instruments defining the rights of holders with respect to long-term debt
in excess of 10
percent of the total assets of the Company on a consolidated basis. Other
long-term indebtedness of
the Company is described in Note 6 of Notes to Consolidated Financial
Statements in the Companys
1999 Annual Report to Stockholders. The Company agrees to furnish copies of
all such instruments
defining the rights of the holders of such indebtedness to the Commission
upon request. |
|
10(a)* |
|
1989 Stock Option
Plan for Employees. Exhibit A to the Companys Proxy Statement
covering the
Annual Meeting of Stockholders held on January 11, 1990, is incorporated by
reference herein. |
|
(b)*
|
|
Amendment No. 1 to
the 1989 Stock Option Plan for Employees. Annex B to the Companys
Proxy
Statement covering the Annual Meeting of Stockholders held on February 18,
1993, is incorporated by
reference herein. |
|
(c)* |
|
Amendment No. 2 to
the 1989 Stock Option Plan for Employees. Exhibit 10(e) to the Company
s
Annual Report on Form 10-K for the fiscal year ended December 31, 1993, is
incorporated by
reference herein. |
|
(d)* |
|
1989 Stock Option
Plan for Non-Employee Directors. Exhibit B to the Companys Proxy
Statement
covering the Annual Meeting of Stockholders held on January 11, 1990, is
incorporated by reference
herein. |
|
(e)* |
|
Amendment No. 1 to
the 1989 Stock Option Plan for Non-Employee Directors. Annex C to the
Companys Proxy Statement covering the Annual Meeting of Stockholders
held on February 18, 1993,
is incorporated by reference herein. |
* Exhibits 10(a) through and
including 10(v) are compensatory plans or management contracts.
10(f)* |
|
Amendment No. 2 to
the 1989 Stock Option Plan for Non-Employee Directors. Exhibit 10(h) to
the
Companys Annual Report on Form 10-K for the fiscal year ended
December 31, 1993, is
incorporated by reference herein. |
|
(g)*
|
|
1989 Stock Option
Plan for Non-Employee Directors, as amended and restated in 1998. Exhibit
A to
the Companys Proxy Statement covering the Annual Meeting of
Stockholders held on May 14, 1998,
is incorporated by reference herein. |
|
(h)* |
|
1996 Stock
Incentive Plan for Employees. Annex A to the Companys Proxy
Statement covering the
Annual Meeting of Stockholders held on May 9, 1996, is incorporated by
reference herein. |
|
(i)* |
|
1996 Stock
Incentive Plan for Employees as amended in 1998. Exhibit C to the Company
s Proxy
Statement covering the Annual Meeting of Stockholders held on May 14, 1998,
is incorporated by
reference herein. |
|
(j)* |
|
Executive
Management Incentive Compensation PlanGroup A, Corporate. Exhibit C
to the
Companys Proxy Statement covering the Annual Meeting of Stockholders
held on May 26, 1994, is
incorporated by reference herein. |
|
(k)* |
|
Humana Inc. 1998
Executive Management Incentive Compensation Plan. Exhibit B to the Company
s
Proxy Statement covering the Annual Meeting of Stockholders held on May 14,
1998, is incorporated
by reference herein. |
|
(l)* |
|
Restated agreement
providing for termination benefits in the event of a change of control.
Exhibit
10(m) to the Companys Annual Report on Form 10-K for the fiscal year
ended December 31, 1997,
is incorporated by reference herein. |
|
(m)* |
|
Humana Inc. 1998
Management Incentive Compensation Plan. Exhibit 10(n) to the Company
s
Annual Report on Form 10-K for the fiscal year ended December 31, 1997, is
incorporated by
reference herein. |
|
(n)* |
|
Employment
AgreementGregory H. Wolf, dated December 1, 1998. Exhibit 10(q) to
the
Companys Annual Report on Form 10-K for the year ended December 31,
1998, is incorporated by
reference herein. |
|
(o)* |
|
Employment
AgreementKenneth J. Fasola, dated March 29, 1999. Exhibit 10 to the
Companys
Quarterly Report on Form 10-Q for the quarter ended March 31, 1999, is
incorporated by reference
herein. |
|
(p)* |
|
Trust under Humana
Inc. Deferred Compensation Plans, filed herewith. |
|
(q)* |
|
Severance policy.
Exhibit 10 to the Companys Quarterly Report on Form 10-Q for the
quarter ended
September 30, 1999, is incorporated by reference herein. |
|
(r)* |
|
Agreement
David A. Jones, dated December 15, 1999, filed herewith. |
|
(s)* |
|
Humana Officers
Target Retirement Plan, as amended. Exhibit 10(p) to the Company
s Annual
Report on From 10-K for the fiscal year ended December 31, 1997, is
incorporated by reference
herein. |
|
(t)* |
|
Humana Thrift
Excess Plan as amended. Exhibit 10(s) to the Companys Annual Report
on Form 10-
K for the fiscal year ended December 31, 1994, is incorporated by reference
herein. |
|
(u)* |
|
Humana
Supplemental Executive Retirement Plan as amended. Exhibit 10(t) to the
Companys
Annual Report on Form 10-K for the fiscal year ended December 31, 1994, is
incorporated by
reference herein. |
|
(v)* |
|
Letter agreement
with Company officers concerning health insurance availability. Exhibit
10(mm) to
the Companys Annual Report on Form 10-K for the fiscal year ended
December 31, 1994, is
incorporated by reference herein. |
* Exhibits 10(a) through and
including 10(v) are compensatory plans or management contracts.
10(w) |
|
Indemnity
Agreement. Appendix B to the Companys Proxy Statement covering the
Annual Meeting of
Stockholders held on January 8, 1987, is incorporated by reference
herein. |
|
(x)
|
|
Agreement between
the Secretary of the Department of Health and Human Services and Humana
Medical Plan, Inc. Exhibit 10(w) to the Companys Annual Report on
Form 10-K for the fiscal year
ended December 31, 1993, is incorporated by reference herein. |
|
(y) |
|
The $1.5 Billion
Credit Facility between the Company and Chase Manhattan Bank and the First
Amendment thereto (Credit Agreement). Exhibit 10 to the Company
s Current Report on Form 8-K
filed on September 23, 1997, is incorporated by reference
herein. |
|
(z) |
|
Second Amendment
to the Credit Agreement dated November 19, 1999, filed
herewith. |
|
(aa) |
|
The $1.5 Billion
Commercial Paper Private Placement Memorandum between the Company and
Chase
Securities, Inc. Exhibit 4a to the Companys Current Report on Form
8-K filed on September 23, 1997,
is incorporated by reference herein. |
|
(bb) |
|
The $1.5 Billion
Commercial Paper Private Placement Memorandum between the Company and
Merrill Lynch Money Markets, Inc. Exhibit 4b to the Companys Current
Report on Form 8-K filed on
September 23, 1997, is incorporated by reference herein. |
|
(cc) |
|
Assumption of
Liabilities and Indemnification Agreement between the Company and Galen
Health
Care, Inc. (Galen). Exhibit 10(g) to the Companys Current
Report on Form 8-K filed on March 5,
1993, is incorporated by reference herein. |
|
(dd) |
|
Agreement between
the United States Department of Defense and Humana Military Healthcare
Services, Inc., a wholly owned subsidiary of the Company. Exhibit 10(dd) to
the Companys Annual
Report on Form 10-K for the fiscal year ended December 31, 1995, is
incorporated by reference herein. |
|
12 |
|
Statement re:
Computation of Ratio of Earnings to Fixed Charges, filed
herewith. |
|
13 |
|
1999 Annual Report
to Stockholders, filed herewith. The Annual Report shall not be deemed to
be filed
with the Commission except to the extent that information is specifically
incorporated by reference
herein. |
|
21 |
|
List of
Subsidiaries, filed herewith. |
|
23 |
|
Consent of
PricewaterhouseCoopers LLP, filed herewith. |
|
27 |
|
Financial Data
Schedule, filed herewith. |
(b) Reports on Form
8-K:
|
For the quarter
ended December 31, 1999, there were no reports filed on Form 8-K. As of
the filing date, Humana Inc. filed the following reports on Form
8-K:
|
|
(1)
|
On January 3,
2000, the Company filed a report on Form 8-K regarding a proposed charge
in the range of $400 million to $500 million relating primarily to
goodwill and the proposed sale of its workers compensation and
Medicare supplemental businesses.
|
|
(2)
|
On February 3,
2000, the Company filed a report on Form 8-K regarding the appointment of
Michael B. McCallister as President and Chief Executive Officer of the
Company.
|
Pursuant to the requirements of
Sections 13 or 15(d) of the Securities Exchange Act of 1934, the Company
has duly caused this report to be signed on its behalf by the undersigned,
thereto duly authorized.
|
Chief Operating
OfficerHealth Plan Division and Chief Financial Officer
|
Pursuant to the requirements of
the Securities Exchange Act of 1934, this report has been signed below by
the following persons on behalf of the Company and in the capacities and on
the date indicated.
Signature
|
|
Title
|
|
Date
|
|
|
/S
/ JAMES
E. MURRAY
James E. Murray |
|
Chief Operating
OfficerHealth
Plan Division and Chief Financial
Officer
(Principal Accounting Officer) |
|
March 30,
2000 |
|
|
/S
/ DAVID
A. JONES
David A. Jones |
|
Chairman of the
Board |
|
March 30,
2000 |
|
|
/S
/ DAVID
A. JONES
, JR
.
David A. Jones, Jr. |
|
Vice Chairman of
the Board |
|
March 30,
2000 |
|
|
/S
/ K. FRANK
AUSTEN
, M.D.
K. Frank Austen, M.D. |
|
Director |
|
March 30,
2000 |
|
|
/S
/ MICHAEL
E. GELLERT
Michael E. Gellert |
|
Director |
|
March 30,
2000 |
|
|
/S
/ JOHN
R. HALL
John R. Hall |
|
Director |
|
March 30,
2000 |
|
|
/S
/ IRWIN
LERNER
Irwin Lerner |
|
Director |
|
March 30,
2000 |
|
|
/S
/ MICHAEL
B. MC
CALLISTER
Michael B. McCallister |
|
Director,
President and
Chief Executive Officer |
|
March 30,
2000 |
|
|
/S
/ W. ANN
REYNOLDS
, PH
.D.
W. Ann Reynolds, Ph.D. |
|
Director |
|
March 30,
2000 |
|
REPORT OF
INDEPENDENT ACCOUNTANTS
To the Board of
Directors
Humana
Inc.
Our audits of the consolidated
financial statements referred to in our report February 9, 2000 appearing
in the 1999 Annual Report of Stockholders of Humana Inc. which report and
consolidated financial statements are incorporated by reference in this
Annual Report on Form 10-K, also included an audit of the financial
statement schedules listed in Item 14(a)(2) of this Form 10-K. In our
opinion, these financial statement schedules present fairly, in all
material respects, the information set forth therein when read in
conjunction with the related consolidated financial statements.
PRICEWATERHOUSECOOPERS LLP
Louisville,
Kentucky
February 9,
2000
HUMANA
INC.
SCHEDULE I
PARENT COMPANY FINANCIAL INFORMATION (a)
CONDENSED BALANCE
SHEETS
December 31, 1999
and 1998
(In millions,
except share amounts)
|
|
1999
|
|
1998
|
ASSETS |
|
|
Receivables from
operating subsidiaries (b) |
|
$
120 |
|
$
168 |
Other current
assets |
|
51 |
|
57 |
|
|
|
|
|
Total current assets |
|
171 |
|
225 |
Property and
equipment, net |
|
176 |
|
181 |
Investments in
subsidiaries |
|
1,886 |
|
2,380 |
Other |
|
40 |
|
48 |
|
|
|
|
|
TOTAL ASSETS |
|
$2,273 |
|
$2,834 |
|
|
|
|
|
|
LIABILITIES AND
STOCKHOLDERS EQUITY |
|
Book
overdraft |
|
$
159 |
|
$
175 |
Other current
liabilities (b) |
|
114 |
|
106 |
Commercial
paper |
|
686 |
|
730 |
|
|
|
|
|
Total current
liabilities |
|
959 |
|
1,011 |
Debt |
|
|
|
93 |
Other |
|
46 |
|
42 |
|
|
|
|
|
Total liabilities |
|
1,005 |
|
1,146 |
|
|
|
|
|
Contingencies
(b) |
Preferred stock,
$1 par; authorized 10,000,000 shares, none issued |
Common stock,
$0.16-2/3 par; authorized 300,000,000 shares; issued and outstanding
167,514,7101999, 167,515,362
1998 |
|
28 |
|
28 |
Other stockholders
equity |
|
1,240 |
|
1,660 |
|
|
|
|
|
Total stockholders
equity |
|
1,268 |
|
1,688 |
|
|
|
|
|
TOTAL LIABILITIES AND
STOCKHOLDERS EQUITY |
|
$2,273 |
|
$2,834 |
|
|
|
|
|
(a)
|
Parent company
financial information has been derived from the consolidated financial
statements of the Company and excludes the accounts of all operating
subsidiaries. This information should be read in conjunction with the
consolidated financial statements of the Company.
|
(b)
|
In the normal
course of business, the parent company indemnifies certain of its
subsidiaries for health plan obligations its subsidiaries may be unable
to meet.
|
HUMANA
INC.
SCHEDULE I
PARENT COMPANY FINANCIAL INFORMATION (a)
CONDENSED
STATEMENTS OF OPERATIONS
For the Years
Ended December 31, 1999, 1998 and 1997
(In
millions)
|
|
1999
|
|
1998
|
|
1997 (b)
|
Revenues: |
|
|
|
Management fees charged to
operating subsidiaries |
|
$364 |
|
|
$297 |
|
|
$228 |
|
Interest and other
income |
|
14 |
|
|
1 |
|
|
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
378 |
|
|
298 |
|
|
233 |
|
|
|
|
|
|
|
|
|
|
|
Expenses: |
Selling, general and
administrative |
|
331 |
|
|
293 |
|
|
201 |
|
Depreciation |
|
36 |
|
|
33 |
|
|
26 |
|
Interest |
|
30 |
|
|
40 |
|
|
17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
397 |
|
|
366 |
|
|
244 |
|
|
|
|
|
|
|
|
|
|
|
Loss before
income taxes and equity in income of subsidiaries |
|
(19 |
) |
|
(68 |
) |
|
(11 |
) |
Income tax benefit |
|
6 |
|
|
38 |
|
|
9 |
|
|
|
|
|
|
|
|
|
|
|
Loss before
equity in income of subsidiaries |
|
(13 |
) |
|
(30 |
) |
|
(2 |
) |
(Loss) equity in income of
subsidiaries |
|
(369 |
) |
|
159 |
|
|
175 |
|
|
|
|
|
|
|
|
|
|
|
Net (loss)
income |
|
$(382 |
) |
|
$129 |
|
|
$173 |
|
|
|
|
|
|
|
|
|
|
|
(a)
|
Parent company
financial information has been derived from the consolidated financial
statements of the Company and excludes the accounts of all operating
subsidiaries. This information should be read in conjunction with the
consolidated financial statements of the Company.
|
(b)
|
Includes the
operations of Health Direct, Inc., Physician Corporation of America and
ChoiceCare Corporation since their dates of acquisition, February 28,
1997, September 8, 1997 and October 17, 1997, respectively.
|
HUMANA
INC.
SCHEDULE I
PARENT COMPANY FINANCIAL INFORMATION (a)
CONDENSED
STATEMENTS OF CASH FLOWS
For the Years
Ended December 31, 1999, 1998 and 1997
(In
millions)
|
|
1999
|
|
1998
|
|
1997
|
Net cash provided
by operating activities (b) |
|
$354 |
|
|
$105 |
|
|
$191 |
|
|
Cash flows from
investing activities: |
Purchases of property and
equipment |
|
(11 |
) |
|
(43 |
) |
|
(38 |
) |
Purchases of marketable
securities |
|
|
|
|
(1 |
) |
|
(6 |
) |
Maturities and sales of
marketable securities |
|
7 |
|
|
7 |
|
|
1 |
|
Parent funding of operating
subsidiaries |
|
(191 |
) |
|
(59 |
) |
|
(209 |
) |
Acquisition of health
plans |
|
|
|
|
|
|
|
(656 |
) |
Other |
|
(7 |
) |
|
(11 |
) |
|
17 |
|
|
|
|
|
|
|
|
|
|
|
Net cash used in investing
activities |
|
(202 |
) |
|
(107 |
) |
|
(891 |
) |
|
|
|
|
|
|
|
|
|
|
Cash flows from
financing activities: |
Issuance of long-term
debt |
|
|
|
|
123 |
|
|
300 |
|
Repayment of long-term
debt |
|
(93 |
) |
|
(330 |
) |
|
|
|
Net commercial paper
(repayments) borrowings |
|
(44 |
) |
|
141 |
|
|
367 |
|
Other |
|
(15 |
) |
|
68 |
|
|
33 |
|
|
|
|
|
|
|
|
|
|
|
Net cash (used in) provided by financing
activities |
|
(152 |
) |
|
2 |
|
|
700 |
|
|
|
|
|
|
|
|
|
|
|
Change in cash
and cash equivalents |
|
|
|
|
|
|
|
|
|
Cash and cash
equivalents at beginning of period |
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash
equivalents at end of period |
|
$
|
|
|
$
|
|
|
$
|
|
|
|
|
|
|
|
|
|
|
|
(a)
|
Parent company
financial information has been derived from the consolidated financial
statements of the Company and excludes the accounts of all operating
subsidiaries. This information should be read in conjunction with the
consolidated financial statements of the Company.
|
(b)
|
During the years
ended December 31, 1999, 1998 and 1997, the Company received dividends
from its operating subsidiaries totaling $276 million, $93 million and
$146 million, respectively.
|
HUMANA
INC.
SCHEDULE II
VALUATION AND QUALIFYING ACCOUNTS
For the Years
Ended December 31, 1999, 1998 and 1997
(In
millions)
|
|
Balance at
Beginning
of Period
|
|
Acquired
Balances
|
|
Additions
|
|
Deductions
or
Write-offs
|
|
Balance at
End of Period
|
|
|
|
|
Charged to
Costs and
Expenses
|
|
Charged to
Other
Accounts
|
Allowance for
loss on premiums
receivable: |
|
|
|
|
|
|
|
|
|
|
|
|
Years ended December
31,: |
1999 |
|
$62 |
|
|
|
$12 |
|
$(11 |
) |
|
$(2 |
) |
|
$61 |
1998 |
|
48 |
|
|
|
11 |
|
14 |
|
|
(11 |
) |
|
62 |
1997 |
|
38 |
|
$9 |
|
10 |
|
3 |
|
|
(12 |
) |
|
48 |