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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
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þ
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QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
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For the quarterly period ended March 31, 2005 |
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OR |
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o
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
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For the transition period
from to |
Commission File Number 001-31574
AMERIGROUP Corporation
(Exact name of registrants 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, VA
(Address of principal executive offices) |
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23462
(Zip Code) |
Registrants telephone number, including area code:
(757) 490-6900
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 whether the registrant is an accelerated
filer (as defined in Rule 12b-2 of the Exchange
Act). Yes þ No o
As of May 2, 2005, there were 51,160,228 shares
outstanding of AMERIGROUPs common stock, par value $0.01.
AMERIGROUP Corporation
And Subsidiaries
Table Of
Contents
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Part I. Financial
Information |
Item 1.
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Financial Statements |
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3 |
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Condensed Consolidated Balance Sheets as of March 31, 2005
and December 31, 2004 |
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3 |
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Condensed Consolidated Income Statements for the three month
periods ended March 31, 2005 and 2004 |
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4 |
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Condensed Consolidated Statements of Cash Flows for the three
month periods ended March 31, 2005 and 2004 |
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5 |
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Notes to Condensed Consolidated Financial Statements |
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6 |
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Item 2.
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Managements Discussion and Analysis of Financial Condition
and Results of Operations |
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11 |
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Item 3.
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Quantitative and Qualitative Disclosures About Market Risk |
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17 |
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Item 4.
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Controls and Procedures |
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17 |
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Part II. Other
Information |
Item 1.
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Legal Proceedings |
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18 |
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Item 2.
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Unregistered Sales of Equity Securities and Use of Proceeds |
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18 |
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Item 3.
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Defaults Upon Senior Securities |
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18 |
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Item 4.
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Submission of Matters to a Vote of Security Holders |
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18 |
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Item 5.
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Other Information |
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19 |
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Item 6.
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Exhibits |
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20 |
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2
Part I. Financial
Information
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Item 1. |
Financial Statements |
AMERIGROUP Corporation
And Subsidiaries
Condensed Consolidated
Balance Sheets
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March 31, | |
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December 31, | |
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2005 | |
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2004 | |
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(Dollars in thousands) | |
ASSETS |
Current assets:
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Cash and cash equivalents
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$ |
289,567 |
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$ |
227,130 |
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Short-term investments
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48,178 |
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176,364 |
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Premium receivables
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39,347 |
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44,081 |
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Deferred income taxes
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12,264 |
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11,019 |
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Prepaid expenses and other current assets
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20,755 |
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18,737 |
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Total current assets
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410,111 |
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477,331 |
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Long-term investments
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213,391 |
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208,565 |
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Investments on deposit for licensure
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51,988 |
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38,365 |
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Property and equipment, net
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35,814 |
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34,030 |
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Software, net
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18,881 |
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16,268 |
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Other long-term assets
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5,443 |
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4,909 |
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Goodwill and other intangible assets, net
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252,051 |
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140,382 |
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$ |
987,679 |
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$ |
919,850 |
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LIABILITIES AND STOCKHOLDERS EQUITY |
Current liabilities:
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Claims payable
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$ |
254,304 |
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$ |
241,253 |
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Accounts payable
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4,594 |
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4,826 |
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Unearned revenue
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62,431 |
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34,228 |
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Accrued payroll and related liabilities
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18,247 |
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18,606 |
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Accrued expenses and other current liabilities
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25,599 |
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35,068 |
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Current portion of capital lease obligations
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2,824 |
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3,168 |
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Total current liabilities
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367,999 |
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337,149 |
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Capital lease obligations, less current portion
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2,383 |
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2,878 |
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Deferred income taxes and other long-term liabilities
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16,085 |
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11,111 |
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Total liabilities
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386,467 |
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351,138 |
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Stockholders equity:
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Common stock, $0.01 par value. Authorized
100,000,000 shares; issued and outstanding 51,158,829 and
50,529,724 at March 31, 2005 and December 31, 2004,
respectively
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512 |
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505 |
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Additional paid-in capital
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364,533 |
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352,417 |
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Retained earnings
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236,167 |
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215,790 |
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Total stockholders equity
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601,212 |
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568,712 |
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$ |
987,679 |
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$ |
919,850 |
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See accompanying notes to condensed consolidated financial
statements.
3
AMERIGROUP Corporation
And Subsidiaries
Condensed Consolidated
Income Statements
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Three Months Ended | |
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March 31, | |
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2005 | |
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2004 | |
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(Dollars in thousands, except for | |
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per share data) | |
Revenues:
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Premium
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$ |
553,888 |
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$ |
422,335 |
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Investment income and other
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3,624 |
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1,960 |
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Total revenues
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557,512 |
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424,295 |
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Expenses:
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Health benefits
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454,404 |
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342,247 |
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Selling, general and administrative
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62,041 |
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45,487 |
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Depreciation and amortization
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7,091 |
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5,624 |
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Interest
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160 |
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181 |
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Total expenses
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523,696 |
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393,539 |
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Income before income taxes
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33,816 |
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30,756 |
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Income tax expense
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13,373 |
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12,318 |
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Net income
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$ |
20,443 |
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$ |
18,438 |
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Net income per share:
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Basic net income per share
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$ |
0.40 |
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$ |
0.38 |
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Weighted average number of common shares outstanding
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50,737,252 |
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49,124,828 |
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Diluted net income per share
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$ |
0.39 |
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$ |
0.36 |
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Weighted average number of common shares and dilutive potential
common shares outstanding
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52,961,652 |
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51,258,930 |
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See accompanying notes to condensed consolidated financial
statements.
4
AMERIGROUP Corporation
And Subsidiaries
Condensed Consolidated
Statements Of Cash Flows
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Three Months Ended | |
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March 31, | |
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2005 | |
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2004 | |
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(Dollars in thousands) | |
Cash flows from operating activities:
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Net income
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$ |
20,443 |
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$ |
18,438 |
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Adjustments to reconcile net income to net cash provided by
operating activities:
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Depreciation and amortization
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7,091 |
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5,624 |
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Loss on disposal or abandonment of property, equipment and
software
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1,112 |
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Deferred tax (benefit) expense
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(1,480 |
) |
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|
931 |
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Amortization of deferred compensation
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57 |
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Tax benefit related to exercise of stock options
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6,210 |
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2,397 |
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Changes in assets and liabilities increasing
(decreasing) cash flows from operations:
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Premium receivables
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10,561 |
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3,843 |
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Prepaid expenses and other current assets
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1,118 |
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122 |
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Other assets
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(608 |
) |
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(816 |
) |
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Claims payable
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(14,373 |
) |
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592 |
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Accounts payable, accrued expenses and other, net
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(12,666 |
) |
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(4,984 |
) |
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Unearned revenue
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28,110 |
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(27,575 |
) |
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Other long-term liabilities
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(723 |
) |
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338 |
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Net cash provided by operating activities
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43,683 |
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79 |
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Cash flows from investing activities:
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Proceeds from sales of available-for-sale securities
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795,775 |
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911,771 |
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Purchase of available for sale investments
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(669,275 |
) |
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(977,250 |
) |
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Proceeds from redemption of held-to-maturity securities
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23,500 |
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|
109,978 |
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Purchase of held-to-maturity investments
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(26,706 |
) |
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(51,781 |
) |
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Purchase of property and equipment and software
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(4,894 |
) |
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(3,999 |
) |
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Proceeds from redemption of investments on deposit for licensure
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7,844 |
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30,083 |
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Purchase of investments on deposit for licensure
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(13,440 |
) |
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(30,194 |
) |
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Acquisition, net of cash acquired
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(99,030 |
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Purchase price adjustment received
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48 |
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Net cash provided by (used in) investing activities
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|
13,774 |
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(11,344 |
) |
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Cash flows from financing activities:
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Net decrease in bank overdrafts
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(3,876 |
) |
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Payment of capital lease obligations
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(933 |
) |
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(1,131 |
) |
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Proceeds from exercise of common stock options and employee
stock purchases
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|
5,913 |
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|
4,454 |
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Net cash provided by (used in) financing activities
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|
4,980 |
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(553 |
) |
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Net increase (decrease) in cash and cash equivalents
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|
62,437 |
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(11,818 |
) |
Cash and cash equivalents at beginning of period
|
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|
227,130 |
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|
84,030 |
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Cash and cash equivalents at end of period
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$ |
289,567 |
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$ |
72,212 |
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Supplemental disclosures of cash flow information:
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Cash paid for interest
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$ |
164 |
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$ |
92 |
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|
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Cash paid for income taxes
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$ |
1,255 |
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$ |
2,591 |
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On January 1, 2005, we completed our acquisition of
CarePlus, LLC, which operates as CarePlus Health Plan
(CarePlus). The following summarizes cash paid for this
acquisition:
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Assets acquired, including cash of $27,755
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$ |
163,869 |
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Liabilities assumed
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|
37,084 |
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Net assets acquired
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$ |
126,785 |
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|
See accompanying notes to condensed consolidated financial
statements.
5
AMERIGROUP Corporation
And Subsidiaries
Notes To Condensed
Consolidated Financial Statements
(Dollars in thousands, except for per share data)
1. The accompanying condensed consolidated financial
statements as of March 31, 2005 and for the three month
periods ended March 31, 2005 and 2004 are unaudited and
reflect all adjustments which are, in the opinion of management,
necessary for a fair presentation of the financial position at
March 31, 2005 and operating results for the interim
periods. The December 31, 2004 balance sheet information
was derived from the audited consolidated financial statements
as of that date.
The condensed consolidated financial statements should be read
in conjunction with the consolidated financial statements and
notes thereto and managements discussion and analysis of
financial condition and results of operations for the year ended
December 31, 2004 contained in our Annual Report on
Form 10-K filed with the Securities and Exchange Commission
(SEC) on March 9, 2005. The results of operations for
the three month period ended March 31, 2005 are not
necessarily indicative of the results to be expected for the
entire year ending December 31, 2005.
Certain 2004 amounts have been reclassified to conform to the
current period financial statement presentation.
2. Basic net income per common share is computed by
dividing net income by the weighted average number of shares of
common stock outstanding. Diluted net income per common share is
computed by dividing net income by the weighted average number
of shares of common stock outstanding plus other dilutive
potential securities. The following table sets forth the
calculation of basic and diluted net income per share:
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Three Months Ended | |
|
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March 31, | |
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| |
|
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2005 | |
|
2004 | |
|
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| |
|
| |
Basic net income per share:
|
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|
|
|
|
|
|
|
|
Net income
|
|
$ |
20,443 |
|
|
$ |
18,438 |
|
|
|
|
|
|
|
|
|
Weighted average number of common shares outstanding
|
|
|
50,737,252 |
|
|
|
49,124,828 |
|
|
|
|
|
|
|
|
|
Basic net income per share
|
|
$ |
0.40 |
|
|
$ |
0.38 |
|
|
|
|
|
|
|
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
Net income
|
|
$ |
20,443 |
|
|
$ |
18,438 |
|
|
|
|
|
|
|
|
|
Weighted average number of common shares outstanding
|
|
|
50,737,252 |
|
|
|
49,124,828 |
|
|
Dilutive effect of stock options (as determined by applying the
treasury stock method)
|
|
|
2,224,400 |
|
|
|
2,134,102 |
|
|
|
|
|
|
|
|
|
Weighted average number of common shares and dilutive potential
common shares outstanding
|
|
|
52,961,652 |
|
|
|
51,258,930 |
|
|
|
|
|
|
|
|
|
Diluted net income per share
|
|
$ |
0.39 |
|
|
$ |
0.36 |
|
|
|
|
|
|
|
|
6
AMERIGROUP Corporation
And Subsidiaries
Notes To Condensed
Consolidated Financial
Statements (Continued)
3. 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 Transition and Disclosure
(SFAS No. 148), was issued which requires that we
illustrate the effect on net income and net income per share as
if we had applied the fair value principles included in
SFAS No. 123 for both annual and interim financial
statements. The following table illustrates the effect on net
income and earnings per share as if the Company had applied fair
value recognition.
|
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|
|
|
|
|
|
|
|
|
|
Three Months Ended | |
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Net income:
|
|
|
|
|
|
|
|
|
|
Reported net income
|
|
$ |
20,443 |
|
|
$ |
18,438 |
|
|
Deduct: Total stock-based employee compensation expense
determined under fair value based method for all awards, net of
related tax effects
|
|
|
4,231 |
|
|
|
2,104 |
|
|
|
|
|
|
|
|
|
Proforma net income
|
|
$ |
16,212 |
|
|
$ |
16,334 |
|
|
|
|
|
|
|
|
Basic net income per share:
|
|
|
|
|
|
|
|
|
|
Reported basic net income per share
|
|
$ |
0.40 |
|
|
$ |
0.38 |
|
|
Proforma basic net income per share
|
|
|
0.32 |
|
|
|
0.33 |
|
Diluted net income per share:
|
|
|
|
|
|
|
|
|
|
Reported diluted net income per share
|
|
$ |
0.39 |
|
|
$ |
0.36 |
|
|
Proforma diluted net income per share
|
|
|
0.31 |
|
|
|
0.33 |
|
As of March 31, 2005, we had 5,670,158 options outstanding
with a weighted average exercise price of $22.61. For the three
months ended March 31, 2005, we granted 1,556,748 options
with a weighted average exercise price of $41.60.
The fair value of each 2005 option grant is estimated on the
date of grant using an option pricing model with the following
assumptions: no dividend yield, risk-free interest rate of
4.26%, expected life of 6.20 years and volatility of 26.96%.
4. Effective January 1, 2005, we completed our stock
acquisition of CarePlus, LLC (CarePlus), in New York City, New
York for $126,785 in cash, including acquisition costs, pursuant
to the terms of the merger agreement entered into on
October 26, 2004. Additional consideration may be paid
contingent upon the achievement of specific criteria during 2005
and 2006 as follows: $4,000 in the event CarePlus receives
approval from and a contract with the State of New York to
conduct a long-term care business in the State of New York and
enrolls membership in the business by January 1, 2007; up
to $10,000 if CarePlus meets certain earnings thresholds during
the twelve months ended December 31, 2005; and a multiple
of revenues realized for the month ended December 31, 2004
in excess of a contractually agreed target, currently under
review. If the criteria are met and additional payments become
due, they will be accounted for as an additional cost of the
acquisition. Beginning January 1, 2005, the results of
operations of CarePlus have been included in the accompanying
Condensed Consolidated Income Statements.
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 at December 31, 2004 providing us with an entry into
the New York market. CarePlus is also authorized to offer
7
AMERIGROUP Corporation
And Subsidiaries
Notes To Condensed
Consolidated Financial
Statements (Continued)
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 with unregulated cash. Goodwill and
other intangibles total $114,164 which includes $13,980 of
specifically identifiable intangibles allocated to the rights to
membership, the provider network, non-compete agreements and
trademarks. Intangible assets related to the rights to
membership are being amortized based on the timing of the
related cash flows with an expected amortization of ten years.
Intangible assets related to the provider network are being
amortized over ten years on a straight-line basis. Intangible
assets related to the trademarks and non-compete agreements are
being amortized over 12 to 36 months on a straight-line
basis. The merger agreement provides for purchase price
adjustments related to the future settlement of certain
purchased liabilities. Additionally, as acquisition was recently
consummated, we have not yet finalized our fair value analysis.
Therefore, the allocation of the purchase price is subject to
adjustment.
The following table summarizes the fair values of the assets
acquired and liabilities assumed of CarePlus at the date of the
acquisition.
|
|
|
|
|
|
Cash and cash equivalents
|
|
$ |
27,755 |
|
Investments on deposit for licensure
|
|
|
8,027 |
|
Goodwill and other intangible assets
|
|
|
114,164 |
|
Property and equipment
|
|
|
3,941 |
|
Other assets
|
|
|
9,982 |
|
|
|
|
|
|
Total assets acquired
|
|
|
163,869 |
|
|
|
|
|
Claims payable
|
|
|
27,424 |
|
Other liabilities
|
|
|
9,660 |
|
|
|
|
|
|
Total liabilities assumed
|
|
|
37,084 |
|
|
|
|
|
|
Net assets acquired
|
|
$ |
126,785 |
|
|
|
|
|
The following table summarizes intangible assets resulting from
the CarePlus transaction:
|
|
|
|
|
|
|
|
|
|
|
|
|
Amortization | |
|
|
|
|
Period | |
|
|
|
|
| |
Membership rights and provider network
|
|
$ |
12,900 |
|
|
|
10 years |
|
Non-compete agreement and trademarks
|
|
|
1,080 |
|
|
|
1 - 3 years |
|
|
|
|
|
|
|
|
|
|
$ |
13,980 |
|
|
|
|
|
|
|
|
|
|
|
|
The following is the proforma results of operations for the year
ended December 31, 2004 as if the acquisition had been
completed on January 1, 2004:
|
|
|
|
|
Total revenue
|
|
$ |
2,017,349 |
|
|
|
|
|
Health benefits
|
|
|
1,608,656 |
|
Selling, general and administrative
|
|
|
230,543 |
|
Deprecation and amortization
|
|
|
28,734 |
|
|
|
|
|
Income before income taxes
|
|
|
149,416 |
|
Provision for income taxes
|
|
|
59,093 |
|
|
|
|
|
Net income
|
|
$ |
90,323 |
|
|
|
|
|
8
AMERIGROUP Corporation
And Subsidiaries
Notes To Condensed
Consolidated Financial
Statements (Continued)
5. In April 2004, the Maryland Legislature enacted a budget
for the 2005 fiscal year beginning July 1, 2004 that
included a provision to reduce the premium paid to managed care
organizations (MCOs) that did not meet certain HEDIS scores and
whose medical loss ratio was below 84% for the calendar year
ended December 31, 2002. In May 2004, the Maryland
Secretary of Health and Mental Hygiene, in consultation with
Marylands legislative leadership, determined our premium
recoupment to be $846. 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 study, which were released in October 2004, did
not directly address what would happen in the future if an MCO
reported a medical loss ratio below 84%. As a result, we
believed the Maryland Legislature could enact similar
legislation in 2005 as part of its fiscal year 2006 budget,
requiring premium recoupment. Accordingly, we recorded a
reduction in premium of $6,100 in our financial statements
during the year ended December 31, 2004, which was our best
estimate of the possible outcome of this issue.
The Maryland Legislative Session ended on April 11, 2005
and it addressed the medical loss ratio assessment in the
following manner. First, no budget action was taken to recoup
premium relating to 2003 as it did in the 2004 legislative
session. Second, the Legislature amended the existing statute to
clarify the process and required that regulations be promulgated
by the Department of Health and Mental Hygiene before an action
could be taken to recoup premium based upon an MCOs
medical loss ratio. Based on this information, we reversed the
reduction in premium that was previously recorded resulting in
$6,100 of additional premium revenue in the three months ended
March 31, 2005.
6. 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
complaint is captioned the United States of America and the
State of Illinois, ex rel., Cleveland A. Tyson v.
AMERIGROUP Illinois, Inc. The complaint was filed in the
U.S. District Court for the Northern District of Illinois,
Eastern Division. The complaint alleges that AMERIGROUP
Illinois, Inc. submitted false claims under the Medicaid
program. The United States has not sought to intervene in the
case. Mr. Tysons amended complaint was unsealed and
served on AMERIGROUP Illinois, Inc. in June 2003. Therein,
Mr. Tyson alleges that AMERIGROUP Illinois, Inc. maintained
a scheme to discourage or avoid the enrollment into the health
plan of pregnant women and other Medicaid recipients with
special needs. In his suit, Mr. Tyson seeks an unspecified
amount of damages and statutory penalties of no less than $5 and
no more than $11 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. filed a
motion for summary judgment in December 2004 and it is pending
before the court. On February 15, 2005, we received a
motion filed by the State of Illinois on February 10, 2005,
seeking court approval to intervene. On March 2, 2005, the
court granted the States motion to intervene. On
March 3, 2005, AMERIGROUP Illinois, Inc. filed a motion to
dismiss for lack of subject matter jurisdiction, based upon a
recent opinion of the United States Court of Appeals for the
District of Columbia Circuit. That motion is pending disposition
by the court. On March 3, 2005, the Office of the Attorney
General of the State of Illinois issued a subpoena to AMERIGROUP
Corporation as part of an investigation pursuant to the Illinois
Whistleblower Reward and Protection Act to determine whether a
violation of the Act has occurred. AMERIGROUP Corporation has
filed a motion objecting to the subpoena on the grounds, among
other things, that the subpoena is duplicative of one previously
served on AMERIGROUP Corporation in the federal court Tyson
litigation with which AMERIGROUP Corporation is complying.
At this time, discovery is ongoing and no trial date has been
set. 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
March 31, 2005. 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.
9
AMERIGROUP Corporation
And Subsidiaries
Notes To Condensed
Consolidated Financial
Statements (Continued)
7. On December 16, 2004, the Financial Accounting
Standards Board issued Statement of Financial Accounting
Standards 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 25, SFAS 148
and amends Statement of Financial Accounting Standards
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
January 1, 2006. 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 January 1,
2006.
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. |
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. 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
$6,210 and $2,397 for the three months ended March 31, 2005
and 2004, respectively.
8. The differences between net income and total
comprehensive income resulted from changes in unrealized gains
and losses on investments available-for-sale, as follows:
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended | |
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Net income
|
|
$ |
20,443 |
|
|
$ |
18,438 |
|
Changes in unrealized loss on investments, net of tax
|
|
|
(66 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
Total comprehensive income
|
|
$ |
20,377 |
|
|
$ |
18,438 |
|
|
|
|
|
|
|
|
10
|
|
Item 2. |
Managements Discussion and Analysis of Financial
Condition and Results of Operations |
Forward-looking Statements
This Quarterly Report on Form 10-Q, 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:
|
|
|
|
|
national, state and local economic conditions, including their
effect on the rate increase process, timing of payments, and the
availability and cost of labor, utilities and materials; |
|
|
|
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; |
|
|
|
changes in Medicaid payment levels and methodologies and the
application of such methodologies by the Federal and state
governments; |
|
|
|
liabilities and other claims asserted against us; |
|
|
|
our ability to attract and retain qualified personnel; |
|
|
|
our ability to maintain compliance with all minimum capital
requirements; |
|
|
|
the availability and terms of capital to fund acquisitions and
capital improvements; |
|
|
|
the competitive environment in which we operate; |
|
|
|
our ability to maintain and increase membership levels; |
|
|
|
demographic changes; and |
|
|
|
terrorism. |
Investors should also refer to our Annual Report on
Form 10-K for the fiscal period ended December 31,
2004 filed with the Securities and Exchange Commission on
March 9, 2005 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.
11
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 our first quarter ended March 31, 2005, we increased our
total revenues by 31.4% over the same period in 2004. Total
membership increased 180,000, or 20.8%, to 1,047,000 as of
March 31, 2005, from 867,000 as of March 31, 2004. Our
revenue growth was due to a number of factors including:
|
|
|
|
|
Organic growth Our same-store premium revenues for
the three months ended March 31, 2005, increased 17.8% over
the same period in 2004 from membership increases in existing
service areas and new markets and premium rate increases
received after March 31, 2004 to date. The reversal of an
estimated Maryland premium recoupment previously recorded
accounted for 1.4% of the increase in our same-store premium
revenue. |
|
|
|
Growth through acquisitions Effective
January 1, 2005, we completed our stock acquisition of
CarePlus in New York City, New York, pursuant to the terms of
the merger agreement. CarePlus services approximately 115,000
members covered by New York States Medicaid, Child Health
Plus and Family Health Plus programs. CarePlus service
areas include New York City (Brooklyn, Manhattan, Queens and
Staten Island) and Putnam County, New York. CarePlus accounted
for 42.8% of the premium revenue increase in the first quarter
of 2005 over the first quarter of 2004. |
For the three months ended March 31, 2005, our health
benefits ratio (HBR) was 82.0% versus 81.0% in the same
period of the prior year. The HBR increase is driven primarily
by a higher incidence of flu in the first quarter of 2005
compared to the first quarter of 2004.
Selling, general and administrative expenses (SG&A) were
11.1% of total revenues for the three months ended
March 31, 2005 compared to 10.7% in the same period of the
prior year. Our SG&A ratio increased due to the effect of
increases related to the CarePlus acquisition and premium taxes.
Cash and investments totaled $603.1 million at
March 31, 2005. A significant portion of this cash is
regulated by state capital requirements. However,
$168.1 million of our cash and investments was unregulated
and held at the parent level.
We expect acquisitions to continue to be an important part of
our growth strategy. As of March 31, 2005, over 48% of our
current membership has resulted from ten acquisitions. We are
currently evaluating potential acquisition opportunities. We are
also focused on growth opportunities in new markets and new
products.
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.
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 23,000 are signed up with primary
care physicians who are either employees of CCPN or exclusively
contracted with CCPN. On February 25, 2005, we received a
written notice from CCHCN and CCPN that the risk sharing
agreement would not be extended beyond its
12
termination date of August 31, 2005. We believe that the
notice of termination was given by CCHCN and CCPN in order to
give them greater flexibility depending upon the outcome of the
awards under the RFP.
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. In the
event another Health Maintenance Organization (HMO) is
awarded a contract in Fort Worth, CCPN may choose to
contract with it, either on an exclusive or non-exclusive basis
resulting in a possible loss of membership. We believe that
CCHCN has filed a bid to contract with the State of Texas to
provide Medicaid services in Fort Worth. In addition, if we
are successful in re-contracting with CCHCN and/or CCPN the
terms of any new contract may not be as favorable as the current
risk-sharing arrangement. Therefore, our results from operations
could be harmed.
In April 2004, the Maryland Legislature enacted a budget for the
2005 fiscal year beginning July 1, 2004 that included a
provision to reduce the premium paid to managed care
organizations (MCOs) that did not meet certain HEDIS scores and
whose medical loss ratio was below 84% for the calendar year
ended December 31, 2002. In May 2004, the Maryland
Secretary of Health and Mental Hygiene, in consultation with
Marylands legislative leadership, determined our premium
recoupment to be $846,000. A liability for the recoupment was
recorded with a corresponding charge to premium revenue during
the year ended December 31, 2004. Additionally, the
Legislature directed that the Department of Health and Mental
Hygiene complete a study by September 2004 on the relevance of
the medical loss ratio threshold as an indicator of quality. The
results of this study, which were released in October 2004, did
not directly address what would happen in the future if an MCO
reported a medical loss ratio below 84%. As a result, we
believed the Maryland Legislature could enact similar
legislation in 2005 as part of its fiscal year 2006 budget,
requiring premium recoupment. Accordingly, we recorded a
reduction in premium in our financial statements during the year
ended December 31, 2004, which was our best estimate of the
possible outcome of this issue.
The Maryland Legislative Session ended on April 11, 2005
and it addressed the medical loss ratio assessment in the
following manner. First, no budget action was taken to recoup
premium relating to 2003 as it did in the 2004 legislative
session. Second, the Legislature amended the existing statute to
clarify the process and required that regulations be promulgated
by the Department of Health and Mental Hygiene before an action
could be taken to recoup premium based upon an MCOs
medical loss ratio. Based on this information, we reversed the
reduction in premium that was previously recorded resulting in
$6.1 million of additional premium revenue in the three
months ended March 31, 2005.
The following table sets forth the approximate number of our
members we served in each state for the dates presented.
|
|
|
|
|
|
|
|
|
|
|
March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Texas |
|
|
392,000 |
|
|
|
340,000 |
|
Florida
|
|
|
219,000 |
|
|
|
232,000 |
|
Maryland
|
|
|
131,000 |
|
|
|
124,000 |
|
New York
|
|
|
119,000 |
|
|
|
|
|
New Jersey
|
|
|
107,000 |
|
|
|
101,000 |
|
District of Columbia
|
|
|
41,000 |
|
|
|
37,000 |
|
Chicago
|
|
|
38,000 |
|
|
|
33,000 |
|
|
|
|
|
|
|
|
Total
|
|
|
1,047,000 |
|
|
|
867,000 |
|
|
|
|
|
|
|
|
Percentage growth from March 31, 2004 to March 31, 2005
|
|
|
20.8 |
% |
|
|
|
|
13
The following table sets forth the approximate number of our
members in each of our products on the dates presented.
|
|
|
|
|
|
|
|
|
|
|
March 31, | |
|
|
| |
Product |
|
2005 | |
|
2004 | |
|
|
| |
|
| |
AMERICAID (Medicaid TANF)
|
|
|
735,000 |
|
|
|
589,000 |
|
AMERIKIDS (SCHIP)
|
|
|
194,000 |
|
|
|
189,000 |
|
AMERIPLUS (Medicaid SSI)
|
|
|
82,000 |
|
|
|
74,000 |
|
AMERIFAM (FamilyCare)
|
|
|
36,000 |
|
|
|
15,000 |
|
|
|
|
|
|
|
|
Total
|
|
|
1,047,000 |
|
|
|
867,000 |
|
|
|
|
|
|
|
|
As of March 31, 2005, we served approximately 1,047,000
members, which reflects an increase of 180,000 members compared
to March 31, 2004. The CarePlus acquisition effective
January 1, 2005, added the New York market with 119,000
members as of March 31, 2005. The remaining same-store
growth occurred in all of our markets, except Florida, due to
new product offerings, new geographies, successful direct
marketing initiatives, as well as competitors leaving the
market. The Florida market decrease of 13,000 members is
primarily a decrease in the SCHIP program, Florida Healthy Kids.
This decrease is a direct result of changes made by the State of
Florida during 2004 from a monthly enrollment to a semi-annual
enrollment process and in the eligibility re-determination
process, both of which have negatively impacted the statewide
membership in the Florida Healthy Kids program. The Florida
Legislature has passed legislation to change back the enrollment
period from semi-annual to monthly which is pending the
governors signature.
On a sequential quarter basis, same-store membership grew by
10,000 members offset by a loss of 14,000 members primarily
due to enrollment difficulties in the Florida Healthy Kids
program as noted above as well as Medicaid eligibility
processing issues in Texas. Texas statewide membership decreased
due to a temporary interruption in the States ability to
process new Medicaid applications. This interruption is a result
of the States decision to outsource the eligibility
determination process in 2005 causing employee turnover. The
transition to the States outsourcing contract is expected
to be completed in 2005. We can give no assurances that either
the Florida legislative changes or the completion of the Texas
eligibility outsourcing will have a positive impact on our
membership growth.
Results of Operations
The following table sets forth selected operating ratios. All
ratios, with the exception of the HBR, are shown as a percentage
of total revenues. We operate in one business segment with a
single line of business.
|
|
|
|
|
|
|
|
|
|
|
Three Months | |
|
|
Ended March 31, | |
|
|
| |
|
|
2005 | |
|
2004 | |
|
|
| |
|
| |
Premium revenue
|
|
|
99.3 |
% |
|
|
99.5 |
% |
Investment income and other
|
|
|
0.7 |
|
|
|
0.5 |
|
|
|
|
|
|
|
|
Total revenues
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
Health benefits(1)
|
|
|
82.0 |
% |
|
|
81.0 |
% |
Selling, general and administrative expenses
|
|
|
11.1 |
% |
|
|
10.7 |
% |
Income before income taxes
|
|
|
6.1 |
% |
|
|
7.2 |
% |
Net income
|
|
|
3.7 |
% |
|
|
4.3 |
% |
|
|
(1) |
The HBR is shown as a percentage of premium revenue because
there is a direct relationship between the premium received and
the health benefits provided. |
14
Three Month Period Ended March 31, 2005 Compared to
Three Month Period Ended March 31, 2004
Premium revenue for the three months ended March 31, 2005
increased $131.6 million, or 31.2%, to $553.9 million
from $422.3 million for the three months ended
March 31, 2004. The increase was due to the CarePlus
acquisition, internal growth in overall membership, premium rate
increases and the reversal of the estimated Maryland premium
recoupment previously recorded of $6.1 million. Total
membership increased by 180,000, or 20.8%, to 1,047,000 as of
March 31, 2005, from 867,000 as of March 31, 2004.
Investment income and other increased $1.6 million to
$3.6 million for the three months ended March 31, 2005
from $2.0 million for the three months ended March 31,
2004. The increase in investment income and other was due to
favorable interest rates over the prior year.
Expenses relating to health benefits for the three months ended
March 31, 2005 increased $112.2 million, or 32.8%, to
$454.4 million from $342.2 million for the three
months ended March 31, 2004. This increase was primarily
due to an increase in membership due to a combination of
same-store growth as well as the CarePlus acquisition. Our HBR
was 82.0% for the three months ended March 31, 2005,
compared to 81.0% for the same period of the prior year. The
increase in our HBR was due primarily to a higher incidence of
flu seasonality reflected in pharmacy and physician services as
well as less favorable prior period development in the
comparative quarter offset by the resolution of the Maryland
premium recoupment described above under the heading
Overview.
|
|
|
Selling, general and administrative expenses |
Our SG&A to total revenue ratio was 11.1% and 10.7% for the
three months ended March 31, 2005 and 2004, respectively.
SG&A for the three months ended March 31, 2005
increased $16.5 million, or 36.3%, to $62.0 million
from $45.5 million for the three months ended
March 31, 2004. The increase in the SG&A ratio for the
first three months of 2005 compared to the same period in 2004
is primarily a result of the CarePlus acquisition and an
increase in the premium tax effect on the SG&A ratio offset
by the benefit of the Maryland premium recoupment and improved
efficiencies in SG&A.
Interest expense was $0.2 million for each of the three
months ended March 31, 2005 and 2004.
|
|
|
Provision for income taxes |
Income tax expense for the three months ended March 31,
2005 was $13.4 million with an effective tax rate of 39.5%
compared to $12.3 million for the three months ended
March 31, 2004 with an effective tax rate of 40.1%. The
decrease in the effective tax rate for the period is primarily
due to a decrease in non-deductible expenses.
|
|
|
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 March 31, 2005, we had cash and
cash equivalents of $289.5 million, short and long-term
investments of $261.6 million and restricted investments on
deposit for licensure of $52.0 million. A significant
portion of this cash and investments is regulated by state
capital requirements. Unregulated cash and investments as of
March 31, 2005 were approximately $168.1 million. As
of March 31, 2005, there were no borrowings outstanding
under our $95.0 million 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
15
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.
We are currently in the process of amending our Credit Agreement
(the Amended Credit Agreement), to, among other
things, increase commitments to $150.0 million and extend
the term for an additional five years from the date of the
amendment. We anticipate that the Amended Credit Agreement will
be effective during the second quarter of 2005.
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 March 31, 2005, 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.
On March 11, 2005, we filed a shelf registration statement
on Form S-3 with the Securities and Exchange Commission
covering the issuance of up to $400.0 million of securities
including common stock, preferred stock depositary shares debt
securities, warrants, stock purchase contracts and stock
purchase units. No securities have been issued under the shelf
registration. Upon effectiveness of the shelf registration, we
may publicly offer securities from time-to-time at prices and
terms to be determined at the time of the offering.
Effective January 1, 2005, we completed our stock
acquisition of CarePlus in New York City, pursuant to the terms
of the merger agreement entered into on October 26, 2004
for $126.8 million in cash, including acquisition costs.
This acquisition was accounted for under the purchase method of
accounting and was funded with unregulated cash. Goodwill and
other intangibles total $114.2 million which includes
$14.0 million of specifically identifiable intangibles
allocated to the rights to membership, the provider network,
non-compete agreements and trademarks.
Cash provided by operating activities was $43.7 million for
the three months ended March 31, 2005, compared to
$0.1 million for the three months ended March 31,
2004. The increase in cash from operations of $43.6 million
was primarily due to the following:
Increases in cash flows due to:
|
|
|
|
|
an increase in net income of $2.0 million; |
|
|
|
an increase in the change in premium receivables of
$6.7 million primarily due to an increase in the rate of
payment from a 60 day lag to a 30 day lag in one of
the states in which we do business; and |
|
|
|
an increase in the change of unearned revenue of
$55.7 million due to the timing of premium receipts in one
of our states; |
Offset by decreases in cash flows due to:
|
|
|
|
|
a decrease in the change in claims payable of $15.0 million
primarily due to increased claims payments that resulted from
claim systems improvements in the first quarter of 2005; and |
|
|
|
a decrease in the change in accounts payable, accrued expenses
and other liabilities of $7.7 million primarily as a result
of the decrease in the contingent liability accrued for the
Maryland market. |
For the three months ended March 31, 2005, cash provided by
investing activities was $13.8 million and cash used in
investing activities was $11.3 million for the three months
ended March 31, 2004. The increase in
16
cash provided by investing activities related primarily to an
increase in net investment proceeds in excess of purchases of
$125.1 million offset by the purchase of CarePlus net of
the cash acquired of $99.0 million. We currently anticipate
total capital expenditures of approximately $26.0 to
$28.0 million in 2005.
Our investment policies are designed to preserve capital,
provide liquidity and maximize total return on invested assets.
As of March 31, 2005, our investment portfolio consisted
primarily of fixed-income securities. The weighted average
maturity is slightly under nine months. We utilize investment
vehicles such as commercial paper, money market funds, municipal
bonds, U.S. government agency securities, auction-rate
securities and U.S. Treasury instruments. The states in
which we operate prescribe the types of instruments in which our
subsidiaries may invest their cash. The weighted average taxable
equivalent yield on consolidated investments as of
March 31, 2005 was approximately 2.41%.
Cash provided by financing activities was $5.0 million for
the three months ended March 31, 2005 compared to cash used
in financing activities of $0.6 million for the three
months ended March 31, 2004. The increase primarily related
to a reduction in bank overdrafts and an increase in proceeds
from the exercise of employee stock options.
We believe that existing cash and investment balances,
internally generated funds and available funds under our credit
facility will be sufficient to support continuing operations,
capital expenditures and our growth strategy for at least
12 months.
Regulatory Capital and Dividend Restrictions
Our operations are conducted through our wholly-owned
subsidiaries, which include HMOs and one managed care
organization (MCO). HMOs and MCOs are subject to state
regulations that, among other things, may 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, state regulatory agencies may
require individual HMOs to maintain statutory capital levels
higher than the state regulations. We believe our subsidiaries
are in compliance with all minimum statutory capital
requirements.
|
|
Item 3. |
Quantitative and Qualitative Disclosures About Market
Risk |
As of March 31, 2005 we had short-term investments of
$48.2 million, long-term investments of $213.4 million
and investments on deposit for licensure of $52.0 million.
These investments consist primarily of investments with
maturities between three and twenty-four 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, municipal
bonds, U.S. government agency securities, auction-rate
securities and U.S. Treasury instruments. 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 expect any decrease in the value of these
investments resulting from any decrease in changes in market
interest rates to be temporary. As of March 31, 2005, a
hypothetical 1% change in interest rates would result in an
approximate $3.1 million change in our annual investment
income.
|
|
Item 4. |
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 (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,
17
including our Chief Executive Officer and Chief Financial
Officer, as appropriate, to allow timely decisions regarding
required disclosure.
(b) Changes in Internal Controls over Financial Reporting.
During the first quarter of 2005, in connection with our
evaluation of internal control over financial reporting in
accordance with Section 404 of the Sarbanes-Oxley Act of
2002, we concluded there were no changes in our internal control
procedures that materially affected, or are reasonably likely to
materially affect, our internal control over financial reporting.
Part II. Other
Information
|
|
Item 1. |
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 complaint is captioned the
United States of America and the State of Illinois, ex
rel., Cleveland A. Tyson v. AMERIGROUP Illinois, Inc.
The complaint was filed in the U.S. District Court for the
Northern District of Illinois, Eastern Division. The complaint
alleges that Amerigroup Illinois, Inc. submitted false claims
under the Medicaid program. The United States has not sought to
intervene in the case. Mr. Tysons amended complaint
was unsealed and served on AMERIGROUP Illinois, Inc. in June
2003. Therein, Mr. Tyson alleges that AMERIGROUP Illinois,
Inc. maintained a scheme to discourage or avoid the enrollment
into the health plan of pregnant women and other Medicaid
recipients 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. filed a motion for summary judgment in
December 2004 and it is pending before the court. On
February 15, 2005, we received the motion filed by the
State of Illinois on February 10, 2005, seeking court
approval to intervene. On March 2, 2005, the court granted
the States motion to intervene. On March 3, 2005,
AMERIGROUP Illinois, Inc. filed a motion to dismiss for lack of
subject matter jurisdiction, based upon a recent opinion of the
United States Court of Appeals for the District of Columbia
Circuit. That motion is pending disposition by the court. On
March 3, 2005, the Office of the Attorney General of the
State of Illinois issued a subpoena to AMERIGROUP Corporation as
part of an investigation pursuant to the Illinois Whistleblower
Reward and Protection Act to determine whether a violation of
the Act has occurred. AMERIGROUP Corporation has filed a motion
objecting to the subpoena on the grounds, among other things,
that the subpoena is duplicative of one previously served on
AMERIGROUP Corporation in the federal court Tyson litigation
with which AMERIGROUP Corporation is complying.
At this time, discovery is ongoing and no trial date has been
set. 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
March 31, 2005. 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.
We are from time-to-time the subject 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 2. |
Unregistered Sales of Equity Securities and Use of
Proceeds |
None.
|
|
Item 3. |
Defaults Upon Senior Securities |
None.
|
|
Item 4. |
Submission of Matters to a Vote of Security Holders |
None.
18
|
|
Item 5. |
Other Information |
None.
19
Item 6.
|
|
|
|
|
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. 333-347410)). |
|
|
10 |
.22.7 |
|
Amendment No. 00017, dated March 1, 2005, to the District
of Columbia Healthy Families Programs, Department of Health
Medical Assistance Administration, Prepaid, Capital Risk
Contract (POHC-2002-D-2003) (incorporated by reference to
Exhibit 10.22.7 to our Current Report on Form 8-K, filed on
May 5, 2005). |
|
|
10 |
.23.3 |
|
Amendment No. 13, dated August 31, 2004, to the
September 1, 2002 Contract for Services between the Health
and Human Services and AMERIGROUP Texas, Inc. (Childrens Health
Insurance Program Agreement (No. 52-00-139-M)) (incorporated by
reference to Exhibit 10.23.3 to our Current Report on Form
8-K, filed on May 5, 2005). |
|
|
10 |
.25.3 |
|
Amendment No. 4, dated February 28, 2005, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and AMERIGROUP
Florida Inc. (AHCA Contract No. FA523) (incorporated by
reference to Exhibit 10.25.3 to our Current Report on
Form 8-K, filed on May 5, 2005). |
|
|
10 |
.25.4 |
|
Amendment No. 5, dated March 31, 2005, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and AMERIGROUP
Florida Inc. (AHCA Contract No. FA523) (incorporated by
reference to Exhibit 10.25.4 to our Current Report on
Form 8-K, filed on May 5, 2005). |
|
|
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 |
|
Medicaid Managed Care Model Contract between New York City
Department of Health and Mental Hygiene and CarePlus, L.L.C.
date October 1, 2004 (incorporated by reference to
Exhibit 10.48 to our Current Report on Form 8-K, filed
on May 5, 2005). |
|
|
10 |
.48.1 |
|
Contract Amendment, dated January 1, 2005, to the Medicaid
Managed Care Model Contract between New York City Department of
Health and Mental Hygiene and CarePlus L.L.C. (incorporated by
reference to Exhibit 10.48.1 to our Current Report on Form
8-K, filed on May 5, 2005). |
|
|
10 |
.49 |
|
Child Health Plus Contract by and between The State of New York
Department of Health and Care Plus Health Plan is effective for
the period July 1, 1998 through June 30, 2005
(Contract No. C-015473) (incorporated by reference to
Exhibit 10.49 to our Current Report on Form 8-K, filed
on May 5, 2005). |
|
|
10 |
.50 |
|
Family Health Plus Model Contract by and between New York State
Department of Health and CarePlus LLC is effective for the
period October 1, 2001 through September 30, 2003
(Contract No. C-017699) (incorporated by reference to
Exhibit 10.50 to our Current Report on Form 8-K, filed on
May 6, 2005). |
|
|
10 |
.51 |
|
Medicaid Managed Care Model Contract by and between the County
of Putnam Department of Social Services and CarePlus Health Plan
date October 1, 2004 (incorporated by reference to
Exhibit 10.51 to our Current Report on Form 8-K, filed on
May 6, 2005). |
20
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
|
10 |
.51.1 |
|
Contract Amendment dated January 1, 2005, to the Medicaid
Managed Care Model Contract by and between the County of Putnam
Department of Social Services and Care Plus Health Plan
(incorporated by reference to Exhibit 10.51.1 to our
Current Report on Form 8-K, filed on May 6, 2005). |
|
|
31 |
.1 |
|
Certification of Chief Executive Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated May 6,
2005. |
|
|
31 |
.2 |
|
Certification of Chief Financial Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated May 6,
2005. |
|
|
32 |
.1 |
|
Certification of Chief Executive Officer and Chief Accounting
Officer pursuant to Section 906 of Sarbanes-Oxley Act of
2002, dated May 6, 2005. |
21
Signatures
Pursuant to the requirements of the Securities Exchange Act
of 1934, the Registrant has duly caused this Report to be signed
on its behalf by the undersigned thereunto duly authorized.
|
|
|
|
By: |
/s/ Jeffrey L. McWaters
|
|
|
|
|
|
Jeffrey L. McWaters |
|
Chairman and Chief Executive Officer |
Date: May 6, 2005
|
|
|
|
By: |
/s/ E. Paul Dunn, Jr.
|
|
|
|
|
|
E. Paul Dunn, Jr. |
|
Executive Vice President, |
|
Chief Financial Officer and Treasurer |
Date: May 6, 2005
22
Exhibits
|
|
|
|
|
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. 333-347410)). |
|
|
10 |
.22.7 |
|
Amendment No. 00017, dated March 1, 2005, to the District
of Columbia Healthy Families Programs, Department of Health
Medical Assistance Administration, Prepaid, Capital Risk
Contract (POHC-2002-D-2003) (incorporated by reference to
Exhibit 10.22.7 to our Current Report on Form 8-K, filed on May
5, 2005). |
|
|
10 |
.23.3 |
|
Amendment No. 13, dated August 31, 2004, to the
September 1, 2002 Contract for Services between the Health
and Human Services and AMERIGROUP Texas, Inc. (Childrens Health
Insurance Program Agreement (No. 52-00-139-M)) (incorporated by
reference to Exhibit 10.23.3 to our Current Report on Form 8-K,
filed on May 5, 2005). |
|
|
10 |
.25.3 |
|
Amendment No. 4, dated February 28, 2005, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and AMERIGROUP
Florida Inc. (AHCA Contract No. FA523) (incorporated by
reference to Exhibit 10.25.3 to our Current Report on
Form 8-K, filed on May 5, 2005). |
|
|
10 |
.25.4 |
|
Amendment No. 5, dated March 31, 2005, to the
June 28, 2002 Medical Contract between the State of
Florida, Agency for Health Care Administration and AMERIGROUP
Florida Inc. (AHCA Contract No. FA523) (incorporated by
reference to Exhibit 10.25.4 to our Current Report on
Form 8-K, filed on May 5, 2005). |
|
|
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 |
|
Medicaid Managed Care Model Contract between New York City
Department of Health and Mental Hygiene and CarePlus, L.L.C.
date October 1, 2004 (incorporated by reference to
Exhibit 10.48 to our Current Report on Form 8-K, filed
on May 5, 2005). |
|
|
10 |
.48.1 |
|
Contract Amendment, dated January 1, 2005, to the Medicaid
Managed Care Model Contract between New York City Department of
Health and Mental Hygiene and CarePlus L.L.C. (incorporated by
reference to Exhibit 10.48.1 to our Current Report on Form
8-K, filed on May 5, 2005). |
|
|
10 |
.49 |
|
Child Health Plus Contract by and between The State of New York
Department of Health and Care Plus Health Plan is effective for
the period July 1, 1998 through June 30, 2005
(Contract No. C-015473) (incorporated by reference to
Exhibit 10.49 to our Current Report on Form 8-K, filed
on May 5, 2005). |
|
|
10 |
.50 |
|
Family Health Plus Model Contract by and between New York State
Department of Health and CarePlus LLC is effective for the
period October 1, 2001 through September 30, 2003
(Contract No. C-017699) (incorporated by reference to
Exhibit 10.50 to our Current Report on Form 8-K, filed on
May 6, 2005). |
|
|
10 |
.51 |
|
Medicaid Managed Care Model Contract by and between the County
of Putnam Department of Social Services and CarePlus Health Plan
date October 1, 2004 (incorporated by reference to
Exhibit 10.51 to our Current Report on Form 8-K, filed on
May 6, 2005). |
23
|
|
|
|
|
Exhibit |
|
|
Number |
|
Description |
|
|
|
|
|
10 |
.51.1 |
|
Contract Amendment dated January 1, 2005, to the Medicaid
Managed Care Model Contract by and between the County of Putnam
Department of Social Services and Care Plus Health Plan
(incorporated by reference to Exhibit 10.51.1 to our
Current Report on Form 8-K, filed on May 6, 2005). |
|
|
31 |
.1 |
|
Certification of Chief Executive Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated May 6,
2005. |
|
|
31 |
.2 |
|
Certification of Chief Financial Officer pursuant to
Section 302 of Sarbanes-Oxley Act of 2002, dated May 6,
2005. |
|
|
32 |
.1 |
|
Certification of Chief Executive Officer and Chief Accounting
Officer pursuant to Section 906 of Sarbanes-Oxley Act of
2002, dated May 6, 2005. |
24