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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-K
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
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For the fiscal year ended December 31, 2004 |
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
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For the transition period
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Commission File Number 001-31574
AMERIGROUP Corporation
(Exact name of registrant as specified in its charter)
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Delaware
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54-1739323 |
(State or Other Jurisdiction of Incorporation or
Organization) |
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(I.R.S. Employer Identification No.) |
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4425 Corporation Lane, Virginia Beach, Virginia
(Address of principal executive offices) |
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23462
(Zip Code) |
Registrants telephone number, including area code:
(757) 490-6900
Securities registered pursuant to Section 12(b) of the
Act:
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Title of Each Class |
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Name of Each Exchange on Which Registered |
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Common Stock, $.01 par value |
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New York Stock Exchange |
Indicate by check mark whether the registrant: (1) has
filed all reports required to be filed by Section 13 or
15(d) of the Securities Exchange Act of 1934 during the
preceding 12 months (or for such shorter period that the
registrant was required to file such reports), and (2) has
been subject to such filing requirements for the past
90 days. Yes þ No o
Indicate by check mark if disclosure of delinquent filers
pursuant to Item 405 of Regulation S-K is not
contained herein, and will not be contained, to the best of the
registrants knowledge, in definitive proxy or information
statements incorporated by reference in Part III of this
Form 10-K or any amendment to this
10-K. o
Indicate by check mark whether the registrant is an accelerated
filer (as defined in Rule 12b-2 of the
Act). Yes þ No o
The aggregate market value of common stock held by
non-affiliates at June 30, 2004 was $1,211,398,858.
The number of shares of common stock, $0.01 par value,
outstanding as of March 1, 2005, was 50,858,382.
Document Incorporated by Reference
Part III of this Report incorporates by reference
information from the definitive
Proxy Statement for the Registrants 2005 Annual Meeting
of Stockholders
TABLE OF CONTENTS
1
Forward-looking Statements
This Annual Report on Form 10-K, and other information we
provide from time-to-time, contains certain
forward-looking statements as that term is defined
by Section 27A of the Securities Act of 1933 and
Section 21E of the Securities Exchange Act of 1934. All
statements regarding our expected future financial position,
membership, results of operations or cash flows, our continued
performance improvements, our ability to service our debt
obligations and refinance our debt obligations, our ability to
finance growth opportunities, our ability to respond to changes
in government regulations and similar statements including,
without limitation, those containing words such as
believes, anticipates,
expects, may, will,
should, estimates, intends,
plans and other similar expressions are
forward-looking statements.
Forward-looking statements involve known and unknown risks and
uncertainties that may cause our actual results in future
periods to differ materially from those projected or
contemplated in the forward-looking statements as a result of,
but not limited to, the following factors:
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national, state and local economic conditions, including their
effect on the rate increase process, timing of payments, as well
as their effect on the availability and cost of labor, utilities
and materials; |
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the effect of government regulations and changes in regulations
governing the healthcare industry, including our compliance with
such regulations and their effect on certain of our unit costs
and our ability to manage our medical costs; |
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changes in Medicaid payment levels and methodologies and the
application of such methodologies by the government; |
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liabilities and other claims asserted against us; |
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our ability to attract and retain qualified personnel; |
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our ability to maintain compliance with all minimum capital
requirements; |
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the availability and terms of capital to fund acquisitions and
capital improvements; |
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the competitive environment in which we operate; |
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our ability to maintain and increase membership levels; |
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demographic changes; and |
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terrorism. |
Investors should also refer to the section entitled Risk
Factors following section 7A entitled
Quantitative and Qualitative Disclosures About Market
Risk for a discussion of risk factors. Given these risks
and uncertainties, we can give no assurances that any
forward-looking statements will, in fact, transpire and,
therefore, caution investors not to place undue reliance on them.
2
PART I.
Overview
We are a multi-state managed healthcare company focused on
serving people who receive healthcare benefits through publicly
sponsored programs, including Medicaid, State Childrens
Health Insurance Program (SCHIP) and FamilyCare. We believe
that we are better qualified and positioned than many of our
competitors to meet the unique needs of our target populations
because of our focus on providing managed care to these
populations, our medical management programs and our
community-based education and outreach programs. Unlike many
managed care organizations that attempt to serve the general
commercial population, as well as Medicare and Medicaid
populations, we are focused exclusively on the Medicaid, SCHIP
and FamilyCare populations. We do not currently offer Medicare
or commercial products. In general, as compared to commercial or
Medicare populations, our target population is younger, accesses
healthcare in an inefficient manner and has a greater percentage
of medical expenses related to obstetrics, diabetes, circulatory
and respiratory conditions. We design our programs to address
the particular needs of our members, for whom we facilitate
access to healthcare benefits pursuant to agreements with the
applicable regulatory authority. We combine medical, social and
behavioral health services to help our members obtain quality
healthcare in an efficient manner. Our success in establishing
and maintaining strong relationships with state governments,
providers and members has enabled us to obtain new contracts and
to establish a leading market position in many of the markets we
serve. Providers are hospitals, physicians and ancillary medical
programs that provide medical services to our members. Members
are said to be enrolled with our health plans to
receive benefits. Accordingly, our total membership is generally
referred to as our enrollment. As of December 31, 2004, we
provided an array of products to approximately 936,000 members
in the District of Columbia, Illinois, Florida, Maryland, New
Jersey and Texas. Effective January 1, 2005, we acquired
CarePlus, LLC, which operates as CarePlus Health Plan
(CarePlus), in New York City, New York and provides services to
members covered by New York States Medicaid, Child Health
Plus and Family Health Plus programs. CarePlus service
areas include New York City (Brooklyn, Manhattan, Queens and
Staten Island) and Putnam County, New York. With the acquisition
of CarePlus, we began providing services to approximately
115,000 additional members.
We were incorporated in Delaware on December 9, 1994 as
AMERICAID Community Care by a team of experienced senior
managers led by Jeffrey L. McWaters, our Chairman and Chief
Executive Officer. From 1994 through 1995, we were involved
primarily in financial planning, recruiting and training
personnel, developing products and markets and negotiating
contracts with various state governments. During 1996, we began
enrolling Medicaid members in our Fort Worth, New Jersey
and Chicago plans. In 1997, we obtained a contract and began
enrolling members in our Houston plan. In 1999, we began
operating in Maryland and the District of Columbia, and obtained
a contract and began enrolling members in our Dallas plan. Our
operations in Maryland and the District of Columbia are the
result of acquiring contract rights from Prudential Healthcare.
In 2003, we began operations in Florida as a result of an
acquisition of PHP Holdings, Inc. and its subsidiary, Physicians
Health Plans, Inc. (PHP). In 2004, we were selected to provide
Medicaid benefits in the Travis service area of Texas. In
addition, in the District of Columbia, Florida, New Jersey and
Texas, we have increased membership through acquisitions of
Medicaid contract rights and related assets of other health
plans in these service areas. Effective January 1, 2005, we
began operations in New York as a result of an acquisition.
Market Opportunity
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Emergence of managed care |
Healthcare in the United States has grown from a
$27 billion industry in 1960 to a highly regulated market
of approximately $1.7 trillion in 2003, an increase of 7.7% from
2002, according to the federal governments Centers for
Medicare & Medicaid Services (CMS).
CMS projects total U.S. healthcare spending to reach $3.4
trillion in 2013, growing at an average annual rate of 7.3% from
2002 through 2013. In response to the dramatic increases in
healthcare-related costs in the late 1960s, Congress enacted the
Federal Health Maintenance Organization Act of 1973, a statute
designed to
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encourage the establishment and expansion of care and cost
management. The private sector responded to this legislation by
forming health maintenance organizations (HMOs). HMOs were
intended to address the needs of employers, insurers, government
entities and healthcare providers who sought a cost-effective
alternative to traditional indemnity insurance. Since the
establishment of HMOs, enrollment has increased more than
twelve-fold from 6.0 million in 1976 to nearly
76.1 million in 2002. Over that time, many HMOs have been
formed to focus on a specific or specialty population of
healthcare such as commercial plans for employees, Medicare,
Medicaid, dental care and behavioral healthcare. Additionally,
HMOs have been formed in a variety of sizes, from small
community-based plans to multi-state organizations.
Despite these efforts to organize care delivery, the costs
associated with medical care have continued to increase. As a
result, it has become increasingly important for HMOs to
understand the populations they serve in order to develop an
infrastructure and programs tailored to the medical and social
profiles of their members.
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Medicaid, SCHIP and FamilyCare Programs |
Medicaid, a state-administered program, was enacted in 1965 to
make federal matching funds available to all states for the
delivery of healthcare benefits to eligible individuals,
principally those with incomes below specified levels who meet
other state-specified requirements. Medicaid is structured to
allow each state to establish its own eligibility standards,
benefits package, payment rates and program administration under
broad federal guidelines. By contrast, Medicare, in which we do
not currently participate, is a program administered by the
federal government and is made available to the aged and
disabled. Some of the differences between Medicaid and Medicare
are set forth below:
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Medicaid |
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Medicare |
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state administered,
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federally operated, |
state and matching federal funds,
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federal funds only, |
average age of our members is 14,
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average age of recipients is over 70, |
30 million people in managed care in 2004,
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5 million people in managed care in 2004, |
prescription drug coverage and
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prescription drug coverage begins in 2006 and |
mandatory managed care in most states.
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no mandatory managed care. |
We do not currently offer Medicare products or participate in
the Medicare program. However, CMS has announced demonstration
projects, which would allow HMOs to cover Medicare dual-eligible
members to be reimbursed for the acute care medical cost
currently funded by Medicare. The benefits for this program
would be similar to the benefits provided by Medicaid for
non-dual eligible members. If we decide to participate in any of
the programs and are selected by CMS to participate, some of our
revenue would be funded by Medicare.
Most states determine threshold Medicaid eligibility by
reference to other federal financial assistance programs,
including Temporary Assistance to Needy Families (TANF), and
Supplemental Security Income (SSI).
TANF provides assistance to low-income families with children
and was adopted to replace the Aid to Families with Dependent
Children program. SSI is a federal program that provides
assistance to low-income aged, blind or disabled individuals.
However, states can broaden eligibility criteria.
SCHIP, developed in 1997, is a federal/state matching program
that provides healthcare coverage to children not otherwise
covered by Medicaid or other insurance programs. SCHIP enables a
segment of the large uninsured population in the U.S. to
receive healthcare benefits. States have the option of
administering SCHIP through their Medicaid programs.
FamilyCare programs have been established in several states
including New Jersey and the District of Columbia. The New
Jersey FamilyCare Health Coverage Act is a Medicaid expansion
program providing healthcare access to an estimated 90,000
previously uninsured or underinsured New Jersey residents in
fiscal 2005. New Jersey FamilyCare is a voluntary federal and
state-funded health insurance program created to help uninsured
families, single adults and couples without dependent children
obtain affordable healthcare coverage.
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Nationally, approximately 64% of Medicaid spending is directed
toward hospital, physician and other acute care services, and
the remaining approximately 36% is for nursing home and other
long-term care. In general, inpatient and emergency room
utilization tends to be higher within the Medicaid population
than among the general population because of the inability to
afford access to a primary care physician (PCP), leading to the
postponement of treatment until acute care is required.
The highest healthcare expenses for the non-elderly and disabled
Medicaid population include:
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obstetrics, |
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respiratory illness, |
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diabetes, |
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neonatal care, |
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sickle cell disease, and |
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HIV/ AIDS. |
During fiscal year 2005, the federal government estimates
spending of approximately $188 billion on Medicaid with a
corresponding state match of approximately $142 billion.
Federal government estimates indicate that total Medicaid
outlays may reach approximately $192.5 billion for fiscal
year 2006, with an additional $5.4 billion spent on SCHIP
programs. Key factors driving Medicaid spending include:
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number of eligible individuals who enroll, |
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price of medical and long-term care services, |
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use of covered services, |
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state decisions regarding optional services and optional
eligibility groups, and |
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effectiveness of programs to reduce costs of providing benefits,
including managed care. |
The federal government pays a share of the medical assistance
expenditures under each states Medicaid program. That
share, known as the Federal Medical Assistance Percentage
(FMAP), is determined annually by a formula that compares the
states average per capita income level with the national
average per capita income level. Thus, states with higher per
capita income levels are reimbursed a smaller share of their
costs than states with lower per capita income levels. The FMAP
cannot be lower than 50% or higher than 83%. In fiscal 2005, the
FMAPs vary from 50% in 12 states and five territories to
77.1% in Mississippi, and 57% overall. In addition, the Balanced
Budget Act of 1997 permanently raised the FMAP for the District
of Columbia from 50% to 70%. The states fiscal
2005 FMAPs for the markets in which we have contracts are:
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FMAP |
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District of Columbia
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70.0 |
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Florida
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58.9 |
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Illinois
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50.0 |
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Maryland
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50.0 |
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New Jersey
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50.0 |
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New York
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50.0 |
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Texas
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60.9 |
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The federal government also matches administrative costs,
generally about 50%, although higher percentages are paid for
certain activities and functions, such as development of
automated claims processing systems. Federal payments have no
set limits (other than for SCHIP programs), but rather are made
on a matching basis. In 2004, Medicaid spending surpassed
elementary and secondary education spending in total state
spending, rising
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to 21.9% of total state spending for Medicaid and 21.5% for
elementary and secondary education. In 2003, 43.5% of total
federal funds provided to states were spent on Medicaid, the
highest category of federal funds provided to states.
State governments pay the share of Medicaid and SCHIP costs not
paid by the federal government. Some states require counties to
pay part of the states share of Medicaid costs.
Federal law establishes general rules governing how states
administer their Medicaid and SCHIP programs. Within those
rules, states have considerable flexibility, including
flexibility in how they set most provider prices and service
utilization controls. Generally, state Medicaid budgets are
developed and approved annually by the states governors
and legislatures. Medicaid expenditures are monitored during the
year against budgeted amounts. Federal law requires states to
offer at least two HMOs in any urban market with mandatory HMO
enrollment. If Medicaid HMO market departures result in only one
or no HMOs in an urban area, the affected state must also offer
the fee-for-service Medicaid program.
Under the Health Insurance Flexibility and Accountability
Demonstration Program (HIFA), states can seek waivers from
specific provisions of federal Medicaid requirements to increase
the number of individuals with health coverage through current
Medicaid and SCHIP resource levels. Currently, eight states are
involved in approved waiver programs. The current federal
administration has emphasized providing coverage to populations
with income below 200 percent of the federal poverty level.
Historically, the traditional Medicaid programs made payments
directly to providers after delivery of care. Under this
approach, recipients received care from disparate sources, as
opposed to being cared for in a systematic way. As a result,
care for routine needs was often accessed through emergency
rooms or not at all.
The delivery of episodic healthcare under the traditional
Medicaid program limited the ability of the states to provide
quality care, implement preventive measures and control
healthcare costs. Over the past decade, in response to rising
healthcare costs and in an effort to ensure quality healthcare,
the federal government has expanded the ability of state
Medicaid agencies to explore, and, in some cases, mandate the
use of managed care for Medicaid beneficiaries. If Medicaid
managed care is not mandatory, individuals entitled to Medicaid
may choose either the traditional Medicaid program or a managed
care plan, if available. According to information published by
CMS, from 1993 to 2002, managed care enrollment among Medicaid
beneficiaries increased to more than 57% of all enrollees. All
the markets in which we operate, except Illinois, have
state-mandated Medicaid managed care programs in place.
The AMERIGROUP Approach
Unlike many managed care organizations that attempt to serve the
general population, as well as Medicare and Medicaid
populations, we are focused exclusively on serving people who
receive healthcare benefits through publicly sponsored programs.
We do not currently offer Medicare or commercial products. Our
success in establishing and maintaining strong relationships
with state governments, providers and members has enabled us to
obtain new contracts and to establish a strong market position
in the markets we serve. We have been able to accomplish this by
addressing the various needs of these constituent groups.
We have been successful in bidding for contracts and
implementing new products because of our ability to facilitate
access to quality healthcare services in a cost-effective
manner. Our education and outreach programs, our disease and
medical management programs and our information systems benefit
the communities we serve while providing the state governments
with predictability of cost. Our education and outreach programs
are designed to decrease the use of emergency care services as
the primary access to healthcare through the provision of
certain programs such as member health education seminars and
system-wide 24-hour on-call nurses. Our information systems are
designed to measure and track our performance, enabling us to
demonstrate the effectiveness of our programs to the government.
While we promote ourselves directly in applying for new
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contracts or seeking to add new benefit plans, we believe that
our ability to obtain additional contracts and expand our
service areas within a state results primarily from our
demonstration of prior success in facilitating access to quality
care, while reducing and managing costs, and our
customer-focused approach to working in partnership with state
governments. We believe we will also benefit from this
experience when bidding for and acquiring contracts in new state
markets.
In each of the communities where we operate, we have established
extensive provider networks and have been successful in
continuing to establish new provider relationships. We have
accomplished this by working closely with physicians to help
them operate efficiently by providing financial, statistical and
utilization information, physician and patient educational
programs and disease and medical management programs, as well as
by adhering to a prompt payment policy. In addition, as we
increase our market penetration, we provide our physicians with
a growing base of potential patients in the markets they serve.
This network of providers and relationships assists us in
implementing preventive care methods, managing costs and
improving access to healthcare for members. We believe that our
experience working and contracting with Medicaid providers will
give us a competitive advantage in entering new markets. While
we do not directly market to or through our providers, they are
important in helping us attract new members and retain existing
members.
In both signing up new members and retaining existing members,
we focus on our understanding of the unique needs of the
Medicaid, SCHIP and FamilyCare populations. We have developed a
system that provides our members with appropriate access to
care. We supplement this care with community-based education and
outreach programs designed to improve the well-being of our
members. These programs not only help our members control and
manage their medical care, but also have been proven to decrease
the incidence of emergency room care, which is traumatic for the
individual and expensive and inefficient for the healthcare
system. We also help our members access prenatal care which
improves outcomes for our members and is less costly than
unmanaged care. As our presence in a market matures, these
programs and other value-added services, help us build and
maintain membership levels.
We focus on the members we serve and the communities where they
live. Many of our employees, including the sales force and
outreach staff, are a part of the communities we serve. We are
active in our members communities through education and
outreach programs. We often provide programs in our
members physician offices, churches and community centers.
Upon entering a new market, we use these programs and other
advertising to create brand awareness and loyalty in the
community.
Strategy
Our objective is to become the leading managed care organization
in the U.S. focused on serving people who receive
healthcare benefits through publicly sponsored programs. To
achieve this objective we intend to:
Increase our membership in existing and new markets through
internal growth and acquisitions. We intend to increase our
membership in existing and new markets through development and
implementation of community-specific products, alliances with
key providers, sales and marketing efforts and acquisitions. We
facilitate access to a broad continuum of healthcare supported
by numerous services such as neonatal intensive care and
high-risk pregnancy programs. These products and services are
developed and administered by us but are also designed to
attract and retain our providers, who are critical to our
overall success. Through strategic and selective contracting
with providers, we are able to customize our provider networks
to meet the unique clinical, cultural and socio-economic needs
of our members. Our providers often are located in the
inner-city neighborhoods where our members live, thereby
providing accessibility to, and an understanding of, the needs
of our members. For example, in our voluntary Chicago market, we
have a sales force to recruit potential members who are
currently in the traditional fee-for-service Medicaid system.
The overall effect of this comprehensive
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approach reinforces our broad brand-name recognition as a
leading managed healthcare company serving people who receive
publicly sponsored healthcare benefits, while complying with
state-mandated marketing guidelines.
We may also choose to increase membership by acquiring Medicaid
contracts and other related assets from competitors in our
existing markets. Since 1996, we have developed markets in
Illinois, New Jersey and Texas and acquired additional Medicaid
contracts and related assets in the District of Columbia,
Florida, Maryland, New Jersey, Texas and New York. We evaluate
potential new markets using our established government
relationships and our historical experience in managing Medicaid
populations. Our management team is experienced in identifying
markets for development of new operations, including
complementary businesses, identifying and executing acquisitions
and integrating these businesses into our existing operations.
For example, in January 2005, we began operations in New York as
a result of the acquisition of CarePlus resulting in
approximately 115,000 additional members in New York City
(Brooklyn, Manhattan, Queens and Staten Island) and Putman
County.
Capitalize on our experience working in partnership with
state governments. We continually strive to be an
industry-recognized leader in government relations and an
important resource to our state government customers. For
example, we have a dedicated legislative affairs team with
experience at the federal, state and local levels. We are, and
intend to continue to be, an active and leading participant in
the formulation and development of new policies and programs for
publicly sponsored healthcare benefits. This also enables us to
competitively expand our service areas and to implement new
products.
Focus on our medical home concept to provide
quality, cost-effective healthcare. We believe that the care
the Medicaid population has historically received can be
characterized as uncoordinated, episodic and short-term focused.
In the long-term, this approach is less desirable for the
patient and more expensive for the state.
Our approach to serving the Medicaid and historically uninsured
populations is based on offering a comprehensive range of
medical and social services intended to improve the well-being
of the member while lowering the overall cost of providing
benefits. Unlike traditional Medicaid, each of our members has a
primary contact, usually a PCP, to coordinate and administer the
provision of care, as well as enhanced benefits, such as 24-hour
on-call nurses. We refer to this coordinated approach as a
medical home.
Utilize population-specific disease management programs and
related techniques to improve quality and reduce costs. An
integral part of our medical home concept is continual quality
management. To help the physician improve the quality of care
and improve the health status of our members, we have developed
a number of programs and procedures to address high frequency,
chronic or high-cost conditions such as pregnancy, respiratory
conditions, diabetes, sickle cell disease and congestive heart
failure. Our procedures include case and disease management,
pre-admission certification, concurrent review of hospital
admissions, discharge planning, retrospective review of claims,
outcome studies and management of inpatient, ambulatory and
alternative care. These policies and programs are designed to
consistently provide high quality care and cost-effective
service to our members.
Products
We have developed several products through which we offer a
range of healthcare services. These products are also
community-based and seek to address the social and economic
issues faced by the populations we serve. Additionally, we seek
to establish strategic relationships with prestigious medical
centers, childrens hospitals and federally qualified
health centers to assist in implementing our products and
medical management programs within the communities we serve. Our
health plans cover various services that vary by state and may
include:
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primary and specialty physician care, |
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inpatient and outpatient hospital care, |
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emergency and urgent care, |
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prenatal care, |
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laboratory and x-ray services, |
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home health and durable medical equipment, |
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behavioral health services and substance abuse, |
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long-term and nursing home care, |
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24-hour on-call nurses, |
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vision care and exam allowances, |
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dental care, |
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chiropractic care, |
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podiatry, |
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prescriptions and limited over-the-counter drugs, |
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assistance with obtaining transportation for office or health
education visits, |
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memberships in the Boys and Girls Clubs, and |
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welcome calls and health status calls to coordinate care. |
Our products, which we may offer under different names in
different markets, focus on specific populations within the
Medicaid, FamilyCare and SCHIP programs. The average premiums
for our products vary significantly due to differences in the
benefits offered and underlying medical conditions in the
populations covered.
AMERICAID, our principal product, is our family-focused Medicaid
managed healthcare product designed for the TANF population that
consists primarily of low-income children and their mothers. We
currently offer our AMERICAID product in all markets we serve.
As of December 31, 2004, we had approximately
662,000 AMERICAID members. Effective January 1, 2005,
the acquisition of CarePlus added approximately
73,000 AMERICAID members to our enrollment.
AMERIKIDS is our managed healthcare product for uninsured
children not eligible for Medicaid. This product is designed for
children in the SCHIP initiative. We began offering AMERIKIDS in
Maryland and the District of Columbia when we acquired
Prudentials contract rights and other related assets in
1999. We began offering AMERIKIDS in New Jersey and Texas in
2000 and in Chicago in 2003. We began offering AMERIKIDS in
Florida when we acquired PHPs contract rights and other
related assets in 2003. As of December 31, 2004, we had
approximately 182,000 AMERIKIDS members. Effective
January 1, 2005, the acquisition of CarePlus added
approximately 22,000 AMERIKIDS members to our enrollment.
AMERIPLUS is our managed healthcare product for SSI recipients.
This population consists of the low-income aged, blind and
disabled. We began offering this product in 1998 and currently
offer it in New Jersey, Maryland, Houston, Texas and Florida. We
expect our AMERIPLUS membership to grow as more states include
SSI benefits in mandatory managed care programs. As of
December 31, 2004, we had approximately
79,000 AMERIPLUS members. Included in this number are
approximately 1,000 members added through a Florida program
called Summit Care. The Summit Care (Long Term Care Diversion)
program helps seniors live safely in their homes or assisted
living facilities as an alternative to nursing home care.
AMERIFAM is our FamilyCare managed healthcare product designed
for uninsured segments of the population other than SCHIP
eligibles. AMERIFAMs current focus is the families of our
SCHIP and Medicaid children. We offer this product in the
District of Columbia and New Jersey where the program covers
parents of SCHIP and Medicaid children. As of December 31,
2004, we had approximately 13,000 AMERIFAM members.
Effective January 1, 2005, the acquisition of CarePlus
added approximately 20,000 AMERIFAM members to our
enrollment.
As of December 31, 2004, of our 936,000 members, 99%
were enrolled in TANF, SCHIP and FamilyCare programs. The
remaining 1% were enrolled in SSI programs. Of these SSI
enrollees, approximately 9,000 were members to whom we
provided limited administrative services but did not provide
health benefits.
9
Disease and Medical Management Programs
We provide specific disease and medical management programs
designed to meet the special healthcare needs of our members
with chronic illnesses, to manage excessive costs and to improve
the overall health of our members. We currently offer disease
and medical management programs in areas such as neonatal,
high-risk pregnancy, asthma and other respiratory conditions,
congestive heart failure, sickle cell disease, diabetes and HIV/
AIDS. These programs focus on preventing acute occurrences
associated with chronic conditions by identifying at-risk
members, monitoring their conditions and proactively managing
their care. We also employ tools such as utilization review and
pre-certification to reduce the excessive costs often associated
with uncoordinated healthcare programs.
Marketing and Educational Programs
An important aspect of our comprehensive approach to healthcare
delivery is our marketing and educational programs, which we
administer system-wide for our providers and members. We often
provide our educational programs in members homes and our
marketing and educational programs in churches and community
centers. The programs we have developed are specifically
designed to increase awareness of various diseases, conditions
and methods of prevention in a manner that supports the
providers, while meeting the unique needs of our members. For
example, we conduct health promotion events in physicians
offices. Direct provider marketing is supported by traditional
marketing venues such as direct mail, telemarketing, television,
radio and cooperative advertising with participating medical
groups.
We believe that we can also increase and retain membership
through marketing and education initiatives. We have a dedicated
staff that actively supports and educates prospective and
existing members and community organizations. Through programs
such as Safe Kids and Taking Care of Baby and Me®, a
prenatal program for pregnant moms and their babies, we promote
a healthy lifestyle, safety and good nutrition to our members.
In addition to these personal health-related programs, we remain
committed to the communities we serve.
We have developed specific strategies for building relationships
with key community organizations, which help enhance community
support for our products and improve service to our members. We
regularly participate in local events and festivals and organize
community health fairs to promote healthy lifestyle practices.
Equally as important, our employees help support community
groups by serving as board members and volunteers. In the
aggregate, these activities serve to act not only as a referral
channel, but also reinforce the AMERIGROUP brand and foster
member loyalty.
In several markets, we provide value-added benefits as a means
to attract and retain members. These benefits include free
memberships to the local Boys and Girls Clubs and vouchers for
over-the-counter medications. We believe that our comprehensive
approach to healthcare positions us well to serve our members,
their providers and the communities in which they both live and
work.
Community Partners
We believe community focus and understanding are important to
attracting and retaining members. To assist in establishing our
community presence in a new market, we seek to establish
relationships with prestigious medical centers, childrens
hospitals, federally qualified health centers, community based
organizations and advocacy groups to offer our products and
programs.
10
Provider Network
We facilitate access to healthcare services to our members
through mutually non-exclusive contracts with PCPs, specialists,
hospitals and ancillary providers. Either prior to or concurrent
with bidding for new contracts, we establish a provider network
in each of our service areas. The following table shows the
total number of PCPs, specialists, hospitals and ancillary
providers participating in our network as of December 31,
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Service Areas |
|
|
|
|
|
|
|
Maryland |
|
|
|
|
Texas |
|
New Jersey |
|
and D.C. |
|
Illinois |
|
Florida |
|
Total |
|
New York(1) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Primary care physicians
|
|
|
1,787 |
|
|
|
1,873 |
|
|
|
1,635 |
|
|
|
570 |
|
|
|
1,629 |
|
|
|
7,494 |
|
|
|
1,559 |
|
|
|
|
|
Specialists
|
|
|
6,243 |
|
|
|
4,608 |
|
|
|
6,960 |
|
|
|
1,330 |
|
|
|
5,230 |
|
|
|
24,371 |
|
|
|
8,150 |
|
|
|
|
|
Hospitals
|
|
|
109 |
|
|
|
71 |
|
|
|
47 |
|
|
|
30 |
|
|
|
88 |
|
|
|
345 |
|
|
|
61 |
|
|
|
|
|
Ancillary providers
|
|
|
819 |
|
|
|
610 |
|
|
|
411 |
|
|
|
371 |
|
|
|
1,343 |
|
|
|
3,554 |
|
|
|
1,689 |
|
|
|
(1) |
Effective January 1, 2005, our provider network for New
York became effective with the acquisition of CarePlus.
Accordingly, our New York network is not included in our
participating network total as of December 31, 2004. |
The PCP is a critical component in care delivery, the management
of costs and the attraction and retention of new members. PCPs
include family and general practitioners, pediatricians,
internal medicine physicians and OB/ GYNs. These physicians
provide preventive and routine healthcare services and are
responsible for making referrals to specialists, hospitals and
other providers. Healthcare services provided directly by PCPs
include the treatment of illnesses not requiring referrals,
periodic physician examinations, routine immunizations, well
child care and other preventive healthcare services.
Specialists provide medical care to members generally upon
referral by the PCPs. However, we have identified specialists
that are part of the ongoing care of our members, such as
allergists, oncologists and surgeons, which our members may
access directly without first obtaining a PCP referral. Our
contracts with both the PCPs and specialists usually are for one
to two-year periods and automatically renew for successive
one-year periods subject to termination by us for cause, if
necessary, based on provider conduct or other appropriate
reasons. The contracts generally can be canceled by either party
without cause upon 90 to 120 days prior written notice.
Our contracts with hospitals are usually for one to two-year
periods and automatically renew for successive one-year periods.
Generally, our hospital contracts may be terminated by either
party without cause upon 90 to 150 days prior written
notice. Pursuant to the contract, the hospital is paid for all
pre-authorized medically necessary inpatient and outpatient
services and all covered emergency and medical screening
services provided to members. With the exception of emergency
services, most inpatient hospital services require advance
approval from the members PCP and our medical management
department. We require hospitals in our network to participate
in utilization review and quality assurance programs.
We have also contracted with other ancillary providers for
physical therapy, mental health and chemical dependency care,
home healthcare, vision care, diagnostic laboratory tests, x-ray
examinations, ambulance services and durable medical equipment.
Additionally, we have contracted with dental vendors that
provide routine dental care in markets where routine dental care
is a covered benefit and with a national pharmacy benefit
manager that provides a local pharmacy network in our markets
where pharmacy is a covered benefit.
In order to ensure the quality of our medical care providers, we
credential and re-credential our providers using standards that
are supported by the National Committee for Quality Assurance.
Additionally, we provide feedback and evaluations on quality and
medical management to them in order to improve the quality of
care provided, increase their support of our programs and
enhance our ability to attract and retain providers.
Provider Payment Methods
Fee-for-Service. This is a reimbursement mechanism that
pays providers based upon services performed. For the year ended
December 31, 2004, approximately 95% of our expenses for
direct health benefits were on a
11
fee-for-service reimbursement basis, including fees paid to
third-party vendors for ancillary services such as pharmacy,
mental health, dental and vision benefits. The primary
fee-for-service arrangements are maximum allowable fee schedule,
per diem, case rates, percent of charges or any combination
thereof. The following is a description of each of these
mechanisms:
|
|
|
Maximum Allowable Fee Schedule. Providers are paid the
lesser of billed charges or a specified fixed payment for a
covered service. The maximum allowable fee schedule is developed
using, among other indicators, the state fee-for-service
Medicaid program fee schedule, Medicare fee schedules, medical
costs trends and market conditions. |
|
|
Per Diem and Case Rates. Hospital facility costs are
typically reimbursed at negotiated per diem or case rates, which
vary by level of care within the hospital setting. Lower rates
are paid for lower intensity services, such as a low birth
weight newborn baby who stays in the hospital a few days longer
than the mother, compared to higher rates for a neonatal
intensive care unit stay for a baby born with severe
developmental disabilities. |
|
|
Percent of Charges. We contract with providers to pay
them an agreed-upon percent of their standard charges for
covered services. This is typically done where hospitals are
reimbursed under the state fee-for-service Medicaid program on a
percent of charges basis. |
Capitation. Some of our PCPs and specialists are paid on
a fixed-fee per member basis, also known as capitation. Our
arrangements with ancillary providers for vision, dental, home
health, laboratory, durable medical equipment, mental health and
chemical dependency services may also be capitated.
We review the fees paid to providers periodically and make
adjustments as necessary. Generally, the contracts with
providers do not allow for automatic annual increases in
payments. Among the factors generally considered in adjustments
are changes to state Medicaid fee schedules, competitive
environment, current market conditions, anticipated utilization
patterns and projected medical expenses. In order to enable us
to better monitor quality and meet our state contractual
encounter reporting obligations, it is our intention to increase
the number of providers we pay on a fee-for-service basis and
reduce the number of capitation contracts we have. States use
the encounter data to monitor quality of care to members and to
set premium rates.
Our Health Plans
Effective with the January 1, 2005 CarePlus acquisition, we
have six active health plan subsidiaries offering healthcare
services in the District of Columbia, Florida, Illinois,
Maryland, New Jersey, Texas and New York. We expect our
relationship with these jurisdictions to continue. Each of our
health plans have one or more contracts that expire at various
times, as set forth below:
|
|
|
|
|
Market |
|
Product |
|
Term End Date |
|
|
|
|
|
|
|
|
|
District of Columbia
|
|
TANF, SCHIP, FamilyCare |
|
July 31, 2005 |
|
|
|
|
Florida
|
|
TANF, SSI, SCHIP |
|
June 30, 2006(a) |
|
|
|
|
Florida
|
|
SCHIP |
|
September 30, 2005 |
|
|
|
|
Florida
|
|
SSI (Summit Care) |
|
June 30, 2005(b) |
|
|
|
|
Illinois
|
|
TANF, SCHIP |
|
July 31, 2006(c) |
|
|
|
|
Maryland(d)
|
|
TANF, SSI, SCHIP |
|
|
|
|
|
|
New Jersey
|
|
TANF, SSI, SCHIP, FamilyCare |
|
June 30, 2005 |
|
|
|
|
New York
|
|
TANF, SSI, FamilyCare |
|
September 30, 2005 |
|
|
|
|
New York
|
|
SCHIP |
|
June 30, 2005 |
|
|
|
|
Texas
|
|
TANF, SSI, SCHIP |
|
August 31, 2005 |
|
|
|
(a) |
|
This contract can be terminated by either party upon
30 days notice. |
|
(b) |
|
This contract can be terminated by either party upon
60 days notice. |
|
(c) |
|
This contract can be terminated by either party upon
90 days written notice. |
|
(d) |
|
Our Maryland contract does not have a set term. |
12
Our Maryland subsidiary, AMERIGROUP Maryland, Inc., a Managed
Care Organization, is also licensed as an HMO in the District of
Columbia and became operational there in August 1999. As of
December 31, 2004, we had approximately 41,000 members in
the District of Columbia. We believe that we have the largest
Medicaid membership in the District of Columbia. We offer
AMERICAID, AMERIKIDS and AMERIFAM in the District of Columbia.
Our contract with the District of Columbia extends through
July 31, 2005, with the Districts option to continue
contract extensions for two additional one-year terms through
July 31, 2007.
Our Florida subsidiary, AMERIGROUP Florida, Inc., is licensed as
an HMO and became operational in January 2003 with the
acquisition of PHP. In July 2003, we acquired the Medicaid
contract rights and related assets of St. Augustine. Our current
service areas include the metropolitan areas of Miami/
Fort Lauderdale, Orlando and Tampa that include 13 counties
in Florida. As of December 31, 2004, we had approximately
229,000 members, consisting of approximately 58,000 members in
Miami/ Fort Lauderdale, 45,000 members in Orlando and
126,000 members in Tampa. We believe we have the third largest
Medicaid membership in the Miami/ Fort Lauderdale market,
second largest Medicaid membership in the Orlando market and the
largest Medicaid membership in the Tampa market. We offer
AMERICAID, AMERIKIDS and AMERIPLUS in each of our Florida
markets. Our TANF, SSI and SCHIP contracts expire June 30,
2006 and can be terminated by either party upon 30 days
notice. Our Summit Care contract expires June 30, 2005 and
we anticipate the new contract to be effective as of
July 1, 2005. However, either party can terminate the
contract upon 60 days notice. Currently, we are in good
standing with the Department of Elder Affairs, the agency with
regulatory oversight of the Long Term Care program, and have no
reason to believe that the contract will not be renewed. As a
result of a successful Florida SCHIP re-bid in 2004, individual
county contracts were consolidated into one contract covering
eight counties, through September 30, 2005, with the option
to continue contract extensions for two additional one-year
terms.
Our Illinois subsidiary, AMERIGROUP Illinois, Inc., is licensed
as an HMO and became operational in April 1996. Our current
service area includes the counties of Cook and DuPage in the
Chicago area. In Chicago, enrollment in a Medicaid managed care
plan is voluntary. As of December 31, 2004, we had
approximately 37,000 members in Chicago. We believe that we have
the second largest Medicaid health plan membership in Cook
County. We offer AMERICAID and AMERIKIDS in the Chicago area.
Our contract with the State of Illinois, which can be terminated
by either party with 90 days written notice, was extended
through July 31, 2004, and included an automatic renewal
provision for two consecutive one-year terms, thereby extending
the contract through July 31, 2006.
Our Maryland subsidiary, AMERIGROUP Maryland, Inc., a Managed
Care Organization, is authorized to operate as a managed care
organization (MCO) in Maryland and became operational in
June 1999. Our current service areas include 20 of the 24
counties in Maryland. As of December 31, 2004, we had
approximately 130,000 members in Maryland. We believe that we
have the largest Medicaid membership in Maryland. We offer
AMERICAID, AMERIKIDS and AMERIPLUS in Maryland. Our contract
with the State of Maryland does not have a set term. We can
terminate our contract with Maryland by notifying the State by
October 1st of any given year for an effective
termination date of January 1st of the following year.
The State may waive this timeframe if the circumstances warrant,
including but not limited to reduction in rates outside the
normal rate setting process or an MCO exit from the program.
Our New Jersey subsidiary, AMERIGROUP New Jersey, Inc., is
licensed as an HMO and became operational in February 1996. Our
current service areas include 20 of the 21 counties in New
Jersey. As of
13
December 31, 2004, we had approximately 105,000 members in
New Jersey. We believe that we have the third largest Medicaid
membership in New Jersey. We offer AMERICAID, AMERIPLUS,
AMERIKIDS and AMERIFAM in New Jersey. Our contract with the
State of New Jersey expires on June 30, 2005, with the
States option to extend the contract on an annual basis
through an executed contract amendment.
Effective January 1, 2005, we acquired CarePlus, which is
licensed as an HMO in New York. CarePlus service areas
include New York City, within the boroughs of Brooklyn,
Manhattan, Queens and Staten Island, and Putman County. We did
not have any membership in New York during 2004. Effective
January 1, 2005, through the acquisition of CarePlus, we
added approximately 115,000 members, consisting of approximately
50,000 members in Brooklyn, 7,000 members in Manhattan, 52,000
members in Queens, 6,000 members in Staten Island and less than
500 members in Putnam County to whom we offer AMERICAID,
AMERIKIDS and AMERIFAM. Our TANF, SSI and FamilyCare contracts
with the State expire on September 30, 2005. At the option
of the Department of Health, the TANF and SSI contracts may be
extended for up to an additional three-year period, and the
FamilyCare contract may be extended for an additional one-year
period. Our SCHIP contract with the State expires on
June 30, 2005. We expect continued extension of this
contract at the States discretion.
Our Texas subsidiary, AMERIGROUP Texas, Inc., is licensed as an
HMO and became operational in September 1996. Our current
service areas include the cities of Austin, Dallas,
Fort Worth and Houston and the surrounding counties. As of
December 31, 2004, we had approximately 394,000 members in
Texas, consisting of approximately 8,000 members in Austin,
approximately 98,000 members in Dallas, approximately 129,000
members in Fort Worth and approximately 159,000 members in
Houston. We believe that we have the largest Medicaid membership
in each of our Fort Worth and Houston markets and the
second largest Medicaid membership in our Austin and Dallas
markets. We offer AMERICAID in each of our Texas markets,
AMERIKIDS in Dallas and Houston and AMERIPLUS in Houston. The
Texas Health and Human Services Commission selected AMERIGROUP
Texas, Inc. to provide Medicaid benefits to the Travis service
area. Effective May 1, 2004, we began providing our
services to these Medicaid recipients. Our TANF contract in
Fort Worth and the Travis service area, our TANF and
SCHIP contracts in Dallas and our TANF, SCHIP and SSI contracts
in Houston are set to expire on August 31, 2005. We
participated in a re-procurement process of all product
contracts and all service areas in mid-year 2004. Although the
State has said it will announce contract awards in early 2005
with implementation continuing into 2006, the announcement of
the awards may not occur until after the conclusion of the Texas
legislative session on May 30, 2005.
Quality Management
We have a comprehensive quality management plan designed to
improve access to cost-effective quality care. We have developed
policies and procedures to ensure that the healthcare services
arranged by our health plans meet the professional standards of
care established by the industry and the medical community.
These procedures include:
|
|
|
|
|
Analysis of healthcare utilization data. To avoid
duplication of services or medications, in conjunction with the
PCPs, healthcare utilization data is analyzed and, through
comparative provider data and periodic meetings with physicians,
we identify areas in which a physicians utilization rate
differs significantly from the rates of other physicians. On the
basis of this analysis, we suggest opportunities for improvement
and follow-up with the PCP to monitor utilization. |
|
|
|
Medical care satisfaction studies. We evaluate the
quality and appropriateness of care provided to our health plan
members by reviewing healthcare utilization data and responses
to member and physician questionnaires and grievances. |
|
|
|
Clinical care oversight. Each of our health plans has a
medical advisory committee comprised of physician
representatives and chaired by the plans medical director.
This committee reviews credentialing, approves clinical
protocols and practice guidelines and evaluates new physician
group candidates. |
14
|
|
|
|
|
Based on regular reviews, the medical directors who head these
committees develop recommendations for improvements in the
delivery of medical care. |
|
|
|
Quality improvement plan. A quality improvement plan is
implemented in each of our health plans and is governed by a
quality management committee. The quality management committee
is comprised of senior management at our health plans, who
review and evaluate the quality of our health services and are
responsible for the development of quality improvement plans
spanning both clinical quality and customer service quality.
These plans are developed from provider and membership feedback,
satisfaction surveys and results of action plans. Our corporate
quality improvement council oversees and meets regularly with
our health plan quality management committees to help ensure
that we have a coordinated, quality-focused approach relating to
our members, providers and state governments. |
Management Information Systems
The ability to capture, process and allow local access to data
and to translate it into meaningful information is essential to
our ability to operate across a multi-state service area in a
cost-effective manner. Our centralized technology platform
supports our core processing functions enabled by a common
systems strategy. This integrated approach helps to assure that
consistent sources of claim, provider and member information are
provided across all of our health plans. We use these common
systems for billing, claims and encounter processing,
utilization management, marketing and sales tracking, financial
and management accounting, medical cost trending, reporting,
planning and analysis. The platform also supports our internal
member and provider service functions, including on-line access
to member eligibility verification, PCP membership roster,
authorization and claims status.
In November 2003, we signed a software licensing agreement with
The Trizetto Group, Inc. for their Facets Extended
Enterprisetm
administrative system (Facets). During 2004, we invested in the
implementation and testing of Facets with a staggered conversion
to Facets by health plan beginning in 2005 and continuing
through 2007. We estimate that our current claims payment
system, without Facets, could be at full capacity within the
next 16 months. We currently expect that Facets will meet
our software needs for a minimum of 10 years and will
support our long-term growth strategies.
Competition
Our principal competitors for state contracts, members and
providers consist of the following types of organizations:
|
|
|
|
|
Primary Care Case Management Programs (PCCMs)
Programs established by the states through contracts with PCPs
to provide primary care services to the Medicaid recipient, as
well as provide limited oversight over other services. |
|
|
|
Commercial HMOs National and regional commercial
managed care organizations that have Medicaid and Medicare
members in addition to members in private commercial plans. |
|
|
|
Medicaid HMOs Managed care organizations that focus
solely on serving people who receive healthcare benefits through
Medicaid. |
We will continue to face varying levels of competition as we
expand in our existing service areas or enter new markets. In
Illinois, where enrollment in a managed care plan is voluntary,
we also compete for members with the traditional means for
accessing care, including hospitals and other healthcare
providers. Healthcare reform proposals may cause a number of
commercial managed care organizations already in our service
areas to decide to enter or exit the Medicaid market. However,
the licensing requirements and bidding and contracting
procedures in some states present barriers to entry into the
Medicaid managed healthcare industry.
We compete with other managed care organizations to obtain state
contracts, as well as to attract new members and to retain
existing members. States generally use either a formal proposal
process reviewing many bidders or award individual contracts to
qualified applicants that apply for entry to the program. In
order to be awarded a state contract, state governments consider
many factors, which include providing quality care,
15
satisfying financial requirements, demonstrating an ability to
deliver services, and establishing networks and infrastructure.
People who wish to enroll in a managed healthcare plan or to
change healthcare plans typically choose a plan based on the
service offered, ease of access to services, a specific provider
being part of the network and the availability of supplemental
benefits.
In addition to competing for members, we compete with other
managed care organizations to enter into contracts with
independent physicians, physician groups and other providers. We
believe the factors that providers consider in deciding whether
to contract with us include potential member volume,
reimbursement rates, our medical management programs, timeliness
of reimbursement and administrative service capabilities.
Regulation
Our healthcare operations are regulated at both the state and
federal levels. Government regulation of the provision of
healthcare products and services is a changing area of law that
varies from jurisdiction to jurisdiction. Regulatory agencies
generally have discretion to issue regulations and interpret and
enforce laws and rules. Changes in applicable laws and rules may
also occur periodically.
Five of our health plan subsidiaries are authorized to operate
as HMOs in the District of Columbia, Florida, New Jersey
and Texas, and as an MCO in Maryland. In each of the
jurisdictions in which we operate, we are regulated by the
relevant health, insurance and/or human services departments
that oversee the activities of HMOs and MCOs providing or
arranging to provide services to Medicaid enrollees.
The process for obtaining the authorization to operate as an HMO
or MCO is lengthy and complicated and requires demonstration to
the regulators of the adequacy of the health plans
organizational structure, financial resources, utilization
review, quality assurance programs and complaint procedures.
Both under state HMO and MCO statutes and state insurance laws,
our health plan subsidiaries must comply with minimum net worth
requirements and other financial requirements, such as minimum
capital, deposit and reserve requirements. Insurance regulations
may also require the prior state approval of acquisitions of
other managed care organizations businesses and the
payment of dividends, as well as notice for loans or the
transfer of funds. Each of our subsidiaries is also subject to
periodic reporting requirements. In addition, each health plan
must meet numerous criteria to secure the approval of state
regulatory authorities before implementing operational changes,
including the development of new product offerings and, in some
states, the expansion of service areas.
Medicaid was established, as was Medicare, by 1965 amendments to
the Social Security Act of 1935. The amendments, known
collectively as the Social Security Act of 1965, created a joint
federal-state program in which each state:
|
|
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|
|
establishes its own eligibility standards, |
|
|
|
determines the type, amount, duration and scope of services, |
|
|
|
sets the rate of payment for services, and |
|
|
|
administers its own program. |
Medicaid policies for eligibility, services, rates and payment
are complex, and vary considerably among states, and the state
policies may change from time-to-time.
States are also permitted by the federal government to seek
waivers from certain requirements of the Social Security Act of
1965. In the past decade, partly due to advances in the
commercial healthcare field, states have been increasingly
interested in experimenting with pilot projects and statewide
initiatives to control costs and expand coverage and have done
so under waivers authorized by the Social Security Act of 1965
and with the
16
approval of the federal government. The waivers most relevant to
us are the Section 1915(b) freedom of choice waivers that
enable:
|
|
|
|
|
mandating Medicaid enrollment into managed care, |
|
|
|
utilizing a central broker for enrollment into plans, |
|
|
|
using cost savings to provide additional services, and |
|
|
|
limiting the number of providers for additional services. |
Waivers are approved for two-year periods and can be renewed on
an ongoing basis if the state applies. A 1915(b) waiver cannot
negatively impact beneficiary access or quality of care and must
be cost-effective. Managed care initiatives may be state-wide
and required for all classes of Medicaid eligible recipients, or
may be limited to service areas and classes of recipients. All
jurisdictions in which we operate, except Illinois, have some
sort of mandatory Medicaid program. However, under the waivers
pursuant to which the mandatory programs have been implemented,
there must be at least two managed care plans operating from
which Medicaid eligible recipients may choose.
Many states, including Maryland, operate under a
Section 1115 demonstration rather than a 1915(b) waiver.
This is a more expansive form of waiver that enables the state
to have a Medicaid program that is broader than typically
permitted under the Social Security Act of 1965. For example,
Marylands 1115 waiver allows it to include more
individuals in its managed care program than typically allowed
under Medicaid.
In all the states in which we operate, we must enter into a
contract with the states Medicaid regulator in order to be
a Medicaid managed care organization. States generally use
either a formal proposal process, reviewing many bidders, or
award individual contracts to qualified applicants that apply
for entry to the program. Although other states have done so in
the past and may do so in the future, currently the District of
Columbia, Florida and Texas are the only jurisdictions in which
we operate that use competitive bidding processes.
The contractual relationship with the state is generally for a
period of one to two years and renewable on an annual or
biannual basis. The contracts with the states and regulatory
provisions applicable to us generally set forth in great detail
the requirements for operating in the Medicaid sector including
provisions relating to:
|
|
|
|
|
eligibility, enrollment and disenrollment processes, |
|
|
|
covered services, |
|
|
|
eligible providers, |
|
|
|
subcontractors, |
|
|
|
record-keeping and record retention, |
|
|
|
periodic financial and informational reporting, |
|
|
|
quality assurance, |
|
|
|
marketing, |
|
|
|
financial standards, |
|
|
|
timeliness of claims payment, |
|
|
|
health education and wellness and prevention programs, |
|
|
|
safeguarding of member information, |
|
|
|
fraud and abuse detection and reporting, |
|
|
|
grievance procedures, and |
|
|
|
organization and administrative systems. |
17
A health plans compliance with these requirements is
subject to monitoring by the state regulator and by CMS. A
health plan is subject to periodic comprehensive quality
assurance evaluation by a third-party reviewing organization and
generally by the insurance department of the jurisdiction that
licenses the health plan. A health plan must also submit
quarterly and annual statutory financial statements and
utilization reports, as well as many other reports.
Federal Regulation
In accordance with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), health plans are required to
comply with all HIPAA regulations relating to standards for
electronic transactions and code sets, privacy of health
information, security of healthcare information, national
provider identifiers, and national employer identifiers.
AMERIGROUP providers and healthcare clearinghouses were required
to comply with HIPAA privacy requirements on or before
April 14, 2003, and with HIPAA Transactions and Code Sets
(T&CS) requirements by October 16, 2003.
AMERIGROUP implemented its privacy compliance program by
April 14, 2003. AMERIGROUP received a two-year privacy
accreditation from the Utilization Review Accreditation
Commission (URAC) on November 1, 2003.
On July 24, 2003, CMS issued guidance regarding compliance
with the T&CS regulations in which CMS stated that it would
not impose penalties on covered entities that deployed
contingencies (in order to ensure the smooth flow of payments)
if they have made reasonable and diligent efforts to become
compliant and, in the case of health plans, to facilitate the
compliance of their trading partners. AMERIGROUP implemented a
T&CS contingency plan in March 2003, and has since acted
aggressively to complete implementation of the T&CS
regulations, subject to compliance by its trading partners and
the various state Medicaid programs.
On February 20, 2003, HHS published its final security
regulations. The security rule applies only to protected health
information in electronic form, and is specifically concerned
with security information systems. A security gap analysis was
completed in 2004 and AMERIGROUP expects to be compliant with
the security rule by the April 20, 2005 deadline.
Implementation of the National Provider Identifier (NPI) is
required by May 27, 2007. A gap analysis for implementation
of the NPI will be started sometime in late 2005.
Future costs may be incurred in 2005 in implementation of the
security and NPI standards, but we do not yet know the extent of
such costs.
|
|
|
Medicaid Managed Care Regulations |
On January 19, 2001, HHS issued Medicaid managed care
regulations to implement certain provisions of the Balanced
Budget Act of 1997 (BBA). These provisions permit states to
require certain Medicaid beneficiaries to enroll in managed care
programs, give states more flexibility to develop their managed
care programs and provide certain new protections for Medicaid
beneficiaries. States had until August 13, 2003 to bring
their Medicaid managed care programs into compliance with the
requirements of the rule.
The rule implements BBA provisions intended to (i) give
states the flexibility to enroll certain Medicaid recipients in
managed care plans without a federal waiver if the state
provides the recipients with a choice of managed care plans;
(ii) establish protections for members in areas such as
quality assurance, grievance rights and coverage of emergency
services; and (iii) eliminate certain requirements viewed
by the states as impediments to the growth of managed care
programs, such as the enrollment composition requirement, the
right to disenroll without cause at any time, and the
prohibition against enrollee cost sharing. The rule also
establishes strict requirements intended to ensure that state
Medicaid managed care capitation rates are actuarially sound.
According to HHS, this requirement eliminates the generally
outdated regulatory ceiling on what states may pay managed care
plans, a particularly important provision as more state Medicaid
programs include people with chronic illnesses and disabilities.
18
Although some of the states in which we operate have already
implemented requirements similar to those provided for in the
rule, the manner in which the rule is implemented in each of the
states could increase our healthcare costs and administrative
expenses, reduce our reimbursement rates, and otherwise
adversely affect our business, results of operations, and
financial condition.
President Bush, in his 2006 Budget submission to Congress, has
proposed $1 billion in grant outreach monies over a
two-year period to increase healthcare coverage of children
eligible for Medicaid and SCHIP that are not currently enrolled.
The Presidents 2006 Budget also included funding for
expansion of vaccines for children. In addition, the President
has proposed demonstration projects entitled New Freedom
Initiatives to expand access and quality for people with
disabilities. Finally, the 2006 Budget includes proposals to
continue current law for Transitional Medical Assistance and
Medicare Premium Assistance for Medicaid.
The Presidents 2006 Budget also includes a number of
proposals to reduce or eliminate inappropriate
financing mechanisms employed by the states, primarily through
use of intergovernmental transfers. These initiatives, together
with Medicaid expansion proposals, are estimated to generate
$45 billion in net reductions in Medicaid spending over a
ten-year period. HHS is also interested in offering states
increased flexibility of its Medicaid program for optional
populations and services in exchange for more predictable cost
growth within the overall Medicaid program. The Presidents
2006 Budget contains little detail on this Medicaid Reform
proposal, and it is expected that more discussion of the
Medicaid Reform proposal will occur throughout the year. It is
uncertain whether any of these proposals, or a variation
thereof, will be enacted sometime in the future.
|
|
|
Patients Rights Legislation |
The U.S. Congress has considered several versions of
patients rights legislation in previous sessions. Though
no bill has been introduced in the 109th Congress, it is likely
to remain an issue. Legislation could expand our potential
exposure to lawsuits and increase our regulatory compliance
costs. Depending on the final form of any patients rights
legislation, such legislation could, among other things, expose
us to liability for economic and punitive damages for making
determinations that deny benefits or delay beneficiaries
receipt of benefits as a result of our medical necessity or
other coverage determinations. We cannot predict whether
patients rights legislation will be reconsidered in the
future or if enacted, what final form such legislation might
take.
|
|
|
Other Fraud and Abuse Laws |
Investigating and prosecuting healthcare fraud and abuse has
become a top priority for law enforcement entities. The funding
of such law enforcement efforts has increased in the past few
years and these increases are expected to continue. The focus of
these efforts has been directed at participants in public
government healthcare programs such as Medicaid. These
regulations and contractual requirements applicable to
participants in these programs are complex and changing. We have
re-emphasized our regulatory compliance efforts for these
programs, but ongoing vigorous law enforcement and the highly
technical regulatory scheme mean that compliance efforts in this
area will continue to require substantial resources.
Customers
As of December 31, 2004, we served members who received
healthcare benefits through our 13 contracts with the
regulatory entities in the jurisdictions in which we operate.
Five of these contracts, which are with the States of Florida,
Maryland, New Jersey and Texas, individually accounted for 10%
or more of our revenues for the year ended December 31,
2004, with the largest of these contracts representing
approximately 19% of our revenues. Effective January 1,
2005, we began serving members who receive health benefits
through an additional four contracts with the regulatory
entities in New York.
19
Employees
As of December 31, 2004, we had approximately 2,300
employees. Our employees are not represented by a union. We
believe our relationships with our employees are good.
Available Information
We file annual, quarterly and current reports, proxy statements
and all amendments to these reports and other information with
the U.S. Securities and Exchange Commission (SEC). We make
available free of charge on or through our website at
www.amerigroupcorp.com our Annual Report on
Form 10-K, Quarterly Reports on Form 10-Q, Current
Reports on Form 8-K; all amendments to those reports as
soon as reasonably practicable after such material is
electronically filed with or furnished to the SEC, our Corporate
Governance Principles, our Audit, Compensation and Nominating
and Corporate Governance charters and our Code of Business
Conduct and Ethics. Further, we will provide, without charge
upon written request, a copy of our Annual Report on
Form 10-K, Quarterly Reports on Form 10-Q, Current
Reports on Form 8-K, and all amendments to those reports.
Requests for copies should be addressed to Investor Relations,
AMERIGROUP Corporation, 4425 Corporation Lane, Virginia
Beach, VA 23462.
We do not own any real property. We lease office space in
Virginia Beach, Virginia, where our primary headquarters, call,
claims and data centers are located. We also lease real property
in each of the health plan locations. We are obligated by
various insurance and Medicaid regulatory authorities to have
offices in the service areas where we provide Medicaid benefits.
In September 2003, we entered into a 15-year lease for a new
106,000 square-foot building in Virginia Beach, Virginia.
The construction of this new location was completed in September
2004. The new facility currently houses our primary call and
data centers.
|
|
Item 3. |
Legal Proceedings |
In 2002, Cleveland A. Tyson, a former employee of AMERIGROUP
Illinois, Inc., filed a federal Qui Tam or whistleblower action
against our Illinois subsidiary, the United States of America
and the State of Illinois, es rel., Cleveland A. Tyson v.
AMERIGROUP Illinois, Inc., in the U.S. District Court of
the Northern District, Eastern Division, alleging the submission
of false claims under the Medicaid program. The United States is
not a party to the action. Mr. Tysons amended
complaint was unsealed and served on AMERIGROUP Illinois, Inc.,
in June 2003. Mr. Tyson alleges that AMERIGROUP Illinois,
Inc. maintained a scheme to discourage or avoid the enrollment
of pregnant women and members with special needs. In his suit,
Mr. Tyson seeks an unspecified amount of damages and
statutory penalties of no less than $5,000 and no more than
$11,000 per violation. Mr. Tysons complaint does
not specify the number of alleged violations. The court denied
AMERIGROUP Illinois, Inc.s motion to dismiss on
September 26, 2004. AMERIGROUP Illinois, Inc.s motion
for summary judgment was filed in December 2004. That motion is
fully briefed, and is ready for disposition by the court. On
February 15, 2005, we received a motion filed by
Mr. Tyson on February 10, 2005, seeking permission to
amend his complaint and add AMERIGROUP Corporation as a
defendant. On February 15, 2005, we also received the
motion filed by the State of Illinois on February 10, 2005,
seeking court approval to intervene on Mr. Tysons
behalf. On March 2, 2005, the Court granted the
States motion to intervene and denied
Mr. Tysons motion to amend to add AMERIGROUP
Corporation as a defendant. On March 3, 2005, AMERIGROUP
Illinois, Inc. filed a motion to dismiss for lack of subject
matter jurisdiction, based upon a recent opinion of the United
States Court of Appeals for the District of Columbia Circuit.
At this time, discovery is ongoing. Although it is possible that
the outcome of this case will not be favorable to us, no range
of liability can be estimated. Accordingly, we have not recorded
any liability at December 31, 2004. There can be no
assurance that the ultimate outcome of this matter will not have
a material adverse effect on our consolidated financial
position, results of operations, or liquidity.
20
We are from time-to-time the subject matter of, or involved in,
other legal proceedings including claims for reimbursement by
providers. We believe that any liability or loss resulting from
such other legal matters will not have a material adverse effect
on our financial position or results of operations.
|
|
Item 4. |
Submission of Matters to a Vote of Security Holders |
None.
Executive Officers of the Company
Our executive officers, their ages and positions as of
February 28, 2005, are as follows*:
|
|
|
|
|
|
|
Name |
|
Age |
|
Position |
|
|
|
|
|
|
|
|
|
Jeffrey L. McWaters
|
|
|
48 |
|
|
Chairman of the Board of Directors and Chief Executive Officer |
|
|
|
|
James G. Carlson
|
|
|
52 |
|
|
President, Chief Operating Officer |
|
|
|
|
E. Paul Dunn, Jr.
|
|
|
51 |
|
|
Executive Vice President, Chief Financial Officer |
|
|
|
|
Stanley F. Baldwin
|
|
|
56 |
|
|
Executive Vice President, General Counsel and Secretary |
|
|
|
|
Janet M. Brashear
|
|
|
44 |
|
|
Executive Vice President, Strategic Planning |
|
|
|
|
Catherine S. Callahan
|
|
|
47 |
|
|
Executive Vice President, Associate Services |
|
|
|
|
Nancy L. Grden
|
|
|
53 |
|
|
Executive Vice President, Specialty Product Group |
|
|
|
|
John E. Littel
|
|
|
40 |
|
|
Executive Vice President, Government Relations |
|
|
|
|
Leon A. Root, Jr.
|
|
|
51 |
|
|
Executive Vice President, Chief Information Officer |
|
|
|
|
Kathleen K. Toth
|
|
|
43 |
|
|
Executive Vice President, Chief Accounting Officer |
|
|
|
|
Richard C. Zoretic
|
|
|
46 |
|
|
Executive Vice President, Chief Marketing Officer |
|
|
|
|
Sherri E. Lee
|
|
|
53 |
|
|
Senior Vice President, Treasurer |
Jeffrey L. McWaters has been our Chairman of the
Board of Directors and Chief Executive Officer since he founded
our company in December 1994. From 1991 to 1994,
Mr. McWaters served as President and Chief Executive
Officer of Options Mental Health, a national managed behavioral
healthcare company and prior to that, in various senior
operating positions with EQUICOR-Equitable HCA Corporation and
CIGNA HealthCare. Mr. McWaters is Vice Rector of the Board
of Visitors of the College of William and Mary, a director of
the American Association of Health Plans and a member of the New
York Stock Exchange Listed Companies Advisory Board.
James G. Carlson joined us as our President and
Chief Operating Officer in April 2003. Prior to joining us,
Mr. Carlson co-founded Workscape, Inc. in 1999, a privately
held provider of benefits and workforce management solutions,
for which he also served as Chief Executive Officer and a
Director. From 1995 to 1998, Mr. Carlson served as
Executive Vice President of UnitedHealth Group and President of
the UnitedHealthcare business unit, which served more than
10 million members in HMO and PPO plans nationwide.
E. Paul Dunn, Jr. joined us in November
2004 as our Executive Vice President and Chief Financial
Officer. From 1998 to November 2004, Mr. Dunn served as
Vice President of Finance and Treasurer for IGM Global, Inc. He
also served as Chief Financial Officer for GATX Terminals
Corporation, a subsidiary of GATX Corporation, which provides
distribution assets and financial services. Previously, at GATX,
he also held the position of Treasurer. Prior to that,
Mr. Dunn served as Assistant Treasurer with the Hertz
Corporation. He began his career as a Financial Analyst at W.R.
Grace & Company.
Stanley F. Baldwin has served as our General
Counsel and Secretary since 1997. Prior to that,
Mr. Baldwin held senior officer and General Counsel
positions with EPIC Healthcare Group, Inc., EQUICOR-Equitable HCA
* Effective February 11, 2005, Lorenzo
Childress, Jr., M.D., resigned from the position
of Executive Vice President, Chief Medical Officer but remains
on the payroll through April 1, 2005. On an interim basis,
his role is being filled by our experienced medical management
staff, including the two current corporate executive medical
directors.
21
Corporation and CIGNA Healthplans, Inc. Mr. Baldwin is
licensed to practice law in the States of Virginia, Tennessee
and Texas.
Janet M. Brashear joined us in September 2004 as
our Executive Vice President, Strategic Planning. From 1999 to
2004, Ms. Brashear provided consulting and executive
services to new ventures in the hospitality industry.
Previously, she served as Executive Vice President, Strategy for
Marriott International, and Senior Vice President, Strategy and
Operations for Marriott Lodging. She began her career in sales
with Procter and Gamble.
Catherine S. Callahan joined us in 1999 and serves
as our head of Associate Services. From 1991 to 1999,
Ms. Callahan was Chief Administrative Officer of FHC Health
Systems.
Nancy L. Grden joined us as our head of Planning
and Development in 2001. Prior to joining us, Ms. Grden
served as President and Founder of Avenir, LLC, a consulting
firm specializing in new ventures, and as Chief Executive
Officer for Lifescape, LLC, a web-based workplace services
company, from 1998 to 2000. She previously served as Executive
Vice President and Chief Marketing Officer for ValueOptions, a
national managed behavioral healthcare company, from 1992 to
1998.
John E. Littel joined us in 2001 as head of
Government Relations. Mr. Littel has served in a variety of
positions in federal and state governments, including as Deputy
Secretary of Health and Human Resources for the Commonwealth of
Virginia, where he was responsible for the states welfare
reform and healthcare initiatives, and as Director of
Intergovernmental Affairs for the White House Drug Policy
Office. Prior to joining AMERIGROUP, he served as counsel and
deputy director of the Citizenship Project at the Heritage
Foundation and in the current Bush Administration as senior
counselor to the Director of the Office of Personnel Management.
Mr. Littel is licensed to practice law in the State of
Pennsylvania.
Leon A. Root, Jr. joined us in May 2002 as a
Senior Vice President and has served as our Executive Vice
President and Chief Information Officer since June 2003. From
2001 to 2002, Mr. Root served as Senior Vice President and
Chief Information Officer at Medunite, Inc., a private
e-commerce company. From 1998 to 2001, Mr. Root served as
Senior Vice President of McKessonHBOC Business System Division.
Kathleen K. Toth joined us in 1995 and serves as
our Executive Vice President and Chief Accounting Officer. Prior
to joining us, Ms. Toth was the Vice President of Service
Operations at Options Mental Health from 1992 to 1995.
Ms. Toth also worked for CIGNA Healthplan of Texas, Inc. as
Director of Financial Services and for EQUICOR Health Plan of
Florida as Controller from 1987 to 1992. Ms. Toth is a
certified public accountant.
Richard C. Zoretic was named as our Chief
Marketing Officer in September 2003. Before joining us,
Mr. Zoretic served as Senior Vice President of network
operations and distribution at CIGNA Dental Health from February
2003. From November 2001 to February 2003, Mr. Zoretic
worked as a senior manager for Deloitte Consultings global
management consulting practice, specializing in the health plan
segment. From March 2000 to October 2001, Mr. Zoretic was
an Executive Vice President and General Manager of Workscape,
Inc., a privately held provider of benefits and workforce
management solutions. From October 1995 to March 2000,
Mr. Zoretic served in a variety of leadership positions at
United Healthcare Group, including President of United
Healthcares Middle Market Business segment and Regional
Operating President of United Healthcares Mid-Atlantic
operations, including its Maryland plan, for which he also
served as Chief Executive Officer.
Sherri E. Lee joined us in 1998 as our Chief
Financial Officer and Treasurer. In 2001, Ms. Lee resigned
her position as Chief Financial Officer, but continues to serve
as Senior Vice President and Treasurer. Ms. Lee served as
Executive Vice President Finance of Pharmacy
Corporation of America and prior to that, as Senior Vice
President and Controller for Beverly Enterprises, Inc.
Ms. Lee is a certified public accountant. Ms. Lee has
tendered her resignation as Senior Vice President and Treasurer,
effective April 1, 2005, and intends to retire.
22
PART II.
|
|
Item 5. |
Market for Our Common Equity and Related Stockholder
Matters |
Our common stock has been listed on the New York Stock Exchange
(NYSE) under the symbol AGP since January 3,
2003. From November 6, 2001 until January 2, 2003, our
common stock was quoted on the NASDAQ National Market under the
symbol AMGP. Prior to November 6, 2001, there
was no public market for our common stock.
On December 14, 2004, we announced a two-for-one split of
our common stock. The stock split was in the form of a one
hundred percent stock dividend of one share of common stock for
every share of common stock issued and outstanding. The stock
dividend was distributed on January 18, 2005, to our
shareholders of record on December 31, 2004.
The following table sets forth the range of high and low sales
prices for our common stock (after giving retroactive effect to
the two-for-one stock split effective January 18, 2005) for
the period indicated.
|
|
|
|
|
|
|
|
|
2003 |
|
High |
|
Low |
|
|
|
|
|
|
|
|
|
First Quarter
|
|
$ |
16.88 |
|
|
$ |
12.00 |
|
|
|
|
|
Second Quarter
|
|
|
19.30 |
|
|
|
13.63 |
|
|
|
|
|
Third Quarter
|
|
|
22.86 |
|
|
|
18.35 |
|
|
|
|
|
Fourth Quarter
|
|
|
23.82 |
|
|
|
19.80 |
|
|
|
|
|
|
|
|
|
|
2004 |
|
|
|
|
|
|
|
|
|
First Quarter
|
|
$ |
23.08 |
|
|
$ |
18.23 |
|
|
|
|
|
Second Quarter
|
|
|
24.75 |
|
|
|
19.61 |
|
|
|
|
|
Third Quarter
|
|
|
28.46 |
|
|
|
22.03 |
|
|
|
|
|
Fourth Quarter
|
|
|
38.44 |
|
|
|
26.50 |
|
|
|
|
|
December 31, 2004 Closing Sales Price
|
|
$ |
37.83 |
|
|
|
|
|
On March 1, 2005, the last reported sales price of our
common stock was $40.35 per share as reported on the NYSE.
As of March 1, 2005, we had 38 shareholders of record.
We have never declared or paid any cash dividends on our common
stock. We currently anticipate that we will retain any future
earnings for the development and operation of our business.
Also, under the terms of our credit facility, we are limited in
the amount of dividends that we may pay to our stockholders
without the consent of our lenders. Accordingly, we do not
anticipate declaring or paying any cash dividends in the
foreseeable future.
In addition, our ability to pay dividends is dependent on cash
dividends from our subsidiaries. State insurance and Medicaid
regulations limit the ability of our subsidiaries to pay
dividends to us.
Use of Proceeds from Public Offering
On October 16, 2003, we completed a public offering of
6,325,000 shares of common stock, including an
over-allotment issuance of 825,000 shares (after giving
retroactive effect to the two-for-one stock split effective
January 18, 2005). The shares of common stock sold in the
offering were registered under the Securities Act of 1933 on a
Registration Statement on Form S-3, Registration
Number 333-108831, which was declared effective by the SEC
on October 9, 2003, and a Registration Statement on
Form S-3, Registration Number 333-109609, filed with
the SEC pursuant to Rule 462(b) of the General Rules and
Regulations under the Securities Act of 1933 on October 9,
2003. All 6,325,000 shares sold in the public offering were
sold at a price of $23.25 per share for an aggregate
offering price of $147.1 million. We received proceeds from
the offering of approximately $138.8 million, net of
approximately $7.4 million of underwriting fees and
$0.9 million of expenses. On October 21, 2003, we used
$30.0 million of proceeds from the offering to repay the
outstanding balance of our credit facility. The balance of
approximately $108.8 million was used to partially fund the
CarePlus acquisition effective January 1, 2005.
Banc of America Securities LLC and Credit Suisse First Boston
LLC acted as joint book-running managers of the offering. CIBC
World Markets Corp. and Stephens Inc. acted as representatives
of the underwriters.
23
|
|
Item 6. |
Selected Financial Data |
The following selected consolidated financial data should be
read in connection with the financial statements and related
notes and Managements Discussion and Analysis of Financial
Condition and Results of Operations appearing elsewhere in this
Form 10-K. Selected financial data as of and for each of
the years in the five-year period ended December 31, 2004
are derived from our consolidated financial statements, which
have been audited by KPMG, LLP, independent registered public
accounting firm. All share and per share amounts included in the
following consolidated financial data have been retroactively
adjusted to reflect the two-for-one stock split effective
January 18, 2005.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
2001 |
|
2000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Dollars in thousands, except per share data) |
|
|
|
|
Income Statement Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premium
|
|
$ |
1,813,391 |
|
|
$ |
1,615,508 |
|
|
$ |
1,152,636 |
|
|
$ |
880,510 |
|
|
$ |
646,408 |
|
|
|
|
|
|
Investment income
|
|
|
10,340 |
|
|
|
6,726 |
|
|
|
8,026 |
|
|
|
10,664 |
|
|
|
13,107 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenues
|
|
|
1,823,731 |
|
|
|
1,622,234 |
|
|
|
1,160,662 |
|
|
|
891,174 |
|
|
|
659,515 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Health benefits
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
933,591 |
|
|
|
709,034 |
|
|
|
523,566 |
|
|
|
|
|
|
Selling, general and administrative
|
|
|
191,915 |
|
|
|
186,856 |
|
|
|
133,409 |
|
|
|
109,822 |
|
|
|
85,114 |
|
|
|
|
|
|
Depreciation and amortization
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
13,149 |
|
|
|
9,348 |
|
|
|
6,275 |
|
|
|
|
|
|
Interest
|
|
|
731 |
|
|
|
1,913 |
|
|
|
791 |
|
|
|
763 |
|
|
|
781 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total expenses
|
|
|
1,682,493 |
|
|
|
1,508,319 |
|
|
|
1,080,940 |
|
|
|
828,967 |
|
|
|
615,736 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
141,238 |
|
|
|
113,915 |
|
|
|
79,722 |
|
|
|
62,207 |
|
|
|
43,779 |
|
|
|
|
|
Income tax expense
|
|
|
55,224 |
|
|
|
46,591 |
|
|
|
32,686 |
|
|
|
26,127 |
|
|
|
17,687 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
|
86,014 |
|
|
|
67,324 |
|
|
|
47,036 |
|
|
|
36,080 |
|
|
|
26,092 |
|
|
|
|
|
Accretion of redeemable preferred stock dividends
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(6,228 |
) |
|
|
(7,284 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to common stockholders
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
$ |
29,852 |
|
|
$ |
18,808 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
$ |
1.17 |
|
|
$ |
4.04 |
|
|
$ |
11.81 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares outstanding
|
|
|
49,721,945 |
|
|
|
43,245,408 |
|
|
|
40,355,456 |
|
|
|
7,389,688 |
|
|
|
1,592,818 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
$ |
1.10 |
|
|
$ |
1.04 |
|
|
$ |
0.78 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of shares and dilutive potential common
shares outstanding
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
|
|
42,938,844 |
|
|
|
33,299,442 |
|
|
|
31,636,350 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
2001 |
|
2000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(Dollars in thousands) |
|
|
|
|
Balance Sheet Data:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents and short and long-term investments
|
|
$ |
612,059 |
|
|
$ |
535,103 |
|
|
$ |
306,935 |
|
|
$ |
301,837 |
|
|
$ |
189,325 |
|
|
|
|
|
|
Total assets
|
|
|
919,850 |
|
|
|
826,021 |
|
|
|
578,484 |
|
|
|
406,942 |
|
|
|
268,126 |
|
|
|
|
|
|
Long-term debt
|
|
|
|
|
|
|
|
|
|
|
50,000 |
|
|
|
|
|
|
|
6,177 |
|
|
|
|
|
|
Total liabilities
|
|
|
351,138 |
|
|
|
364,307 |
|
|
|
339,103 |
|
|
|
223,426 |
|
|
|
185,191 |
|
|
|
|
|
|
Redeemable preferred stock
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
78,190 |
|
|
|
|
|
|
Stockholders equity
|
|
|
568,712 |
|
|
|
461,714 |
|
|
|
239,381 |
|
|
|
183,516 |
|
|
|
4,745 |
|
24
|
|
Item 7. |
Managements Discussion and Analysis of Financial
Condition and Results of Operations |
Overview
We are a multi-state managed healthcare company focused on
serving people who receive healthcare benefits through publicly
sponsored programs, including Medicaid, SCHIP and FamilyCare. We
were founded in December 1994 with the objective of becoming the
leading managed care organization in the U.S. focused on
serving people who receive these types of benefits. Having
concluded our tenth year of operations, we continue to believe
that managed healthcare remains the only proven mechanism that
significantly reduces medical cost trends and helps our state
partners control their costs.
In 2004, we increased our total revenues by 12.4% over 2003.
Total membership increased by 79,000 members, or 9.2%, to
936,000 members as of December 2004. Our 2004 revenue growth
came from a number of factors including:
|
|
|
|
|
In a difficult state budgetary environment, we leveraged our
partnerships with our states and negotiated a weighted average
rate increase of 4.9% for each of the states budget years
that began in 2004. |
|
|
|
During the year of 2004, we successfully integrated members in
Texas, Florida and the District of Columbia which came to us
from competitors exiting these markets. |
|
|
|
We implemented new product or program expansions: |
|
|
|
|
|
The State of Texas awarded us a contract for the Travis service
area, which includes Austin and seven additional counties,
bringing the number of counties that we serve in Texas
to 27. While initial estimates of growth are modest, this
service area complements our long-term growth strategy.
Currently, these counties are served by only one other health
plan. |
|
|
|
We successfully insourced our behavioral health benefits
servicing eligible members in four states and the District of
Columbia. We believe this strategy optimizes member health
status, and reinforces our mission to coordinate our
members physical and behavioral health and positions us
well for future growth in existing states. |
|
|
|
|
|
Our 2004 same-store premium revenues increased 11.2% over 2003
from expansion in existing service areas and new markets. |
In 2004, our health benefits ratio (HBR) was 81.0% versus
80.2% in 2003. The HBR increase is driven by a reduction in the
favorable prior year development offset by increased leverage of
premium revenue. The reduction in favorable prior year
development is due to a decrease in claims payment variability
related to maturing products and markets.
Selling, general and administrative expenses (SG&A) were
10.5% of total revenues for the year ended December 31,
2004 compared to 11.5% in 2003. This improvement is a result of
a reduction in overall SG&A dollars, excluding the effect of
premium tax, and an increased leverage of premium revenue due to
favorable rate increases.
Cash and investments totaled $612.1 million at the end of
2004. A significant portion of this cash is regulated by state
capital requirements. However, $271.7 million of our cash
and investments was unregulated and held at the parent level. In
January 2005, we used $126.8 million of unregulated cash to
effect the stock acquisition of CarePlus.
We expect acquisitions to continue to be an important part of
our growth strategy. As of December 31, 2004, over 41% of
our current membership has resulted from nine acquisitions and
we are currently evaluating potential acquisition opportunities.
Effective January 1, 2005, we acquired CarePlus with
membership of approximately 115,000 participating in New York
State Medicaid, Child Health Plus and Family Health Plus
programs. We believe our undrawn credit facility and our cash
flows from operating activities position us to continue to take
advantage of acquisition opportunities.
The State of Florida approved our request effective
March 1, 2005 for expansion into Polk and Pasco counties
for long-term care services.
25
We have an exclusive risk-sharing arrangement with Cook
Childrens Health Care Network (CCHCN) and Cook
Childrens Physician Network (CCPN), which includes Cook
Childrens Medical Center (CCMC), that covers an estimated
129,000 AMERICAID members in Fort Worth, Texas. Of
these members, approximately 110,000, or 85%, are children under
the age of 15 who may utilize services of either CCPN or CCMC.
Of this subset, approximately 25,000 are signed up with primary
care physicians who are either employees of CCPN or exclusively
contracted with CCPN. Unless either party gives the other a
written notice of non-renewal six months in advance, the
risk-sharing arrangement with CCHCN and CCPN would automatically
be extended for a one year period commencing on August 31,
2005. On February 25, 2005, we received a written notice of
non-renewal from CCHCN and CCPN; therefore this contract will
terminate on August 31, 2005.
It is our intent to enter into a new contract with CCPN, CCMC
and the CCPN physicians individually. However, there is no
assurance that our contracting effort will be successful or that
the terms of any new contract will be as favorable as the
current risk-sharing arrangement. Therefore, our results from
operations could be harmed as a result of the expiration of the
risk-sharing arrangement and the impact could be material.
Additionally, we could lose members if CCPN chooses to associate
with another HMO or if CCHCN obtains its own contract with the
State of Texas to provide healthcare services to Medicaid
recipients.
On July 2, 2004, the State of Texas released a Request for
Proposal (RFP) to re-procure its current Medicaid managed care
programs, as well as to expand the current programs. Although
the State has said it will announce contract awards in early
2005 with implementation continuing into 2006, the announcement
of the awards may not occur until after the conclusion of the
Texas legislative session on May 30, 2005. The RFP includes
all of the current Texas service areas and products in which we
operate. Our response to the RFP included our current Texas
service areas and products as well as expansion into new service
areas and products. If we lost one or more contracts through the
re-procurement process, our operating results could be
materially and adversely affected.
On September 14, 2004, we were informed that we were a
successful bidder in a request for proposal from the State of
Indiana for expansion of its managed care program in 2005.
Because of limited expansion opportunities and provider network
restrictions, we evaluated our market entry options and decided
not to enter the market at this time.
In April 2004, the Maryland Legislature enacted a budget for the
2005 fiscal year beginning July 1, 2004 that included a
provision to reduce the premium paid to managed care
organizations that did not meet certain HEDIS scores and whose
medical loss ratio was below 84% for the calendar year ended
December 31, 2002. In May 2004, the Maryland Secretary of
Health and Mental Hygiene, in consultation with Marylands
legislative leadership, determined our premium recoupment to be
$846,000. A liability for the recoupment was recorded with a
corresponding charge to premium revenue during the year ended
December 31, 2004. Additionally, the Legislature directed
that the Department of Health and Mental Hygiene complete a
study by September 2004 on the relevance of the medical loss
ratio threshold as an indicator of quality. The results of this,
which were released in October 2004, did not directly address
what would happen in the future if a managed care organization
reported a medical loss ratio below 84%. As a result, we believe
the Maryland Legislature could enact similar legislation in 2005
as part of its fiscal year 2006 budget, requiring premium
recoupment. We have recorded a reduction in premium in our
financial statements of our best estimate of the outcome of this
issue as of the year ended December 31, 2004. It is
possible that the Maryland Legislature in 2006, as part of its
fiscal year 2007 budget, could enact similar legislation
relating to the year ended December 31, 2004. However, at
this time we are unable to predict the regulatory, economic or
political climate that might exist at that time. Accordingly, we
have not recorded any liability for the twelve months ended
December 31, 2004. However, if the Maryland Legislature
were to enact legislation in April 2006 consistent with the
legislation passed in April 2004 and we failed to meet the
required quality measures, we could have a recoupment obligation
for that period commencing on July 1, 2006 ranging from
zero to approximately $757,000 with respect to the premium
revenue for the twelve month period ended December 31, 2004.
In the fourth quarter of 2003, our Florida health plan
implemented medical review procedures designed to reduce the
incidence of inappropriate authorizations of speech therapy and
occupational therapy services. In February of 2004, the health
plan was informed by the applicable regulatory agency, Agency
for Health Care Administration (AHCA), that the medical review
procedures it had implemented were not compliant with the
Medicaid contract and the states therapy services
handbook. We were directed to reprocess and pay all denied
26
claims and to file a corrective action plan. Our Florida health
plan disputed AHCAs assessment of its medical review
procedures. AHCA rejected the health plans corrective
action plan and we appealed their decision. On January 18,
2005, the Florida health plan reached an agreement with AHCA to
settle the issues relating to speech therapy and occupational
therapy services. The settlement did not have a material impact
on the fourth quarter results of operations.
Discussion of Critical Accounting Policies
In the ordinary course of business, we have made a number of
estimates and assumptions relating to the reporting of results
of operations and financial condition in the preparation of our
financial statements in conformity with U.S. generally
accepted accounting principles. We base our estimates on
historical experience and on various other assumptions that we
believe to be reasonable under the circumstances. Actual results
could differ from those estimates and the differences could be
significant. We believe that the following discussion addresses
our critical accounting policies, which are those that are most
important to the portrayal of our financial condition and
results of operations and require managements most
difficult, subjective and complex judgments, often as a result
of the need to make estimates about the effect of matters that
are inherently uncertain.
We generate revenues primarily from premiums we receive from the
states in which we operate to arrange for health benefit
services for our members. We generally receive premiums in
advance of arranging for services, and recognize premium revenue
during the period in which we are obligated to provide services
to our members. A fixed premium per member per month is paid to
us to arrange for healthcare benefit services for our members
pursuant to our contracts in each of our markets. These premium
payments are based upon eligibility determined by the state
governments with which we have contracted. Errors in this
eligibility determination on which we rely can result in
positive and negative premium adjustments to the extent this
information is adjusted by the state. In all of our states,
except Florida, we are eligible to receive supplemental payments
for newborn obstetric deliveries. Each state contract is
specific as to what is required before payments are generated.
Upon delivery of a newborn, each state is notified according to
our contract. Revenue is recognized in the period that the
delivery occurs and the related services are provided to our
member based on our authorization system for these services.
Additionally, in some states we receive supplemental payments
for certain services such as high cost drugs and early childhood
prevention screenings. Any amounts that have not been received
from the state by the end of the period are recorded on our
balance sheet as premium receivables. We also generate income
from investments.
|
|
|
Estimating health benefits expense and claims
payable |
Our results of operations depend on our ability to effectively
manage expenses related to health benefits, as well as our
ability to accurately predict costs incurred in recording the
amounts in our consolidated financial statements. Expenses
related to health benefits have two components: direct medical
expenses and medically related administrative costs. Direct
medical expenses include fees paid to hospitals, physicians and
providers of ancillary medical services, such as pharmacy,
laboratory, radiology, dental and vision. Medically related
administrative costs include expenses related to services such
as health promotion, quality assurance, case management, disease
management and 24-hour on-call nurses. Direct medical expenses
also include estimates of medical expenses incurred but not yet
reported (IBNR). For the year ended December 31, 2004,
approximately 95% of our direct medical payments related to fees
paid on a fee-for-service basis to our PCPs, specialist
physicians and other providers, including fees paid to
third-party vendors for ancillary services. The balance related
to fees paid on a capitation, or per member, basis. Primary care
and specialist physicians not paid on a capitated basis are paid
on a maximum allowable fee schedule set forth in the contracts
with our providers. We reimburse hospitals on a negotiated per
diem, case rate or an agreed upon percent of their standard
charges. In Maryland, the state sets the amount reimbursed to
hospitals.
We have used the same methodology for estimating our medical
expenses and medical liabilities since our inception, and have
refined our assumptions to take into account our maturing
claims, product and market experience. As medical utilization
patterns and cost trends change from year-to-year, our
underlying claims payments reflect the variations in experience.
Our estimates are revised based upon actual claims payments using
27
historical per-member per-month claims cost, including provider
settlements, changes in the age and gender of our membership and
variations in the severity of medical conditions. These
variations are considered in determining our current medical
liabilities and adjusted to reflect expected changes in cost or
utilization patterns.
There are certain aspects of the managed care business that are
not predictable with consistency. These aspects include the
incidences of illness or disease state (e.g., cardiac heart
failure cases, cases of upper respiratory illness, diabetes, the
number of full-term versus premature births, and the number of
neonatal intensive care babies) as well as non-medical aspects,
such as changes in provider contracting and contractual
benefits. Therefore, we must rely upon our historical
experience, as continually monitored, to reflect the
ever-changing mix and growth of members.
Monthly, we estimate our IBNR based on a number of factors,
including prior claims experience and authorization data.
Authorization data is information captured in our medical
management system, which identifies services requested by
providers or members. The medical cost related to these
authorizations is estimated by pricing the approved services
using contractual or historical amounts adjusted for known
variables such as historical claims trends. These estimated
costs are included as a component of IBNR in the more current
months. As part of this review, we also consider the costs to
process medical claims, and estimates of amounts to cover
uncertainties related to fluctuations in claims payment
patterns, membership, products and authorization trends. These
estimates are adjusted as more information becomes available and
any adjustments are included in current operations. We utilize
the services of independent actuarial consultants, who are
contracted to review our estimates quarterly. Judgments are made
based on knowledge and experience about past and current events.
There is a likelihood that actual results could be materially
different if different assumptions or conditions prevail.
Also included in claims payable are estimates for provider
settlements due to clarification of contract terms,
out-of-network reimbursement and claims payment differences, as
well as amounts due to or from contracted providers under
risk-sharing arrangements.
The following table shows the components of the change in
medical claims payable for the years ended December 31,
2004, 2003 and 2002 (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
Medical claims payable as of January 1
|
|
$ |
239,532 |
|
|
$ |
202,430 |
|
|
$ |
180,346 |
|
|
|
|
|
Medical claims payable assumed from businesses acquired
during the year
|
|
|
|
|
|
|
20,421 |
|
|
|
|
|
|
|
|
|
Health benefits expenses incurred during the year:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Related to current year
|
|
|
1,505,482 |
|
|
|
1,355,065 |
|
|
|
988,628 |
|
|
|
|
|
|
Related to prior years
|
|
|
(36,385 |
) |
|
|
(59,165 |
) |
|
|
(55,037 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total incurred
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
933,591 |
|
|
|
|
|
Health benefits payments during the year:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Related to current year
|
|
|
1,274,460 |
|
|
|
1,135,082 |
|
|
|
803,432 |
|
|
|
|
|
|
Related to prior years
|
|
|
192,916 |
|
|
|
144,137 |
|
|
|
108,075 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total payments
|
|
|
1,467,376 |
|
|
|
1,279,219 |
|
|
|
911,507 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medical claims payable as of December 31
|
|
$ |
241,253 |
|
|
$ |
239,532 |
|
|
$ |
202,430 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
In the current year, we experienced a reduction in the favorable
prior year development of approximately $22.8 million
related to 2003 and prior. In 2003, we experienced an increase
in the favorable prior year development of $4.1 million related
to 2002 and prior. The current year reduction was primarily the
result of more precise claims estimates at December 31,
2003 due to a decrease in claims payment variability related to
our maturing products and markets compared to the prior year.
Actuarial claims estimates are based upon facts and
circumstances at the time we record them. We believe that our
claims experience has stabilized as the Company has grown,
allowing us to more accurately estimate our medical expense
liabilities at each period end. As we add new markets and
products, the claims fluctuations may increase, but overall
growth in the size of the Company mitigates this volatility on a
consolidated basis.
28
The Companys methodology includes adding a factor to
compensate for normal claim uncertainty. The more precisely we
have been able to predict claims patterns, the lower the
required factor for uncertainty as a percentage of our medical
liability. Due to the changing mix of members, products and
markets, this factor is a necessary component of our medical
liabilities. While our prior year development historically has
been favorable, there is no guarantee this will continue and the
factor for uncertainty mitigates the risk of emerging claims
experience that is different from historical patterns. The
health benefits expenses incurred during the period related to
prior years relate almost entirely to revisions in estimates for
the immediately preceding year. The application of our
methodology has resulted in reversals of estimated incurred
claims related to prior years in each of the years in the
three-year period ended December 31, 2004. The resulting
impact on operations is a function of the variation of the
change in estimate from year-to-year. Included above was the
impact on earnings of the change in our factor for uncertainty
of a favorable development of $1.5 million in 2004, an
unfavorable development of $3.5 million in 2003 and a
favorable development of $4.3 million in 2002.
Changes in estimates are primarily the result of obtaining more
complete claims information that directly correlates with the
claims and provider reimbursement trends. Since our estimates
are based upon the blended per-member per-month claims
experience, changes cannot typically be explained by any single
factor, but are the result of a number of interrelated
variables, all influencing the resulting experience. These
variables include fluctuations in claims payment patterns,
changes in membership levels, number and mix of products,
benefit structure, severity of illness and authorization trends.
We believe there will be less volatility as we increase in size
and gain more maturity in our markets.
We believe that the amount of claims payable is adequate to
cover our ultimate liability for unpaid claims as of
December 31, 2004; however, actual claim payments and other
items may differ from established estimates. Assuming a
hypothetical 1% difference between our December 31, 2004
estimates of claims payable and actual claims payable, net
income for the year ended December 31, 2004 would increase
or decrease by approximately $1.5 million and diluted
earnings per share would increase or decrease by approximately
$0.03 per share.
On a quarterly basis, we estimate our required tax liability and
assess the recoverability of our deferred tax assets. Our taxes
payable are estimated based on enacted rates, including
estimated tax rates in states where we do business applied to
the income expected to be taxed currently. Management assesses
the realizability of our deferred tax assets based on the
availability of carrybacks of future deductible amounts and
managements projections for future taxable income. We
cannot guarantee that we will generate income in future years.
Historically we have not experienced significant differences in
our estimates of our tax accrual.
|
|
|
Goodwill and intangible assets |
As of December 31, 2004 and 2003, we had goodwill and other
intangible assets of $140.4 million and
$144.4 million, respectively, net of accumulated
amortization. We review our intangible assets with defined lives
for impairment whenever events or changes in circumstances
indicate we might not recover their carrying value. We assess
our goodwill for impairment at least annually. In assessing the
recoverability of these assets, we must make assumptions
regarding estimated future utility and cash flows and other
internal and external factors to determine the fair value of the
respective assets. If these estimates or their related
assumptions change in the future, we may be required to record
impairment charges for these assets.
|
|
|
Recent Accounting Standards |
On December 16, 2004, the Financial Accounting Standards
Board (FASB) issued Statement of Financial Accounting
Standard No. 123 (revised 2004)
(SFAS No. 123(R)), Shared-Based Payment, which
is a revision of Statement of Financial Accounting Standards
No. 123, Accounting for Stock-Based Compensation
(SFAS No. 123). SFAS No. 123(R) supersedes
APB Opinion No. 25, Accounting for Stock Issued to
Employees, and SFAS No. 148, Accounting for
Stock Based Compensation, and amends FASB Statement of
Financial Accounting Standard No. 95, Statement of Cash
Flows. Generally, the approach in SFAS No. 123(R)
is similar to the approach described in SFAS No. 123.
However, SFAS No. 123(R) requires all share-based
payments to
29
employees, including grants of employee stock options, to be
recognized in the income statement based on their fair values.
Proforma disclosure is no longer an alternative.
SFAS No. 123(R) must be adopted no later than
July 1, 2005. Early adoption will be permitted in periods
in which financial statements have not yet been issued. We
expect to adopt SFAS No. 123(R) on July 1, 2005.
SFAS No. 123(R) permits public companies to adopt its
requirements using one of two methods:
|
|
|
1. A modified prospective method in which
compensation cost is recognized beginning with the effective
date (a) based on the requirements of
SFAS No. 123(R) for all share-based payments granted
after the effective date and (b) based on the requirements
of SFAS No. 123 for all awards granted to employees
prior to the effective date of SFAS No. 123(R) that
remain unvested on the effective date. |
|
|
2. A modified retrospective method which
includes the requirements of the modified prospective method
described above, but also permits entities to restate based on
the amounts previously recognized under SFAS No. 123
for purposes of proforma disclosures either (a) all prior
presented or (b) prior interim periods of the year of
adoption. |
We are in the process of evaluating these methods.
As permitted by SFAS No. 123, we currently account for
share-based payments to employees using APB Opinion
No. 25s intrinsic value method and, as such,
generally recognize no compensation cost for employee stock
options. Accordingly, the adoption of the fair value method of
SFAS No. 123(R) will have a significant impact on our
results of operations, although it will have no impact on our
overall financial position. The impact of adoption of
SFAS No. 123(R) cannot be predicted at this time
because it will depend on levels of share-based payments granted
in the future. However, had we adopted SFAS No. 123(R)
in prior periods, the impact of the standard would have
approximated the impact of SFAS No. 123 as described
in the disclosure of proforma net income and earnings per share
in Note 2(h) to our consolidated financial statements.
SFAS No. 123(R) also requires the benefits of tax
deductions in excess of recognized compensation cost to be
reported as a financing cash flow, rather than as an operating
cash flow as required under current literature. This requirement
will reduce net operating cash flows and increase net financing
cash flows in periods after adoption. While we cannot estimate
what those amounts will be in the future (because they depend
on, among other things, when employees exercise stock options),
the amount of operating cash flows recognized in prior periods
for such excess tax deductions were $8.0 million,
$4.5 million and $3.8 million in 2004, 2003 and 2002,
respectively.
Results of Operations
The following table sets forth selected operating ratios for the
years ended December 31, 2004, 2003 and 2002. All ratios,
with the exception of the health benefits ratio, are shown as a
percentage of total revenues.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
Premium revenue
|
|
|
99.4 |
% |
|
|
99.6 |
% |
|
|
99.3 |
% |
|
|
|
|
Investment income
|
|
|
0.6 |
|
|
|
0.4 |
|
|
|
0.7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenues
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Health benefits(1)
|
|
|
81.0 |
% |
|
|
80.2 |
% |
|
|
81.0 |
% |
|
|
|
|
Selling, general and administrative expenses
|
|
|
10.5 |
% |
|
|
11.5 |
% |
|
|
11.5 |
% |
|
|
|
|
Income before income taxes
|
|
|
7.7 |
% |
|
|
7.0 |
% |
|
|
6.9 |
% |
|
|
|
|
Net income
|
|
|
4.7 |
% |
|
|
4.2 |
% |
|
|
4.1 |
% |
|
|
(1) |
The health benefits ratio is shown as a percentage of premium
revenue because there is a direct relationship between the
premium received and the health benefits provided. |
30
The following table sets forth the approximate number of our
members in each of our service areas for the periods presented.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
|
|
Market |
|
2004 |
|
2003 |
|
2002 |
|
2001 |
|
2000 |
|
|
|
|
|
|
|
|
|
|
|
Texas |
|
|
394,000 |
|
|
|
343,000 |
|
|
|
296,000 |
|
|
|
214,000 |
|
|
|
139,000 |
|
|
|
|
|
Florida
|
|
|
229,000 |
|
|
|
221,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Maryland
|
|
|
130,000 |
|
|
|
124,000 |
|
|
|
125,000 |
|
|
|
118,000 |
|
|
|
95,000 |
|
|
|
|
|
New Jersey
|
|
|
105,000 |
|
|
|
99,000 |
|
|
|
99,000 |
|
|
|
88,000 |
|
|
|
57,000 |
|
|
|
|
|
District of Columbia
|
|
|
41,000 |
|
|
|
38,000 |
|
|
|
37,000 |
|
|
|
13,000 |
|
|
|
13,000 |
|
|
|
|
|
Illinois
|
|
|
37,000 |
|
|
|
32,000 |
|
|
|
34,000 |
|
|
|
39,000 |
|
|
|
29,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
|
936,000 |
|
|
|
857,000 |
|
|
|
591,000 |
|
|
|
472,000 |
|
|
|
333,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On December 14, 2004, we announced a two-for-one split of
our common stock. The stock split was in the form of a one
hundred percent stock dividend of one share of common stock for
every share of common stock issued and outstanding. The stock
dividend was distributed on January 18, 2005, to
shareholders of record on December 31, 2004. All share and
per share data described herein give retroactive effect to the
two-for-one stock split effective January 18, 2005.
Year Ended December 31, 2004 Compared to Year Ended
December 31, 2003
Premium revenue for the year ended December 31, 2004
increased $197.9 million, or 12.3%, to
$1,813.4 million from $1,615.5 million in 2003. The
increase was primarily due to internal growth in membership as
well as premium rate increases. Total membership increased 9.2%
to 936,000 as of December 31, 2004 from 857,000 as of
December 31, 2003.
Investment income increased $3.6 million to
$10.3 million for the year ended December 31, 2004.
The increase in investment income is primarily due to increased
levels of cash and investments that were a result of having the
proceeds from the secondary offering that occurred in October
2003 available for a full year of investing in 2004 and cash
generated from operations, as well as increases in market
interest rates and a shift in our investment portfolio toward
longer term investments with higher yields.
Expenses relating to health benefits for the year ended
December 31, 2004 increased $173.2 million, or 13.4%,
to $1,469.1 million from $1,295.9 million for the year
ended December 31, 2003. The increase was primarily due to
an increase in membership. The HBR for the year ended
December 31, 2004 was 81.0% compared to 80.2% in 2003. The
increase in HBR is driven by less favorable development than in
the prior year due to a combination of more mature claims
patterns in existing products and markets offset by increased
leverage of premium revenue. This had the effect of increasing
the current year HBR even though there was no increase in our
core medical run rates. The underlying medical performance
continues to be stable with trend patterns consistent with those
of the prior year, except for more moderate seasonal respiratory
disorders than in the prior year and continued elevated
obstetric services.
|
|
|
Selling, general and administrative expenses |
SG&A increased $5.0 million to $191.9 million for
the year ended December 31, 2004 compared to
$186.9 million in 2003. The net increase in SG&A was
primarily due to:
|
|
|
|
|
an increase in premium taxes that the States of Texas and New
Jersey began assessing in September 2003 and July 2004,
respectively; |
31
|
|
|
|
|
a decrease in purchased services related to strategic
initiatives in 2003 for operational improvements, including
expenses related to the implementation of the HIPAA
guidelines; and |
|
|
|
a decrease in experience rebate expense in our Texas market. |
Our SG&A ratio for the year ended December 31, 2004 was
10.5% compared to 11.5% in 2003. This improvement was achieved
due to increased leverage of premium revenue from successful
rate increases and increased membership levels.
Interest expense was $0.7 million and $1.9 million for
the years ended December 31, 2004 and 2003, respectively.
The decrease primarily relates to the repayment of our
outstanding balance of our credit facility on October 21,
2003, with a portion of the net proceeds from our
October 16, 2003 public offering.
|
|
|
Provision for income taxes |
Income tax expense for 2004 was $55.2 million with an
effective tax rate of 39.1% as compared to the
$46.6 million for 2003 with an effective tax rate of 40.9%.
The decrease in the effective tax rate is primarily attributable
to a decrease in expenses that are not deductible for tax
purposes, an increase in investments in tax advantaged
securities and the resolution of potential tax issues from a
prior year.
Net income for 2004 rose $18.7 million to
$86.0 million, or $1.66 per diluted share, compared to
$67.3 million, or $1.48 per diluted share in 2003.
Diluted earnings per share rose 12.2% as compared to an increase
in net income of 27.8% due to the increase in shares outstanding
primarily resulting from the issuance of 6,325,000 shares
from our October 16, 2003 public offering.
Year Ended December 31, 2003 Compared to Year Ended
December 31, 2002
Premium revenue for the year ended December 31, 2003
increased $462.9 million, or 40.2%, from
$1,152.6 million in 2002. The increase was primarily due to
the acquisition of PHP (193,000 members) and St. Augustine
(26,000 members), as well as internal growth in overall
membership. Total membership increased 45.0% to 857,000 as of
December 31, 2003 from 591,000 as of December 31, 2002.
Investment income decreased $1.3 million to
$6.7 million for the year ended December 31, 2003. The
decrease in investment income was primarily due to the continued
decline in market interest rates and increased levels of
tax-advantaged securities partially offset by an increase in
overall cash and investments levels throughout the year. Cash
and investments levels increased due to proceeds from our public
offering and cash generated from operations.
Expenses relating to health benefits for the year ended
December 31, 2003 increased $362.3 million, or 38.8%,
to $1,295.9 million from $933.6 million for the year
ended December 31, 2002. The increase was primarily due to
the increase in membership. The health benefits ratio, as a
percentage of premium revenue, for the year ended
December 31, 2003 was 80.2% compared to 81.0% in 2002.
|
|
|
Selling, general and administrative expenses |
SG&A increased $53.5 million to $186.9 million for
the year ended December 31, 2003 compared to
$133.4 million in 2002. The increase in SG&A was
primarily due to an increase in wages and related expenses for
additional staff to support our increased membership, expenses
related to implementation of the HIPAA
32
guidelines, as well as expenses related to market development
activities. Our SG&A ratio to revenue was 11.5% for both the
years ended December 31, 2003 and 2002.
Interest expense was $1.9 million and $0.8 million for
the years ended December 31, 2003 and 2002, respectively.
The increase primarily related to increased average borrowings
under our revolving credit facility to partially finance the PHP
acquisition. On October 21, 2003, we used a portion of the
net proceeds from our October 16, 2003 public offering to
repay the outstanding balance under our revolving credit
facility.
|
|
|
Provision for income taxes |
Income tax expense for 2003 was $46.6 million with an
effective tax rate of 40.9% as compared to the
$32.7 million for 2002 with an effective tax rate of 41.0%.
Net income for 2003 rose $20.3 million to
$67.3 million, or $1.48 per diluted share, compared to
$47.0 million, or $1.10 per diluted share in 2002.
Diluted earnings per share rose 34.5% as compared to an increase
in net income of 43.2%, due to the increase in shares
outstanding primarily resulting from the issuance of
6,325,000 shares from our October 16, 2003 public
offering.
Liquidity and Capital Resources
Our primary sources of liquidity are cash and cash equivalents,
short and long-term investments, cash flows from operations and
borrowings under our Amended and Restated Credit Agreement
(Credit Agreement). As of December 31, 2004, we had cash
and cash equivalents of $227.1 million, short and long-term
investments of $384.9 million and restricted investments on
deposit for licensure of $38.4 million. As of
December 31, 2004, there were no borrowings outstanding
under our $95.0 million Credit Agreement. Cash and
investments totaled $612.1 million at December 31,
2004. A significant portion of this cash and investments is
regulated by state capital requirements. However,
$271.7 million of our cash and investments were unregulated
and held at the parent level.
On October 16, 2003, we completed a public offering of
6,325,000 shares of common stock at $23.25 per share,
including an over-allotment issuance of 825,000 shares. Net
proceeds from the offering, after fees and expenses, were
approximately $138.8 million. On October 21, 2003, we
used $30.0 million of proceeds from the offering to repay
the outstanding balance under our revolving credit facility. The
balance of approximately $108.8 million was used to
partially fund the CarePlus acquisition effective
January 1, 2005.
Cash from operations was $102.1 million for the year ended
December 31, 2004 compared to $128.5 million for the
year ended December 31, 2003. The decrease in cash from
operations is primarily due to the following items:
|
|
|
|
|
Reductions in cash flows due to: |
|
|
|
|
|
a change of $48.9 million in unearned revenue due to the
early receipt of premium revenue received for two states in 2003
versus one state in 2004 and 2002; |
|
|
|
a reduction in the increase in the claim liability of
$15.0 million primarily related to the payment of provider
settlements in 2004; |
|
|
|
an increase of $9.7 million in the change of accounts
payable, accrued and other due to an increase in premium tax
payable and the accrual of a potential recoupment of premium in
Maryland; |
|
|
|
|
|
Offset by increases in cash flows due to: |
|
|
|
|
|
a decrease in the reduction of prepaid expenses and other
current assets of $5.2 million due to the accrual of an
experience rebate receivable in 2003 that remains in
2004; and |
33
|
|
|
|
|
an increase in net income of $18.7 million. |
Cash flows provided by investing activities was
$37.9 million for the year ended December 31, 2004
compared to cash flows used in investing activities of
$246.1 million for the year ended December 31, 2003.
The increase in cash provided by investing activities was
primarily due to a net increase in the proceeds from sales of
investments offset by purchases of investments in 2004 compared
to 2003. The cash for these additional investments in 2003 was
generated from our public offering in October 2003, as well as
cash flow from operations. We currently anticipate that our 2005
capital expenditures will be approximately $28.0 million.
Our investment policies are designed to provide liquidity,
preserve capital and maximize total return on invested assets.
As of December 31, 2004, our investment portfolio consisted
primarily of fixed-income securities. The weighted average
maturity is less than six months. We utilize investment vehicles
such as commercial paper, municipal bonds, U.S. government
backed agencies, auction rate securities and U.S. Treasury
instruments. The states in which we operate prescribe the types
of instruments in which our subsidiaries may invest their cash.
The weighted average taxable equivalent yield on consolidated
investments as of December 31, 2004 was approximately 2.24%.
Cash provided by financing activities was $3.1 million and
$98.6 million for the year ended December 31, 2004 and
2003, respectively. The decrease in cash provided by financing
activities consisted primarily of net proceeds from our public
offering in 2003 of $138.8 million partially offset by
$50.0 million in repayments in 2003 of borrowings under our
revolving credit facility.
On October 22, 2003, we entered into a $95.0 million
Credit Agreement with a syndicate of banks. The Credit Agreement
contains a provision which allows us to obtain, subject to
certain conditions, an increase in revolving commitments of up
to an additional $30.0 million. The proceeds of the Credit
Agreement are available for general corporate purposes,
including, without limitation, permitted acquisitions of
businesses, assets and technologies. The borrowings under the
Credit Agreement will accrue interest at one of the following
rates, at our option: Eurodollar plus the applicable margin or
an alternate base rate plus the applicable margin. The
applicable margin for Eurodollar borrowings is between 2.00% and
2.50% and the applicable margin for alternate base rate
borrowings is between 1.00% and 1.50%. The applicable margin
will vary depending on our leverage ratio. The Credit Agreement
is secured by substantially all of the assets of AMERIGROUP
Corporation and its wholly-owned subsidiary, PHP Holdings, Inc.,
including the stock of their respective wholly-owned managed
care subsidiaries. There is a commitment fee on the unused
portion of the Credit Agreement that ranges from 0.375% to
0.50%, depending on the leverage ratio. The Credit Agreement
terminates on October 22, 2006 and was undrawn as of
December 31, 2004.
Our subsidiaries are required to maintain minimum statutory
capital requirements prescribed by various jurisdictions,
including the departments of insurance in each of the states in
which we operate. As of December 31, 2004, our subsidiaries
were in compliance with all minimum statutory capital
requirements. We believe that we will continue to be in
compliance with these requirements for the next 12 months.
In January 2005, we used $126.8 million of unregulated cash
to effect the stock acquisition of CarePlus. Remaining cash,
cash equivalents and short-term investments are sufficient to
meet current cash requirements without the need to liquidate
securities held earlier than anticipated.
We believe that internally generated funds and available funds
under our Credit Agreement will be sufficient to support
continuing operations, capital expenditures and our growth
strategy for at least 12 months.
34
The following table summarizes our material contractual
obligations, including both on- and off-balance sheet
arrangements, and our commitments at December 31, 2004 (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Contractual Obligations |
|
Total |
|
2005 |
|
2006 |
|
2007 |
|
2008 |
|
2009 |
|
Thereafter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Lease financing:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating lease obligations
|
|
$ |
57,001 |
|
|
$ |
8,878 |
|
|
$ |
8,474 |
|
|
$ |
7,677 |
|
|
$ |
5,262 |
|
|
$ |
4,378 |
|
|
$ |
22,332 |
|
|
|
|
|
|
Capital lease obligations
|
|
|
6,435 |
|
|
|
3,387 |
|
|
|
1,751 |
|
|
|
871 |
|
|
|
426 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total lease financing
|
|
$ |
63,436 |
|
|
$ |
12,265 |
|
|
$ |
10,225 |
|
|
$ |
8,548 |
|
|
$ |
5,688 |
|
|
$ |
4,378 |
|
|
$ |
22,332 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Expiring in |
|
Expiring in |
|
Expiring in |
|
Expiring in |
|
Expiring in |
|
|
Commitments |
|
Total |
|
2005 |
|
2006 |
|
2007 |
|
2008 |
|
2009 |
|
Thereafter |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Lease guarantee related to Florida office space
|
|
$ |
99 |
|
|
$ |
99 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Lease Financing
Operating Lease Obligations. Our operating lease
obligations are primarily for payments under non-cancelable
office space leases.
Capital Lease Obligations. Our capital lease obligations
are primarily related to leased furniture, fixtures and
equipment. The terms of these leases are normally between three
and five years.
Long-term Borrowings
Credit Agreement. On October 22, 2003, we entered
into a $95.0 million Credit Agreement with a syndicate of
banks. The Credit Agreement contains a provision which allows us
to obtain, subject to certain conditions, an increase in
revolving commitments of up to an additional $30.0 million.
The proceeds of the Credit Agreement are available for general
corporate purposes, including, without limitation, permitted
acquisitions of businesses, assets and technologies. The
commitment fee on the unused portion of the Credit Agreement
ranges from 0.375% to 0.50%, depending on our leverage ratio.
The Credit Agreement terminates on October 22, 2006 and was
undrawn as of December 31, 2004.
Commitments
Lease Guarantee. In connection with our acquisition of
PHP, we agreed to guarantee a certain lease for office space
operated by the former management of PHP. The lease term ends on
March 31, 2005.
Regulatory Capital and Dividend Restrictions
Our operations are conducted through our wholly-owned
subsidiaries, which include HMOs and one MCO. HMOs and MCOs are
subject to state regulations that, among other things, require
the maintenance of minimum levels of statutory capital, as
defined by each state, and restrict the timing, payment and
amount of dividends and other distributions that may be paid to
their stockholders. Additionally, certain state regulatory
agencies require individual HMOs to maintain statutory capital
levels higher than the state regulations. As of
December 31, 2004, we believe our subsidiaries are in
compliance with all minimum statutory capital requirements. We
believe that we will continue to be in compliance with these
requirements at least through the end of 2005.
As of December 31, 2004, our subsidiaries had aggregate
statutory capital and surplus of approximately
$132.0 million, compared with the required minimum
aggregate statutory capital and surplus requirements of
approximately $67.7 million.
The National Association of Insurance Commissioners (NAIC) has
adopted rules which, to the extent that they are implemented by
the states, set new minimum net worth requirements for insurance
companies, HMOs and other entities bearing risk for healthcare
coverage. The requirements take the form of risk-based capital
rules.
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The change in rules for insurance companies became effective as
of December 31, 1998. Illinois, Texas and the District of
Columbia adopted various forms of the rules as of
December 31, 1999, 2000 and 2003, respectively. Since our
Maryland subsidiary is licensed in both the District of Columbia
and Maryland, the highest risk-based capital requirement between
the two will prevail. New Jersey and Florida have not yet
adopted risk-based capital as their net worth requirements. The
NAICs HMO rules, if adopted by these states in their
proposed form, may increase the minimum capital required for our
subsidiaries. Effective December 31, 2004, our New Jersey
subsidiary is required to maintain a statutory capital level
greater than the state regulations.
Inflation
Although the general rate of inflation has remained relatively
stable and healthcare cost inflation has stabilized in recent
years, the national healthcare cost inflation rate still exceeds
the general inflation rate. We use various strategies to
mitigate the negative effects of healthcare cost inflation.
Specifically, our health plans try to control medical and
hospital costs through contracts with independent providers of
healthcare services. Through these contracted care providers,
our health plans emphasize preventive healthcare and appropriate
use of specialty and hospital services.
While we currently believe our strategies to mitigate healthcare
cost inflation will continue to be successful, competitive
pressures, new healthcare and pharmaceutical product
introductions, demands from healthcare providers and customers,
applicable regulations or other factors may affect our ability
to control the impact of healthcare cost increases.
Off-Balance Sheet Arrangements
Our off-balance sheet arrangements at December 31, 2004
include future minimum rental commitments of $57.0 million
and a lease guarantee of $99,000, both of which are disclosed in
Note 11(c) to the consolidated financial statements. We
have no investments, loans or any other known contractual
arrangements with special-purpose entities, variable interest
entities or financial partnerships.
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Item 7A. |
Quantitative and Qualitative Disclosures About Market
Risk |
As of December 31, 2004, we had short-term investments of
$176.4 million, long-term investments of
$208.6 million and investments on deposit for licensure of
$38.4 million. These investments consist of highly liquid
investments with maturities between three and 24 months.
These investments are subject to interest rate risk and will
decrease in value if market rates increase. Credit risk is
managed by investing in commercial paper, money market funds,
U.S. Treasury securities, cash escrow accounts,
asset-backed securities, debt securities of government sponsored
entities, municipal bonds and auction rate securities. Our
investment policies are subject to revision based upon market
conditions and our cash flow and tax strategies, among other
factors. We have the ability to hold these investments to
maturity, and as a result, we would not expect the value of
these investments to decline significantly as a result of a
sudden change in market interest rates. As of December 31,
2004, a hypothetical 1% change in interest rates would result in
an approximate $3.0 million change in our annual investment
income.
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RISK FACTORS
Risks related to being a regulated entity
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Changes in government regulations designed to protect
providers and members rather than our stockholders could force
us to change how we operate and could harm our business. |
Our business is extensively regulated by the states in which we
operate and by the federal government. These laws and
regulations are generally intended to benefit and protect
providers and health plan members rather than stockholders.
Changes in existing laws and rules, the enactment of new laws
and rules and changing interpretations of these laws and rules
could, among other things:
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force us to change how we do business, |
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restrict revenue and enrollment growth, |
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increase our health benefits and administrative costs, |
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impose additional capital requirements, and |
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increase or change our claims liability. |
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If state regulators do not approve payments of dividends,
distributions or administrative fees by our subsidiaries to us,
it could negatively affect our business strategy. |
We principally operate through our health plan subsidiaries.
These subsidiaries are subject to regulations that limit the
amount of dividends and distributions that can be paid to us
without prior approval of, or notification to, state regulators.
We also have administrative services agreements with our
subsidiaries in which we agree to provide them with services and
benefits (both tangible and intangible) in exchange for the
payment of a fee. If the regulators were to deny our
subsidiaries requests to pay dividends to us or restrict
or disallow the payment of the administrative fee, the funds
available to our company as a whole would be limited, which
could harm our ability to implement our business strategy.
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Regulations could limit our profits as a percentage of
revenues. |
Our New Jersey and Maryland subsidiaries are subject to minimum
medical expense levels as a percentage of premium revenue. Our
Florida subsidiary is subject to minimum behavioral health
expense levels as a percentage of behavioral health premium. In
New Jersey, Maryland and Florida, contractual sanctions may be
imposed if these levels are not met. In addition, our Texas
plans are required to pay a rebate to the state in the event
profits exceed established levels. These regulatory
requirements, changes in these requirements and additional
requirements by our other regulators could limit our ability to
increase our overall profits as a percentage of revenues, which
could harm our operating results. We have been required, and may
in the future be required, to make payments to the states as a
result of not meeting these expense and profit levels.
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Our failure to comply with government regulations could
subject us to civil and criminal penalties and limitations on
our profitability. |
Violation of the laws or regulations governing our operations
could result in the imposition of sanctions, the cancellation of
our contracts to provide services, or in the extreme case, the
suspension or revocation of our licenses. For example, in two
markets in which we operate we are required to spend a minimum
percentage of our premium revenue on medical expenses. If we
fail to comply with this requirement, we could be required to
pay monetary damages. Additionally, we could be required to file
a corrective plan of action with the state and we could be
subject to further fines and additional corrective measures if
we did not comply with the corrective plan of action. Our
failure to comply could also affect future rate determinations.
These regulations could limit the profits we can obtain.
While we have not been subject to any fines or violations that
were material, we cannot assure you that we will not become
subject to material fines or other sanctions in the future. If
we became subject to material fines or if other sanctions or
other corrective actions were imposed upon us, our ability to
continue to operate our business could be materially and
adversely affected. From time-to-time we have been subject to
sanctions as a result of
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violations of marketing regulations in Illinois and Florida and
for failure to meet timeliness of the payment requirements in
New Jersey. In 2004 and 2003, our Florida plan was fined for
marketing violations.
In July 2003, our New Jersey subsidiary received a notice of
deficiency for failure to maintain provider network requirements
in one New Jersey county as required by our Medicaid contract
with New Jersey. We submitted to the State of New Jersey a
corrective action plan and a request for a waiver of certain
contractual provisions on August 10, 2003. On
October 3, 2003, the State of New Jersey denied our request
for a waiver, but we have been granted extensions to correct the
network deficiency through March 31, 2005. Prior to the
expiration of the extension, we will renew our request for a
waiver or an additional extension of the time in which to
correct the network deficiencies.
On October 12, 2001, we responded to a Civil Investigative
Demand (CID) of the HMO industry by the Office of the
Attorney General of the State of Texas relating to processing of
provider claims. We understand from the Office of the Attorney
General that responses were required from the nine largest HMOs
in Texas, of which, at the time, we were the ninth. The other
eight are HMOs that primarily provide commercial products. The
CID is being conducted in connection with allegations of unfair
contracting, delegating and payment practices and violations of
the Texas Deceptive Trade Practices Consumer
Protection Act and Article 21.21 of the Texas Insurance
Code by HMOs. It is our understanding that we are not currently
the target of any investigation by the Office of the Attorney
General. We have responded to all of the requests for
information. The Office of the Attorney General could request
additional information or clarification that could be costly and
time consuming for us to produce.
HIPAA broadened the scope of fraud and abuse laws applicable to
healthcare companies. HIPAA created civil penalties for, among
other things, billing for medically unnecessary goods or
services. HIPAA establishes new enforcement mechanisms to combat
fraud and abuse, including a whistle-blower program. Further,
HIPAA imposes civil and criminal penalties for failure to comply
with the privacy and security standards set forth in the
regulation. Despite a press release issued by the Department of
Health and Human Services, (HHS) recommending that Congress
create a private right of action under HIPAA, no such private
cause of action has yet been created, and we do not know when or
if such changes may be enacted.
The federal government has enacted, and state governments are
enacting, other fraud and abuse laws as well. Our failure to
comply with HIPAA or these other laws could result in criminal
or civil penalties and exclusion from Medicaid or other
governmental healthcare programs and could lead to the
revocation of our licenses. These penalties or exclusions, were
they to occur, would negatively impact our ability to operate
our business.
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Compliance with new federal and state rules and
regulations may require us to make unanticipated
expenditures. |
In August 2000, HHS issued a regulation under HIPAA requiring
the use of uniform electronic data transmission standards for
healthcare claims and payment transactions submitted or received
electronically. Although compliance with the new transactions
regulation was required by October 16, 2003, CMS issued its
guidance on the October 2003 compliance deadline for the HIPAA
transactions and code set rules, stating that enforcement by CMS
will be on a complaint-driven basis. Since that time, many
health organizations have operated under contingency plans
pending their full implementation of these regulatory
requirements. In February 2003, HHS finalized a regulation to
protect the security of electronically maintained or transmitted
health-related information. This security regulation requires
compliance by April 2005. The next milestone date for us is
implementation of the National Provider Identifier (NPI) by
May 2007. We expect to be fully compliant by the required dates.
To the extent that state laws impose stricter privacy standards
than the HIPAA privacy regulations or to the extent that a state
seeks and receives an exception from HHS regarding certain state
laws, such laws will not be preempted. The states ability
to promulgate stricter rules regarding privacy make compliance
with the regulatory landscape more difficult. If we enter new
markets with different, more stringent privacy rules, we may
incur significant additional costs in complying with these more
stringent state rules, or our existing programs and systems may
not enable us to comply in all respects with these rules.
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Future costs may be incurred in complying with the security and
NPI regulations. We are in the process of developing our
compliance plan for the NPI regulations and cannot estimate the
cost of compliance at this time.
Further, compliance with these regulations may require
additional changes, beyond those implemented to comply with
privacy requirements, to many of the procedures we currently use
to conduct our business, which may lead to additional costs that
we have not yet identified. We do not know whether, or the
extent to which, we will be able to recover our costs of
complying with these new regulations from the states. The new
regulations and related costs to comply with the new regulations
could have a material adverse effect on our business. In
addition, failure to comply with the new regulations could also
have a material adverse effect on our business.
On June 14, 2002, CMS published final regulations regarding
Medicaid managed care. The final regulations implemented
requirements of the Balanced Budget Act of 1997 (BBA) that
are intended to give states more flexibility in their
administration of Medicaid managed care programs, provide
certain new patient protections for Medicaid managed care
enrollees, and require states rates to meet new actuarial
soundness requirements. The effective date for compliance with
the regulation was August 13, 2003, with an extension
provided to states operating under an 1115 demonstration waiver
with a three-year BBA extension. If states fail to comply with
the new regulations they could lose their funding from the
federal fund matching program. The new regulations have been
reflected in amendments in our contracts or new contracts with
the Medicaid agencies in our various markets, with the exception
of the Maryland market, which currently operates under the 1115
demonstration waiver with the BBA extension. Compliance with
these new provisions have required changes to many of the
procedures we currently use to conduct our business, which may
lead to additional costs that we have not yet identified.
In addition, the Sarbanes-Oxley Act of 2002, as well as rules
subsequently implemented by the SEC and the NYSE, have imposed
various requirements on public companies, including requiring
changes in corporate governance practices. Our management and
other personnel will need to continue to devote a substantial
amount of time to these new compliance initiatives. Moreover,
these rules and regulations will increase our legal and
financial compliance costs and will make some activities more
time-consuming and costly.
The Sarbanes-Oxley Act of 2002 requires, among other things,
that we maintain effective internal control over financial
reporting. In particular, we must perform system and process
evaluation and testing of our internal controls over financial
reporting to allow management to report on, and our independent
registered public accounting firm to attest to, our internal
controls over our financial reporting as required by
Section 404 of the Sarbanes-Oxley Act of 2002. Our testing,
or the subsequent testing by our independent registered public
accounting firm, may reveal deficiencies in our internal
controls over financial reporting that are deemed to be material
weaknesses. Our compliance with Section 404 will continue
to require that we incur substantial accounting expense and
expend significant management time and effort. Moreover, if we
are not able to continue to comply with the requirements of
Section 404 in a timely manner, or if we or our independent
registered public accounting firm identifies deficiencies in our
internal control over financial reporting that are deemed to be
material weaknesses, the market price of our stock could decline
and we could be subject to sanctions or investigations by the
NYSE, SEC or other regulatory authorities, which would require
additional financial and management resources.
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Changes in healthcare laws could reduce our
profitability. |
Numerous proposals relating to changes in healthcare law have
been introduced, some of which have been passed by Congress and
the states in which we operate or may operate in the future.
Changes in applicable laws and regulations are continually being
considered and interpretations of existing laws and rules may
also change from time-to-time. We are unable to predict what
regulatory changes may occur or what effect any particular
change may have on our business. Although some of the recent
changes in government regulations, such as the removal of the
requirements on the enrollment mix between commercial and public
sector membership, have encouraged managed care participation in
public sector programs, we are unable to predict whether new
laws or proposals will continue to favor or hinder the growth of
managed healthcare.
An example is state and federal legislation that would enable
physicians to collectively bargain with managed healthcare
organizations. The legislation, as currently proposed, generally
contains an exemption for
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public sector managed healthcare organizations. If legislation
of this type were passed without this exemption, it would
negatively impact our bargaining position with many of our
providers and might result in an increase in our cost of
providing medical benefits.
We cannot predict the outcome of these legislative or regulatory
proposals, nor the effect which they might have on us.
Legislation or regulations that require us to change our current
manner of operation, provide additional benefits or change our
contract arrangements could seriously harm our operations and
financial results.
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Changes in federal funding mechanisms could reduce our
profitability. |
As part of President Bushs 2006 Budget submission to
Congress, there are a number of proposals designed to crack down
on inappropriate financing mechanisms employed by the states,
primarily through use of intergovernmental transfers. These
initiatives, together with Medicaid expansion proposals, are
estimated to generate $45 billion in net reductions in
Medicaid spending over a ten-year period. HHS is also interested
in offering states increased flexibility of its Medicaid program
for optional populations and services in exchange for more
predictable cost growth within the overall Medicaid program. The
Presidents 2006 Budget contains little detail on this
Medicaid Reform proposal, and it is expected that more
discussion of the Presidents Medicaid Reform proposal will
occur throughout the year. It is uncertain whether any of these
proposals, or a variation thereof, will be enacted sometime in
the future. If the Presidents proposals are ultimately
adopted and states are required to reduce or change funding
mechanisms, our operations and financial performance could be
adversely affected.
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Reductions in Medicaid funding by the states could
substantially reduce our profitability. |
Most of our revenues come from state government Medicaid
premiums. The base premium rate paid by each state differs,
depending on a combination of various factors such as defined
upper payment limits, a members health status, age,
gender, county or region, benefit mix and member eligibility
category. Future levels of Medicaid premium rates may be
affected by continued government efforts to contain medical
costs and may further be affected by state and federal budgetary
constraints. Changes to Medicaid programs could reduce the
number of persons enrolled or eligible, reduce the amount of
reimbursement or payment levels, or increase our administrative
or healthcare costs under such programs. States periodically
consider reducing or reallocating the amount of money they spend
for Medicaid. We believe that additional reductions in Medicaid
payments could substantially reduce our profitability. Further,
our contracts with the states are subject to cancellation by the
state in the event of unavailability of state funds. In some
jurisdictions, such cancellation may be immediate and in other
jurisdictions a notice period is required.
State governments generally are experiencing budgetary
shortfalls. Budget problems in the states in which we operate
could result in limited increases or even decreases in the
premiums paid to us by the states. If any state in which we
operate were to decrease premiums paid to us, or pay us less
than the amount necessary to keep pace with our cost trends, it
could have a material adverse effect on our profitability.
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If state governments do not renew our contracts with them
on favorable terms, our business will suffer. |
As of December 31, 2004, we served members who received
healthcare benefits through 13 contracts with the
regulatory entities in the jurisdictions in which we operate.
Five of these contracts, which are with the States of Florida,
Maryland, New Jersey and Texas, individually accounted for
10% or more of our revenues for the year ended December 31,
2004, with the largest of these contracts representing
approximately 19% of our revenues. If any of our contracts were
not renewed on favorable terms or were terminated for cause or
if we were to lose a contract in a re-bidding process, our
business would suffer. All our contracts have been extended
until at least mid-2005. Termination or non-renewal of any
single contract could materially impact our revenues and
operating results.
Some of our contracts are subject to a re-bidding process. For
example, we are subject to a re-bidding process in each of our
three Texas markets. Our Texas markets are re-bid every six
years and the re-bidding process occurred in 2004. Although the
State of Texas has said it will announce contract awards in
early 2005 with implementation continuing into 2006, the
announcement of the awards may not occur until after the
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conclusion of the Texas legislative session on May 30,
2005. Until the announcement is made and the legislative review
process is complete, we can give no assurance that we will be
able to enter into new markets and new products or retain our
current business in existing markets. If we lost a contract
through the re-bidding process, or if an increased number of
competitors were awarded contracts in a specific market, our
operating results could be materially and adversely affected.
Our SCHIP contract covering our three Florida markets expires on
September 30, 2005, with the State of Florida having the
option to extend the contract for two additional one-year terms.
We can give no assurance that the contracts will not be re-bid.
If we lost a contract through the re-bidding process, or if an
increased number of competitors were awarded contracts in a
specific market, our operating results could be materially and
adversely affected.
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If a state fails to renew its federal waiver application
for mandated Medicaid enrollment into managed care or such
application is denied, our membership in that state will likely
decrease. |
States may only mandate Medicaid enrollment into managed care
under federal waivers or demonstrations. Waivers and programs
under demonstrations are approved for two-year periods and can
be renewed on an ongoing basis if the state applies. We have no
control over this renewal process. If a state does not renew its
mandated program or the federal government denies the
states application for renewal, our business would suffer
as a result of a likely decrease in membership.
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We rely on the accuracy of eligibility lists provided by
the state government. Inaccuracies in those lists would
negatively affect our results of operations. |
Premium payments to us are based upon eligibility lists produced
by the state government. From time-to-time, states require us to
reimburse them for premiums paid to us based on an eligibility
list that a state later discovers contains individuals who are
not in fact eligible for a government sponsored program or are
eligible for a different premium category or a different
program. Alternatively, a state could fail to pay us for members
for whom we are entitled to receive payment. Our results of
operations would be adversely affected as a result of such
reimbursement to the state if we had made related payments to
providers and were unable to recoup such payments from the
providers.
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If state regulatory agencies require a statutory capital
level higher than the state regulations we may be required to
make additional capital contributions. |
Our operations are conducted through our wholly-owned
subsidiaries, which include HMOs and one MCO. HMOs and MCOs are
subject to state regulations that, among other things, require
the maintenance of minimum levels of statutory capital, as
defined by each state. Additionally, state regulatory agencies
may require, at their discretion, individual HMOs to maintain
statutory capital levels higher than the state regulations. If
this were to occur to one of our subsidiaries, we may be
required to make additional capital contributions to the
affected subsidiary. Any additional capital contribution made to
one of the affected subsidiaries could have a material adverse
effect on our liquidity and our ability to grow.
Risks related to our business
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Receipt of inadequate or significantly delayed premiums
would negatively impact our revenues, profitability and cash
flow. |
Most of our revenues are generated by premiums consisting of
fixed monthly payments per member. These premiums are fixed by
contract, and we are obligated during the contract period to
facilitate access to healthcare services as established by the
state governments. We have less control over costs related to
the provision of healthcare than we do over our selling, general
and administrative expenses. Historically, our expenses related
to health benefits as a percentage of premium revenue have
fluctuated. For example, our expenses related to health benefits
were 81.0% of our premium revenue in 2004, and 80.2% of our
premium revenue in 2003. If premiums are not increased and
expenses related to health benefits rise, our earnings could be
impacted negatively. In addition, our actual health benefits
costs may exceed our estimated costs. The premiums we receive
under our current contracts may therefore be inadequate to cover
all claims, which could cause our profits to decline.
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Maryland sets the rates that must be paid to hospitals by all
payors. It is possible for the state to increase rates payable
to the hospitals without granting a corresponding increase in
premiums to us. If this were to occur, or if other states were
to take similar actions, our profitability would be harmed.
Premiums are contractually payable to us before or during the
month for services that we are obligated to provide to our
members. Our cash flow would be negatively impacted if premium
payments are not made according to contract terms.
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Our inability to manage medical costs effectively would
reduce our profitability. |
Our profitability depends, to a significant degree, on our
ability to predict and effectively manage medical costs. Changes
in healthcare regulations and practices, level of use of
healthcare services, hospital costs, pharmaceutical costs, major
epidemics, new medical technologies and other external factors,
including general economic conditions such as inflation levels,
are beyond our control and could reduce our ability to predict
and effectively control the costs of healthcare services.
Although we have been able to manage medical costs through a
variety of techniques, including various payment methods to
primary care physicians and other providers, advance approval
for hospital services and referral requirements, medical
management and quality management programs, our information
systems and reinsurance arrangements, we may not be able to
continue to manage costs effectively in the future. It is
possible that claims previously denied and claims previously
paid to non-network providers will be appealed and subsequently
reprocessed at different amounts. This would result in an
adjustment to claims expense. If our costs for medical services
increase, our profits could be reduced, or we may not remain
profitable.
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We have a significant relationship with Cook
Childrens Physician Network in Fort Worth, Texas. Any
material modification or discontinuation of this relationship
could negatively affect our results of operations. |
We have an exclusive risk-sharing arrangement with Cook
Childrens Health Care Network (CCHCN) and Cook
Childrens Physician Network (CCPN), which includes Cook
Childrens Medical Center (CCMC), that covers an estimated
129,000 AMERICAID members in Fort Worth, Texas. Of
these members, approximately 110,000, or 85%, are children under
the age of 15 who may utilize services of either CCPN or CCMC.
Of this subset, approximately 25,000 are signed up with primary
care physicians who are either employees of CCPN or exclusively
contracted with CCPN. Unless either party gives the other a
written notice of non-renewal six months in advance, the
risk-sharing arrangement with CCHCN and CCPN would automatically
be extended for a one-year period commencing on August 31,
2005. On February 25, 2005, we received a written notice of
non-renewal from CCHCN and CCPN; therefore this contract will
terminate on August 31, 2005.
It is our intent to enter into a new contract with CCPN, CCMC
and the CCPN physicians individually. However, there is no
assurance that our contracting effort will be successful or that
the terms of any new contract will be as favorable as the
current risk-sharing arrangement. Therefore, our results from
operations could be harmed as a result of the expiration of the
risk-sharing arrangement and the impact could be material.
Additionally, we could lose members if CCPN chooses to associate
with another HMO or if CCHCN obtains its own contract with the
State of Texas to provide healthcare services to Medicaid
recipients.
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Our limited ability to predict our incurred medical
expenses accurately could negatively impact our reported
results. |
Our medical expenses include estimates of medical expenses IBNR.
We estimate our IBNR medical expenses based on a number of
factors, including authorization data, prior claims experience,
maturity of markets, complexity and mix of products and
stability of provider networks. Adjustments, if necessary, are
made to medical expenses in the period during which the actual
claim costs are ultimately determined or when criteria used to
estimate IBNR change. We utilize the services of independent
actuaries who are contracted on a regular basis to calculate and
review the adequacy of our medical liabilities, in addition to
using our internal resources. We cannot be sure that our IBNR
estimates are adequate or that adjustments to such IBNR
estimates will not harm our results of operations. Further, our
inability to accurately estimate IBNR may also affect our
ability to take timely corrective actions, further exacerbating
the extent of the harm on our results.
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We maintain reinsurance to protect us against severe or
catastrophic medical claims, but we can provide no assurance
that such reinsurance coverage will be adequate or available to
us in the future or that the cost of such reinsurance will not
limit our ability to obtain it.
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Difficulties in executing our acquisition strategy or
integrating acquired business could adversely affect our
business. |
Historically, acquisitions including the acquisition of Medicaid
contract rights and related assets of other health plans, both
in our existing service areas and in new markets, have been a
significant factor in our growth. Although we cannot predict our
rate of growth as the result of acquisitions with complete
accuracy, we believe that acquisitions similar in nature to
those we have historically executed will be important to our
growth strategy. Many of the other potential purchasers of these
assets have greater financial resources than we have. In
addition, many of the sellers are interested in either
(1) selling, along with their Medicaid assets, other assets
in which we do not have an interest; or (2) selling their
companies, including their liabilities, as opposed to just the
assets of the ongoing business. Therefore, we cannot be sure
that we will be able to complete acquisitions on terms favorable
to us or that we can obtain the necessary financing for these
acquisitions.
We are currently evaluating potential acquisitions that would
increase our membership, as well as acquisitions of
complementary healthcare service businesses. These potential
acquisitions are at various stages of consideration and
discussion and we may enter into letters of intent or other
agreements relating to these proposals at any time. However, we
cannot predict when or whether we will actually acquire these
businesses.
We are generally required to obtain regulatory approval from one
or more state agencies when making acquisitions. In the case of
an acquisition of a business located in a state in which we do
not currently operate, we would be required to obtain the
necessary licenses to operate in that state. In addition,
although we may already operate in a state in which we acquire a
new business, we will be required to obtain additional
regulatory approval if, as a result of the acquisition, we will
operate in an area of the state in which we did not operate
previously. There can be no assurance that we would be able to
comply with these regulatory requirements for an acquisition in
a timely manner, or at all.
Our existing credit facility imposes certain restrictions on
acquisitions. We may not be able to meet these restrictions.
In addition to the difficulties we may face in identifying and
consummating acquisitions, we will also be required to integrate
our acquisitions with our existing operations. This may include
the integration of:
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additional employees who are not familiar with our operations, |
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existing provider networks, which may operate on different terms
than our existing networks, |
|
|
|
existing members, who may decide to switch to another healthcare
provider, and |
|
|
|
disparate information and record keeping systems. |
We may be unable to successfully identify, consummate and
integrate future acquisitions, including integrating the
acquired businesses on to our technology platform, or to
implement our operations strategy in order to operate acquired
businesses profitably. We also may be unable to obtain
sufficient additional capital resources for future acquisitions.
There can be no assurance that incurring expenses to acquire a
business will result in the acquisition being consummated. These
expenses could impact our selling, general and administrative
expense ratio. If we are unable to effectively execute our
acquisition strategy or integrate acquired businesses, our
future growth will suffer and our results of operations could be
harmed.
|
|
|
Failure of a new business would negatively impact our
results of operations. |
Start-up costs associated with a new business can be
substantial. For example, in order to obtain a certificate of
authority in most jurisdictions, we must first establish a
provider network, have systems in place and demonstrate our
ability to be able to obtain a state contract and process
claims. If we were unsuccessful in obtaining the necessary
license, winning the bid to provide service or attracting
members in numbers sufficient to cover our costs, the new
business would fail. We also could be obligated by the state to
continue to provide
43
services for some period of time without sufficient revenue to
cover our ongoing costs or recover start-up costs. The costs
associated with starting up the business could have a
significant impact on our results of operations.
|
|
|
Ineffective management of rapid growth or our inability to
grow could negatively affect our results of operations,
financial condition and business. |
We have experienced rapid growth. In 1996, we had
$22.9 million of premium revenue. In 2004, we had
$1,813.4 million in premium revenue. This increase
represents a compound annual growth rate of 72.7%.
Depending on acquisition and other opportunities, we expect to
continue to grow rapidly. Continued growth could place a
significant strain on our management and on other resources. We
anticipate that continued growth, if any, will require us to
continue to recruit, hire, train and retain a substantial number
of new and highly skilled medical, administrative, information
technology, finance and other support personnel. Our ability to
compete effectively depends upon our ability to implement and
improve operational, financial and management information
systems on a timely basis and to expand, train, motivate and
manage our work force. If we continue to experience rapid
growth, our personnel, systems, procedures and controls may be
inadequate to support our operations, and our management may
fail to anticipate adequately all demands that growth will place
on our resources. In addition, due to the initial costs incurred
upon the acquisition of new businesses, rapid growth could
adversely affect our short-term profitability. Our inability to
manage growth effectively or our inability to grow could have a
negative impact on our business, operating results and financial
condition.
We
are subject to competition that impacts our ability to increase
our penetration of the markets that we serve.
We compete for members principally on the basis of size and
quality of provider network, benefits provided and quality of
service. We compete with numerous types of competitors,
including other health plans and traditional state Medicaid
programs that reimburse providers as care is provided. Some of
the health plans with which we compete have substantially larger
enrollments, greater financial and other resources and offer a
broader scope of products than we do.
While many states mandate health plan enrollment for Medicaid
eligible participants, the programs are voluntary in other
states, such as Illinois. Subject to limited exceptions by
federally approved state applications, the federal government
requires that there be choice for Medicaid recipients among
managed care programs. Voluntary programs and mandated
competition will impact our ability to increase our market share.
In addition, in most states in which we operate we are not
allowed to market directly to potential members, and therefore,
we rely on creating name brand recognition through our
community-based programs. Where we have only recently entered a
market or compete with health plans much larger than we are, we
may be at a competitive disadvantage unless and until our
community-based programs and other promotional activities create
brand awareness.
|
|
|
Restrictions and covenants in our credit facility could
limit our ability to take actions. |
On October 22, 2003, we entered into a new
$95.0 million Credit Agreement with four lenders. The
Credit Agreement contains a provision which allows us to obtain,
subject to certain conditions, an increase in revolving
commitments of up to an additional $30.0 million. Our
Credit Agreement is secured by our assets and by the common
stock of our direct, wholly-owned subsidiaries. Pursuant to the
Credit Agreement, we must meet certain financial covenants at
the parent company and consolidated level. As of
December 31, 2004, we were in compliance with such
covenants. These financial covenants include meeting certain
financial ratios, a limit on annual capital expenditures, and a
minimum net worth requirement. As of December 31, 2004, the
Credit Agreement was undrawn.
Events beyond our control, such as prevailing economic
conditions and changes in the competitive environment, could
impair our operating performance, which could affect our ability
to comply with the terms of the Credit Agreement. Breaching any
of the covenants or restrictions could result in the
unavailability of the Credit Agreement or a default under the
Credit Agreement. We can provide no assurance that our assets or
cash flows will be sufficient to fully repay outstanding
borrowings under the Credit Agreement or that we would
44
be able to restructure such indebtedness on terms favorable to
us. If we were unable to repay, refinance or restructure our
indebtedness under the Credit Agreement, the lenders could
proceed against the collateral securing the indebtedness.
|
|
|
Our inability to maintain satisfactory relationships with
providers would harm our profitability. |
Our profitability depends, in large part, upon our ability to
contract favorably with hospitals, physicians and other
healthcare providers. Our provider arrangements with our primary
care physicians and specialists usually are for one to two-year
periods and automatically renew for successive one-year terms,
subject to termination by us for cause based on provider conduct
or other appropriate reasons. The contracts generally may be
canceled by either party upon 90 to 120 days prior written
notice. Our contracts with hospitals are usually for one to
two-year periods and automatically renew for successive one-year
periods, subject to termination for cause due to provider
misconduct or other appropriate reasons. Generally, our hospital
contracts may be canceled by either party without cause on 90 to
150 days prior written notice. There can be no assurance
that we will be able to continue to renew such contracts or
enter into new contracts enabling us to service our members
profitably. We will be required to establish acceptable provider
networks prior to entering new markets. Although we have
established long-term relationships with many of our providers,
we may be unable to enter into agreements with providers in new
markets on a timely basis or under favorable terms. If we are
unable to retain our current provider contracts or enter into
new provider contracts timely or on favorable terms, our
profitability will be harmed.
On occasion, our members obtain care from providers that are not
in our network and with which we do not have contracts. To the
extent that we know of such instances, we attempt to redirect
their care to a network provider. We have generally reimbursed
non-network providers at the rates paid to comparable network
providers or at the applicable rate that the provider could have
received under the traditional fee-for-service Medicaid program
or at a discount therefrom. In some instances, we pay
non-network providers pursuant to the terms of our contracts
with the state. However, some non-network providers have
requested that we pay them at their highest billing rate, or
full-billed charges. Full-billed charges are
significantly more than the amount the non-network providers
could otherwise receive under the traditional fee-for-service
Medicaid program.
To the extent that non-network providers are successful in
obtaining payment at rates in excess of the rates that we have
historically paid to non-network providers, our profitability
could be materially adversely affected.
|
|
|
Negative publicity regarding the managed care industry may
harm our business and operating results. |
In the past, the managed care industry has received negative
publicity. This publicity has led to increased legislation,
regulation, review of industry practices and private litigation
in the commercial sector. These factors may adversely affect our
ability to market our services, require us to change our
services and increase the regulatory burdens under which we
operate, further increasing the costs of doing business and
adversely affecting our operating results.
|
|
|
We may be subject to claims relating to medical
malpractice, which could cause us to incur significant
expenses. |
Our providers and employees involved in medical care decisions
may be exposed to the risk of medical malpractice claims. In
addition, some states are considering legislation that permits
managed care organizations to be held liable for negligent
treatment decisions or benefits coverage determinations. Claims
of this nature, if successful, could result in substantial
damage awards against us and our providers that could exceed the
limits of any applicable insurance coverage. Therefore,
successful malpractice or tort claims asserted against us, our
providers or our employees could adversely affect our financial
condition and profitability.
In addition, we may be subject to other litigation that may
adversely affect our business or results of operations. We
maintain errors and omissions insurance and such other lines of
coverage as we believe are reasonable in light of our experience
to date. However, this insurance may not be sufficient or
available at a reasonable cost to protect us from liabilities
that might adversely affect our business or results of
operations. Even if any claims brought against us were
unsuccessful or without merit, we would still have to defend
ourselves against such claims. Any such defenses may be
time-consuming and costly, and may distract our
managements attention. As a result, we may incur
significant expenses and may be unable to effectively operate
our business.
45
|
|
|
Changes in the number of Medicaid eligibles, or benefits
provided to Medicaid eligibles or a change in mix of Medicaid
eligibles could cause our operating results to suffer. |
Historically, the number of persons eligible to receive Medicaid
benefits has increased more rapidly during periods of rising
unemployment, corresponding to less favorable general economic
conditions. However, during such economic downturns, state
budgets could decrease, causing states to attempt to cut
healthcare programs, benefits and rates. If this were to happen
while our membership was increasing, our results of operations
could suffer. Conversely, the number of persons eligible to
receive Medicaid benefits may grow more slowly or even decline
if economic conditions improve, thereby causing our operating
results to suffer. In either case, in the event that the company
experiences a change in product mix to less profitable product
lines, our profitability could be negatively impacted.
|
|
|
Changes in SCHIP rules restricting eligibility could cause
our operating results to suffer. |
The states in which we operate have experienced budget deficits.
In Florida and Texas, the rules governing SCHIP have either
recently changed, or may change in the near future, to restrict
or limit eligibility for benefits through the imposition of
waiting periods, enrollment caps and/ or new or increased
co-payments. These changes in SCHIP eligibility could cause us
to experience a net loss in SCHIP membership. If the states in
which we operate continue to restrict or limit SCHIP
eligibility, our operating results could suffer.
|
|
|
Our inability to integrate, manage and grow our
information systems effectively could disrupt our
operations. |
Our operations are significantly dependent on effective
information systems. The information gathered and processed by
our information systems assists us in, among other things,
monitoring utilization and other cost factors, processing
provider claims and providing data to our regulators. Our
providers also depend upon our information systems for
membership verifications, claims status and other information.
In November 2003, we signed a software licensing agreement with
The Trizetto Group, Inc. for their Facets Extended
Enterprisetm
administrative system (Facets). During 2004, we invested in the
implementation and testing of Facets with a staggered conversion
to Facets by health plan beginning in 2005 and continuing
through 2007. We estimate that our current claims payment
system, without Facets, could be at full capacity within the
next 16 months. We currently expect that Facets will meet
our software needs for an estimated 10 years and will
support our long-term growth strategies. However, if we cannot
execute a successful system conversion, our operations could be
disrupted, which would have a negative impact on our
profitability and our ability to grow could be harmed.
Our information systems and applications require continual
maintenance, upgrading and enhancement to meet our operational
needs. Moreover, our acquisition activity requires frequent
transitions to or from, and the integration of, various
information systems. We are continually upgrading and expanding
our information systems capabilities. If we experience
difficulties with the transition to or from information systems
or are unable to properly maintain or expand our information
systems, we could suffer, among other things, from operational
disruptions, loss of existing members and difficulty in
attracting new members, regulatory problems and increases in
administrative expenses. For example, we acquired a New York
health plan as of January 1, 2005, that uses information
systems that are different from those used by the rest of our
business. We expect to continue using this system exclusively
for our New York plan for a number of months until such
time as the New York subsidiary can be successfully integrated
onto our systems. Operating that system as a separate
information system can be expected to increase our costs in the
short term, and there is no assurance that we can effect a
seamless transition of the New York plan to a new system.
Both the increased operational costs of this system and any
difficulties in conversion to a new system could have a negative
impact on our profitability.
|
|
|
Acts of terrorism could cause our business to
suffer. |
Our profitability depends, to a significant degree, on our
ability to predict and effectively manage medical costs. If acts
of terrorism were to occur in markets in which we operate, our
business could suffer. The results of terrorist acts could lead
to higher than expected medical costs, network and information
technology disruptions, and other related factors beyond our
control, which would cause our business to suffer.
46
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation and Subsidiaries:
We have audited the accompanying consolidated balance sheets of
AMERIGROUP Corporation and subsidiaries as of December 31,
2004 and 2003, and the related consolidated income statements
and statements of stockholders equity and cash flows for
each of the years in the three-year period ended
December 31, 2004. These consolidated financial statements
are the responsibility of the Companys management. Our
responsibility is to express an opinion on these consolidated
financial statements based on our audits.
We conducted our audits in accordance with the standards of the
Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether the financial statements are
free of material misstatement. An audit includes examining, on a
test basis, evidence supporting the amounts and disclosures in
the financial statements. An audit also includes assessing the
accounting principles used and significant estimates made by
management, as well as evaluating the overall financial
statement presentation. We believe that our audits provide a
reasonable basis for our opinion.
In our opinion, the consolidated financial statements referred
to above present fairly, in all material respects, the financial
position of AMERIGROUP Corporation and subsidiaries as of
December 31, 2004 and 2003, and the results of their
operations and their cash flows for each of the years in the
three-year period ended December 31, 2004 in conformity
with U.S. generally accepted accounting principles.
We also have audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
effectiveness of AMERIGROUP Corporations internal control
over financial reporting as of December 31, 2004, based on
criteria established in Internal Control
Integrated Framework, issued by the Committee of Sponsoring
Organizations of the Treadway Commission (COSO), and our report
dated February 25, 2005 expressed an unqualified opinion on
managements assessment of, and the effective operation of,
internal control over financial reporting.
/s/ KPMG, LLP
February 25, 2005
Norfolk, Virginia
47
|
|
Item 8. |
Financial Statements and Supplementary Data |
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
DECEMBER 31, 2004 and 2003
|
|
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
|
|
|
|
|
|
(Dollars in thousands) |
|
|
|
|
ASSETS |
|
|
|
|
Current assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
227,130 |
|
|
$ |
84,030 |
|
|
|
|
|
|
Short-term investments
|
|
|
176,364 |
|
|
|
331,940 |
|
|
|
|
|
|
Premium receivables
|
|
|
44,081 |
|
|
|
38,259 |
|
|
|
|
|
|
Deferred income taxes
|
|
|
11,019 |
|
|
|
10,164 |
|
|
|
|
|
|
Prepaid expenses and other current assets
|
|
|
18,737 |
|
|
|
15,995 |
|
|
|
|
|
|
|
|
|
|
|
|
Total current assets
|
|
|
477,331 |
|
|
|
480,388 |
|
|
|
|
|
Long-term investments
|
|
|
208,565 |
|
|
|
119,133 |
|
|
|
|
|
Investments on deposit for licensure
|
|
|
38,365 |
|
|
|
35,346 |
|
|
|
|
|
Property and equipment, net
|
|
|
34,030 |
|
|
|
31,734 |
|
|
|
|
|
Software, net of accumulated amortization of $20,317 and $16,384
at December 31, 2004 and 2003, respectively
|
|
|
16,268 |
|
|
|
10,424 |
|
|
|
|
|
Other long-term assets
|
|
|
4,909 |
|
|
|
4,598 |
|
|
|
|
|
Goodwill and other intangible assets, net of accumulated
amortization of $15,226 and $11,722 at December 31, 2004
and 2003, respectively
|
|
|
140,382 |
|
|
|
144,398 |
|
|
|
|
|
|
|
|
|
|
|
|
$ |
919,850 |
|
|
$ |
826,021 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND STOCKHOLDERS EQUITY |
|
|
|
|
Current liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Claims payable
|
|
$ |
241,253 |
|
|
$ |
239,532 |
|
|
|
|
|
|
Accounts payable
|
|
|
4,826 |
|
|
|
5,523 |
|
|
|
|
|
|
Unearned revenue
|
|
|
34,228 |
|
|
|
54,324 |
|
|
|
|
|
|
Accrued payroll and related liabilities
|
|
|
18,606 |
|
|
|
17,700 |
|
|
|
|
|
|
Accrued expenses and other current liabilities
|
|
|
35,068 |
|
|
|
31,358 |
|
|
|
|
|
|
Current portion of capital lease obligations
|
|
|
3,168 |
|
|
|
4,373 |
|
|
|
|
|
|
|
|
|
|
|
|
Total current liabilities
|
|
|
337,149 |
|
|
|
352,810 |
|
|
|
|
|
Capital lease obligations less current portion
|
|
|
2,878 |
|
|
|
6,146 |
|
|
|
|
|
Deferred income taxes and other long-term liabilities
|
|
|
11,111 |
|
|
|
5,351 |
|
|
|
|
|
|
|
|
|
|
|
|
Total liabilities
|
|
|
351,138 |
|
|
|
364,307 |
|
|
|
|
|
|
|
|
|
|
Commitments and contingencies (note 11)
|
|
|
|
|
|
|
|
|
|
|
|
|
Stockholders equity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock, $0.01 par value. Authorized
100,000,000 shares; issued and outstanding 50,529,724 and
48,889,244 at December 31, 2004 and 2003, respectively
|
|
|
505 |
|
|
|
489 |
|
|
|
|
|
|
Additional paid-in capital
|
|
|
352,417 |
|
|
|
331,506 |
|
|
|
|
|
|
Retained earnings
|
|
|
215,790 |
|
|
|
129,776 |
|
|
|
|
|
|
Deferred compensation
|
|
|
|
|
|
|
(57 |
) |
|
|
|
|
|
|
|
|
|
|
|
Total stockholders equity
|
|
|
568,712 |
|
|
|
461,714 |
|
|
|
|
|
|
|
|
|
|
|
|
$ |
919,850 |
|
|
$ |
826,021 |
|
|
|
|
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
48
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED INCOME STATEMENTS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Years Ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
|
|
(Dollars in thousands, except per share data) |
|
|
|
|
Revenues:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premium
|
|
$ |
1,813,391 |
|
|
$ |
1,615,508 |
|
|
$ |
1,152,636 |
|
|
|
|
|
|
Investment income
|
|
|
10,340 |
|
|
|
6,726 |
|
|
|
8,026 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenues
|
|
|
1,823,731 |
|
|
|
1,622,234 |
|
|
|
1,160,662 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Expenses:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Health benefits
|
|
|
1,469,097 |
|
|
|
1,295,900 |
|
|
|
933,591 |
|
|
|
|
|
|
Selling, general and administrative
|
|
|
191,915 |
|
|
|
186,856 |
|
|
|
133,409 |
|
|
|
|
|
|
Depreciation and amortization
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
13,149 |
|
|
|
|
|
|
Interest
|
|
|
731 |
|
|
|
1,913 |
|
|
|
791 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total expenses
|
|
|
1,682,493 |
|
|
|
1,508,319 |
|
|
|
1,080,940 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income before income taxes
|
|
|
141,238 |
|
|
|
113,915 |
|
|
|
79,722 |
|
|
|
|
|
Income tax expense
|
|
|
55,224 |
|
|
|
46,591 |
|
|
|
32,686 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
$ |
1.17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares outstanding
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
|
|
40,355,456 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
$ |
1.10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
|
|
42,938,844 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
49
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF STOCKHOLDERS EQUITY
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common stock |
|
Additional |
|
|
|
|
|
Total |
|
|
|
|
paid-in |
|
Retained |
|
Deferred |
|
stockholders |
|
|
Shares |
|
Amount |
|
capital |
|
earnings |
|
compensation |
|
equity |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Dollars in thousands) |
|
|
|
|
Balances at January 1, 2002
|
|
|
39,703,380 |
|
|
$ |
397 |
|
|
$ |
168,478 |
|
|
$ |
15,416 |
|
|
$ |
(775 |
) |
|
$ |
183,516 |
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,400,508 |
|
|
|
14 |
|
|
|
4,682 |
|
|
|
|
|
|
|
|
|
|
|
4,696 |
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
3,775 |
|
|
|
|
|
|
|
|
|
|
|
3,775 |
|
|
|
|
|
Amortization of deferred compensation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
358 |
|
|
|
358 |
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
47,036 |
|
|
|
|
|
|
|
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2002
|
|
|
41,103,888 |
|
|
|
411 |
|
|
|
176,935 |
|
|
|
62,452 |
|
|
|
(417 |
) |
|
|
239,381 |
|
|
|
|
|
Common stock issued from public offering, net of expenses of
$8,226
|
|
|
6,325,000 |
|
|
|
63 |
|
|
|
138,766 |
|
|
|
|
|
|
|
|
|
|
|
138,829 |
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,460,356 |
|
|
|
15 |
|
|
|
11,258 |
|
|
|
|
|
|
|
|
|
|
|
11,273 |
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
4,547 |
|
|
|
|
|
|
|
|
|
|
|
4,547 |
|
|
|
|
|
Amortization of deferred compensation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
360 |
|
|
|
360 |
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
67,324 |
|
|
|
|
|
|
|
67,324 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2003
|
|
|
48,889,244 |
|
|
|
489 |
|
|
|
331,506 |
|
|
|
129,776 |
|
|
|
(57 |
) |
|
|
461,714 |
|
|
|
|
|
Common stock issued upon exercise of stock options and purchases
under the employee stock purchase plan
|
|
|
1,640,480 |
|
|
|
16 |
|
|
|
12,902 |
|
|
|
|
|
|
|
|
|
|
|
12,918 |
|
|
|
|
|
Tax benefit from exercise of options
|
|
|
|
|
|
|
|
|
|
|
8,009 |
|
|
|
|
|
|
|
|
|
|
|
8,009 |
|
|
|
|
|
Amortization of deferred compensation
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
57 |
|
|
|
57 |
|
|
|
|
|
Net income
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
86,014 |
|
|
|
|
|
|
|
86,014 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at December 31, 2004
|
|
|
50,529,724 |
|
|
$ |
505 |
|
|
$ |
352,417 |
|
|
$ |
215,790 |
|
|
$ |
|
|
|
$ |
568,712 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
See accompanying notes to consolidated financial statements.
50
AMERIGROUP CORPORATION AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Years Ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
|
|
(Dollars in thousands) |
|
|
|
|
Cash flows from operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
Adjustments to reconcile net income to net cash provided by
operating activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and amortization
|
|
|
20,750 |
|
|
|
23,650 |
|
|
|
13,149 |
|
|
|
|
|
|
|
Loss on disposal or abandonment of property, equipment and
software
|
|
|
971 |
|
|
|
74 |
|
|
|
123 |
|
|
|
|
|
|
|
Deferred tax expense (benefit)
|
|
|
2,878 |
|
|
|
(3,272 |
) |
|
|
993 |
|
|
|
|
|
|
|
Amortization of deferred compensation
|
|
|
57 |
|
|
|
360 |
|
|
|
358 |
|
|
|
|
|
|
|
Tax benefit related to exercise of stock options
|
|
|
8,009 |
|
|
|
4,547 |
|
|
|
3,775 |
|
|
|
|
|
|
|
Changes in assets and liabilities increasing
(decreasing) cash flows from operations:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Premium receivables
|
|
|
(5,822 |
) |
|
|
(3,026 |
) |
|
|
(6,058 |
) |
|
|
|
|
|
|
|
Prepaid expenses and other current assets
|
|
|
(2,742 |
) |
|
|
(7,954 |
) |
|
|
(456 |
) |
|
|
|
|
|
|
|
Other assets
|
|
|
(941 |
) |
|
|
(750 |
) |
|
|
(1,225 |
) |
|
|
|
|
|
|
|
Claims payable
|
|
|
1,721 |
|
|
|
16,681 |
|
|
|
22,084 |
|
|
|
|
|
|
|
|
Accounts payable, accrued expenses and other, net
|
|
|
9,234 |
|
|
|
(494 |
) |
|
|
12,219 |
|
|
|
|
|
|
|
|
Unearned revenue
|
|
|
(20,096 |
) |
|
|
28,806 |
|
|
|
25,278 |
|
|
|
|
|
|
|
|
Other long-term liabilities
|
|
|
2,027 |
|
|
|
2,548 |
|
|
|
704 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by operating activities
|
|
|
102,060 |
|
|
|
128,494 |
|
|
|
117,980 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from investing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proceeds from sale of available-for-sale securities
|
|
|
5,121,916 |
|
|
|
804,047 |
|
|
|
164,231 |
|
|
|
|
|
|
Purchase of available-for-sale securities
|
|
|
(4,972,080 |
) |
|
|
(1,034,040 |
) |
|
|
(153,781 |
) |
|
|
|
|
|
Proceeds from redemption of held-to-maturity securities
|
|
|
74,971 |
|
|
|
190,360 |
|
|
|
113,875 |
|
|
|
|
|
|
Purchase of held-to-maturity investments
|
|
|
(158,663 |
) |
|
|
(207,501 |
) |
|
|
(103,377 |
) |
|
|
|
|
|
Purchase of property and equipment and software
|
|
|
(25,727 |
) |
|
|
(13,294 |
) |
|
|
(20,830 |
) |
|
|
|
|
|
Proceeds from redemption of investments on deposit for licensure
|
|
|
35,525 |
|
|
|
40,009 |
|
|
|
30,340 |
|
|
|
|
|
|
Purchase of investments on deposit for licensure
|
|
|
(38,544 |
) |
|
|
(45,496 |
) |
|
|
(30,898 |
) |
|
|
|
|
|
Purchase of contract rights and related assets
|
|
|
|
|
|
|
(8,581 |
) |
|
|
(6,633 |
) |
|
|
|
|
|
Purchase price adjustment received
|
|
|
512 |
|
|
|
963 |
|
|
|
|
|
|
|
|
|
|
Cash acquired through stock acquisition
|
|
|
|
|
|
|
27,473 |
|
|
|
|
|
|
|
|
|
|
Escrow deposit for pending acquisition and related costs
|
|
|
|
|
|
|
|
|
|
|
(124,133 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by (used in) investing activities
|
|
|
37,910 |
|
|
|
(246,060 |
) |
|
|
(131,206 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash flows from financing activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net (decrease) increase in bank overdrafts
|
|
|
(5,315 |
) |
|
|
4,828 |
|
|
|
(1,963 |
) |
|
|
|
|
|
Borrowings under credit facility
|
|
|
|
|
|
|
|
|
|
|
50,000 |
|
|
|
|
|
|
Repayments of borrowings under credit facility
|
|
|
|
|
|
|
(50,000 |
) |
|
|
|
|
|
|
|
|
|
Payment of debt issuance costs
|
|
|
|
|
|
|
(1,428 |
) |
|
|
(440 |
) |
|
|
|
|
|
Payment of capital lease obligations
|
|
|
(4,473 |
) |
|
|
(4,902 |
) |
|
|
(2,521 |
) |
|
|
|
|
|
Proceeds from exercise of common stock options and employee
stock purchases
|
|
|
12,918 |
|
|
|
11,273 |
|
|
|
4,696 |
|
|
|
|
|
|
Proceeds from issuance of common stock upon public offering, net
of issuance costs
|
|
|
|
|
|
|
138,829 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net cash provided by financing activities
|
|
|
3,130 |
|
|
|
98,600 |
|
|
|
49,772 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net increase (decrease) in cash and cash equivalents
|
|
|
143,100 |
|
|
|
(18,966 |
) |
|
|
36,546 |
|
|
|
|
|
Cash and cash equivalents at beginning of year
|
|
|
84,030 |
|
|
|
102,996 |
|
|
|
66,450 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash and cash equivalents at end of year
|
|
$ |
227,130 |
|
|
$ |
84,030 |
|
|
$ |
102,996 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Supplemental disclosures of cash flow information:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash paid for interest
|
|
$ |
717 |
|
|
$ |
1,755 |
|
|
$ |
767 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Cash paid for income taxes
|
|
$ |
53,628 |
|
|
$ |
40,671 |
|
|
$ |
27,795 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Supplemental disclosures of non-cash activities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Property and equipment acquired under capital lease
|
|
$ |
|
|
|
$ |
5,977 |
|
|
$ |
7,775 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Effective January 1, 2003, we completed our acquisition of
PHP Holdings, Inc. and its subsidiary, Physicians Healthcare
Plans, Inc. The escrow deposit for pending acquisition and
related costs of $124,133 was paid in 2003 and, as a result, we
recorded the estimated fair values of the assets acquired and
liabilities assumed (see note 5(c)).
See accompanying notes to consolidated financial statements.
51
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
December 31, 2004, 2003 and 2002
(Dollars in thousands, except for per share data)
|
|
(1) |
Corporate Organization and Principles of Consolidation |
|
|
|
(a) Corporate Organization |
AMERIGROUP Corporation, a Delaware corporation (the
Company), is a multi-state managed healthcare
company focused on serving people who receive healthcare
benefits through publicly sponsored programs, including
Medicaid, State Childrens Health Insurance Program
(SCHIP) and FamilyCare.
During 1995, we incorporated wholly-owned subsidiaries in
New Jersey, Illinois and Texas to develop, own and operate
HMOs in those states. During 1996, we began enrolling Medicaid
members in HMOs: AMERIGROUP New Jersey, Inc., AMERIGROUP
Illinois, Inc. and AMERIGROUP Texas, Inc. During 1999, we
incorporated a wholly-owned subsidiary in Delaware, AMERIGROUP
Maryland, Inc., a Managed Care Organization, to develop, own and
operate an MCO in Maryland and an HMO in the District of
Columbia. Effective January 1, 2003, AMERIGROUP Maryland
Inc., a Managed Care Organization, changed its domicile of
incorporation to the District of Columbia. During 2001, we
incorporated a wholly-owned subsidiary in Florida, AMERIGROUP
Florida, Inc., an HMO, to develop, own and operate HMOs in
Florida. Effective January 1, 2003, AMERIGROUP Corporation
acquired PHP Holdings, Inc. and its subsidiary, Physicians
Health Plans, Inc., (PHP) and merged it with AMERIGROUP
Florida, Inc. During 2004, we incorporated a wholly-owned
subsidiary in New York, AMERIGROUP Acquisition Corp., to
effect the stock acquisition of CarePlus, LLC (CarePlus).
Effective January 1, 2005, AMERIGROUP Corporation acquired
CarePlus and merged it with AMERIGROUP Acquisition Corp.
(note 14).
On October 16, 2003, we completed a public offering of
6,325,000 shares of common stock, including an
over-allotment issuance of 825,000 shares at a price of
$23.25 per share. We received net proceeds from the
offering of $138,829. On October 21, 2003, we used $30,000
of proceeds from the offering to repay the outstanding balance
of our credit facility.
On December 14, 2004, our Board of Directors approved a
two-for-one split of our common stock effected in the form of a
one hundred percent stock dividend. As a result of the
stock split, our stockholders received one additional share of
our common stock for each share of common stock held of record
on December 31, 2004. The additional shares of our common
stock were distributed on January 18, 2005. All share and
per share amounts in these consolidated financial statements and
related notes have been retroactively adjusted to reflect this
stock split for all periods presented.
|
|
(b) |
Principles of Consolidation |
The consolidated financial statements include the financial
statements of AMERIGROUP Corporation and our five wholly-owned
subsidiaries: AMERIGROUP Florida, Inc., AMERIGROUP Illinois,
Inc., AMERIGROUP New Jersey, Inc. and AMERIGROUP Texas,
Inc., each an HMO; AMERIGROUP Maryland, Inc., a Managed Care
Organization, and PHP Holdings, Inc., a holding company that is
the parent company of AMERIGROUP Florida, Inc. All significant
intercompany balances and transactions have been eliminated in
consolidation.
|
|
(2) |
Summary of Significant Accounting Policies and Practices |
We consider all highly liquid temporary investments with
original maturities of three months or less to be cash
equivalents. We had cash equivalents of $2,513 at
December 31, 2004 which consist of commercial paper. There
were no cash equivalents at December 31, 2003.
52
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
|
|
(b) |
Short and Long-Term Investments and Investments on Deposit
for Licensure |
Short and long-term investments and investments on deposit for
licensure at December 31, 2004 and 2003 consist of
commercial paper, money market funds, U.S. Treasury
securities, cash escrow accounts, asset-backed securities, debt
securities of government sponsored entities, municipal bonds and
auction rate securities. We consider all investments with
original maturities greater than three months but less than
twelve months to be short-term investments. We classify our debt
and equity securities in one of three categories: trading,
available-for-sale or held-to-maturity. Trading securities are
bought and held principally for the purpose of selling them in
the near term. Held-to-maturity securities are those securities
in which we have the ability and intent to hold the security
until maturity. All other securities not included in trading or
held-to-maturity are classified as available-for-sale. At
December 31, 2004 and 2003, our auction rate securities are
classified as available-for-sale. All other securities are
classified as held-to-maturity.
Available-for-sale securities are recorded at fair value.
Changes in fair value are reported in other comprehensive income
until realized through the sale or maturity of the security.
Held-to-maturity securities are recorded at amortized cost,
adjusted for the amortization or accretion of premiums or
discounts. A decline in the market value of any held-to-maturity
security below cost that is deemed other than temporary results
in a reduction in carrying amount to fair value. The impairment
is charged to earnings and a new cost basis for the security is
established. Premiums and discounts are amortized or accreted
over the life of the related held-to-maturity security as an
adjustment to yield using the effective-interest method.
Dividend and interest income is recognized when earned.
Included in short-term and long-term investments are auction
rate securities totaling $187,157 and $336,993 at
December 31, 2004 and 2003, respectively. Auction rate
securities are securities with an underlying component of a
long-term debt or an equity instrument. These auction rate
securities trade or mature on a shorter term than the underlying
instrument based on an auction bid that resets the interest rate
of the security. The auction or reset dates occur at intervals
that are typically less than three months providing high
liquidity to otherwise longer term investments. The Company had
previously classified its auction rate securities as
held-to-maturity and as cash equivalents, short-term investments
or long-term investments based on the period from the purchase
date to the first reset date. In 2004, the Company reclassified
auction rate securities from cash equivalents to short-term
investments because the underlying instruments have maturity
dates exceeding 3 months. Additionally, the Company
reclassified these securities to available-for-sale as the
securities are not held to the maturity date of the underlying
security. Prior periods have been reclassified to provide
consistent presentation.
|
|
(c) |
Property and Equipment |
Property and equipment are stated at cost less accumulated
depreciation and amortization. Depreciation and amortization
expense on property and equipment is calculated on the
straight-line method over the estimated useful lives of the
assets. Property and equipment held under leasehold improvements
are amortized on the straight-line method over the shorter of
the lease term or estimated useful life of the asset.
Depreciation and amortization expense on property and equipment
was $12,495, $14,389 and $10,769 for the years ended
December 31, 2004, 2003 and 2002, respectively. The
estimated useful lives are as follows:
|
|
|
|
|
|
|
Leasehold improvements
|
|
3-15 years |
|
|
|
|
Furniture and fixtures
|
|
5-7 years |
|
|
|
|
Equipment
|
|
3-5 years |
Software is stated at cost less accumulated amortization in
accordance with Statement of Position 98-1, Accounting for
the Costs of Software Developed or Obtained for Internal
Use. Software is amortized over its
53
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
estimated useful life of three years, using the straight-line
method. Amortization expense on software was $4,121, $2,972 and
$2,064 for the years ended December 31, 2004, 2003 and
2002, respectively.
|
|
(e) |
Goodwill and Other Intangibles |
Goodwill represents the excess of cost over fair value of
businesses acquired. In accordance with Statement of Financial
Accounting Standards No. 142, Goodwill and Other
Intangible Assets (SFAS No. 142), goodwill and
intangible assets acquired in a purchase business combination
and determined to have an indefinite useful life are not
amortized, but instead tested for impairment at least annually.
SFAS No. 142 also requires that intangible assets with
estimable useful lives be amortized over their respective
estimated useful lives to their estimated residual values, and
reviewed for impairment in accordance with Statement of
Financial Accounting Standards No. 144, Accounting for
Impairment or Disposal of Long-Lived Assets.
Other assets include deposits, debt issuance costs and cash
surrender value of life insurance policies.
Income taxes are accounted for under the asset and liability
method. Deferred tax assets and liabilities are recognized for
the future tax consequences attributable to differences between
the financial statement carrying amounts of existing assets and
liabilities and their respective tax bases and tax credit
carryforwards. Deferred tax assets and liabilities are measured
using enacted tax rates expected to apply to taxable income in
the years in which those temporary differences are expected to
be recovered or settled. The effect on deferred tax assets and
liabilities of a change in tax rates is recognized in income in
the period that includes the enactment date.
|
|
(h) |
Stock-Based Compensation |
As permitted under Statement of Financial Accounting Standards
No. 123, Accounting for Stock-Based Compensation
(SFAS No. 123), we have chosen to account for
stock-based compensation using the intrinsic value method
prescribed in Accounting Principles Board Opinion No. 25,
Accounting for Stock Issued to Employees (APB Opinion
No. 25), and related interpretations. Accordingly,
compensation cost for stock options is measured as the excess,
if any, of the estimated fair value of our stock at the date of
grant over the amount an employee must pay to acquire the stock.
In December 2002, Statement of Financial Accounting Standards
No. 148, Accounting for Stock-Based Compensation
(SFAS No. 148), was issued which requires that we
illustrate the effect on net income and net income per share if
we had applied the fair value principles included in
54
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
SFAS No. 123 for both annual and interim financial
statements. The following table illustrates the effect on net
income and earnings per share as if the Company had applied the
fair value recognition.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
Net income:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reported net income
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
Deduct: Total stock-based employee compensation expense
determined under fair value based method for all awards, net of
related tax effects
|
|
|
9,321 |
|
|
|
9,577 |
|
|
|
5,800 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Proforma net income
|
|
$ |
76,693 |
|
|
$ |
57,747 |
|
|
$ |
41,236 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reported basic net income per share
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
$ |
1.17 |
|
|
|
|
|
|
Proforma basic net income per share
|
|
|
1.54 |
|
|
|
1.34 |
|
|
|
1.02 |
|
|
|
|
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Reported diluted net income per share
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
$ |
1.10 |
|
|
|
|
|
|
Proforma diluted net income per share
|
|
|
1.49 |
|
|
|
1.28 |
|
|
|
0.96 |
|
We record premium revenue based on membership and premium
information from each state. Premiums are due monthly and are
recognized as revenue during the period in which we are
obligated to provide services to members. In all of our states
except Florida, we are eligible to receive supplemental payments
for newborn obstetric deliveries. Each state contract is
specific as to what is required before payments are generated.
Upon delivery of a newborn, each state is notified according to
our contract. Revenue is recognized in the period that the
delivery occurs and the related services are provided to our
member. Additionally, in some states we receive supplemental
payments for certain services such as high cost drugs and early
childhood prevention screenings. Any amounts that have not been
received from the state by the end of the period are recorded on
our balance sheet as premium receivables.
|
|
(j) |
Experience Rebate Payable |
Experience rebate payable, included in accrued expenses, capital
leases and other current liabilities, consists of estimates of
amounts due under contracts with a state government. These
amounts are computed based on a percentage of the contract
profits, as defined, in the contract with the state. The
profitability computation includes premium revenue received from
the state less actual medical and administrative costs incurred
and paid and less estimated unpaid claims payable for the
applicable membership. The unpaid claims payable estimates are
based on historical payment patterns using actuarial techniques.
A final settlement is generally made 334 days after the
contract period ends using paid claims data. Any adjustment made
to the experience rebate payable as a result of final settlement
is included in current operations.
Accrued medical expenses for inpatient, outpatient surgery,
emergency room, specialist, pharmacy and ancillary medical
claims include amounts billed and not paid and an estimate of
costs incurred for unbilled services provided. These liabilities
are principally based on historical payment patterns using
actuarial techniques. In addition, claims processing costs are
accrued based on an estimate of the costs necessary to process
unpaid claims. Claims payable are reviewed and adjusted
periodically and, as adjustments are made, differences are
included in current operations. Claims payable also includes
estimates of amounts due to or from contracted providers under
risk-sharing arrangements. The arrangements are typically based
upon quality
55
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
measures as well as medical results. Estimates relating to
risk-sharing arrangements are calculated as a percentage,
typically 25% to 50%, of the differences between actual results
and specified targets of medical expense and may include a
sharing of profits in excess of the targeted medical and
administrative expenses, typically 7% to 10% of total premiums
covered under the contract.
Stop-loss premiums, net of recoveries, are included in health
benefits expense in the accompanying consolidated income
statements.
|
|
(m) |
Impairment of Long-Lived Assets |
Long-lived assets, such as property and equipment and purchased
intangibles subject to amortization, are reviewed for impairment
whenever events or changes in circumstances indicate that the
carrying amount of an asset may not be recoverable.
Recoverability of assets to be held and used is measured by a
comparison of the carrying amount of an asset to estimated
undiscounted future cash flows expected to be generated by the
asset. If the carrying amount of an asset exceeds its estimated
future cash flows, an impairment charge is recognized by the
amount by which the carrying amount of the asset exceeds the
fair value of the asset. Assets to be disposed of would be
separately presented in the balance sheet and reported at the
lower of the carrying amount or fair value less costs to sell,
and are no longer depreciated. The assets and liabilities of a
group classified as held for sale would be presented separately
in the appropriate asset and liability sections of the balance
sheet. No impairment of long-lived assets was recorded in 2004,
2003 or 2002.
Goodwill is tested annually for impairment, and is tested for
impairment more frequently if events and circumstances indicate
that the asset might be impaired. An impairment loss is
recognized to the extent that the carrying amount exceeds the
assets fair value. This determination is made at the
reporting unit level and consists of two steps. First, we
determine the fair value of a reporting unit and compare it to
its carrying amount. Second, if the carrying amount of a
reporting unit exceeds its fair value, an impairment loss is
recognized for any excess of the carrying amount of the
reporting units goodwill over the implied fair value of
that goodwill. The implied fair value of goodwill is determined
by allocating the fair value of the reporting unit in a manner
similar to a purchase price allocation, in accordance with
Statement of Financial Accounting Standards No. 141,
Business Combinations. The residual fair value after this
allocation is the implied fair value of the reporting unit
goodwill. No impairment of goodwill was recorded in 2004, 2003
or 2002.
Basic net income per share has been computed by dividing net
income attributable to common stockholders by the weighted
average number of common shares outstanding. Diluted net income
per share reflects the potential dilution that could occur
assuming the inclusion of dilutive potential common shares and
has been computed by dividing net income attributable to common
stockholders by the weighted average number of common shares and
dilutive potential common shares outstanding. Dilutive potential
common shares include all outstanding stock options after
applying the treasury stock method to the extent the options are
dilutive.
Our management has made a number of estimates and assumptions
relating to the reporting of assets and liabilities and the
disclosure of contingent assets and liabilities at the date of
the consolidated financial statements and the reported amounts
of revenues and expenses during the reporting period to prepare
these consolidated financial statements in conformity with
U.S. generally accepted accounting principles. Actual
results could differ from those estimates.
56
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
Certain reclassifications have been made to prior year amounts
to conform to the current year presentation.
|
|
(q) |
Recent Accounting Standards |
On December 16, 2004, the Financial Accounting Standards
Board (FASB) issued Statement of Financial Accounting
Standard No. 123 (revised 2004)
(SFAS No. 123(R)), Shared-Based Payment, which
is a revision of SFAS No. 123.
SFAS No. 123(R) supersedes APB Opinion No. 25,
Accounting for Stock Issued to Employees, and
SFAS No. 148 and amends FASB Statement of Financial
Accounting Standard No. 95, Statement of Cash Flows.
Generally, the approach in SFAS No. 123(R) is similar
to the approach described in SFAS No. 123. However,
SFAS No. 123(R) requires all share-based payments to
employees, including grants of employee stock options, to be
recognized in the income statement based on their fair values.
Proforma disclosure is no longer an alternative.
SFAS No. 123(R) must be adopted no later than
July 1, 2005. Early adoption will be permitted in periods
in which financial statements have not yet been issued. We
expect to adopt SFAS No. 123(R) on July 1, 2005.
SFAS No. 123(R) permits public companies to adopt its
requirements using one of two methods:
|
|
|
1. A modified prospective method in which
compensation cost is recognized beginning with the effective
date (a) based on the requirements of
SFAS No. 123(R) for all share-based payments granted
after the effective date and (b) based on the requirements
of SFAS No. 123 for all awards granted to employees
prior to the effective date of SFAS No. 123(R) that
remain unvested on the effective date. |
|
|
2. A modified retrospective method which
includes the requirements of the modified prospective method
described above, but also permits entities to restate based on
the amounts previously recognized under SFAS No. 123
for purposes of proforma disclosures either (a) all prior
presented or (b) prior interim periods of the year of
adoption. |
We are in the process of evaluating these methods.
As permitted by SFAS No. 123, the Company currently
accounts for share-based payments to employees using APB Opinion
No. 25s intrinsic value method and, as such,
generally recognizes no compensation cost for employee stock
options. Accordingly, the adoption of the fair value method of
SFAS No. 123(R) will have a significant impact on our
results of operations, although it will have no impact on our
overall financial position. The impact of adoption of
SFAS No. 123(R) cannot be predicted at this time
because it will depend on levels of share-based payments granted
in the future. However, had we adopted SFAS No. 123(R)
in prior periods, the impact of the standard would have
approximated the impact of SFAS No. 123 as described
in the disclosure of proforma net income and earnings per share
in Note 2(h) to our consolidated financial statements.
SFAS No. 123(R) also requires the benefits of tax
deductions in excess of recognized compensation cost to be
reported as a financing cash flow, rather than as an operating
cash flow as required under current literature. This requirement
will reduce net operating cash flows and increase net financing
cash flows in periods after adoption. While the company cannot
estimate what those amounts will be in the future (because they
depend on, among other things, when employees exercise stock
options), the amount of operating cash flows recognized in prior
periods for such excess tax deductions were $8,009, $4,547 and
$3,775 in 2004, 2003 and 2002, respectively.
|
|
(r) |
Risks and Uncertainties |
Our profitability depends in large part on accurately predicting
and effectively managing health benefits expense. We continually
review our premium and benefit structure to reflect its
underlying claims experience and revised actuarial data;
however, several factors could adversely affect the health
benefits expense. Certain of these factors, which include
changes in healthcare practices, inflation, new technologies,
major epidemics, natural disasters and malpractice litigation,
are beyond any health plans control and could adversely
affect our ability to
57
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
accurately predict and effectively control healthcare costs.
Costs in excess of those anticipated could have a material
adverse effect on our results of operations.
At December 31, 2004, we served members who received
healthcare benefits through 13 contracts with the regulatory
entities in the jurisdictions in which we operate. Five of these
contracts individually accounted for 10% or more of our revenues
for the year ended December 31, 2004, with the largest of
these contracts representing approximately 19% of our revenues.
Our state contracts have terms that are generally one to
two-years in length, some of which contain optional renewal
periods at the discretion of the individual state. Some
contracts also contain a termination clause with notification
periods ranging from 30 to 90 days. At the termination of
these contracts, re-negotiation of terms or the requirement to
enter into a re-bidding or re-procurement process is required to
execute a new contract. Our contracts in our Texas market, which
represented approximately 41% of our revenues in 2004, are
currently undergoing a re-procurement process. Although the
State of Texas has said it will announce contract awards in
early 2005 with implementation continuing into 2006, the
announcement of the awards may not occur until after the
conclusion of the Texas legislative session on May 30, 2005.
|
|
(3) |
Short and Long-Term Investments and Investments on Deposit
for Licensure |
The carrying amount, gross unrealized holding gains, gross
unrealized holding losses and fair value for available-for-sale
and held-to-maturity short-term investments are as follows at
December 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross |
|
Gross |
|
|
|
|
|
|
unrealized |
|
unrealized |
|
|
|
|
Carrying |
|
holding |
|
holding |
|
Fair |
|
|
amount |
|
gains |
|
losses |
|
value |
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Auction rate securities available-for-sale
|
|
$ |
150,401 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
150,401 |
|
|
|
|
|
|
Held-to-maturity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Commercial paper
|
|
|
18,476 |
|
|
|
|
|
|
|
6 |
|
|
|
18,470 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
|
7,487 |
|
|
|
|
|
|
|
12 |
|
|
|
7,475 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
176,364 |
|
|
$ |
|
|
|
$ |
18 |
|
|
$ |
176,346 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Auction rate securities available-for-sale
|
|
$ |
329,690 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
329,690 |
|
|
|
|
|
|
Held-to-maturity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Commercial paper
|
|
|
1,000 |
|
|
|
|
|
|
|
|
|
|
|
1,000 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
|
1,250 |
|
|
|
|
|
|
|
|
|
|
|
1,250 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
331,940 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
331,940 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
58
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The carrying amount, gross unrealized holding gains, gross
unrealized holding losses and fair value for available-for-sale
and held-to-maturity long-term investments are as follows at
December 31, 2004 and 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross |
|
Gross |
|
|
|
|
|
|
unrealized |
|
unrealized |
|
|
|
|
Carrying |
|
holding |
|
holding |
|
Fair |
|
|
amount |
|
gains |
|
losses |
|
value |
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Auction rate securities available-for-sale
|
|
$ |
36,756 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
36,756 |
|
|
|
|
|
|
Held-to-maturity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Municipal bonds
|
|
|
16,436 |
|
|
|
|
|
|
|
60 |
|
|
|
16,376 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
within one year
|
|
|
46,993 |
|
|
|
|
|
|
|
313 |
|
|
|
46,680 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
108,380 |
|
|
|
|
|
|
|
1,074 |
|
|
|
107,306 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
208,565 |
|
|
$ |
|
|
|
$ |
1,447 |
|
|
$ |
207,118 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Auction rate securities available-for-sale
|
|
$ |
7,303 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
7,303 |
|
|
|
|
|
|
Held-to-maturity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Municipal bonds
|
|
|
7,115 |
|
|
|
3 |
|
|
|
|
|
|
|
7,118 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
within one year
|
|
|
1,500 |
|
|
|
1 |
|
|
|
|
|
|
|
1,501 |
|
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
103,215 |
|
|
|
146 |
|
|
|
96 |
|
|
|
103,265 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
119,133 |
|
|
$ |
150 |
|
|
$ |
96 |
|
|
$ |
119,187 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
59
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
As a condition for licensure by various state governments to
operate HMOs or MCOs, we are required to maintain certain funds
on deposit with or under the control of the various departments
of insurance. Accordingly, at December 31, 2004 and 2003,
the amortized cost, gross unrealized holding gains, gross
unrealized holding losses and fair value for these
held-to-maturity securities are summarized as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross |
|
Gross |
|
|
|
|
|
|
unrealized |
|
unrealized |
|
|
|
|
Amortized |
|
holding |
|
holding |
|
Fair |
|
|
cost |
|
gains |
|
losses |
|
value |
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Money market funds
|
|
$ |
599 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
599 |
|
|
|
|
|
|
U.S. Treasury securities, maturing within one year
|
|
|
5,933 |
|
|
|
|
|
|
|
7 |
|
|
|
5,926 |
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
within one year
|
|
|
11,373 |
|
|
|
|
|
|
|
69 |
|
|
|
11,304 |
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
17,607 |
|
|
|
|
|
|
|
137 |
|
|
|
17,470 |
|
|
|
|
|
|
Cash escrow account
|
|
|
2,853 |
|
|
|
|
|
|
|
|
|
|
|
2,853 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
38,365 |
|
|
$ |
|
|
|
$ |
213 |
|
|
$ |
38,152 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Money market funds
|
|
$ |
4,718 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
4,718 |
|
|
|
|
|
|
U.S. Treasury securities, maturing within one year
|
|
|
5,543 |
|
|
|
18 |
|
|
|
|
|
|
|
5,561 |
|
|
|
|
|
|
U.S. Treasury securities, maturing between one year and
five years
|
|
|
407 |
|
|
|
1 |
|
|
|
|
|
|
|
408 |
|
|
|
|
|
|
Debt securities of government sponsored entities, maturing
between one year and five years
|
|
|
22,432 |
|
|
|
61 |
|
|
|
4 |
|
|
|
22,489 |
|
|
|
|
|
|
Cash escrow account
|
|
|
2,246 |
|
|
|
|
|
|
|
|
|
|
|
2,246 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total
|
|
$ |
35,346 |
|
|
$ |
80 |
|
|
$ |
4 |
|
|
$ |
35,422 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The state governments in which we operate require us to maintain
investments on deposit in specific dollar amounts based on
either formulas or set amounts as determined by state
regulations. We purchase interest-based investments with a fair
value equal to or greater than the required dollar amount. The
interest that accrues on these investments is not restricted and
is available for withdrawal.
60
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The following table shows the fair value of our held-to-maturity
investments with unrealized losses that are not deemed to be
other-than-temporarily impaired, aggregated by investment
category and length of time that individual securities have been
in a continuous unrealized loss position, at December 31,
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Less than 12 months |
|
12 months or greater |
|
|
|
|
|
|
|
|
|
Gross |
|
|
|
|
|
Gross |
|
|
|
|
|
|
unrealized |
|
Total |
|
|
|
unrealized |
|
Total |
|
|
|
|
holding |
|
number of |
|
Fair |
|
holding |
|
number of |
|
|
Fair value |
|
losses |
|
securities |
|
value |
|
losses |
|
securities |
|
|
|
|
|
|
|
|
|
|
|
|
|
2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Commercial paper
|
|
$ |
14,970 |
|
|
$ |
6 |
|
|
|
10 |
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
|
179,771 |
|
|
|
1,567 |
|
|
|
91 |
|
|
|
5,962 |
|
|
|
38 |
|
|
|
3 |
|
|
|
|
|
|
Municipal bonds
|
|
|
16,376 |
|
|
|
60 |
|
|
|
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
U.S. Treasury securities
|
|
|
5,926 |
|
|
|
7 |
|
|
|
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total temporarily impaired securities
|
|
$ |
217,043 |
|
|
$ |
1,640 |
|
|
|
116 |
|
|
$ |
5,962 |
|
|
$ |
38 |
|
|
|
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following table shows the fair value of our held-to-maturity
investments with unrealized losses that are not deemed to be
other-than-temporarily impaired, aggregated by investment
category, at December 31, 2003, all of which had
experienced declines in value for less than 12 months.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross |
|
|
|
|
|
|
unrealized |
|
Total |
|
|
Fair |
|
holding |
|
number of |
|
|
value |
|
losses |
|
securities |
|
|
|
|
|
|
|
2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Debt securities of government sponsored entities
|
|
$ |
26,283 |
|
|
$ |
100 |
|
|
|
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The temporary declines in value as of December 31, 2004 and
2003, are primarily due to fluctuations in short-term market
interest rates.
|
|
(4) |
Property and Equipment, Net |
Property and equipment, net at December 31, 2004 and 2003
is summarized as follows:
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
|
|
|
|
Leasehold improvements
|
|
$ |
17,506 |
|
|
$ |
11,096 |
|
|
|
|
|
Furniture and fixtures
|
|
|
11,918 |
|
|
|
11,445 |
|
|
|
|
|
Equipment
|
|
|
43,551 |
|
|
|
37,196 |
|
|
|
|
|
|
|
|
|
|
|
|
|
72,975 |
|
|
|
59,737 |
|
|
|
|
|
Accumulated depreciation and amortization
|
|
|
(38,945 |
) |
|
|
(28,003 |
) |
|
|
|
|
|
|
|
|
|
|
|
$ |
34,030 |
|
|
$ |
31,734 |
|
|
|
|
|
|
|
|
|
|
61
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
Effective January 1, 2002, we purchased certain assets of
MethodistCare, Inc.s (MethodistCare) Houston, Texas
Medicaid line of business. The assets purchased consisted of
MethodistCares rights to provide managed care services to
its Medicaid members. We paid $1,232 in cash, including
transaction costs, resulting in goodwill of the same amount, all
of which is deductible for income tax purposes.
|
|
(b) |
Capital Community Health Plan |
Effective July 1, 2002, we purchased the Medicaid contracts
and related assets of Capital Community Health Plan (CCHP) in
Washington, D.C. for $6,970, including acquisition costs.
The assets purchased consisted primarily of CCHPs rights
to provide managed care services to its Medicaid members. During
2003, we settled on the final purchase price as provided under
the asset purchase agreement and reduced goodwill by $963.
Goodwill and other intangibles totaling $6,007 included $423 for
identifiable intangibles allocated to the membership purchased,
all of which is deductible for income tax purposes. Identifiable
intangibles with definite useful lives are being amortized based
on the timing of related cash flows over eight years.
Effective January 1, 2003, we completed our acquisition of
PHP pursuant to the terms of a merger agreement entered into on
August 22, 2002 for $124,260, including acquisition costs
of $1,260.
Established in 1992, PHP served 193,000 Medicaid and SCHIP
members at December 31, 2002 in 12 counties, including
the metropolitan areas of Orlando, Tampa and
Ft. Lauderdale/ Miami. PHP also served Medicare and
commercial members which were spun off from PHP prior to
December 31, 2002 and not acquired by us.
Of the $124,260 acquisition cost which includes transaction
costs, approximately $50,000 was financed through our credit
facility with the balance funded through unregulated cash.
Goodwill and other intangibles totaling $116,075 includes $8,990
of identifiable intangibles allocated to the rights to
membership and a non-compete agreement, none of which is
deductible for tax purposes. Intangible assets related to the
non-compete agreement and rights to membership are being
amortized based on the timing of related cash flows. A portion
of the purchase price remains in escrow pending various
settlement provisions between us and the former shareholders of
PHP Holdings, Inc. During 2004, $512 of the escrow was returned
to us as part of an interim settlement provision. Goodwill was
reduced accordingly by $512. During 2003, as part of the
finalization of our fair value analysis, purchase price
adjustments totaling $127 were recorded and reflected as a
reduction in goodwill in the period. Further, purchase price
adjustments may arise in the future as a result of the
settlement provisions.
62
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The following table summarizes the fair values of the assets
acquired and liabilities assumed of PHP at the date of
acquisition.
|
|
|
|
|
|
|
|
|
|
Current assets, including cash and cash equivalents
|
|
$ |
31,668 |
|
|
|
|
|
Intangible assets
|
|
|
8,990 |
|
|
|
|
|
Goodwill
|
|
|
107,085 |
|
|
|
|
|
Other assets
|
|
|
2,482 |
|
|
|
|
|
|
|
Total assets acquired
|
|
|
150,225 |
|
|
|
|
|
|
Claims payable
|
|
|
20,574 |
|
|
|
|
|
Other liabilities
|
|
|
6,030 |
|
|
|
|
|
|
|
Total liabilities assumed
|
|
|
26,604 |
|
|
|
|
|
|
|
Net assets acquired
|
|
$ |
123,621 |
|
|
|
|
|
|
The following table summarizes intangible assets resulting from
the PHP transaction:
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortization |
|
|
|
|
period |
|
|
|
|
|
|
|
|
|
Membership rights
|
|
$ |
8,650 |
|
|
|
10 years |
|
|
|
|
|
Non-compete agreement
|
|
|
340 |
|
|
|
5 years |
|
|
|
|
|
|
|
|
|
|
|
|
$ |
8,990 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following unaudited proforma summary information presents
the consolidated income statement information for the twelve
month period ended December 31, 2002 as if the PHP
transaction had been consummated on January 1, 2002, and
does not purport to be indicative of what would have occurred
had the acquisition been made at that date or of the results
which may occur in the future.
|
|
|
|
|
|
|
|
|
Premium revenue
|
|
$ |
1,412,916 |
|
|
|
|
|
|
Net income
|
|
$ |
55,035 |
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
2.56 |
|
|
|
|
|
|
The unaudited proforma summary information reflects adjustments
made to our historical financial statements by including the
applicable results of operations of PHPs Medicaid and
SCHIP lines of business in Florida prior to the acquisition.
Effective July 1, 2003, we purchased the Medicaid contracts
and related assets known as St. Augustine for $8,581. The assets
purchased consisted primarily of St. Augustines rights to
provide managed care services to its 26,000 Medicaid members who
receive healthcare benefits under Floridas Medicaid
program in nine counties in the Miami/ Ft. Lauderdale,
Orlando and Tampa markets. Goodwill and other intangibles
totaling $8,581 includes $2,151 for identifiable intangibles
allocated to a non-compete agreement and the rights to the
membership, all of which is deductible for income tax purposes.
Intangible assets related to the non-compete agreement and the
rights to the membership are being amortized based on the timing
of related cash flows.
63
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The following table summarizes intangible assets resulting from
the St. Augustine transaction:
|
|
|
|
|
|
|
|
|
|
|
Amortization |
|
|
|
|
period |
|
|
|
|
|
|
|
|
|
Membership rights
|
|
$ 2,143 |
|
|
8 years |
|
|
|
|
|
Non-compete agreement
|
|
8 |
|
|
3 years |
|
|
|
|
|
|
|
|
|
|
$ 2,151 |
|
|
|
|
|
|
|
|
|
|
|
|
|
(e) |
Summary of Goodwill and Acquired Intangible Assets |
Goodwill and acquired intangible assets for the years ended
December 31, 2004 and 2003 are as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
|
|
|
|
|
|
Gross carrying |
|
Accumulated |
|
Gross carrying |
|
Accumulated |
|
|
amount |
|
amortization |
|
amount |
|
amortization |
|
|
|
|
|
|
|
|
|
Goodwill
|
|
$ |
143,944 |
|
|
$ |
(5,773 |
) |
|
$ |
144,456 |
|
|
$ |
(5,773 |
) |
|
|
|
|
Membership rights
|
|
|
11,216 |
|
|
|
(9,213 |
) |
|
|
11,216 |
|
|
|
(5,780 |
) |
|
|
|
|
Non-compete agreement
|
|
|
448 |
|
|
|
(240 |
) |
|
|
448 |
|
|
|
(169 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
155,608 |
|
|
$ |
(15,226 |
) |
|
$ |
156,120 |
|
|
$ |
(11,722 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortization expense for the years ended December 31, 2004,
2003 and 2002 was $3,504, $5,849 and $0, respectively, and the
estimated aggregate amortization expense for the five succeeding
years is as follows:
|
|
|
|
|
|
|
Estimated |
|
|
amortization |
|
|
expense |
|
|
|
2005
|
|
$ |
1,286 |
|
|
|
|
|
2006
|
|
|
549 |
|
|
|
|
|
2007
|
|
|
262 |
|
|
|
|
|
2008
|
|
|
76 |
|
|
|
|
|
2009
|
|
|
27 |
|
Total income taxes for the years ended December 31, 2004,
2003 and 2002 were allocated as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Years Ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
Income from continuing operations
|
|
$ |
55,224 |
|
|
$ |
46,591 |
|
|
$ |
32,686 |
|
|
|
|
|
Stockholders equity, tax benefit on exercise of stock
options
|
|
|
(8,009 |
) |
|
|
(4,547 |
) |
|
|
(3,775 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
47,215 |
|
|
$ |
42,044 |
|
|
$ |
28,911 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
64
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
Income tax expense (benefit) for the years ended
December 31, 2004, 2003 and 2002 consists of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current |
|
Deferred |
|
Total |
|
|
|
|
|
|
|
Year ended December 31, 2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
U.S. federal
|
|
$ |
44,235 |
|
|
$ |
2,335 |
|
|
$ |
46,570 |
|
|
|
|
|
|
State and local
|
|
|
8,111 |
|
|
|
543 |
|
|
|
8,654 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
52,346 |
|
|
$ |
2,878 |
|
|
$ |
55,224 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2003:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
U.S. federal
|
|
$ |
42,238 |
|
|
$ |
(2,409 |
) |
|
$ |
39,829 |
|
|
|
|
|
|
State and local
|
|
|
7,625 |
|
|
|
(863 |
) |
|
|
6,762 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
49,863 |
|
|
$ |
(3,272 |
) |
|
$ |
46,591 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year ended December 31, 2002:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
U.S. federal
|
|
$ |
25,798 |
|
|
$ |
854 |
|
|
$ |
26,652 |
|
|
|
|
|
|
State and local
|
|
|
5,895 |
|
|
|
139 |
|
|
|
6,034 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
31,693 |
|
|
$ |
993 |
|
|
$ |
32,686 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income tax expense differed from the amounts computed by
applying the U.S. federal income tax rate to income before
income taxes as a result of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Years Ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
|
|
Amount |
|
% |
|
Amount |
|
% |
|
Amount |
|
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Tax expense at statutory rate
|
|
$ |
49,434 |
|
|
|
35.0 |
|
|
$ |
39,870 |
|
|
|
35.0 |
|
|
$ |
27,902 |
|
|
|
35.0 |
|
|
|
|
|
Increase in income taxes resulting from:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State and local income taxes, net of federal income tax effect
|
|
|
5,625 |
|
|
|
4.0 |
|
|
|
4,395 |
|
|
|
3.9 |
|
|
|
3,922 |
|
|
|
4.9 |
|
|
|
|
|
|
Effect of nondeductible expenses and other, net
|
|
|
165 |
|
|
|
0.1 |
|
|
|
2,326 |
|
|
|
2.0 |
|
|
|
862 |
|
|
|
1.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total income tax expense
|
|
$ |
55,224 |
|
|
|
39.1 |
|
|
$ |
46,591 |
|
|
|
40.9 |
|
|
$ |
32,686 |
|
|
|
41.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
65
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The tax effects of temporary differences that give rise to
significant portions of the deferred tax assets and deferred tax
liabilities at December 31, 2004 and 2003 are presented
below:
|
|
|
|
|
|
|
|
|
|
|
|
|
December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
|
|
|
|
Deferred tax assets:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Estimated claims incurred but not reported, a portion of which
is deductible as paid for tax purposes
|
|
$ |
2,160 |
|
|
$ |
2,338 |
|
|
|
|
|
|
Vacation, bonus and other accruals, deductible as paid for tax
purposes
|
|
|
10,343 |
|
|
|
6,689 |
|
|
|
|
|
|
Accounts receivable allowances, deductible as written off for
tax purposes
|
|
|
590 |
|
|
|
762 |
|
|
|
|
|
|
Start up costs, deductible in future periods for tax purposes
|
|
|
552 |
|
|
|
718 |
|
|
|
|
|
|
Goodwill, due to timing differences in book and tax amortization
|
|
|
|
|
|
|
209 |
|
|
|
|
|
|
Unearned revenue, a portion of which is includible in income as
received for tax purposes
|
|
|
2,636 |
|
|
|
4,330 |
|
|
|
|
|
|
State net operating loss/credit carryforwards, deductible in
future periods for tax purposes
|
|
|
1,616 |
|
|
|
1,780 |
|
|
|
|
|
|
|
|
|
|
|
|
Gross deferred tax asset
|
|
|
17,897 |
|
|
|
16,826 |
|
|
|
|
|
Deferred tax liabilities:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Goodwill, due to timing differences in book and tax amortization
|
|
|
(474 |
) |
|
|
|
|
|
|
|
|
|
Property and equipment, due to timing differences in book and
tax depreciation
|
|
|
(8,822 |
) |
|
|
(5,271 |
) |
|
|
|
|
|
Deductible prepaid expenses and other
|
|
|
(2,217 |
) |
|
|
(2,293 |
) |
|
|
|
|
|
|
|
|
|
|
|
Gross deferred tax liabilities
|
|
|
(11,513 |
) |
|
|
(7,564 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net deferred tax asset
|
|
$ |
6,384 |
|
|
$ |
9,262 |
|
|
|
|
|
|
|
|
|
|
To assess the recoverability of deferred tax assets, we consider
whether it is more likely than not that deferred tax assets will
be realized. In making this determination, we take into account
the scheduled reversal of deferred tax liabilities and whether
projected future taxable income is sufficient to permit
deduction of the deferred tax assets. Based on the level of
historical taxable income and projections for future taxable
income, we believe it is more likely than not that we will fully
realize the benefits of the gross deferred tax assets of
$17,897. State net operating loss carryforwards that expire in
2023 and 2024 comprise $1,616 of the gross deferred tax assets.
Prepaid income tax was $2,287 at December 31, 2004 and is
included in prepaid expenses and other current assets. Income
taxes payable was $7,005 at December 31, 2003 and is
included in accrued expenses and other current liabilities.
On October 22, 2003, we entered into a $95,000 Amended and
Restated Credit Agreement (Credit Agreement) with a syndicate of
banks. The Credit Agreement contains a provision which allows us
to obtain, subject to certain conditions, an increase in
revolving commitments of up to an additional $30,000. The
proceeds of the Credit Agreement are available for general
corporate purposes, including, without limitation, permitted
acquisitions of businesses, assets and technologies. The
borrowings under the Credit Agreement will accrue interest at
one of the following rates, at our option: Eurodollar plus the
applicable margin or an alternate base rate plus the applicable
margin. The applicable margin for Eurodollar borrowings is
between 2.00% and 2.50% and the applicable margin for alternate
base rate borrowings is between 1.00% and 1.50%. The applicable
margin will vary depending on our leverage ratio. The Credit
Agreement is secured by substantially all of the assets of
66
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
AMERIGROUP Corporation and its wholly-owned subsidiary, PHP
Holdings, Inc., including the stock of their respective
wholly-owned managed care subsidiaries. There is a commitment
fee on the unused portion of the Credit Agreement that ranges
from 0.375% to 0.50%, depending on the leverage ratio. The
Credit Agreement terminates on October 22, 2006 and was
undrawn as of December 31, 2004.
During 2001, we entered into a Credit and Guaranty Agreement
with a syndicate of banks to obtain a $60,000 revolving credit
facility. In July 2002, we expanded the facility to include an
additional bank and to increase the revolving credit facility to
$75,000. The facility was secured by the assets of AMERIGROUP
Corporation and by the common stock of its direct, wholly-owned
subsidiaries. At December 31, 2002, $50,000 was outstanding
under the facility. Amounts outstanding under the facility
accrued interest at one of the following rates, at our option:
LIBOR plus the applicable margin or an alternate bank rate plus
the applicable margin. The applicable margin for LIBOR
borrowings was between 2.0% and 2.5%. The applicable margin for
alternate bank rate borrowings was between 1.0% and 1.5%. The
applicable margin varied depending on our leverage ratio. We
also paid a 0.50% commitment fee on the unused portion of the
facility. This credit facility was repaid during 2003 and
replaced with the Credit Agreement.
Pursuant to the Credit Agreement, we must meet certain financial
covenants. These financial covenants include meeting certain
financial ratios, a limit on annual capital expenditures, and a
minimum net worth requirement. Additionally, under the terms of
our Credit Agreement, we are limited in the amount of dividends
that we may pay to our stockholders without the consent of our
lenders.
In May 2003, our shareholders approved and we adopted the 2003
Equity Incentive Plan (2003 Plan), which provides for the
granting of stock options, restricted stock, phantom stock and
stock bonuses to employees and directors. We reserved for
issuance a maximum of 3,300,000 shares of common stock
under the 2003 Plan. In addition, shares remaining available for
issuance under our 2000 Stock Plan (described below) and our
1994 Stock Plan (described below) will be available for issuance
under the 2003 Plan. Under all plans, an options maximum
term is ten years. As of December 31, 2004, we had a total
of 1,601,552 options available for issuance under our 2003 Plan,
2000 Plan and 1994 Plan.
In July 2000, we adopted the 2000 Equity Incentive Plan (2000
Plan), which provides for the granting of stock options,
restricted stock, phantom stock and stock bonuses to employees,
directors and consultants. We reserved for issuance a maximum of
4,128,000 shares of common stock under the 2000 Plan at
inception. In addition, shares remaining available for issuance
under our 1994 Stock Plan (described below) were available for
issuance under the 2000 Plan. Twenty percent of the options vest
upon grant date or at an employees hiring anniversary
date, whichever is later, and five percent at the end of each
three-month period thereafter.
In 1994, we established the 1994 Stock Plan (1994 Plan), which
provides for the granting of either incentive stock options or
nonqualified options to purchase shares of our common stock by
employees, directors and consultants of the Company for up to
4,199,000 shares of common stock as of December 31,
1999. On February 9, 2000, we increased the number of
options available for grant to 4,499,000.
67
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
A summary of stock plans at December 31, 2004, 2003, and
2002 and the changes during the years then ended follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
|
|
|
|
Weighted- |
|
|
|
Weighted- |
|
|
|
Weighted- |
|
|
|
|
average |
|
|
|
average |
|
|
|
average |
|
|
|
|
exercise |
|
|
|
exercise |
|
|
|
exercise |
|
|
Shares |
|
price |
|
Shares |
|
price |
|
Shares |
|
price |
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at beginning of year
|
|
|
5,365,464 |
|
|
$ |
10.50 |
|
|
|
4,829,868 |
|
|
$ |
7.20 |
|
|
|
4,149,468 |
|
|
$ |
3.96 |
|
|
|
|
|
Granted
|
|
|
1,534,076 |
|
|
|
21.71 |
|
|
|
2,297,346 |
|
|
|
15.43 |
|
|
|
2,155,786 |
|
|
|
11.06 |
|
|
|
|
|
Exercised
|
|
|
1,578,796 |
|
|
|
7.46 |
|
|
|
1,390,278 |
|
|
|
7.39 |
|
|
|
1,295,096 |
|
|
|
2.94 |
|
|
|
|
|
Forfeited
|
|
|
511,872 |
|
|
|
15.84 |
|
|
|
371,472 |
|
|
|
10.26 |
|
|
|
180,290 |
|
|
|
9.54 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding at end of year
|
|
|
4,808,872 |
|
|
$ |
14.73 |
|
|
|
5,365,464 |
|
|
$ |
10.50 |
|
|
|
4,829,868 |
|
|
$ |
7.20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following table summarizes information related to the stock
options outstanding at December 31, 2004:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted- |
|
|
|
|
|
|
|
|
|
|
average |
|
|
|
|
|
|
|
|
|
|
remaining |
|
Weighted- |
|
|
|
Weighted- |
|
|
Options |
|
contractual |
|
average |
|
Options |
|
average |
Range of exercise prices |
|
outstanding |
|
life (years) |
|
exercise price |
|
exercisable |
|
exercise price |
|
|
|
|
|
|
|
|
|
|
|
$0.00 $3.81
|
|
|
250,102 |
|
|
|
2.1 |
|
|
$ |
0.70 |
|
|
|
250,102 |
|
|
$ |
0.70 |
|
|
|
|
|
$3.82 $7.62
|
|
|
452,968 |
|
|
|
5.3 |
|
|
|
6.88 |
|
|
|
391,733 |
|
|
|
6.79 |
|
|
|
|
|
$7.63 $11.42
|
|
|
919,832 |
|
|
|
6.7 |
|
|
|
10.30 |
|
|
|
554,713 |
|
|
|
10.42 |
|
|
|
|
|
$11.43 $15.23
|
|
|
917,656 |
|
|
|
7.6 |
|
|
|
13.20 |
|
|
|
582,711 |
|
|
|
13.21 |
|
|
|
|
|
$15.24 $19.04
|
|
|
1,543,438 |
|
|
|
8.6 |
|
|
|
17.41 |
|
|
|
677,883 |
|
|
|
17.25 |
|
|
|
|
|
$19.05 $22.85
|
|
|
334,876 |
|
|
|
8.9 |
|
|
|
21.26 |
|
|
|
91,251 |
|
|
|
21.52 |
|
|
|
|
|
$22.86 $26.67
|
|
|
20,000 |
|
|
|
9.6 |
|
|
|
22.93 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$30.46 $34.27
|
|
|
340,000 |
|
|
|
9.9 |
|
|
|
30.51 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$34.28 $38.08
|
|
|
30,000 |
|
|
|
0.2 |
|
|
|
38.08 |
|
|
|
7,500 |
|
|
|
38.08 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4,808,872 |
|
|
|
7.5 |
|
|
$ |
14.73 |
|
|
|
2,555,893 |
|
|
$ |
11.84 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
On February 9, 2005, we granted an additional 1,491,012
options at an exercise price of $41.60.
We apply APB Opinion No. 25 and related interpretations in
accounting for our stock plans. Accordingly, compensation cost
related to stock options issued to employees would be recorded
on the date of grant only if the current market price of the
underlying stock exceeded the exercise price. During 2000, we
recorded deferred charges of $1,833, representing the difference
between the exercise price and the deemed fair value of our
common stock for the options granted in 2000. The deferred
compensation has been amortized to expense over the period the
options vested, generally four to five years. We recognized $57,
$360 and $358 in non-cash compensation expense related to the
amortization of deferred compensation during 2004, 2003 and
2002, respectively.
The fair value of each option grant is estimated on the date of
grant using an option pricing model with the following
assumptions: no dividend yield for all years, risk-free interest
rate of 3.1%, 3.2% and 3.6%, expected life of 5.4, 6.7 and
4.0 years and volatility of 29.5%, 44.6% and 49.7%, for the
years ended December 31, 2004, 2003 and 2002, respectively.
68
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
The following table sets forth the calculation of basic and
diluted net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
|
|
|
|
2004 |
|
2003 |
|
2002 |
|
|
|
|
|
|
|
Basic net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to common stockholders
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares outstanding
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
|
|
40,355,456 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic net income per share
|
|
$ |
1.73 |
|
|
$ |
1.56 |
|
|
$ |
1.17 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income attributable to common stockholders
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income attributable to common stockholders
|
|
$ |
86,014 |
|
|
$ |
67,324 |
|
|
$ |
47,036 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares outstanding
|
|
|
49,721,945 |
|
|
|
43,245,409 |
|
|
|
40,355,456 |
|
|
|
|
|
|
Dilutive effect of stock options (as determined by applying the
treasury stock method)
|
|
|
2,115,634 |
|
|
|
2,357,891 |
|
|
|
2,583,388 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
51,837,579 |
|
|
|
45,603,300 |
|
|
|
42,938,844 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
1.66 |
|
|
$ |
1.48 |
|
|
$ |
1.10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(10) |
Fair Value of Financial Instruments |
The fair value of a financial instrument is the amount at which
the instrument could be exchanged in a current transaction
between willing parties. The following methods and assumptions
were used to estimate the fair value of each class of financial
instruments:
Cash and cash equivalents, premium receivables, prepaid expenses
and other current assets, deposits, accounts payable, unearned
revenue, accrued payroll and related liabilities, accrued
expenses and other current liabilities and claims payable: The
carrying amounts approximate fair value because of the short
maturity of these items.
Short-term investments, long-term investments and investments on
deposit for licensure: The carrying amounts approximate their
fair values, which were determined based upon quoted market
prices (note 3).
Cash surrender value of life insurance policies: The carrying
amount approximates fair value which was determined based on
quoted market prices.
|
|
(11) |
Commitments and Contingencies |
|
|
(a) |
Minimum Reserve Requirements |
Regulations governing our managed care operations in the
District of Columbia, Florida, Illinois, Maryland, New Jersey
and Texas require the applicable subsidiary to meet certain
minimum net worth requirements. Each subsidiary was in
compliance with its requirements at December 31, 2004.
69
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
We maintain professional liability coverage for certain claims
which is provided by independent carriers and is subject to
annual coverage limits. Professional liability policies are on a
claims-made basis and must be renewed or replaced with
equivalent insurance if claims incurred during its term, but
asserted after its expiration, are to be insured.
We are obligated under capital leases covering certain office
equipment that expires at various dates during the next four
years. At December 31, 2004 and 2003, the gross amount of
office equipment and related accumulated amortization recorded
under capital leases was as follows:
|
|
|
|
|
|
|
|
|
|
|
2004 |
|
2003 |
|
|
|
|
|
Equipment
|
|
$ |
17,247 |
|
|
$ |
17,268 |
|
|
|
|
|
Accumulated amortization
|
|
|
(11,781 |
) |
|
|
(7,794 |
) |
|
|
|
|
|
|
|
|
|
|
|
$ |
5,466 |
|
|
$ |
9,474 |
|
|
|
|
|
|
|
|
|
|
Amortization of assets held under capital leases is included
with depreciation and amortization expense.
We also lease office space under operating leases which expire
at various dates through 2019. Future minimum payments by year
and in the aggregate under all non-cancelable leases are as
follows at December 31, 2004:
|
|
|
|
|
|
|
|
|
|
|
|
Capital Leases |
|
Operating Leases |
|
|
|
|
|
2005
|
|
$ |
3,387 |
|
|
$ |
8,878 |
|
|
|
|
|
2006
|
|
|
1,751 |
|
|
|
8,474 |
|
|
|
|
|
2007
|
|
|
871 |
|
|
|
7,677 |
|
|
|
|
|
2008
|
|
|
426 |
|
|
|
5,262 |
|
|
|
|
|
2009
|
|
|
|
|
|
|
4,378 |
|
|
|
|
|
Thereafter
|
|
|
|
|
|
|
22,332 |
|
|
|
|
|
|
|
|
|
|
|
Total minimum lease payments
|
|
|
6,435 |
|
|
$ |
57,001 |
|
|
|
|
|
|
|
|
|
|
Amount representing interest
|
|
|
(389 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Present value of minimum lease payments
|
|
|
6,046 |
|
|
|
|
|
|
|
|
|
Current installments of obligations under capital leases
|
|
|
(3,168 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Obligations under capital leases, excluding current installments
|
|
$ |
2,878 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
In connection with our acquisition of PHP effective
January 1, 2003, AMERIGROUP Corporation agreed to guarantee
a certain lease for office space occupied by a business operated
by former management of PHP. Minimum lease payments under the
guaranteed lease are $99 in 2005. The fair value of the stand
ready obligation under the guarantee is $7 and has been
reflected in the December 31, 2004 consolidated balance
sheet. If the lessee defaults due to non-payment, all future
rental payments are accelerated, subject to our right to cure,
by bringing the payments up to date. The lease term ends on
March 31, 2005.
Total rent expense for all office space and office equipment
under non-cancelable operating leases was approximately $8,704,
$8,187 and $5,459 in 2004, 2003 and 2002, respectively, and is
included in selling, general and administrative expenses in the
accompanying consolidated income statements.
70
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
|
|
(d) |
Deferred Compensation Plans |
Our employees have the option to participate in a deferred
compensation plan sponsored by the Company. All full-time and
most part-time employees of AMERIGROUP Corporation and
subsidiaries may elect to participate in this plan. This plan is
exempt from income taxes under Section 401(k) of the
Internal Revenue Code. Participants may contribute a certain
percentage of their compensation subject to maximum federal and
plan limits. We may elect to match a certain percentage of each
employees contributions up to specified limits. For the
years ended December 31, 2004, 2003 and 2002, the matching
contribution under the plan in total was $1,227, $720 and $794,
respectively.
During 2003, we added a long-term cash incentive award designed
to retain certain key executives. Each eligible participant is
assigned a cash target, the payment of which is deferred for
three years. The amount of the target is dependent upon the
participants performance against individual major job
objectives in the first year of the program. The target award
amount is funded over the three-year period, with the funding
being dependent upon the Company meeting its financial goals
each year. An executive is eligible for payment of a long-term
incentive earned in any one year only if the executive remains
employed with the Company and is in good standing at the
beginning of the third following year. The expense recorded for
the long-term cash incentive awards was $1,754 and $1,326 in
2004 and 2003, respectively. The related liability of $3,051 and
$1,326 at December 31, 2004 and 2003, respectively, was
included in deferred income taxes and other long-term
liabilities.
In 2002, Cleveland A. Tyson, a former employee of AMERIGROUP
Illinois, Inc., filed a federal Qui Tam or whistleblower action
against our Illinois subsidiary, the United States of America
and the State of Illinois, es rel., Cleveland A.
Tyson v. AMERIGROUP Illinois, Inc., in the
U.S. District Court of the Northern District, Eastern
Division, alleging the submission of false claims under the
Medicaid program. The United States is not a party to the
action. Mr. Tysons amended complaint was unsealed and
served on AMERIGROUP Illinois, Inc., in June 2003.
Mr. Tyson alleges that AMERIGROUP Illinois, Inc. maintained
a scheme to discourage or avoid the enrollment of pregnant women
and members with special needs. In his suit, Mr. Tyson
seeks an unspecified amount of damages and statutory penalties
of no less than $5,000 and no more than $11,000 per
violation. Mr. Tysons complaint does not specify the
number of alleged violations. The court denied AMERIGROUP
Illinois, Inc.s motion to dismiss on September 26,
2004. AMERIGROUP Illinois, Inc.s motion for summary
judgment was filed in December 2004. That motion is fully
briefed, and is ready for disposition by the court. On
February 15, 2005, we received a motion filed by
Mr. Tyson on February 10, 2005, seeking permission to
amend his complaint and add AMERIGROUP Corporation as a
defendant. On February 15, 2005, we also received the
motion filed by the State of Illinois on February 10, 2005,
seeking court approval to intervene on Mr. Tysons
behalf. On March 2, 2005, the Court granted the
States motion to intervene and denied
Mr. Tysons motion to amend to add AMERIGROUP
Corporation as a defendant. On March 3, 2005, AMERIGROUP
Illinois, Inc. filed a motion to dismiss for lack of subject
matter jurisdiction, based upon a recent opinion of the
United States Court of Appeals for the District of Columbia
Circuit.
At this time, discovery is ongoing. Although it is possible that
the outcome of this case will not be favorable to us, no range
of liability can be estimated. Accordingly, we have not recorded
any liability at December 31, 2004. There can be no
assurance that the ultimate outcome of this matter will not have
a material adverse effect on our consolidated financial
position, results of operations, or liquidity.
In April 2004, the Maryland Legislature enacted a budget for the
2005 fiscal year beginning July 1, 2004 that included a
provision to reduce the premium paid to managed care
organizations that did not meet certain HEDIS
71
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
scores and whose medical loss ratio was below 84% for the
calendar year ended December 31, 2002. In May 2004, the
Maryland Secretary of Health and Mental Hygiene, in consultation
with Marylands legislative leadership, determined our
premium recoupment to be $846. A liability for the recoupment
was recorded with a corresponding charge to premium revenue
during the year ended December 31, 2004. Additionally, the
Legislature directed that the Department of Health and Mental
Hygiene complete a study by September 2004 on the relevance of
the medical loss ratio threshold as an indicator of quality. The
results of this, which were released in October 2004, did not
directly address what would happen in the future if a managed
care organization reported a medical loss ratio below 84%. As a
result, we believe the Maryland Legislature could enact similar
legislation in 2005 as part of its fiscal year 2006 budget,
requiring premium recoupment. We have recorded a reduction in
premium in our financial statements of our best estimate of the
outcome of this issue as of December 31, 2004. It is
possible that the Maryland Legislature in 2006, as part of its
fiscal year 2007 budget, could enact similar legislation
relating to the year ended December 31, 2004. However, at
this time we are unable to predict the regulatory, economic or
political climate that might exist at that time. Accordingly, we
have not recorded any liability for the twelve months ended
December 31, 2004. However, if the Maryland Legislature
were to enact legislation in April 2006 consistent with the
legislation passed in April 2004 and we failed to meet the
required quality measures, we could have a recoupment obligation
for that period commencing on July 1, 2006 ranging from
zero to approximately $757 with respect to the premium revenue
for the twelve month period ended December 31, 2004.
|
|
(12) |
Employee Stock Purchase Plan |
On February 15, 2001, the Board of Directors approved and
we adopted an Employee Stock Purchase Plan. All employees are
eligible to participate except those employees who have been
employed by us less than 90 days, whose customary
employment is less than 20 hours per week or any employee
who owns five percent or more of our common stock. Eligible
employees may join the plan every six months. Purchases of
common stock are priced at the lower of the stock price less 15%
on the first day or the last day of the six-month period. We
have reserved for issuance 1,200,000 shares of common
stock. We issued 61,684 and 70,078 shares under the
Employee Stock Purchase Plan in 2004 and 2003, respectively.
|
|
(13) |
Quarterly Financial Data (unaudited) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months ended |
|
|
|
2004 |
|
March 31 |
|
June 30 |
|
September 30 |
|
December 31 |
|
|
|
|
|
|
|
|
|
Premium revenue
|
|
$ |
422,335 |
|
|
$ |
435,918 |
|
|
$ |
468,156 |
|
|
$ |
486,982 |
|
|
|
|
|
Health benefits expenses
|
|
|
342,247 |
|
|
|
354,415 |
|
|
|
374,085 |
|
|
|
398,350 |
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
45,487 |
|
|
|
43,728 |
|
|
|
52,124 |
|
|
|
50,576 |
|
|
|
|
|
Income before income taxes
|
|
|
30,756 |
|
|
|
34,532 |
|
|
|
39,669 |
|
|
|
36,281 |
|
|
|
|
|
Net income
|
|
|
18,438 |
|
|
|
20,846 |
|
|
|
24,333 |
|
|
|
22,397 |
|
|
|
|
|
Diluted net income per share
|
|
|
0.36 |
|
|
|
0.40 |
|
|
|
0.47 |
|
|
|
0.43 |
|
|
|
|
|
Weighted average number of common shares and dilutive potential
shares outstanding
|
|
|
51,258,930 |
|
|
|
51,582,960 |
|
|
|
51,955,940 |
|
|
|
52,552,486 |
|
72
AMERIGROUP CORPORATION AND SUBSIDIARIES
NOTES TO CONSOLIDATED
FINANCIAL STATEMENTS (Continued)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months ended |
|
|
|
2003 |
|
March 31 |
|
June 30 |
|
September 30 |
|
December 31 |
|
|
|
|
|
|
|
|
|
Premium revenue
|
|
$ |
389,562 |
|
|
$ |
392,331 |
|
|
$ |
411,277 |
|
|
$ |
422,338 |
|
|
|
|
|
Health benefits expenses
|
|
|
317,298 |
|
|
|
310,536 |
|
|
|
328,235 |
|
|
|
339,831 |
|
|
|
|
|
Selling, general and administrative expenses
|
|
|
44,070 |
|
|
|
46,945 |
|
|
|
46,781 |
|
|
|
49,060 |
|
|
|
|
|
Income before income taxes
|
|
|
23,570 |
|
|
|
30,265 |
|
|
|
30,911 |
|
|
|
29,169 |
|
|
|
|
|
Net income
|
|
|
13,694 |
|
|
|
17,977 |
|
|
|
18,185 |
|
|
|
17,468 |
|
|
|
|
|
Diluted net income per share
|
|
|
0.32 |
|
|
|
0.41 |
|
|
|
0.41 |
|
|
|
0.34 |
|
|
|
|
|
Weighted average number of common shares and dilutive potential
shares outstanding
|
|
|
43,263,559 |
|
|
|
43,819,299 |
|
|
|
44,657,759 |
|
|
|
50,672,583 |
|
Effective January 1, 2005, we completed our stock
acquisition of CarePlus pursuant to the terms of the merger
agreement entered into on October 26, 2004 for $126,766,
including acquisition costs. Additional consideration may be
paid contingent upon the achievement of specific criteria or
earnings thresholds during 2005 and 2006. If the criteria are
met and additional payments become due, they will be accounted
for as an additional cost of the acquisition. The assets
acquired and liabilities assumed consist primarily of cash,
receivables, property and equipment, claims payable, accounts
payable and accrued expenses.
At December 31, 2004, CarePlus served approximately 115,000
New York State Medicaid, Child Health Plus and Family Health
Plus members in New York City (Brooklyn, Manhattan, Queens and
Staten Island) and Putman County. CarePlus is also authorized to
offer a managed long-term care program in New York City subject
to final regulatory approval and other considerations.
This acquisition was accounted for under the purchase method of
accounting and was funded through unregulated cash. Goodwill and
other intangibles total $106,722 which includes $13,980 of
specifically identifiable intangibles allocated to the rights to
membership, the provider network, non-compete agreements and
trademarks. Intangible assets related to the rights to
membership are being amortized based on the timing of the
related cash flows with an expected amortization of ten years.
Intangible assets related to the provider network are being
amortized over ten years. Intangible assets related to the
trademarks and non-compete agreements are being amortized over
12 to 36 months. We have not yet finalized our fair value
analysis. Therefore, the allocation of the acquisition costs is
subject to adjustment.
73
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation and Subsidiaries:
Under date of February 25, 2005, we reported on the
consolidated balance sheets of AMERIGROUP Corporation and
subsidiaries as of December 31, 2004 and 2003, and the
related consolidated income statements and statements of
stockholders equity and cash flows for each of the years
in the three-year period ended December 31, 2004, which are
included herein. In connection with our audits of the
aforementioned consolidated financial statements, we also
audited the related financial statement schedule,
Schedule II Schedule of Valuation and
Qualifying Accounts, which is also included herein. This
financial statement schedule is the responsibility of the
Companys management. Our responsibility is to express an
opinion on the financial statement schedule based on our audits.
In our opinion, the financial statement schedule,
Schedule II Schedule of Valuation and
Qualifying Accounts, when considered in relation to the basic
consolidated financial statements taken as a whole, presents
fairly, in all material respects, the information set forth
therein.
/s/ KPMG, LLP
February 25, 2005
Norfolk, Virginia
74
SCHEDULE OF VALUATION AND QUALIFYING ACCOUNTS
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Additions- |
|
Deductions- |
|
|
|
|
Balance |
|
Amounts |
|
Amounts |
|
|
|
|
Beginning |
|
Charged to |
|
Credited to |
|
Balance End |
Valuation Allowance on Deferred Tax Assets |
|
of Year |
|
Expense |
|
Expense |
|
of Year |
|
|
|
|
|
|
|
|
|
Year Ended December 31, 2004
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
$ |
|
|
|
|
|
|
Year Ended December 31, 2003
|
|
|
785 |
|
|
|
|
|
|
|
785 |
|
|
|
|
|
|
|
|
|
Year Ended December 31, 2002
|
|
|
|
|
|
|
785 |
|
|
|
|
|
|
|
785 |
|
75
|
|
Item 9. |
Changes in and Disagreements with Accountants on
Accounting and Financial Disclosure |
None.
|
|
Item 9A. |
Controls and Procedures |
|
|
|
|
(a) |
Evaluation of Disclosure Controls and Procedures. |
Our management, with the participation of our Chief Executive
Officer and Chief Financial Officer, has evaluated the
effectiveness of our disclosure controls and procedures (as such
term is defined in Rules 13a-15(e) and 15d-15(e) under the
Securities Exchange Act of 1934, as amended (the Exchange
Act)) as of the end of the period covered by this report.
Based on such evaluation, our Chief Executive Officer and Chief
Financial Officer have concluded that, as of the end of such
period, our disclosure controls and procedures are effective in
recording, processing, summarizing and reporting, on a timely
basis, information required to be disclosed by us in the reports
that we file or submit under the Exchange Act and are effective
in ensuring that information required to be disclosed by us in
the reports that we file or submit under the Exchange Act is
accumulated and communicated to management, including our Chief
Executive Officer and Chief Financial Officer, as appropriate,
to allow timely decisions regarding required disclosure.
|
|
|
|
(b) |
Internal Control over Financial Reporting. |
MANAGEMENTS REPORT ON INTERNAL CONTROL OVER FINANCIAL
REPORTING
The management of AMERIGROUP Corporation is responsible for
establishing and maintaining adequate internal control over
financial reporting. Internal control over financial reporting
is defined in Rules 13a-15(f) and 15d-15(f) under the
Securities Exchange Act of 1934 as a process designed by, or
under the supervision of, the companys principal executive
and principal financial officers and effected by the
companys board of directors, management and other
personnel to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with
U.S. generally accepted accounting principles.
The management of AMERIGROUP Corporation assessed the
effectiveness of the companys internal control over
financial reporting as of December 31, 2004. In making this
assessment, it used the criteria set forth by the Committee of
Sponsoring Organizations of the Treadway Commission (COSO) in
Internal Control Integrated Framework.
Based on our assessment, we believe that, as of
December 31, 2004, the companys internal control over
financial reporting is effective based on those criteria.
Managements assessment of the effectiveness of internal
control over financial reporting as of December 31, 2004
has been audited by KPMG, LLP, an independent registered public
accounting firm, as stated in their report, which is included
herein.
|
|
|
|
(c) |
Changes in Internal Controls. |
During the fourth quarter of 2004, in connection with our
evaluation of internal control over financial reporting in
accordance with Section 404 of the Sarbanes-Oxley Act of
2002, the Company implemented or revised certain internal
control procedures which affect financial reporting. The changes
enhanced controls already in place or introduced new controls
implemented to remove or reduce reliance on compensating
controls. The most significant changes made were in the area of
system access and change management for claims operations.
Our internal control over financial reporting includes policies
and procedures that:
|
|
|
|
|
pertain to the maintenance of records that in reasonable detail
accurately and fairly reflect the transactions and dispositions
of the assets of the company; |
|
|
|
provide reasonable assurance that transactions are recorded as
necessary to permit preparation of financial statements in
accordance with U.S. generally accepted accounting
principles, and that receipts and |
76
|
|
|
|
|
expenditures of the company are being made only in accordance
with authorizations of management and directors of the
company; and |
|
|
|
provide reasonable assurance regarding prevention or timely
detection of unauthorized acquisition, use, or disposition of
the companys assets that could have a material effect on
the financial statements. |
Because of its inherent limitations, internal control over
financial reporting may not prevent or detect misstatements.
Projections of any evaluation of effectiveness to future periods
are subject to the risks that controls may become inadequate
because of changes in conditions, or that the degree of
compliance with the policies or procedures may deteriorate.
|
|
Item 9B. |
Other Information |
We have an exclusive risk-sharing arrangement with Cook
Childrens Health Care Network (CCHCN) and Cook
Childrens Physician Network (CCPN), which includes Cook
Childrens Medical Center (CCMC). Unless either party gives
the other a written notice of non-renewal six months in
advance, the risk-sharing arrangement with CCHCN and CCPN would
automatically be extended for a one-year period commencing on
August 31, 2005. On February 25, 2005, we received a
written notice of non-renewal from CCHCN and CCPN; therefore
this contract will terminate on August 31, 2005. It is our
intent to enter into a new contract with CCPN, CCMC and CCPN
physicians individually. However, there can be no assurance that
our contracting efforts will be successful or that the terms of
any new contract will be as favorable as the current
risk-sharing arrangement. See Managements Discussion
and Analysis of Financial Condition and Results of
Operations Overview and Risk
Factors We have a significant relationship with Cook
Childrens Physician Network in Fort Worth, Texas. Any
material modification or discontinuation of this relationship
could negatively affect our results of operations.
77
REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
The Board of Directors and Stockholders
AMERIGROUP Corporation:
We have audited managements assessment, included in the
accompanying Managements Report on Internal Control Over
Financial Reporting, that AMERIGROUP Corporation maintained
effective internal control over financial reporting as of
December 31, 2004, based on criteria established in
Internal Control Integrated Framework, issued
by the Committee of Sponsoring Organizations of the Treadway
Commission (COSO). AMERIGROUP Corporations management is
responsible for maintaining effective internal control over
financial reporting and for its assessment of the effectiveness
of internal control over financial reporting. Our responsibility
is to express an opinion on managements assessment and an
opinion on the effectiveness of AMERIGROUP Corporations
internal control over financial reporting based on our audit.
We conducted our audit in accordance with the standards of the
Public Company Accounting Oversight Board (United States). Those
standards require that we plan and perform the audit to obtain
reasonable assurance about whether effective internal control
over financial reporting was maintained in all material
respects. Our audit included obtaining an understanding of
internal control over financial reporting, evaluating
managements assessment, testing and evaluating the design
and operating effectiveness of internal control, and performing
such other procedures as we considered necessary in the
circumstances. We believe that our audit provides a reasonable
basis for our opinion.
A companys internal control over financial reporting is a
process designed to provide reasonable assurance regarding the
reliability of financial reporting and the preparation of
financial statements for external purposes in accordance with
U.S. generally accepted accounting principles. A
companys internal control over financial reporting
includes those policies and procedures that (1) pertain to
the maintenance of records that, in reasonable detail,
accurately and fairly reflect the transactions and dispositions
of the assets of the company; (2) provide reasonable
assurance that transactions are recorded as necessary to permit
preparation of financial statements in accordance with
U.S. generally accepted accounting principles, and that
receipts and expenditures of the company are being made only in
accordance with authorizations of management and directors of
the company; and (3) provide reasonable assurance regarding
prevention or timely detection of unauthorized acquisition, use,
or disposition of the companys assets that could have a
material effect on the financial statements.
Because of its inherent limitations, internal control over
financial reporting may not prevent or detect misstatements.
Also, projections of any evaluation of effectiveness to future
periods are subject to the risk that controls may become
inadequate because of changes in conditions, or that the degree
of compliance with the policies or procedures may deteriorate.
In our opinion, managements assessment that AMERIGROUP
Corporation maintained effective internal control over financial
reporting as of December 31, 2004, is fairly stated, in all
material respects, based on criteria established in Internal
Control Integrated Framework, issued by the
Committee of Sponsoring Organizations of the Treadway Commission
(COSO). Also, in our opinion, AMERIGROUP Corporation maintained,
in all material respects, effective internal control over
financial reporting as of December 31, 2004, based on
criteria established in Internal Control
Integrated Framework, issued by the Committee of Sponsoring
Organizations of the Treadway Commission (COSO).
We also have audited, in accordance with the standards of the
Public Company Accounting Oversight Board (United States), the
consolidated balance sheets of AMERIGROUP Corporation and
subsidiaries as of December 31, 2004 and 2003, and the
related consolidated income statements and statements of
stockholders equity and cash flows for each of the years
in the three-year period ended December 31, 2004 and our
report dated February 25, 2005, expressed an unqualified
opinion on those consolidated financial statements.
/s/ KPMG, LLP
February 25, 2005
Norfolk, Virginia
78
PART III.
|
|
Item 10. |
Directors and Executive Officers of the Company |
The information regarding compliance with Section 16(a) of
the Securities and Exchange Act of 1934 is incorporated herein
by reference from the section entitled Section 16(a)
Beneficial Ownership Reporting Compliance of our
definitive Proxy Statement (the Proxy Statement) to
be filed pursuant to Regulation 14A of the Securities
Exchange Act of 1934, as amended, for our Annual Meeting of
Stockholders to be held on Wednesday, May 11, 2005. The
Proxy Statement will be filed within 120 days after the end
of our fiscal year ended December 31, 2004.
The information regarding Executive Officers is contained in
Part I of this Report under the caption Executive
Officers of the Company.
The information regarding directors is incorporated herein by
reference from the section entitled
PROPOSAL #1: ELECTION OF DIRECTORS in the
Proxy Statement.
The information regarding the Companys code of business
conduct and ethics is incorporated herein by reference from the
section entitled Corporate Governance in the Proxy
Statement.
|
|
Item 11. |
Executive Compensation |
Information regarding executive compensation is incorporated
herein by reference from the section entitled Executive
Officer Compensation in the Proxy Statement.
|
|
Item 12. |
Security Ownership of Certain Beneficial Owners and
Management |
Information regarding security ownership of certain beneficial
owners and management and securities authorized for issuance
under equity compensation plans is incorporated herein by
reference from the sections entitled Security Ownership of
Certain Beneficial Owners and Management and Equity
Compensation Plan Information in the Proxy Statement.
|
|
Item 13. |
Certain Relationships and Related Transactions |
Information regarding certain relationships and related
transactions is incorporated herein by reference from the
section entitled Certain Relationships and Related
Transactions in the Proxy Statement.
|
|
Item 14. |
Principal Accountant Fees and Services |
Information regarding principal accountant fees and services is
incorporated herein by reference from the section entitled
Proposal #2: APPOINTMENT OF INDEPENDENT
AUDITORS in the Proxy Statement.
PART IV.
|
|
Item 15. |
Exhibits and Financial Statement Schedules |
(a)(1) Financial Statements.
The following financial statements are filed: Independent
Auditors Report, Consolidated Balance Sheets, Consolidated
Income Statements, Consolidated Statements of Stockholders
Equity, Consolidated Statements of Cash Flows, and Notes to
Consolidated Financial Statements.
(a)(2) Financial Statement Schedules.
The following financial statement schedule is filed: Schedule of
Valuation and Qualifying Accounts
79
(b) Exhibits.
The following exhibits, which are furnished with this annual
report or incorporated herein by reference, are filed as part of
this annual report.
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
3 |
.1 |
|
Amended and Restated Certificate of Incorporation of the Company
(incorporated by reference to exhibit 3.1 to our
Registration Statement on Form S-3 (No. 333-108831)). |
|
3 |
.2 |
|
By-Laws of the Company (incorporated by reference to
exhibit 3.2 to our Registration Statement on Form S-3
(No. 333-108831)). |
|
4 |
.1 |
|
Form of share certificate for common stock (incorporated by
reference to exhibit 4.1 to our Registration Statement on
Form S-1 (No. 333-347410)). |
|
4 |
.2 |
|
AMERIGROUP Corporation Second Restated Investor Rights
Agreement, dated July 28, 1998 (incorporated by reference
to exhibit 4.2 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.6.7 |
|
Amendment to Amended and Restated Contract between State of
New Jersey, Department of Human Services, Division of
Medical Assistance and Health Services and AMERIGROUP New
Jersey, Inc. dated January 1, 2005 (incorporated by
reference to exhibit 10.6 to our Registration Statement on
Form S-3 (no. 333-108831), filed on October 9,
2003). |
|
10 |
.6.8 |
|
Amendment to Amended and Restated Contract between State of
New Jersey, Department of Human Services, Division of
Medical Assistance and Health Services and AMERIGROUP
New Jersey, Inc. dated January 1, 2005 (incorporated
by reference to exhibit 10.6 to our Registration Statement
on Form S-3 (no. 333-108831), filed on October 9,
2003). |
|
10 |
.7.1 |
|
Amended and Restated Credit Agreement, among AMERIGROUP
Corporation, the Guarantors, Lenders, and Arrangers, named
therein, dated October 22, 2003 (incorporated by reference
to exhibit 10.17.3 to our Quarterly Report on
Form 10-Q for the quarter ended September 30, 2003,
filed on November 5, 2003). |
|
10 |
.7.2 |
|
Amended and Restated Security Agreement, between Grantors of
Bank of America, N.A. dated, October 22, 2003 (incorporated
by reference to exhibit 10.17.4 to our Quarterly Report on
Form 10-Q for the quarter ended September 30, 2003,
filed on November 5, 2003). |
|
10 |
.7.3 |
|
Amended and Restated Pledge Agreement between AMERIGROUP
Corporation and Bank of America, N.A., dated October 22,
2003 (incorporated by reference to exhibit 10.17.5 to our
Quarterly Report on Form 10-Q for the quarter ended
September 30, 2003, filed on November 5, 2003). |
|
10 |
.7.4 |
|
Amended and Restated Pledge Agreement (New Jersey) between
AMERIGROUP Corporation and Bank of America, N.A., dated
October 22, 2003 (incorporated by reference to exhibit
10.17.6 to our Quarterly Report on Form 10-Q for the
quarter ended September 30, 2003, filed on November 5,
2003). |
|
10 |
.10 |
|
Form 1994 Stock Plan of the Company (incorporated by reference
to exhibit 10.10 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.11 |
|
Form 2000 Equity Incentive Plan (incorporated by reference to
exhibit 10.11 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.14 |
|
Definitive Agreement dated October 26, 2004, between
CarePlus, LLC and AMERIGROUP Corporation (incorporated by
reference to our Current Report on Form 8-K, filed on
November 1, 2004). |
|
10 |
.15 |
|
AMERIGROUP Corporation announces the appointment of E. Paul
Dunn, Jr. as their new Executive Vice President and Chief
Financial Officer effective November 8, 2004 (incorporated
by reference to our Current Report on Form 8-K, filed on
November 1, 2004). |
|
10 |
.16 |
|
Form the Officer and Director Indemnification Agreement
(incorporated by reference to exhibit 10.16 to our
Registration Statement on Form S-1 (No. 333-37410). |
|
10 |
.17 |
|
Form of Employee Noncompete, Nondisclosure and Developments
Agreement (incorporated by reference to exhibit 10.1 to our
Current Report on Form 8-K, filed on February 23,
2005). |
|
10 |
.18 |
|
Form of Incentive Stock Option Agreement (incorporated by
reference to exhibit 10.2 to our Current Report of
Form 8-K, filed on January 27, 2005). |
80
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
10 |
.19 |
|
Form of Nonqualified Stock Option Agreement (incorporated by
reference to exhibit 10.3.1 to our Current Report on
Form 8-K filed on February 8, 2005). |
|
10 |
.20 |
|
Form of AMERIGROUP Corporation Nonqualified Stock Option
Agreement (incorporated by reference to exhibit 10.3 to our
Current Form 8-K filed on January 27, 2005). |
|
10 |
.21 |
|
The Board of Directors approved and adopted a resolution for
director compensation practices on February 10, 2005
(incorporated by reference to our Current Report on
Form 8-K, filed on February 15, 2005). |
|
10 |
.25.2 |
|
Amendment No. 2, dated November 19, 2004, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and Physicians
Healthcare Plans, Inc. (AHCA Contract No. FA523)
(incorporated by reference to exhibit 10.25 to our
Quarterly Report on Form 10-Q for the quarter ended
September 30, 2004, filed on November 5, 2004). |
|
10 |
.45 |
|
Form 2003 Equity Incentive Plan of the Company (incorporated by
reference to exhibit 10.37 to our Quarterly Report on
Form 10-Q for the quarter ended June 30, 2003, filed
on August 11, 2003). |
|
10 |
.46 |
|
Form 2003 Cash Incentive Plan of the Company (incorporated by
reference to exhibit 10.38 to our Quarterly Report of
Form 10-Q for the last quarter ended June 30, 2003,
filed on August 11, 2003). |
|
10 |
.47 |
|
Closing Agreement dated January 3, 2005, between CarePlus,
LLC and AMERIGROUP Corporation (incorporated by reference to
exhibit 10.47 to our Current Report on Form 8-K, filed
on January 6, 2005). |
|
10 |
.48 |
|
Form of Separation Agreement between AMERIGROUP Corporation and
Lorenzo Childress, Jr., M.D. (incorporated by reference to
exhibit 10.1 to our Current Report on Form 8-K filed
March 4, 2005). |
|
10 |
.49 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on
Form 8-K filed March 4, 2005). |
|
10 |
.50 |
|
Form of 2005 Non-Employee Directors Deferred Compensation Plan
between AMERIGROUP Corporation and Non-Executive Associates
(incorporated by reference to exhibit 10.3 to our Current
Report on Form 8-K filed March 4, 2005). |
|
21 |
.1 |
|
List of Subsidiaries |
|
23 |
.1 |
|
Consent of KPMG, LLP, Independent Registered Public Accounting
Firm, with respect to financial statements of the registrant. |
|
31 |
.1 |
|
Certification of Chief Executive Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated
March 8, 2005. |
|
31 |
.2 |
|
Certification of Chief Financial Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated
March 8, 2005. |
|
32 |
|
|
Certification of Chief Executive Officer and Chief Financial
Officer pursuant to Section 906 of Sarbanes-Oxley Act of
2002, dated March 8, 2005. |
81
SIGNATURES
Pursuant to the requirements of Section 13 or 15(d) of the
Securities Act of 1934, the registrant has duly caused this
report to be signed on its behalf by the undersigned, thereunto
duly authorized, in the City of Virginia Beach, Commonwealth of
Virginia, on March 8, 2005.
|
|
|
|
By: |
/s/ E. Paul Dunn, Jr.
|
|
|
|
|
|
Name: E. Paul Dunn, Jr. |
|
Title: Executive Vice President 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 registrant and in the capacities and on the
dates indicated.
|
|
|
|
|
|
|
Signatures |
|
Title |
|
Date |
|
|
|
|
|
|
/s/ Jeffrey L. McWaters
Jeffrey
L. McWaters |
|
Chairman and Chief Executive Officer |
|
March 8, 2005 |
|
/s/ E. Paul
Dunn, Jr.
E.
Paul Dunn, Jr. |
|
Chief Financial Officer and
Executive Vice President |
|
March 8, 2005 |
|
/s/ Kathleen K. Toth
Kathleen
K. Toth |
|
Chief Accounting Officer and
Executive Vice President |
|
March 8, 2005 |
|
/s/ Thomas E. Capps
Thomas
E. Capps |
|
Director |
|
March 8, 2005 |
|
/s/ Jeffrey B. Child
Jeffrey
B. Child |
|
Director |
|
March 8, 2005 |
|
/s/ William J. McBride
William
J. McBride |
|
Director |
|
March 8, 2005 |
|
/s/ Uwe E.
Reinhardt, Ph.D.
Uwe
E. Reinhardt, Ph.D. |
|
Director |
|
March 8, 2005 |
|
/s/ Richard D. Shirk
Richard
D. Shirk |
|
Director |
|
March 8, 2005 |
82
EXHIBIT INDEX
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
3 |
.1 |
|
Amended and Restated Certificate of Incorporation of the Company
(incorporated by reference to exhibit 3.1 to our
Registration Statement on Form S-3 (No. 333-108831)). |
|
3 |
.2 |
|
By-Laws of the Company (incorporated by reference to
exhibit 3.2 to our Registration Statement on Form S-3
(No. 333-108831)). |
|
4 |
.1 |
|
Form of share certificate for common stock (incorporated by
reference to exhibit 4.1 to our Registration Statement on
Form S-1 (No. 333-347410)). |
|
4 |
.2 |
|
AMERIGROUP Corporation Second Restated Investor Rights
Agreement, dated July 28, 1998 (incorporated by reference
to exhibit 4.2 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.6.7 |
|
Amendment to Amended and Restated Contract between State of
New Jersey, Department of Human Services, Division of
Medical Assistance and Health Services and AMERIGROUP New
Jersey, Inc. dated January 1, 2005 (incorporated by
reference to exhibit 10.6 to our Registration Statement on
Form S-3 (no. 333-108831), filed on October 9,
2003). |
|
10 |
.6.8 |
|
Amendment to Amended and Restated Contract between State of
New Jersey, Department of Human Services, Division of
Medical Assistance and Health Services and AMERIGROUP
New Jersey, Inc. dated January 1, 2005 (incorporated
by reference to exhibit 10.6 to our Registration Statement
on Form S-3 (no. 333-108831), filed on October 9,
2003). |
|
10 |
.7.1 |
|
Amended and Restated Credit Agreement, among AMERIGROUP
Corporation, the Guarantors, Lenders, and Arrangers, named
therein, dated October 22, 2003 (incorporated by reference
to exhibit 10.17.3 to our Quarterly Report on
Form 10-Q for the quarter ended September 30, 2003,
filed on November 5, 2003). |
|
10 |
.7.2 |
|
Amended and Restated Security Agreement, between Grantors of
Bank of America, N.A. dated, October 22, 2003 (incorporated
by reference to exhibit 10.17.4 to our Quarterly Report on
Form 10-Q for the quarter ended September 30, 2003,
filed on November 5, 2003). |
|
10 |
.7.3 |
|
Amended and Restated Pledge Agreement between AMERIGROUP
Corporation and Bank of America, N.A., dated October 22,
2003 (incorporated by reference to exhibit 10.17.5 to our
Quarterly Report on Form 10-Q for the quarter ended
September 30, 2003, filed on November 5, 2003). |
|
10 |
.7.4 |
|
Amended and Restated Pledge Agreement (New Jersey) between
AMERIGROUP Corporation and Bank of America, N.A., dated
October 22, 2003 (incorporated by reference to exhibit
10.17.6 to our Quarterly Report on Form 10-Q for the
quarter ended September 30, 2003, filed on November 5,
2003). |
|
10 |
.10 |
|
Form 1994 Stock Plan of the Company (incorporated by reference
to exhibit 10.10 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.11 |
|
Form 2000 Equity Incentive Plan (incorporated by reference to
exhibit 10.11 to our Registration Statement on
Form S-1 (No. 333-37410)). |
|
10 |
.14 |
|
Definitive Agreement dated October 26, 2004, between
CarePlus, LLC and AMERIGROUP Corporation (incorporated by
reference to our Current Report on Form 8-K, filed on
November 1, 2004). |
|
10 |
.15 |
|
AMERIGROUP Corporation announces the appointment of E. Paul
Dunn, Jr. as their new Executive Vice President and Chief
Financial Officer effective November 8, 2004 (incorporated
by reference to our Current Report on Form 8-K, filed on
November 1, 2004). |
|
10 |
.16 |
|
Form the Officer and Director Indemnification Agreement
(incorporated by reference to exhibit 10.16 to our
Registration Statement on Form S-1 (No. 333-37410). |
|
10 |
.17 |
|
Form of Employee Noncompete, Nondisclosure and Developments
Agreement (incorporated by reference to exhibit 10.1 to our
Current Report on Form 8-K, filed on February 23,
2005). |
|
10 |
.18 |
|
Form of Incentive Stock Option Agreement (incorporated by
reference to exhibit 10.2 to our Current Report of
Form 8-K, filed on January 27, 2005). |
|
10 |
.19 |
|
Form of Nonqualified Stock Option Agreement (incorporated by
reference to exhibit 10.3.1 to our Current Report on
Form 8-K filed on February 8, 2005). |
|
10 |
.20 |
|
Form of AMERIGROUP Corporation Nonqualified Stock Option
Agreement (incorporated by reference to exhibit 10.3 to our
Current Form 8-K filed on January 27, 2005). |
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
10 |
.21 |
|
The Board of Directors approved and adopted a resolution for
director compensation practices on February 10, 2005
(incorporated by reference to our Current Report on
Form 8-K, filed on February 15, 2005). |
|
10 |
.25.2 |
|
Amendment No. 2, dated November 19, 2004, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and Physicians
Healthcare Plans, Inc. (AHCA Contract No. FA523)
(incorporated by reference to exhibit 10.25 to our
Quarterly Report on Form 10-Q for the quarter ended
September 30, 2004, filed on November 5, 2004). |
|
10 |
.45 |
|
Form 2003 Equity Incentive Plan of the Company (incorporated by
reference to exhibit 10.37 to our Quarterly Report on
Form 10-Q for the quarter ended June 30, 2003, filed
on August 11, 2003). |
|
10 |
.46 |
|
Form 2003 Cash Incentive Plan of the Company (incorporated by
reference to exhibit 10.38 to our Quarterly Report of
Form 10-Q for the last quarter ended June 30, 2003,
filed on August 11, 2003). |
|
10 |
.47 |
|
Closing Agreement dated January 3, 2005, between CarePlus,
LLC and AMERIGROUP Corporation (incorporated by reference to
exhibit 10.47 to our Current Report on Form 8-K, filed
on January 6, 2005). |
|
10 |
.48 |
|
Form of Separation Agreement between AMERIGROUP Corporation and
Lorenzo Childress, Jr., M.D. (incorporated by
reference to exhibit 10.1 to our Current Report on
Form 8-K filed March 4, 2005). |
|
10 |
.49 |
|
Form of 2005 Executive Deferred Compensation Plan between
AMERIGROUP Corporation and Executive Associates (incorporated by
reference to exhibit 10.2 to our Current Report on
Form 8-K filed March 4, 2005). |
|
10 |
.50 |
|
Form of 2005 Non-Employee Directors Deferred Compensation Plan
between AMERIGROUP Corporation and Non-Executive Associates
(incorporated by reference to exhibit 10.3 to our Current
Report on Form 8-K filed March 4, 2005). |
|
21 |
.1 |
|
List of Subsidiaries |
|
23 |
.1 |
|
Consent of KPMG, LLP, Independent Registered Public Accounting
Firm, with respect to financial statements of the registrant. |
|
31 |
.1 |
|
Certification of Chief Executive Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated
March 8, 2005. |
|
31 |
.2 |
|
Certification of Chief Financial Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated
March 8, 2005. |
|
32 |
|
|
Certification of Chief Executive Officer and Chief Financial
Officer pursuant to Section 906 of Sarbanes-Oxley Act of
2002, dated March 8, 2005. |