UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D. C. 20549
FORM 10-Q
þ
QUARTERLY REPORT PURSUANT
TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 2004
OR
¨TRANSITION REPORT
PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from ______________ to _________________
COMMISSION FILE NUMBER 1-16477
COVENTRY HEALTH CARE, INC.
(Exact name of registrant as specified in its charter)
Delaware | 52-2073000 |
(State or other jurisdiction of | (I.R.S. Employer |
incorporation or organization) | Identification Number) |
6705 Rockledge Drive,
Suite 900, Bethesda, Maryland 20817
(Address of principal executive offices) (Zip Code)
(301) 581-0600
(Registrants telephone number, including area code)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes þ No¨
Indicate by check mark whether the registrant is an accelerated filer (as defined in the Securities Exchange Act of 1934 Rule 12b-2). Yes þ No¨
Indicate the number of shares outstanding of each of the issuers classes of common stock, as of the latest practicable date.
Class | Outstanding at October 31, 2004 |
Common Stock $.01 Par Value | 89,760,111 |
PART I. FINANCIAL INFORMATION | |||
ITEM 1: Financial Statements | |||
Consolidated Balance Sheets at September 30, 2004 and December 31, 2003 |
3 | ||
Consolidated Statements of Operations for the quarters and nine months ended September 30, 2004 and 2003 |
4 | ||
Condensed Consolidated Statements of Cash Flows for the nine months ended September 30, 2004 and 2003 |
5 | ||
Notes to the Condensed Consolidated Financial Statements | 6 | ||
ITEM 2: Managements Discussion and Analysis of Financial Condition and Results of Operations | 10 | ||
ITEM 3: Quantitative and Qualitative Disclosures of Market Risk | 17 | ||
ITEM 4: Controls and Procedures | 17 | ||
PART II. OTHER INFORMATION | |||
ITEM 1: Legal Proceedings | 18 | ||
ITEM 2: Unregistered Sales of Equity Securities and Use of Proceeds | 19 | ||
ITEM 3, 4 and 5: Not Applicable | 19 | ||
ITEM 6: Exhibits | 20 | ||
SIGNATURES | 21 | ||
INDEX TO EXHIBITS | 22 |
2
September 30, 2004 |
December 31, 2003 | ||||
---|---|---|---|---|---|
ASSETS | (unaudited) | ||||
Current assets: | |||||
Cash and cash equivalents | $ 398,853 | $ 253,331 | |||
Short-term investments | 287,141 | 101,191 | |||
Accounts receivable, net | 91,523 | 89,766 | |||
Other receivables, net | 52,240 | 45,335 | |||
Deferred income taxes | 35,698 | 36,255 | |||
Other current assets | 8,670 | 8,089 | |||
Total current assets | 874,125 | 533,967 | |||
Long-term investments | 949,099 | 1,051,400 | |||
Property and equipment, net | 29,917 | 33,085 | |||
Goodwill | 281,328 | 281,183 | |||
Other intangible assets, net | 26,154 | 27,447 | |||
Other long-term assets | 57,171 | 54,654 | |||
Total assets | $ 2,217,794 | $ 1,981,736 | |||
LIABILITIES AND STOCKHOLDERS' EQUITY | |||||
Current liabilities: | |||||
Medical claims liabilities | $ 597,510 | $ 537,340 | |||
Other medical liabilities | 48,767 | 59,850 | |||
Accounts payable and other accrued liabilities | 198,139 | 183,781 | |||
Deferred revenue | 72,720 | 73,909 | |||
Total current liabilities | 917,136 | 854,880 | |||
Senior notes | 170,500 | 170,500 | |||
Other long-term liabilities | 26,065 | 27,358 | |||
Total liabilities | 1,113,701 | 1,052,738 | |||
Stockholders' equity: | |||||
Common stock, $.01 par value; 200,000 authorized | |||||
105,700 issued and 89,768 outstanding in 2004 | |||||
104,797 issued and 90,571 outstanding in 2003 | 1,057 | 1,048 | |||
Treasury stock, at cost; 15,932 in 2004; 14,226 in 2003 | (291,043) | (204,274) | |||
Additional paid-in capital | 588,923 | 565,734 | |||
Accumulated other comprehensive income | 11,153 | 17,838 | |||
Retained earnings | 794,003 | 548,652 | |||
Total stockholders' equity | 1,104,093 | 928,998 | |||
Total liabilities and stockholders' equity | $ 2,217,794 | $ 1,981,736 | |||
See accompanying notes to the condensed consolidated financial statements.
3
Quarters Ended September 30, | Nine Months Ended September 30, | ||||||||
---|---|---|---|---|---|---|---|---|---|
2004 | 2003 | 2004 | 2003 | ||||||
Operating revenues: | |||||||||
Managed care premiums | $1,302,053 | $1,126,594 | $3,843,529 | $3,244,884 | |||||
Management services | 27,763 | 23,395 | 84,260 | 66,953 | |||||
Total operating revenues | 1,329,816 | 1,149,989 | 3,927,789 | 3,311,837 | |||||
Operating expenses: | |||||||||
Medical costs | 1,043,317 | 906,756 | 3,096,860 | 2,638,031 | |||||
Selling, general and administrative | 154,034 | 136,859 | 455,705 | 397,579 | |||||
Depreciation and amortization | 4,259 | 4,280 | 12,921 | 13,424 | |||||
Total operating expenses | 1,201,610 | 1,047,895 | 3,565,486 | 3,049,034 | |||||
Operating earnings | 128,206 | 102,094 | 362,303 | 262,803 | |||||
Senior notes interest and amortization expense | 3,572 | 4,126 | 10,719 | 11,470 | |||||
Other income, net | 10,809 | 9,211 | 32,581 | 31,115 | |||||
Earnings before income taxes | 135,443 | 107,179 | 384,165 | 282,448 | |||||
Provision for income taxes | 48,421 | 39,656 | 138,814 | 101,991 | |||||
Net earnings | $ 87,022 | $ 67,523 | $ 245,351 | $ 180,457 | |||||
Net earnings per share: | |||||||||
Basic earnings per share | $ 0.99 | $ 0.76 | $ 2.79 | $ 2.05 | |||||
Diluted earnings per share | $ 0.96 | $ 0.74 | $ 2.71 | $ 1.99 | |||||
Weighted average common shares outstanding: | |||||||||
Basic | 88,344 | 88,595 | 87,954 | 87,824 | |||||
Effect of dilutive options, warrants and restricted stock | 2,309 | 2,635 | 2,573 | 2,617 | |||||
Diluted | 90,653 | 91,230 | 90,527 | 90,441 | |||||
See accompanying notes to the condensed consolidated financial statements.
4
Nine Months Ended September 30, | |||||
---|---|---|---|---|---|
2004 | 2003 | ||||
Net cash from operating activities | $ 347,318 | $ 238,006 | |||
Cash flows from investing activities: | |||||
Capital expenditures, net | (7,812) | (6,921) | |||
Proceeds from sales of investments | 248,296 | 364,493 | |||
Proceeds from maturities of investments | 161,033 | 15,138 | |||
Purchases of investments | (514,489) | (449,069) | |||
Payments for acquisitions, net of cash acquired | (975) | (60,473) | |||
Net cash from investing activities | (113,947) | (136,832) | |||
Cash flows from financing activities: | |||||
Proceeds from issuance of stock | 8,886 | 11,851 | |||
Payments for repurchase of stock | (96,602) | (6,049) | |||
Payments for repurchase of senior notes | -- | (4,916) | |||
Payments for fractional shares from stock split | (133) | -- | |||
Net cash from financing activities | (87,849) | 886 | |||
Net change in cash and cash equivalents | 145,522 | 102,060 | |||
Cash and cash equivalents at beginning of period | 253,331 | 186,768 | |||
Cash and cash equivalents at end of period | $ 398,853 | $ 288,828 | |||
See accompanying notes to the condensed consolidated financial statements.
5
A. BASIS OF PRESENTATION
The condensed consolidated financial statements of Coventry Health Care, Inc. and subsidiaries (Coventry or the Company) contained in this report are unaudited but reflect all normal recurring adjustments which, in the opinion of management, are necessary for the fair presentation of the results of the interim periods reflected. Certain information and footnote disclosures normally included in the consolidated financial statements prepared in accordance with accounting principles generally accepted in the United States have been omitted pursuant to applicable rules and regulations of the Securities and Exchange Commission. The results of operations for the interim periods reported herein are not necessarily indicative of results to be expected for the full year. It is suggested that these condensed consolidated financial statements be read in conjunction with the consolidated financial statements and notes thereto included in the Companys most recent Annual Report on Form 10K for the year ended December 31, 2003.
On December 23, 2003, the Companys Board of Directors approved a threefortwo stock split of the Companys common stock. The stock split, in the form of a stock dividend, was distributed January 30, 2004 to stockholders of record on January 9, 2004. The stock split is reflected retroactively in the Companys condensed consolidated financial statements and notes thereto for all periods presented.
B. SIGNIFICANT ACCOUNTING POLICIES
Stockbased Compensation The Company accounts for stockbased compensation to employees under Accounting Principles Board (APB) No. 25 Accounting for Stock Issued to Employees, and complies with the disclosure requirements for Statement of Financial Accounting Standards (SFAS) No. 123 Accounting for StockBased Compensation and SFAS No. 148 Accounting for StockBased Compensation Transition and Disclosure. Unless the accounting rules change, the Company does not expect to transition to the fair value method of accounting for stockbased compensation. Had stockbased compensation cost been determined consistent with SFAS No. 123, the Companys net earnings and earnings per share (EPS) would have been reduced to the following proforma amounts (in thousands, except per share data):
Quarters Ended September 30, | Nine Months Ended September 30, | ||||||||
---|---|---|---|---|---|---|---|---|---|
2004 | 2003 | 2004 | 2003 | ||||||
Net earnings, as reported | $ 87,022 | $ 67,523 | $ 245,351 | $ 180,457 | |||||
Add: Stock-based employee | |||||||||
compensation expense included in reported | |||||||||
net earnings, net of tax | 2,828 | 1,776 | 6,786 | 4,351 | |||||
Deduct: Total stock-based employee | |||||||||
compensation expense determined | |||||||||
under fair-value-based method for all | |||||||||
awards, net of tax | (5,780) | (3,335) | (12,549) | (7,825) | |||||
Net earnings, pro-forma | $ 84,070 | $ 65,964 | $ 239,588 | $ 176,983 | |||||
EPS, basic - as reported | $ 0.99 | $ 0.76 | $ 2.79 | $ 2.05 | |||||
EPS, basic - pro-forma | $ 0.95 | $ 0.74 | $ 2.72 | $ 2.01 | |||||
EPS, diluted - as reported | $ 0.96 | $ 0.74 | $ 2.71 | $ 1.99 | |||||
EPS, diluted - pro-forma | $ 0.93 | $ 0.72 | $ 2.65 | $ 1.96 | |||||
C. SENIOR NOTES
The Companys senior notes contain certain covenants and restrictions regarding incurring additional debt, limiting dividends or other restricted payments, and restricting transactions with affiliates, sales of assets and consolidations or mergers. The Company has complied with all covenants under the senior notes.
6
D. CONTINGENCIES
In the normal course of business, the Company has been named as a defendant in various legal actions such as actions seeking payments for claims denied by the Company, medical malpractice actions, employment related claims and other various claims seeking monetary damages. The claims are in various stages of proceedings and some may ultimately be brought to trial. Incidents occurring through September 30, 2004 may result in the assertion of additional claims. The Company maintains general liability, professional liability and employment practices liability insurances in amounts that the Company believes are appropriate, with varying deductibles for which the Company maintains reserves. The professional liability and employment practices liability insurances are carried through the Companys captive subsidiary.
The Companys captive subsidiary provides up to $5 million in professional liability coverage for each single claim and up to $10 million in coverage for each class action claim. The captive professional liability policy has an aggregate limit of $20 million per year. The captive is also coinsured with a commercial carrier for an additional $10 million for professional liability claims made and reported prior to May 1, 2004. For claims made and reported after May 1, 2004, the Company has chosen to have no coinsurance coverage with a commercial carrier. Additionally, the captive employment practices liability policy provides up to $250,000 per single claim, $10 million per class action claim, and an aggregate policy limit of $10 million. Each year the Company will reevaluate the most cost effective method for insuring these types of claims.
Coventry Health Care, Inc. is a defendant in the provider track in the Managed Care Litigation filed in the United States District Court for the Southern District of Florida, Miami Division, Multi-District Litigation (MDL) No. 1334, styled in re: Humana, Inc., Charles B. Shane, MD, et al. vs. Humana, Inc., et al. This action was filed by a group of physicians as a class action against Coventry and twelve other companies in the managed care industry. In its fourth amended complaint, the plaintiffs have alleged violations of the federal racketeering act, Racketeer Influenced and Corrupt Organizations (RICO), conspiracy to violate RICO and aiding and abetting a scheme to violate RICO. In addition to these RICO claims, the complaint includes counts for breach of contract, violations of various state prompt payment laws and equitable claims for unjust enrichment and quantum meruit. Coventry has filed a motion to dismiss each of these claims because they fail to state a cause of action or, in the alternative, to compel arbitration pursuant to the arbitration provisions which exist in the Companys physician contracts. In response to the motion to dismiss, the trial court dismissed several of the claims and ordered that all physicians who have an arbitration provision in their provider contracts must submit all of their claims to arbitration. As a consequence of this ruling, all the plaintiffs who have arbitration provisions voluntarily dismissed all of their claims that are subject to arbitration. In response to the trial courts order, the defendants filed demands to arbitrate the plaintiffs arbitrable claims. The trial court, however, in response to a motion filed by the plaintiffs, entered an order enjoining the defendants from arbitrating those claims. The 11th Circuit Court of Appeals overturned the trial courts order and dissolved the injunction barring arbitration of the plaintiffs arbitrable claims. The trial court however has ordered that the plaintiffs claims of conspiracy, conspiracy to violate RICO and aiding and abetting violations of RICO are not subject to arbitration. The defendants, including Coventry, have appealed the trial courts order to the 11th Circuit Court of Appeals. The appeal has been fully briefed and argued and the parties are awaiting the decision. The Court of Appeals has stayed the Shane lawsuit pending its decision. The trial court has certified various subclasses of physicians; however, Coventry is not subject to the class certification order because the motion to certify was filed before Coventry was joined as a defendant. The plaintiffs have now filed a motion to certify a class as to Coventry, and Coventry has filed their opposition to that motion. The trial court has not yet issued a ruling on the motion. The defendants who were subject to the certification order filed an appeal to the 11th Circuit Court of Appeals. The Court of Appeals has overturned the class certification order as to the plaintiffs state law claims but affirmed the certification with respect to the plaintiffs federal law claims. The Court of Appeals also suggested to the trial court that it reconsider the various subclasses it had certified. Two defendants have entered into settlement agreements with the plaintiffs. Both settlement agreements have been filed with the Court and have received final approval. The Shane lawsuit has triggered the filing of copycat class action complaints by other health care providers such as chiropractors, podiatrists, acupuncturists and other licensed health care professionals. Each of these actions has been transferred to the MDL and has been designated as tagalong actions to Shane. The court has entered an order which stays all proceedings in the tagalong actions until all pretrial proceedings in Shane have been concluded. Although the Company can not predict the outcome, management believes that the Shane lawsuit and tagalong actions will not have a material adverse effect on its financial position or its results of operations. Management also believes that the claims asserted against the Company in these lawsuits are without merit, and the Company intends to defend its position.
E. RESTRICTED STOCK AWARDS
The Company awarded 27,000 shares of restricted stock in the third quarter of 2004 and 545,500 during the nine months ended September 30, 2004, of which 518,500 shares are subject to certain performance criteria. The weighted average fair value, at the measurement date, of the restricted stock awards was $53.15. The fair value of the restricted shares is amortized over various vesting periods through September 2008. The Company recorded compensation expense related to restricted stock grants, including restricted stock granted in prior periods of approximately $4.6 million and $2.8 million for the quarters ended September 30, 2004 and 2003, respectively, and $10.9 million and $6.8 million for the nine months ended September 30, 2004 and 2003, respectively. The deferred portion of the restricted stock as reported as a reduction to additional paid in capital is $41.3 million at September 30, 2004 and $23.4 million at December 31, 2003.
7
Under a share repurchase program previously approved by the Board of Directors, the Company purchased 2.0 million shares of the Companys common stock during the nine months ended September 30, 2004 at an aggregate cost of $84.6 million. There were no shares repurchased during the current quarter under this program. The program authorized the repurchase of 9.4 million shares, of which 1.8 million remain still to be repurchased. Excluded from these amounts are shares purchased in exchange for employee payroll taxes on vesting of restricted stock awards as these purchases are not considered part of the program.
G. SEGMENT INFORMATION
The Company evaluates the performance of its operating segments and allocates resources based on gross margin. Assets are not allocated to specific products and, accordingly, can not be reported by segment. The following tables summarize the Companys reportable segments through gross margin and include a medical loss ratio (MLR) calculation:
Quarters Ended September 30, | ||||
---|---|---|---|---|
(in thousands) | ||||
Commercial | Medicare | Medicaid | Total | |
2004 | ||||
Revenues | $1,015,184 | $142,761 | $144,108 | $1,302,053 |
Medical costs | 809,630 | 110,631 | 123,056 | 1,043,317 |
Gross margin | $ 205,554 | $ 32,130 | $ 21,052 | $ 258,736 |
MLR | 79.8% | 77.5% | 85.4% | 80.1% |
2003 | ||||
Revenues | $ 872,056 | $120,794 | $133,744 | $1,126,594 |
Medical costs | 696,467 | 97,238 | 113,051 | 906,756 |
Gross margin | $ 175,589 | $ 23,556 | $ 20,693 | $ 219,838 |
MLR | 79.9% | 80.5% | 84.5% | 80.5% |
Nine Months Ended September 30, | ||||
---|---|---|---|---|
(in thousands) | ||||
Commercial | Medicare | Medicaid | Total | |
2004 | ||||
Revenues | $2,997,397 | $419,189 | $426,943 | $3,843,529 |
Medical costs | 2,378,663 | 348,726 | 369,471 | 3,096,860 |
Gross margin | $ 618,734 | $ 70,463 | $ 57,472 | $ 746,669 |
MLR | 79.4% | 83.2% | 86.5% | 80.6% |
2003 | ||||
Revenues | $2,496,041 | $358,315 | $390,528 | $3,244,884 |
Medical costs | 2,003,630 | 295,258 | 339,143 | 2,638,031 |
Gross margin | $ 492,411 | $ 63,057 | $ 51,385 | $ 606,853 |
MLR | 80.3% | 82.4% | 86.8% | 81.3% |
8
H. COMPREHENSIVE INCOME
Comprehensive income for the quarters and nine months ended September 30, 2004 and 2003 was as follows (in thousands):
Quarters Ended September 30, | Nine Months Ended September 30, | |||
---|---|---|---|---|
2004 | 2003 | 2004 | 2003 | |
Net earnings | $ 87,022 | $ 67,523 | $ 245,351 | $ 180,457 |
Other comprehensive gain: | ||||
Holding gain (loss): | 12,047 | (9,479) | (10,768) | (195) |
Reclassification adjustment | 26 | 102 | (191) | (493) |
Sub-total | 12,073 | (9,377) | (10,959) | (688) |
Tax (provision) benefit | (4,708) | 3,329 | 4,274 | 244 |
Comprehensive income | $ 94,387 | $ 61,475 | $ 238,666 | $ 180,013 |
I. SUBSEQUENT EVENTS
Effective October 1, 2004, the Company completed its purchase of certain assets of OmniCare Health Plan (OmniCare), in Detroit, Michigan. Assets purchased include rights to enroll approximately 63,000 Medicaid risk members. The purchase price will be allocated to identifiable assets based on estimated fair values. The purchase price is based on members that enroll with Coventry as of January 1, 2005. Projected payments are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.
On October 14, 2004, the Company announced that it had signed a definitive agreement to acquire First Health Group Corporation (First Health). First Health is a full service national health benefits services company, headquartered in Downers Grove, Illinois, that serves the group health, workers compensation and state public program markets. Pursuant to the agreement, each outstanding share of First Health common stock will be converted into and represent the right to receive 0.1791 shares of the Companys common stock and $9.375 in cash. Based on the closing price of Coventrys shares on October 13, 2004, the indicated combined per share consideration for each outstanding share of First Health common stock amounts to a total indicated purchase price of approximately $1.8 billion. The agreement has been approved by the Boards of Directors of the Company and First Health. The transaction is expected to close in the first quarter of 2005 and is subject to the approval of a majority of First Healths shareholders, regulatory approvals and other customary conditions.
9
This Form 10Q contains forwardlooking statements which are subject to risks and uncertainties in accordance with the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forwardlooking statements, typically include assumptions, estimates or descriptions of our future plans, strategies and expectations, and are generally identifiable by the use of the words anticipate, will, believe, estimate, expect, intend, seek, or other similar expressions. Examples of these include discussions regarding our operating and growth strategy, projections of revenue, income or loss and future operations. Unless this Form 10Q indicates otherwise or the context otherwise requires, the terms we, our, our Company, the Company or us as used in this Form 10Q refer to Coventry Health Care, Inc. and its subsidiaries.
These forwardlooking statements may be affected by a number of factors, including, but not limited to, the Risk Factors contained in Part II, Item 7, Managements Discussion and Analysis of Financial Condition and Results of Operations of our Annual Report on Form 10K for the year ended December 31, 2003. Actual operations and results may differ materially from those expressed in this Form 10Q.
The following discussion and analysis relates to our financial condition and results of operations for the quarters ended and nine months ended September 30, 2004 and 2003. This discussion should be read in conjunction with the condensed consolidated financial statements and other information presented herein as well as in Managements Discussion and Analysis of Financial Condition and Results of Operations contained in our Annual Report on Form 10K for the year ended December 31, 2003, including the critical accounting policies discussed therein.
Highlights of Third
Quarter 2004 Performance
wMembership increased 4.0% over
the prior year quarter.
wRevenue increased 15.6% over the prior year quarter.
wMedical loss ratio of 80.1%
improved 40 basis points over the prior year quarter.
wSelling, general and administrative expenses were 11.6% of operating revenue, a 30 basis
point improvement over the prior year quarter.
wOperating margin of 9.6% improved
70 basis points over the prior year quarter.
wDiluted earnings per share increased 29.7%
over the prior year quarter.
On December 23, 2003, our Board of Directors approved a threefortwo stock split of our common stock, effective January 30, 2004 for stockholders of record on January 9, 2004. The stock split is reflected retroactively in per share data for all periods presented.
Effective October 1, 2004, we completed our purchase of certain assets of OmniCare Health Plan (OmniCare), in Detroit, Michigan. Assets purchased include rights to enroll approximately 63,000 Medicaid risk members. The purchase price will be allocated to identifiable assets based on estimated fair values. The purchase price is based on members that enroll with us through January 1, 2005. Projected payments are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.
On October 14, 2004, we announced that we had signed a definitive agreement to acquire First Health Group Corporation (First Health). First Health is a full service national health benefits services company, headquartered in Downers Grove, Illinois, that serves the group health, workers compensation and state public program markets. Pursuant to the agreement, each outstanding share of First Health common stock will be converted into and represent the right to receive 0.1791 shares of the Companys common stock and $9.375 in cash. Based on the closing price of the Companys shares on October 13, 2004, the indicated combined per share consideration for each outstanding share of First Health common stock amounts to a total indicated purchase price of approximately $1.8 billion. The agreement has been approved by our Board of Directors and the Board of Directors of First Health. The transaction is expected to close in the first quarter of 2005 and is subject to the approval of a majority of First Healths shareholders, regulatory approvals and other customary conditions.
10
The following tables present our membership as of September 30, 2004 and 2003 (amounts in thousands).
September 30, 2004 | ||||||
---|---|---|---|---|---|---|
Market |
Commercial |
Medicare |
Medicaid |
Total Risk |
NonRisk |
Total |
Delaware | 50 | -- | 2 | 52 | 51 | 103 |
Georgia | 40 | -- | -- | 40 | 36 | 76 |
Illinois | 74 | -- | -- | 74 | 13 | 87 |
Iowa | 49 | -- | 5 | 54 | 12 | 66 |
Kansas | 148 | 14 | -- | 162 | 48 | 210 |
Louisiana | 73 | -- | -- | 73 | 3 | 76 |
Missouri | 196 | 18 | 185 | 399 | 96 | 495 |
Nebraska | 45 | -- | -- | 45 | 5 | 50 |
North Carolina | 68 | -- | 12 | 80 | 40 | 120 |
Pennsylvania | 467 | 33 | 94 | 594 | 142 | 736 |
Utah | 119 | -- | -- | 119 | 65 | 184 |
Virginia | 108 | -- | 15 | 123 | 43 | 166 |
West Virginia | 50 | 3 | 20 | 73 | 4 | 77 |
Total | 1,487 | 68 | 333 | 1,888 | 558 | 2,446 |
September 30, 2003 | ||||||
---|---|---|---|---|---|---|
Market |
Commercial |
Medicare |
Medicaid |
Total Risk |
NonRisk |
Total |
Delaware | 50 | -- | -- | 50 | 51 | 101 |
Georgia | 46 | -- | -- | 46 | 31 | 77 |
Illinois | 75 | -- | -- | 75 | -- | 75 |
Iowa | 76 | -- | 3 | 79 | 15 | 94 |
Kansas | 163 | 15 | -- | 178 | 52 | 230 |
Louisiana | 73 | -- | -- | 73 | -- | 73 |
Missouri | 173 | 16 | 187 | 376 | 85 | 461 |
Nebraska | 41 | -- | -- | 41 | 6 | 47 |
North Carolina | 66 | -- | 12 | 78 | 40 | 118 |
Pennsylvania | 455 | 30 | 83 | 568 | 112 | 680 |
Utah | 117 | -- | -- | 117 | 51 | 168 |
Virginia | 100 | -- | 14 | 114 | 40 | 154 |
West Virginia | 51 | 3 | 16 | 70 | 5 | 75 |
Total | 1,486 | 64 | 315 | 1,865 | 488 | 2,353 |
11
Total membership, excluding network rental membership of 574,000, increased by 4% from the prior year third quarter. Nonrisk membership increased 15% from the prior year third quarter. The large increase in nonrisk membership was influenced by three large groups changing from a risk product to a nonrisk product effective January 1, 2004. We expect organic membership growth to be 3-5% for the full year.
Network rental membership has declined from the prior year quarter of 719,000 due primarily to one group. The revenue associated with this group was insignificant.
In January 2005, we expect to lose a large insured account of approximately 25,000 members to an administrative services only (ASO) bid and a large existing ASO account of approximately 20,000 members to another third party administrator. Because of the loss of this membership, we expect that organic growth is likely to be negative in January but net positive for all of 2005.
12
The following table is provided to facilitate a more meaningful discussion regarding the comparison of our operations for the quarters and nine months ended September 30, 2004 and 2003.
Quarters Ended September 30, |
Increase | Nine Months Ended September 30, |
Increase | |||
---|---|---|---|---|---|---|
2004 |
2003 |
(Decrease) |
2004 |
2003 |
(Decrease) | |
Summary Results (in thousands, except EPS) | ||||||
Total operating revenues | $1,329,816 | $1,149,989 | 15.6% | $3,927,789 | $3,311,837 | 18.6% |
Operating earnings | $ 128,206 | $ 102,094 | 25.6% | $ 362,303 | $ 262,803 | 37.9% |
Net earnings | $ 87,022 | $ 67,523 | 28.9% | $ 245,351 | $ 180,457 | 36.0% |
Diluted earnings per share | $ 0.96 | $ 0.74 | 29.7% | $ 2.71 | $ 1.99 | 36.2% |
Managed Care Premium Yields (per member per month): | ||||||
Commercial | $ 228.36 | $ 208.30 | 9.6% | $ 225.00 | $ 204.73 | 9.9% |
Medicare | $ 698.82 | $ 630.56 | 10.8% | $ 691.96 | $ 628.61 | 10.1% |
Medicaid | $ 143.87 | $ 141.33 | 1.8% | $ 141.99 | $ 140.24 | 1.2% |
Medical Costs (per member per month): | ||||||
Commercial | $ 182.12 | $ 166.36 | 9.5% | $ 178.56 | $ 164.34 | 8.7% |
Medicare | $ 541.55 | $ 507.59 | 6.7% | $ 575.65 | $ 517.98 | 11.1% |
Medicaid | $ 122.86 | $ 119.46 | 2.8% | $ 122.88 | $ 121.78 | 0.9% |
Medical Loss Ratios: | ||||||
Commercial | 79.8% | 79.9% | (0.1%) | 79.4% | 80.3% | (0.9%) |
Medicare | 77.5% | 80.5% | (3.0%) | 83.2% | 82.4% | 0.8% |
Medicaid | 85.4% | 84.5% | 0.9% | 86.5% | 86.8% | (0.3%) |
Total | 80.1% | 80.5% | (0.4%) | 80.6% | 81.3% | (0.7%) |
Administrative Statistics: | ||||||
Selling, general and administrative as a percentage of revenue | 11.6% | 11.9% | (0.3%) | 11.6% | 12.0% | (0.4%) |
Days in medical claims liabilities | 52.7 | 55.8 | (3.1) | |||
Days in other medical liabilities | 4.3 | 6.1 | (1.8) |
Managed care premium revenue increased as a result of rate increases that occurred throughout all markets, acquisitions and organic growth. We achieved commercial rate increases in excess of 11.5% on third quarter renewals representing approximately 18% of commercial risk membership. As noted above, the commercial yield PMPM increased 9.6%, but excluding the Altius acquisition the increase was 11.1%. Medicare yields increased as a result of the rate increases from the annual Adjusted Community Rating filings and as a result of the Medicare Modernization Act. The rate increases from the Medicare Modernization Act were for enhanced member benefits and/or network access and thus will not affect profitability. The acquisition of Altius effective September 1, 2003 resulted in an increase in managed care premium revenue of $43.6 million over the prior year quarter.
Management services revenue increased due to the increase in nonrisk membership discussed earlier.
Medical costs expense has increased due to medical trend, organic growth and acquisitions. However, total medical expense as a percentage of premium revenue has improved by 0.4% over the prior year quarter. This favorable change was attributable to both our Medicare and commercial business. The unusually strong Medicare results were due to lower in-patient days in some of our markets and improved revenue beginning in July due to favorable changes to our risk adjusters. This business is relatively small and normal fluctuations can occur routinely. The favorable commercial results are a result of premium rate increases mentioned above outpacing commercial medical trend. Reported commercial medical trend, excluding Altius and net of benefit buy downs, was 11.0%. The Medicaid medical loss ratio deteriorated over the prior year quarter as a result of increased utilization in Missouri, our largest Medicaid market. Days in total medical claims liabilities decreased from the prior year quarter due primarily to faster claim receipts and continually improved processing cycle times.
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Selling, general and administrative expense increased primarily due to normal operating costs of recent acquisitions, an increase in broker commissions and an increase in salary expenses. Broker commissions, excluding acquisitions, have increased due to the growth in both organic membership and in premium rates. Salary expenses, excluding acquisitions, have increased due to annual salary increases, additional amortization expense related to restricted shares of common stock granted in 2003 and 2004, and incremental salary expense related to our organic membership growth. Selling, general and administrative expense as a percentage of revenue has improved as a result of continuing revenue growth and success in controlling customer service costs.
Our provision for income taxes increased primarily due to an increase in earnings. The effective tax rate decreased to 35.8% in the third quarter of 2004 from 37.0% in 2003. We expect a full year 2004 tax rate between 35.8% and 36.2%.
Managed care premium revenue increased as a result of rate increases that occurred throughout all markets, acquisitions and organic growth. Medicare yields increased 10.1% on a PMPM basis as a result of the rate increases from the annual Adjusted Community Rating filings and as a result of the Medicare Modernization Act. The rate increases from the Medicare Modernization Act were for enhanced member benefits and/or network access and thus will not affect profitability. The acquisition of Altius effective September 1, 2003 resulted in an increase in managed care premium revenue of $165.0 million over the prior year nine months.
Management services revenue increased due to the increase in nonrisk membership discussed earlier.
Medical costs expense has increased due to medical trend, acquisitions and organic growth. However, total medical expense as a percentage of premium revenue has improved by 0.7% over the prior year nine months. This favorable change was attributable mostly to our commercial business and is a result of the commercial premium rate increases mentioned above outpacing commercial medical trend. Reported commercial medical trend, excluding Altius and net of benefit buy downs, was 10.2%. Our Medicare business medical loss ratio deteriorated compared to the prior year nine months as a result of unusually high medical utilization in the first quarter of 2004. The deterioration was partially offset by the increase in premium yields discussed above. Our Medicaid medical loss ratio improved as a result of rate increases across our markets and as a result of much improved performance in our Virginia market. The Virginia market benefited from lower utilization, lower drug costs and favorable provider contract renegotiations.
Selling, general and administrative expense increased primarily due to normal operating costs of recent acquisitions, an increase in broker commissions and an increase in salary expenses. Broker commissions, excluding acquisitions, have increased due to the growth in both organic membership and in premium rates. Salary expenses, excluding acquisitions, have increased due to annual salary increases, additional amortization expense related to restricted shares of common stock granted in 2003 and 2004, and incremental salary expense related to our organic membership growth. Selling, general and administrative expenses as a percentage of revenue have improved as a result of continuing revenue growth and success in controlling customer service costs.
Our provision for income taxes increased due to an increase in earnings. The effective tax rate remained flat at 36.1%.
Consolidated
Our total cash and investments, consisting of cash and cash equivalents and shortterm and longterm investments, but excluding deposits of $23.2 million restricted under state regulations, increased $229.2 million to $1.6 billion at September 30, 2004 from December 31, 2003.
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We have classified all of our investments as availableforsale. Our investments at September 30, 2004 mature according to their contractual terms, as follows, in thousands (actual maturities may differ because of call or prepayment rights):
Amortized Cost |
Fair Value | |
---|---|---|
As of September 30, 2004 | ||
Maturities: | ||
Within 1 year | $ 347,005 | $ 347,167 |
1 to 5 years | 473,007 | 480,815 |
5 to 10 years | 248,960 | 255,691 |
Over 10 years | 148,984 | 152,567 |
Total shortterm and longterm securities | $1,217,956 | $1,236,240 |
Net cash from operating activities is primarily driven by net earnings and an increase in certain liabilities. The medical claims liabilities increased during the nine months ended September 30, 2004 due to claim inventories being unusually low at December 31, 2003. Additionally, accounts payable and other accrued liabilities for the nine months increased primarily as a result of tax payments being less than the tax provision. Cash flow from operating activities has improved over the prior year quarter primarily as a result of higher earnings and a larger increase in medical claims liabilities during the nine months ended September 30, 2004 than over the same period of 2003.
Net cash from financing activities decreased from the prior year nine months due primarily to cash paid for the repurchase of stock during the first quarter of 2004. The stock was repurchased under a share repurchase program previously approved by our Board of Directors. The program authorized 9.4 million shares to be repurchased and the total remaining common shares we are authorized to repurchase under this program is 1.8 million.
Projected cash payments for the OmniCare purchase are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.
Projected capital investments in 2004 of approximately $10 million consist primarily of computer hardware, software and related equipment costs associated with the development and implementation of improved operational and communication systems.
Our senior notes contain certain covenants and restrictions regarding incurring additional debt, limiting dividends or other restricted payments, and restricting transactions with affiliates, sales of assets and consolidations or mergers. We have complied with all covenants under the senior notes.
Our investment guidelines emphasize investment grade fixed income instruments in order to provide liquidity to meet future payment obligations and minimize the risk to the principal. The fixed income portfolio includes government and corporate securities with an average quality rating of AAA and an average contractual duration of 2.6 years, as of September 30, 2004. We will continue to fund our working capital requirements from our cash flow from operations. We believe that because our longterm investments are availableforsale, the amount of such investments should be considered when assessing our liquidity. On such basis, current assets plus longterm investments availableforsale less current liabilities increased to $906.1 million at September 30, 2004 from $730.5 million at December 31, 2003.
Health Plans
Our regulated HMO and insurance company subsidiaries are required by state regulatory agencies to maintain minimum surplus balances, thereby limiting the dividends the parent may receive from its regulated entities. During the nine months ended September 30, 2004, we collected $158.6 million in dividends and $12.6 million for note repayments from our regulated subsidiaries.
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The majority of states in which we operate health plans have adopted a riskbased capital (RBC) policy that recommends the health plans maintain statutory reserves at or above the Company Action Level which is currently equal to 200% of their RBC. We have adopted an internal policy to maintain all of our regulated subsidiaries statutory capital and surplus at or above 250% of their RBC and a level of 300% in aggregate (referred to below as 300% of RBC). Some states in which our regulated subsidiaries operate, require deposits to be maintained with the respective states departments of insurance. The table below summarizes our statutory reserve information, as of September 30, 2004 and December 31, 2003 (in millions, except percentage data). The RBC threshold for September 30, 2004 has been estimated as we are not required to update this calculation except on an annual basis. This calculation was based on December 31, 2003 data and when it is recalculated at December 31, 2004 it is likely to increase.
September 30, 2004 |
December 31 2003 | |
---|---|---|
Regulated Capital and surplus | $617.6(a) | $588.6 |
300% of RBC | 449.4 | 449.4 |
Excess capital and surplus above 300% of RBC | 168.2 | 139.2 |
Capital and surplus as a percentage of RBC | 412% | 393% |
Statutory deposits | 23.2 | 23.2 |
(a) estimated |
The increase in capital and surplus for our regulated subsidiaries is a result of income from 2004 offset by dividends paid to the parent company.
Excluding funds held by entities subject to regulation, we had cash and investments of approximately $339.7 million and $209.5 million at September 30, 2004 and December 31, 2003, respectively. The increase in nonregulated cash and investments is primarily a result of dividends received from our regulated subsidiaries, as mentioned above, and ordinary operating activities offset by stock repurchases made during the first quarter. During the nine months ended September 30, 2004, we made a capital contribution of $15 million to our newly formed Michigan subsidiary to meet statutory capital requirements.
Other
The United States Department of Health and Human Services has issued rules, as mandated by the Health Insurance Portability and Accountability Act of 1996, which, among other things, impose security and privacy requirements with respect to individually identifiable patient data, including a members transactions with health care providers and payors, as well as requirements for the standardization of certain electronic transaction code sets and provider identifiers. We anticipate spending approximately $2.0 million in 2004, of which approximately $1.0 million will be capitalized, related to improved functionality of our electronic transaction code sets, improved provider identifier standards, and improved security and patient information privacy standards.
Management believes that the combination of our ability to generate cash flows from operations, cash and investments on hand and the excess funds held in certain of our regulated subsidiaries will be sufficient to fund continuing operations, capital expenditures, debt interest costs and any other reasonably likely future cash requirements.
Share Repurchase Program
Under a share repurchase program previously approved by the Board of Directors, we purchased 2.0 million shares of our common stock during the nine months ended September 30, 2004 at an aggregate cost of $84.6 million. There were no shares purchased during the current quarter under this program. The program authorized 9.4 million shares to be repurchased and the total remaining common shares we are authorized to repurchase under this program is 1.8 million. Excluded from these amounts are shares purchased in exchange for employee payroll taxes on vesting of restricted stock awards as these purchases are not part of the program.
Legal Proceedings
Refer to Part II, Item 1, Legal Proceedings.
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These disclosures should be read in conjunction with the condensed consolidated financial statements, Managements Discussion and Analysis of Financial Condition and Results of Operations, and other information presented herein as well as in Quantitative and Qualitative Disclosures of Market Risk contained in our Annual Report on Form 10K for the year ended December 31, 2003.
No material changes have occurred in our exposures to market risk since the date of our Annual Report on Form 10K for the fiscal year ended December 31, 2003.
Our projections of hypothetical net losses in fair value of our market rate sensitive instruments, should potential changes in market rates occur, are presented below. The projection is based on a model, which incorporates effective duration, convexity and price to forecast hypothetical instantaneous changes in interest rates of positive and negative 100, 200 and 300 basis points. The model only takes into account the fixed income securities in the portfolio and excludes all cash. While we believe that the potential market rate change is reasonably possible, actual results may differ.
Increase (decrease) in fair value of portfolio given an interest rate (decrease) increase of X basis points As of September 30, 2004 (in thousands) | |||||
---|---|---|---|---|---|
(300) | (200) | (100) | 100 | 200 | 300 |
$ 97,308 | $ 63,515 | $ 31,417 | $ (31,325) | $ (62,108) | $ (91,874) |
We have performed an evaluation as of the end of the period covered by this report of the effectiveness of our disclosure controls and procedures (as defined in Rule 13a15(e) promulgated under the Securities Exchange Act of 1934), under the supervision and with the participation of our Chief Executive Officer and Chief Financial Officer. Based upon our evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective.
There have been no significant changes in our internal control over financial reporting during the quarter ended September 30, 2004 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
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In the normal course of business, we have been named as a defendant in various legal actions such as actions seeking payments for claims denied by the Company, medical malpractice actions, employment related claims and other various claims seeking monetary damages. The claims are in various stages of proceedings and some may ultimately be brought to trial. Incidents occurring through September 30, 2004 may result in the assertion of additional claims. We maintain general liability, professional liability and employment practices liability insurances in amounts that we believe are appropriate, with varying deductibles for which we maintain reserves. The professional liability and employment practices liability insurances are carried through our captive subsidiary.
Our captive subsidiary provides up to $5 million in professional liability coverage for each single claim and up to $10 million in coverage for each class action claim. The captive professional liability policy has an aggregate limit of $20 million per year. The captive is also coinsured with a commercial carrier for an additional $10 million for professional liability claims made and reported prior to May 1, 2004. For claims made and reported after May 1, 2004, the Company has chosen to have no coinsurance coverage with a commercial carrier. Additionally, the captive employment practices liability policy provides up to $250,000 per single claim, $10 million per class action claim, and an aggregate policy limit of $10 million. Each year we will reevaluate the most cost effective method for insuring these types of claims.
We are a defendant in the provider track in the Managed Care Litigation filed in the United States District Court for the Southern District of Florida, Miami Division, Multi-District Litigation (MDL) No. 1334, styled in re: Humana, Inc., Charles B. Shane, MD, et al. vs. Humana, Inc., et al. This action was filed by a group of physicians as a class action against Coventry and twelve other companies in the managed care industry. In its fourth amended complaint, the plaintiffs have alleged violations of the federal racketeering act, Racketeer Influenced and Corrupt Organizations (RICO), conspiracy to violate RICO and aiding and abetting a scheme to violate RICO. In addition to these RICO claims, the complaint includes counts for breach of contract, violations of various state prompt payment laws and equitable claims for unjust enrichment and quantum meruit. We have filed a motion to dismiss each of these claims because they fail to state a cause of action or, in the alternative, to compel arbitration pursuant to the arbitration provisions which exist in our physician contracts. In response to the motion to dismiss, the trial court dismissed several of the claims and ordered that all physicians who have an arbitration provision in their provider contracts must submit all of their claims to arbitration. As a consequence of this ruling, all the plaintiffs who have arbitration provisions voluntarily dismissed all of their claims that are subject to arbitration. In response to the trial courts order, the defendants filed demands to arbitrate the plaintiffs arbitrable claims. The trial court, however, in response to a motion filed by the plaintiffs, entered an order enjoining the defendants from arbitrating those claims. The 11th Circuit Court of Appeals overturned the trial courts order and dissolved the injunction barring arbitration of the plaintiffs arbitrable claims. The trial court however has ordered that the plaintiffs claims of conspiracy, conspiracy to violate RICO and aiding and abetting violations of RICO are not subject to arbitration. The defendants, including Coventry, have appealed the trial courts order to the 11th Circuit Court of Appeals. The appeal has been fully briefed and argued and the parties are awaiting the decision. The Court of Appeals has stayed the Shane lawsuit pending its decision. The trial court has certified various subclasses of physicians; however, we are not subject to the class certification order because the motion to certify was filed before we were joined as a defendant. The plaintiffs have now filed a motion to certify a class as to Coventry, and we have filed their opposition to that motion. The trial court has not yet issued a ruling on the motion. The defendants who were subject to the certification order filed an appeal to the 11th Circuit Court of Appeals. The Court of Appeals has overturned the class certification order as to the plaintiffs state law claims but affirmed the certification with respect to the plaintiffs federal law claims. The Court of Appeals also suggested to the trial court that it reconsider the various subclasses it had certified. Two defendants have entered into settlement agreements with the plaintiffs. Both settlement agreements have been filed with the Court and have received final approval. The Shane lawsuit has triggered the filing of copycat class action complaints by other health care providers such as chiropractors, podiatrists, acupuncturists and other licensed health care professionals. Each of these actions has been transferred to the MDL and has been designated as tagalong actions to Shane. The court has entered an order which stays all proceedings in the tagalong actions until all pretrial proceedings in Shane have been concluded. Although we can not predict the outcome, management believes that the Shane lawsuit and tagalong actions will not have a material adverse effect on its financial position or its results of operations. Management also believes that the claims asserted against us in these lawsuits are without merit, and we intend to defend our position.
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The following table shows our purchases of our common stock during the quarter ended September 30, 2004 (in thousands, except per share information).
Total Number of Shares Purchased(1) |
Average Price Paid per Share |
Total Number of Shares Purchased as Part of Publicly Announced Plans |
Maximum Number
of Shares That May Yet be Purchased Under the Plan or Program(2) | |
---|---|---|---|---|
July 131, 2004 | 100 | $ 47.72 | -- | 1,756 |
August 131, 2004 | 5 | $ 50.81 | -- | 1,756 |
September 130, 2004 | -- | $ 51.76 | -- | 1,756 |
Totals | 105 | $ 50.10 | -- | 1,756 |
(1) | These shares were purchased in exchange for employee payroll taxes on vesting of restricted stock awards and are not part of the publicly announced program. |
|
(2) | These shares are under a program previously announced on December 20, 1999, as amended. The program authorized 9.4 million shares to be repurchased and does not have an expiration date. |
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Exhibit No. |
Description of Exhibit | |
---|---|---|
31.1 | Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the SarbanesOxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director. | |
31.2 | Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the SarbanesOxley Act of 2002 made by Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer. | |
32.1 | Certification pursuant to 18 U.S.C. section 1350 as adopted pursuant to section 906 of the SarbanesOxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director and Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer. |
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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.
COVENTRY HEALTH CARE, INC. | ||
(Registrant) | ||
Date: November 8, 2004 | By: /s/ Allen F. Wise | |
Allen F. Wise | ||
President, Chief Executive Officer and Director | ||
Date: November 8, 2004 | By: /s/ Dale B. Wolf | |
Dale B. Wolf | ||
Executive Vice President, Chief Financial Officer and Treasurer | ||
Date: November 8, 2004 | By: /s/ John J. Ruhlmann | |
John J. Ruhlmann | ||
Vice President and Controller |
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Exhibit No. |
Description of Exhibit | |
---|---|---|
31.1 | Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the SarbanesOxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director. | |
31.2 | Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the SarbanesOxley Act of 2002 made by Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer. | |
32.1 | Certification pursuant to 18 U.S.C. section 1350 as adopted pursuant to section 906 of the SarbanesOxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director and Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer. |
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