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UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 


 

FORM 10-Q

 


 

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

 

For the quarterly period ended March 31, 2005

 

OR

 

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

 

For the transition period from              to             

 

Commission file number 1-5975

 


 

HUMANA INC.

(Exact name of registrant as specified in its charter)

 


 

Delaware   61-0647538

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification Number)

 

500 West Main Street

Louisville, Kentucky 40202

(Address of principal executive offices, including zip code)

 

(502) 580-1000

(Registrant’s telephone number, including area code)

 


 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15 (d) of the Securities Exchange Act of 1934 during the preceding 12 months, and (2) has been subject to such filing requirements for the past 90 days.    Yes  x    No  ¨

 

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

 

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

 

Class of Common Stock


 

Outstanding at

April 30, 2005


$0.16 2/3 par value

  161,839,236 shares

 



Table of Contents

Humana Inc.

FORM 10-Q

MARCH 31, 2005

 

INDEX

 

          Page

Part I: Financial Information     
Item 1.    Financial Statements     
     Condensed Consolidated Balance Sheets at March 31, 2005 and December 31, 2004    3
     Condensed Consolidated Statements of Income for the three months ended March 31, 2005 and 2004    4
     Condensed Consolidated Statements of Cash Flows for the three months ended March 31, 2005 and 2004    5
     Notes to Condensed Consolidated Financial Statements    6
Item 2.    Management’s Discussion and Analysis of Financial Condition and Results of Operations    17
Item 3.    Quantitative and Qualitative Disclosures about Market Risk    35
Item 4.    Controls and Procedures    35
Part II: Other Information     
Item 1.    Legal Proceedings    36
Item 2.    Changes in Securities, Use of Proceeds and Issuer Purchases of Equity Securities    36
Item 4.    Submission of Matters to a Vote of Security Holders    36

Item 5.

   Other Information    36
Item 6.    Exhibits    36
     Signatures and Certifications    38

 

2


Table of Contents

Humana Inc.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

 

     March 31,
2005


   

December 31,

2004


 
    

(in thousands, except

share amounts)

 
ASSETS                 

Current assets:

                

Cash and cash equivalents

   $ 560,264     $ 580,079  

Investment securities

     2,136,841       2,145,645  

Receivables, less allowance for doubtful accounts of $37,215 in 2005 and $34,506 in 2004:

                

Premiums

     568,184       554,661  

Administrative services fees

     20,145       24,954  

Securities lending collateral

     126,678       77,840  

Other

     226,339       212,958  
    


 


Total current assets

     3,638,451       3,596,137  
    


 


Property and equipment, net

     428,890       399,506  

Other assets:

                

Long-term investment securities

     345,692       348,465  

Goodwill

     1,244,370       885,572  

Other

     492,190       427,937  
    


 


Total other assets

     2,082,252       1,661,974  
    


 


Total assets

   $ 6,149,593     $ 5,657,617  
    


 


LIABILITIES AND STOCKHOLDERS’ EQUITY                 

Current liabilities:

                

Medical and other expenses payable

   $ 1,546,050     $ 1,422,010  

Trade accounts payable and accrued expenses

     395,498       488,332  

Book overdraft

     192,741       192,060  

Securities lending payable

     126,678       77,840  

Unearned revenues

     143,683       146,326  
    


 


Total current liabilities

     2,404,650       2,326,568  

Long-term debt

     885,271       636,696  

Other long-term liabilities

     659,867       604,229  
    


 


Total liabilities

     3,949,788       3,567,493  
    


 


Commitments and contingencies

                

Stockholders’ equity:

                

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

     —         —    

Common stock, $0.16 2/3 par; 300,000,000 shares authorized; 177,556,156 shares
issued at March 31, 2005 and 176,044,649 shares issued at December 31, 2004

     29,592       29,340  

Capital in excess of par value

     1,055,491       1,017,156  

Retained earnings

     1,339,618       1,229,823  

Accumulated other comprehensive (loss) income

     (5,648 )     16,526  

Unearned stock compensation

     (16,872 )     (1,721 )

Treasury stock, at cost, 15,824,092 shares at March 31, 2005 and 15,778,088 shares
at December 31, 2004

     (202,376 )     (201,000 )
    


 


Total stockholders’ equity

     2,199,805       2,090,124  
    


 


Total liabilities and stockholders’ equity

   $ 6,149,593     $ 5,657,617  
    


 


 

See accompanying notes to condensed consolidated financial statements.

 

3


Table of Contents

Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(Unaudited)

 

     For the three months ended
March 31,


     2005

   2004

    

(in thousands, except per

share results)

Revenues:

             

Premiums

   $ 3,290,815    $ 3,179,181

Administrative services fees

     61,735      78,237

Investment and other income

     34,675      29,531
    

  

Total revenues

     3,387,225      3,286,949
    

  

Operating expenses:

             

Medical

     2,753,733      2,683,516

Selling, general and administrative

     474,033      469,629

Depreciation and amortization

     29,249      26,312
    

  

Total operating expenses

     3,257,015      3,179,457
    

  

Income from operations

     130,210      107,492

Interest expense

     8,523      4,719
    

  

Income before income taxes

     121,687      102,773

Provision for income taxes

     11,892      34,943
    

  

Net income

   $ 109,795    $ 67,830
    

  

Basic earnings per common share

   $ 0.68    $ 0.42
    

  

Diluted earnings per common share

   $ 0.67    $ 0.41
    

  

 

See accompanying notes to condensed consolidated financial statements.

 

 

4


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Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

 

     For the three months ended
March 31,


 
     2005

    2004

 
     (in thousands)  

Cash flows from operating activities

                

Net income

   $ 109,795     $ 67,830  

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

                

Depreciation and amortization

     29,249       26,312  

Provision for deferred income taxes

     7,255       12,223  

Changes in operating assets and liabilities, net of effect of business acquired:

                

Receivables

     (6,425 )     (20,546 )

Other assets

     (8,360 )     (15,472 )

Medical and other expenses payable

     86,665       124,628  

Other liabilities

     (97,548 )     (32,431 )

Unearned revenues

     (22,416 )     (201,699 )

Other, net

     1,013       (900 )
    


 


Net cash provided by (used in) operating activities

     99,228       (40,055 )
    


 


Cash flows from investing activities

                

Acquisitions, net of cash acquired

     (348,099 )     —    

Purchases of property and equipment

     (36,193 )     (22,732 )

Proceeds from sales of property and equipment

     8       19,385  

Purchases of investment securities

     (714,371 )     (1,491,272 )

Maturities of investment securities

     261,665       246,845  

Proceeds from sales of investment securities

     434,506       786,868  

Change in securities lending collateral

     (48,838 )     (15,222 )
    


 


Net cash used in investing activities

     (451,322 )     (476,128 )
    


 


Cash flows from financing activities

                

Borrowings under credit agreement

     294,000       —    

Repayments under credit agreement

     (25,000 )     —    

Change in securities lending payable

     48,838       15,222  

Common stock repurchases

     (1,376 )     (12,836 )

Change in book overdraft

     681       (8,617 )

Proceeds from stock option exercises and other

     15,136       8,657  
    


 


Net cash provided by financing activities

     332,279       2,426  
    


 


Decrease in cash and cash equivalents

     (19,815 )     (513,757 )

Cash and cash equivalents at beginning of period

     580,079       931,404  
    


 


Cash and cash equivalents at end of period

   $ 560,264     $ 417,647  
    


 


Supplemental cash flow disclosures:

                

Interest payments

   $ 10,277     $ 6,581  

Income tax payments, net

   $ 25,831     $ 4,353  

 

See accompanying notes to condensed consolidated financial statements.

 

 

5


Table of Contents

Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

Unaudited

 

(1) Basis of Presentation

 

The accompanying condensed consolidated financial statements are presented in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the disclosures normally required by accounting principles generally accepted in the United States of America, or those normally made in an Annual Report on Form 10-K. References throughout this document to “we,” “us,” “our,” the “Company,” and “Humana,” mean Humana Inc. and all entities we own. For further information, the reader of this Form 10-Q should refer to our Form 10-K for the year ended December 31, 2004, that was filed with the Securities and Exchange Commission, or the SEC, on March 2, 2005.

 

The preparation of our condensed consolidated financial statements, in conformity with accounting principles generally accepted in the United States of America, requires us to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. The areas involving the most significant use of estimates are the estimation of medical expenses payable, the recognition of revenue related to our TRICARE contract, the valuation and related impairment recognition of investment securities, and the valuation and related impairment recognition of long-lived assets, including goodwill. Although our estimates are based on knowledge of current events and anticipated future events, actual results may ultimately differ materially from those estimates. Refer to “Critical Accounting Policies and Estimates” in Humana’s 2004 Annual Report on Form 10-K for information on accounting policies that the Company considers critical in preparing its Consolidated Financial Statements.

 

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

 

(2) Significant Accounting Policies

 

Stock-Based Compensation

 

We have stock-based employee compensation plans, which are described more fully in Note 11 to the consolidated financial statements in Humana’s 2004 Annual Report on Form 10-K. We account for stock options granted to our employees under Accounting Principles Board Opinion No. 25, Accounting for Stock Issued to Employees and related interpretations, or APB No. 25. No employee compensation cost is reflected in net income related to fixed-based stock option awards because these options had an exercise price equal to the market value of the underlying common stock on the date of grant. Generally, if a fixed-based stock option award is subsequently modified, compensation expense, if any, is recorded for the amount that the market price of Humana common stock exceeds the option’s exercise price on the date the option is modified. Compensation expense for performance-based stock options is recognized over the performance period varying based on the market value of the underlying common stock at the end of each period. Compensation expense is recorded for restricted stock grants over their vesting periods based on fair value, which is equal to the market price of Humana common stock on the date of the grant.

 

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

The effect on net income and earnings per share if we had applied the fair value recognition provisions of Statement of Financial Accounting Standards No. 123, Accounting for Stock-Based Compensation, to our fixed-based stock option awards using the Black-Scholes pricing model was as follows for the three months ended March 31, 2005 and 2004.

 

     2005

    2004

 
    

(in thousands, except
per share results)

 

 

Net income, as reported

   $ 109,795     $ 67,830  

Add: Stock-based employee compensation expense included in reported net income, net of related tax

     1,048       782  

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

     (4,108 )     (2,832 )
    


 


Adjusted net income

   $ 106,735     $ 65,780  
    


 


Earnings per share:

                

Basic, as reported

   $ 0.68     $ 0.42  
    


 


Basic, pro forma

   $ 0.66     $ 0.41  
    


 


Diluted, as reported

   $ 0.67     $ 0.41  
    


 


Diluted, pro forma

   $ 0.65     $ 0.40  
    


 


 

Recently Issued Accounting Pronouncements

 

In December 2004, the FASB issued Statement No. 123R, Share-Based Payment, or Statement 123R, which requires companies to expense the fair value of employee stock options and other forms of stock-based compensation. This requirement represents a significant change because fixed-based stock option awards, a predominate form of stock compensation for us, were not recognized as compensation expense under APB 25. Statement 123R requires the cost of the award, as determined on the date of grant at fair value, be recognized over the period during which an employee is required to provide service in exchange for the award (usually the vesting period). The grant-date fair value of the award will be estimated using option-pricing models. We are required to adopt Statement 123R beginning January 1, 2006 under either a prospective or retrospective approach. The effect of expensing stock options under a fair value approach using the Black-Scholes pricing model for the three months ended March 31, 2005 and 2004 is disclosed above. We currently are evaluating all of the provisions of Statement 123R and the expected effect on us including, among other items, selecting an option pricing model and determining the transition method.

 

In March 2004, the FASB issued EITF Issue No. 03-1, or EITF 03-1, The Meaning of Other-Than-Temporary Impairment and its Application to Certain Investments. EITF 03-1 includes new guidance for evaluating and recording impairment losses on certain debt and equity investments when the fair value of the investment security is less than its carrying value. In September 2004, the FASB delayed the previously scheduled third quarter 2004 effective date until the issuance of additional implementation guidance, expected in 2005. Upon issuance of a final standard, we will evaluate the impact on our consolidated financial position and results of operations.

 

 

7


Table of Contents

Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

(3) Acquisitions

 

On February 16, 2005, we acquired CarePlus Health Plans of Florida, or CarePlus, as well as its affiliated 10 medical centers and pharmacy company. CarePlus provides Medicare Advantage HMO plans and benefits to Medicare eligible members in Miami-Dade, Broward and Palm Beach counties. This acquisition enhances our Medicare market position in South Florida. We paid approximately $444.4 million in cash including estimated transaction costs. We financed the transaction with $294.0 million of borrowings under our credit agreement and $150.4 million of cash on hand. The purchase price is subject to a balance sheet settlement process with a nine month claims run-out period. The preliminary fair value of the acquired tangible assets (liabilities), which is subject to further refinement, consisted of the following:

 

     (in thousands)

 

Cash and cash equivalents

   $ 92,116  

Premiums receivable and other current assets

     6,487  

Property and equipment and other assets

     19,037  

Medical and other expenses payable

     (37,375 )

Other current liabilities

     (29,593 )

Other liabilities

     (9,686 )
    


Net tangible assets acquired

   $ 40,986  
    


 

The purchase price exceeded the preliminary estimated fair value of the net tangible assets acquired by approximately $403.4 million. We preliminarily have allocated the excess purchase price over the fair value of the net tangible assets acquired to other intangible assets of $73.0 million and associated deferred tax liabilities of $28.4 million, and goodwill of $358.8 million. The other intangible assets, which consist primarily of subscriber contracts, have a weighted-average useful life of approximately 10 years. Approximately $56.0 million of the acquired goodwill is deductible for income tax purposes. We are using an independent third party valuation specialist firm to assist us in evaluating the fair value of assets acquired. The purchase price allocation is preliminary pending completion of the independent valuation analysis of the tangible and intangible net assets and the balance sheet settlement process.

 

On April 1, 2004, we acquired Ochsner Health Plan, or Ochsner, from the Ochsner Clinic Foundation for $157.1 million in cash. Ochsner, a Louisiana health plan, enabled us to enter a new market with significant market share which should facilitate new sales opportunities in this and surrounding markets, including Houston, Texas.

 

The results of operations and financial condition of CarePlus and Ochsner have been included in our consolidated statements of income and consolidated balance sheets since the acquisition date. The pro forma financial information presented below assumes that the acquisitions of CarePlus and Ochsner had occurred as of the beginning of each respective period. The pro forma adjustments include the pro forma effect of amortization of other intangible assets arising from the purchase price allocation and interest expense related to the assumed financing of the cash purchase price and the associated income tax effects of the pro forma adjustments. The pro forma results have been prepared for comparative purposes only and do not purport to be indicative of the results of operations that would have occurred had the CarePlus and Ochsner acquisitions been consummated at the beginning of the respective periods.

 

     For the three months ended
March 31,


     2005

   2004

     (in thousands)

Revenues

   $ 3,459,140    $ 3,591,819

Net income

   $ 111,925    $ 75,748

Earnings per share:

             

Basic

   $ 0.70    $ 0.47

Diluted

   $ 0.68    $ 0.46

 

 

8


Table of Contents

Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

(4) Goodwill and Other Intangible Assets

 

Changes in the carrying amount of goodwill, by operating segment, for the three months ended March 31, 2005 were as follows:

 

     Commercial

   Government

   Total

     (in thousands)

Balance at December 31, 2004

   $ 698,430    $ 187,142    $ 885,572

CarePlus acquisition

     —        358,798      358,798
    

  

  

Balance at March 31, 2005

   $ 698,430    $ 545,940    $ 1,244,370
    

  

  

 

Other intangible assets primarily relate to acquired subscriber and provider contracts and are included with other long-term assets in the condensed consolidated balance sheets. Amortization expense for other intangible assets was approximately $4.4 million for the three months ended March 31, 2005 and $2.4 million for the three months ended March 31, 2004. The following table presents our estimate of amortization expense for the remaining nine months of 2005, and for each of the five next succeeding fiscal years:

 

     (in thousands)

For the nine month period ending December 31, 2005

   $ 16,851

For the years ending December 31,:

      

    2006

   $ 14,973

    2007

   $ 12,245

    2008

   $ 10,028

    2009

   $ 6,765

    2010

   $ 6,341

 

The following table presents details of our other intangible assets included in other non-current assets in the accompanying condensed consolidated balance sheets at March 31, 2005 and December 31, 2004:

 

    

Weighted

Average
Life


   March 31, 2005

   December 31, 2004

        Cost

   Accumulated
Amortization


   Net

   Cost

   Accumulated
Amortization


   Net

     (in thousands)

Other intangible assets:

                                              

Subscriber contracts

   9.8 yrs    $ 168,256    $ 85,827    $ 82,429    $ 97,256    $ 82,343    $ 14,913

Provider contracts

   9.6 yrs      22,428      11,801      10,627      22,428      11,022      11,406

Licenses and other

   18.6 yrs      7,790      1,966      5,824      5,790      1,787      4,003
         

  

  

  

  

  

Total other intangible assets

   10.1 yrs    $ 198,474    $ 99,594    $ 98,880    $ 125,474    $ 95,152    $ 30,322
         

  

  

  

  

  

 

(5) Comprehensive Income

 

The following table presents details supporting the computation of comprehensive income for the three months ended March 31, 2005 and 2004:

 

    

For the three months ended

March 31,


     2005

    2004

     (in thousands)

Net income

   $ 109,795     $ 67,830

Net unrealized investment (losses) gains, net of tax

     (22,174 )     7,732
    


 

Comprehensive income, net of tax

   $ 87,621     $ 75,562
    


 

 

 

9


Table of Contents

Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

(6) Earnings Per Common Share

 

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

 

The following table presents details supporting the computation of basic and diluted earnings per common share for the three months ended March 31, 2005 and 2004:

 

     For the three months ended
March 31,


     2005

   2004

     (in thousands, except
per share results)

Net income available for common stockholders

   $ 109,795    $ 67,830

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

     160,911      161,966

Dilutive effect of:

             

Employee stock options

     3,259      2,333

Restricted stock

     9      58
    

  

Shares used to compute diluted earnings per common share

     164,179      164,357
    

  

Basic earnings per common share

   $ 0.68    $ 0.42
    

  

Diluted earnings per common share

   $ 0.67    $ 0.41
    

  

Number of antidilutive stock options excluded from computation

     —        124

 

(7) Income Taxes

 

The effective income tax rate was 9.8% for the first quarter of 2005 and 34.0% for the first quarter of 2004. The effective tax rate for the first quarter of 2005 primarily reflects the favorable impact from the resolution of a contingent gain of $22.8 million during the first quarter of 2005 in connection with the expiration of the statute of limitation on a tax position related to the 2000 tax year.

 

10


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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

(8) Long-term Debt

 

Long-term debt outstanding was as follows at March 31, 2005 and December 31, 2004:

 

    

March 31,

2005


   

December 31,

2004


     (in thousands)

Long-term debt:

              

6.30% senior, unsecured notes due Aug. 1, 2018, net of unamortized discount of $766 at March 31, 2005 and $780 at December 31, 2004

   $ 299,234     $ 299,220

7.25% senior, unsecured notes due Aug. 1, 2006, net of unamortized discount of $195 at March 31, 2005 and $231 at December 31, 2004

     299,805       299,769

Fair value of interest rate swap agreements

     (716 )     17,082

Deferred gain from interest rate swap exchange

     13,822       16,338
    


 

Total senior notes

     612,145       632,409

Credit agreement

     269,000       —  

Other long-term borrowings

     4,126       4,287
    


 

Total long-term debt

   $ 885,271     $ 636,696
    


 

 

Swap Agreements

 

In order to hedge the risk of changes in the fair value of our $300 million 6.30% senior notes and our $300 million 7.25% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. The interest rate swap agreements, which have the same critical terms as our 6.30% senior notes and our 7.25% senior notes, are designated fair value hedges. Changes in the fair value of the 6.30% or 7.25% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness. Our swap agreements are recognized in our consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. The fair value of our interest rate swap agreements are estimated based on quoted market prices of comparable agreements, and reflect the amounts we would receive (or pay) to terminate the agreements at the reporting date.

 

Our interest rate swap agreements exchange the fixed interest rate under our 6.30% and 7.25% senior notes for a variable interest rate based on LIBOR. At March 31, 2005, the effective interest rate was 4.00% for the 6.30% senior notes and 4.83% for the 7.25% senior notes, including the amortization of the deferred swap gain. The $300 million swap agreements for the 6.30% senior notes mature on August 1, 2018, and the $300 million swap agreements for the 7.25% senior notes mature on August 1, 2006, and each has the same critical terms as the related senior notes.

 

At March 31, 2005, the fair value of our swap agreements related to the 6.30% senior notes was in our favor by $8.3 million and is included in other long-term assets and the fair value of our swap agreements related to the 7.25% senior notes was out of our favor by $9.0 million and is included in other long-term liabilities. Likewise, the carrying value of our senior notes has been decreased $0.7 million to reflect their fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

 

In June 2003, we recorded a deferred gain and received proceeds of $31.6 million in exchange for new swap agreements discussed above related to our 7.25% senior notes. The corresponding deferred swap gain of $31.6 million is being amortized to reduce interest expense over the remaining term of the 7.25% senior notes. Amortization of the deferred swap gain reduced interest expense $2.5 million for the three months ended March 31, 2005 and $2.4 million for the three months ended March 31, 2004.

 

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Credit Agreement

 

On September 29, 2004, we entered into a 5-year $600 million unsecured revolving credit agreement which will expire in September 2009. Under the agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of the agreement bears interest at either a fixed rate or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 50 to 112.5 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently 15 basis points, may fluctuate between 12.5 and 37.5 basis points, depending upon our credit ratings. In addition, a utilization fee of 12.5 basis points is payable for any day in which borrowings under the facility exceed 50% of the total $600 million commitment. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

 

The 5-year $600 million credit agreement contains customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of net worth, minimum interest coverage, and maximum leverage ratios. At March 31, 2005, we were in compliance with all applicable financial covenant requirements. The terms of this credit agreement also include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow. We have not experienced a material adverse effect, and we know of no circumstances or events which would be reasonably likely to result in a material adverse effect. We do not believe the material adverse effect clause poses a material funding risk to Humana in the future. We have other relationships, including financial advisory and banking, with some of the parties to the credit agreement.

 

On February 16, 2005, we borrowed $294.0 million under the credit agreement to finance the CarePlus acquisition. Since the CarePlus transaction, we have repaid $25 million under the credit agreement. In addition, we have secured letters of credit of $5.6 million under the credit agreement. No amounts have ever been drawn on these letters of credit. As of March 31, 2005, we have $325.4 million of remaining borrowing capacity under the credit agreement.

 

Commercial Paper Program

 

We maintain and may issue short-term debt securities under a commercial paper program when market conditions allow. The program is backed by our credit agreement described above. Aggregate borrowings under both the credit agreement and commercial paper program generally will not exceed $600 million.

 

At March 31, 2005, we had no commercial paper borrowings outstanding.

 

Other Borrowings

 

Other borrowings of $4.1 million at March 31, 2005 represent financing for the renovation of a building, bear interest at 2% per annum, are collateralized by the building, and are payable in various installments through 2014.

 

Shelf Registration

 

Our universal shelf registration with the Securities and Exchange Commission allows us to register debt or equity securities, from time to time, with the amount, price and terms to be determined at the time of the sale. We have up to $300 million remaining from a total of $600 million under the universal shelf registration. The universal shelf registration allows us to use the net proceeds from any future sales of our securities for our operations and for other general corporate purposes, including repayment or refinancing of borrowings, working capital, capital expenditures, investments, acquisitions, or the repurchase of our outstanding securities.

 

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

(9) Guarantees and Contingencies

 

Indemnifications and Guarantees

 

Our operating lease of an airplane, which expires January 1, 2010, provides for a residual value payment of no more than $4.8 million at the end of the lease term. At the end of the term we have the right to exercise a purchase option or the airplane can be sold to a third party. If we decide not to exercise our purchase option, we must pay the lessor a maximum amount of $4.8 million. This amount will be reduced by the net sales proceeds in excess of $4.2 million from the sale of the airplane to a third party.

 

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

 

In the ordinary course of business, we enter into contractual arrangements under which we may agree to indemnify a third party to such arrangement from any losses incurred relating to the services they perform on behalf of us, or for losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims relating to past performance. Such indemnification obligations may not be subject to maximum loss clauses. Historically, payments made related to these indemnifications have been immaterial.

 

Government Contracts

 

Our HMO, PPO and Fee-For-Service products covered under the Medicare Advantage contracts with the federal government are renewed for a one-year term each December 31 unless notice of termination is received at least 90 days prior thereto. No termination notices were received in connection with our currently existing contracts. In December 2003, the Medicare Prescription Drug, Improvement, and Modernization Act, or MMA, was signed into law. We believe MMA offers new opportunities in our Medicare programs, including our HMO, PPO, and Private Fee-For-Service products. We have made additional investments in the Medicare Advantage program to enhance our ability to participate in these expanded programs.

 

Our TRICARE South Region contract covers one of the three regions in the United States as defined by the Department of Defense. The five-year contract, which is subject to annual renewals at the federal government’s option, expires March 31, 2009. Upon renewal notification, we began providing services under the contract’s second option period on April 1, 2005.

 

We currently have Medicaid contracts with the Puerto Rico Health Insurance Administration through June 30, 2005. Due to recent changes in leadership and policy revisions under consideration, the government of Puerto Rico has decided to delay the bid process for new contracts. We are currently negotiating the terms of contract extensions for a period of up to one year. At this time we are unable to predict the ultimate impact that any government policy revisions might have on our Medicaid contracts in Puerto Rico. Our other Medicaid contracts are in Florida and Illinois, and are annual contracts.

 

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

 

Legal Proceedings

 

Managed Care Industry Purported Class Action Litigation

 

We have been involved in several purported class action lawsuits that are part of a wave of generally similar actions that target the health care payer industry and particularly target managed care companies. These include a lawsuit against us and originally nine of our competitors that purports to be brought on behalf of physicians who have treated our members. As a result of action by the Judicial Panel on Multidistrict Litigation (“JPML”), the case was consolidated in the United States District Court for the Southern District of Florida, and has been styled In re Managed Care Litigation.

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

The plaintiffs assert that we and other defendants improperly paid providers’ claims and “downcoded” their claims by paying lesser amounts than they submitted. The complaint alleges, among other things, multiple violations under the Racketeer Influenced and Corrupt Organizations Act, or RICO, as well as various breaches of contract and violations of regulations governing the timeliness of claim payments. The complaint was subsequently amended to add as plaintiffs several medical societies, including the Texas Medical Association, the Medical Association of Georgia, the California Medical Association, the Florida Medical Association, and the Louisiana State Medical Society, each of which purports to bring its action against specified defendants.

 

On September 26, 2002, the Court certified a global class consisting of all medical doctors who provided services to any person insured by any defendant from August 4, 1990, to September 26, 2002. The class included two subclasses. A national subclass consisted of medical doctors who provided services to any person insured by a defendant when the doctor had a claim against such defendant and was not required to arbitrate that claim. A California subclass consisted of medical doctors who provided services to any person insured in California by any defendant when the doctor was not bound to arbitrate the claim.

 

On September 1, 2004, the Court of Appeals for the Eleventh Circuit (“Eleventh Circuit”) agreed with the District Court’s ruling as to the class for the RICO claims, although it suggested that the class should be split so that claims involving capitation and fee-for-service payments would be handled separately. However, it reversed the lower court as to state law claims, including breach of contract, unjust enrichment and violations of prompt pay laws. It found that the state claims were too individualized to be dealt with in a class action. The California subclass was not specifically challenged and therefore was permitted to remain. On October 15, 2004, the defendants filed a Petition for a Writ of Certiorari to the United States Supreme Court, asking for review of the Eleventh Circuit’s decision. The petition was denied on January 10, 2005.

 

On December 9, 2004, the Court issued an order rescheduling the trial for September 6, 2005. On February 10, 2005, the Court ruled that the trial would be bifurcated so that the issue of liability would be tried first, followed by proof of damages, if liability is found.

 

On September 17, 2004, the plaintiffs filed an amended motion for class certification, seeking a global fee-for-service class and five subclasses for the time period from January 1, 1996, to the date of certification. The global class would consist of any medical doctor who provided service on a fee-for-service basis to any person insured by Cigna Corporation or any other defendant for claims of RICO conspiracy and aiding and abetting. The motion seeks subclasses for the conspiracy counts for capitation damages and capitation injunctive relief consisting of all medical doctors who provided services on a capitated basis. The motion also requests a subclass for a direct RICO claim consisting of medical doctors who provided services on a fee-for-service basis to any person insured by Humana pursuant to a contract without an arbitration clause or without a contract. The motion also seeks two California subclasses, one involving physicians who provided services on a fee-for-service basis and the other for capitated physicians. On April 22, 2005, the defendants filed an omnibus motion for summary judgment as to all counts of the complaint. The Court has not ruled on these motions.

 

Two of the defendants, Aetna Inc. and Cigna Corporation, have entered into settlement agreements which have been approved by the Court. On May 2, 2005, Health Net, Inc. announced that it has entered into a settlement agreement with the plaintiffs. The settlement agreement is subject to Court review and approval.

 

We intend to continue to defend this action vigorously.

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Other Litigation and Proceedings

 

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

 

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

 

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

 

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

 

In addition, some courts have issued rulings which make it easier to hold plans liable for medical negligence on the part of network providers on the theory that providers are agents of the plans and that the plans are therefore vicariously liable for the injuries to members by providers.

 

Personal injury claims and claims for extracontractual damages arising from medical benefit denials are covered by insurance from our wholly owned captive insurance subsidiary and excess carriers, except to the extent that claimants seek punitive damages, which may not be covered by insurance in certain states in which insurance coverage for punitive damages is not permitted. In addition, insurance coverage for all or certain forms of liability has become increasingly costly and may become unavailable or prohibitively expensive in the future.

 

The likelihood or outcome of current or future suits, like the purported class action lawsuit described above, or governmental investigations, cannot be accurately predicted with certainty. In addition, the potential for increased liability for medical negligence arising from claims adjudication, along with the increased litigation that has accompanied the negative publicity and public perception of our industry, adds to this uncertainty. Therefore, such legal actions and government audits and investigations could have a material adverse effect on our financial position, results of operations, and cash flows.

 

(10) Segment Information

 

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

 

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

 

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Humana Inc.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS—(Continued)

Unaudited

 

Our segment results for the three months ended March 31, 2005 and 2004 are as follows:

 

     Commercial Segment

    

For the three months

ended March 31,


     2005

   2004

     (in thousands)

Revenues:

             

Premiums:

             

Fully insured

             

PPO

   $ 904,473    $ 944,156

HMO

     612,921      672,964
    

  

Total fully insured

     1,517,394      1,617,120

Specialty

     93,538      85,971
    

  

Total premiums

     1,610,932      1,703,091

Administrative services fees

     50,111      41,696

Investment and other income

     29,390      23,638
    

  

Total revenues

     1,690,433      1,768,425
    

  

Operating expenses:

             

Medical

     1,324,703      1,422,777

Selling, general and administrative

     291,857      286,727

Depreciation and amortization

     18,008      16,065
    

  

Total operating expenses

     1,634,568      1,725,569
    

  

Income from operations

     55,865      42,856

Interest expense

     6,402      3,770
    

  

Income before income taxes

   $ 49,463    $ 39,086
    

  

 

     Government Segment

    

For the three months

ended March 31,


     2005

   2004

     (in thousands)

Revenues:

             

Premiums:

             

Medicare Advantage

   $ 983,141    $ 706,318

TRICARE

     562,328      648,993

Medicaid

     134,414      120,779
    

  

Total premiums

     1,679,883      1,476,090

Administrative services fees

     11,624      36,541

Investment and other income

     5,285      5,893
    

  

Total revenues

     1,696,792      1,518,524
    

  

Operating expenses:

             

Medical

     1,429,030      1,260,739

Selling, general and administrative

     182,176      182,902

Depreciation and amortization

     11,241      10,247
    

  

Total operating expenses

     1,622,447      1,453,888
    

  

Income from operations

     74,345      64,636

Interest expense

     2,121      949
    

  

Income before income taxes

   $ 72,224    $ 63,687
    

  

 

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Humana Inc.

MANAGEMENT’S DISCUSSION AND ANALYSIS OF

FINANCIAL CONDITION AND RESULTS OF OPERATIONS

 

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

 

Overview

 

Headquartered in Louisville, Kentucky, Humana Inc. is one of the nation’s largest publicly traded health benefits companies, based on our 2004 revenues of $13.1 billion. We offer coordinated health insurance coverage and related services through a variety of traditional and Internet-based plans for employer groups, government-sponsored programs, and individuals. As of March 31, 2005, we had approximately 7.0 million members in our medical insurance programs, as well as approximately 1.8 million members in our specialty products programs.

 

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

 

The results of each segment are measured by income before income taxes. We allocate all selling, general and administrative expenses, investment and other income, interest expense, and goodwill, but no other assets or liabilities, to our segments. Members served by our two segments often utilize the same medical provider networks, enabling us to obtain more favorable contract terms with providers. Our segments also share overhead costs and assets. As a result, the profitability of each segment is interdependent. We draw revenues from group, individual, Medicare, Medicaid and military business lines. We believe that it is difficult to time market cycles and external influences on various parts of our businesses. By remaining committed to varied lines of business with a long-term view, we may benefit through short-term market cycles. We believe our diversification across segments and products allows us to increase our chances of success.

 

Our results are impacted by many factors, but most notably are influenced by our ability to establish and maintain a competitive and efficient cost structure and to accurately and consistently establish competitive premium, ASO fee, and plan benefit levels that are commensurate with our medical and administrative costs. Medical costs are subject to a high rate of inflation due to many forces, including new technologies and medical procedures, increasing capacity and supply of medical services, new prescription drugs and therapies, an aging population, the tort liability system, and government regulations.

 

Our strategy to drive Commercial segment profitability focuses on providing solutions for employers to the rising cost of health care through the use of a variety of innovative and consumer-choice product designs. These products are supported by electronic informational capabilities, including education, tools, and technologies provided primarily through the Internet. To that end, we have developed an innovative suite of products styled as “Smart” products. We believe that these Smart products offer the best solution for many employers to the problem

 

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of quickly rising health care costs for their employees. Membership in our Smart products and other consumer-choice health plans exceeded 390,000 members at March 31, 2005, increasing approximately 40% since December 31, 2004. We believe that growth in these products, which are offered both on a fully-insured and ASO basis and may ultimately be competitively priced to produce higher margins, is a key component, among other items, for further improvement in the results of our Commercial segment. Additionally, we have increased the diversification of our commercial membership base, not only through our consumer-choice products, but also by (1) expanding our ASO membership in the mid-market group segment to take advantage of our network discounts and (2) launching our HumanaOne individual product to address an increasing migration of insureds from small group. While we expect our consumer-choice products to become a driver of growth in the years ahead as health care inflation persists, we are enhancing the traditional products which comprise the bulk of our commercial portfolio today by applying our consumer-choice innovation.

 

Other important factors which impact our Commercial segment profitability are both the competitive pricing environment and market conditions. With respect to pricing, there is a tradeoff between sustaining or increasing underwriting margins versus increasing or decreasing enrollment. We have experienced a decline in our membership in the 2 to 300 life group size as a result of pricing actions by some competitors who we perceive as desiring to gain market share in certain markets. With respect to market conditions, we are impacted by economies of scale on administrative overhead. As a result of a decline in preference for tightly-managed HMO products, medical costs have become increasingly comparable among the larger competitors. Product design and consumer involvement have become more important drivers of medical services consumption, and administrative expense efficiency is becoming a more significant driver of commercial margin sustainability. Consequently, we continually evaluate our administrative expense structure and realize administrative expense savings through productivity gains. Additionally, because our Commercial segment shares overhead costs with our Government segment, an increase or decrease in the size of our Government operations impacts our Commercial segment profitability.

 

In our Government segment, the passage of the Medicare Prescription Drug, Improvement, and Modernization Act, or MMA, in December 2003 demonstrated the federal government’s commitment to providing health benefits and options to seniors and has started the resurgence of Medicare as a business line that should bring us accelerating growth in 2005 and 2006. Our current Medicare presence today includes almost 450,000 members in 13 HMO markets, 20 local PPO markets, and 12 states in which we have a private fee-for-service offering. Over the course of the remainder of 2005, we expect to add another 17 local PPO markets, expand our private fee-for-service offering to 35 states and add both a private fee-for-service and HMO product in Puerto Rico. Medicare Private Fee-For-Service plans generally offer additional benefits compared to traditional Medicare in exchange for a monthly premium paid by the member. These plans typically include a prescription drug benefit with no provider network restrictions. Local Medicare PPO plans typically will offer an even higher level of benefits to members, including a prescription drug benefit and a lower level of member cost-sharing on many benefits while seeking medical services from in-network providers. By December 31, 2005, we anticipate having approximately 480,000 to 500,000 Medicare Advantage members.

 

Although still under evaluation, we believe we are well-positioned to participate in Medicare Regional PPO plans and the Medicare Prescription Drug Plan, or PDP, as established by the MMA, beginning in 2006. In connection herewith, we have notified CMS of our intent to bid on these programs. As a long-time successful participant in the Medicare program, we believe that we possess (1) the business competencies and management experience with senior product design, (2) a robust and scalable multi-channel distribution system, (3) an established and competitive network including a national retail pharmacy network, and (4) an established brand awareness with seniors; all of which will enable us to compete for market share in this expanding business line over the next several years.

 

In our TRICARE business, after being awarded the South Region contract in 2003, we transitioned our TRICARE business during 2004 to one of three newly-created regions under the government’s revised TRICARE program. We started the second option year under the South Region contract on April 1, 2005.

 

Other highlights include the following:

 

    The resolution of a contingent tax gain during the first quarter of 2005 contributed to the lower effective tax rate of 9.8% compared to 34.0% during the first quarter of 2004.

 

    In the Government segment, we completed the acquisition of CarePlus Health Plans of Florida, increasing our Medicare presence in South Florida. This transaction is more fully-described below and in Note 3 to the condensed consolidated financial statements.

 

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    Membership in Medicare Advantage products grew by 72,700 members sequentially from December 31, 2004, including 50,400 members from the acquisition of CarePlus and 22,300 members in our existing products.

 

    We filed numerous applications with CMS to expand our Medicare business through local PPOs, private fee- for-service plans, and, in 2006, through regional PPOs and the PDP.

 

    Commercial pretax margins of 2.9% in the first quarter of 2005, improved 70 basis points compared to 2.2% in the first quarter of 2004.

 

    In accordance with the company’s retirement-age policy, Humana’s co-founder and chairman of the board, David A. Jones, and Michael E. Gellert retired from the board of directors. Mr. Jones, who had been chairman since he co-founded Humana with the late Wendell Cherry in 1961, and Mr. Gellert, who had served as a board member since 1968 and as a member of the board’s executive committee since 1993, retired after the 2005 annual meeting of shareholders. David A. Jones, Jr., who has served as vice chairman of Humana’s board of directors since 1996 was appointed chairman of the board.

 

We intend for the discussion of our financial condition and results of operations that follows to assist in the understanding of our financial statements and related changes in certain key items in those financial statements from quarter to quarter, and the primary factors that accounted for those changes, as well as how certain critical accounting principles and estimates impact our financial statements.

 

Recent Acquisitions

 

On February 16, 2005, we acquired CarePlus Health Plans of Florida, or CarePlus, as well as its affiliated 10 medical centers and pharmacy company for approximately $444.4 million in cash including estimated transaction costs, adding approximately 50,400 Medicare eligible beneficiaries in Miami-Dade, Broward and Palm Beach counties. This acquisition enhances our Medicare market position in South Florida. We financed the transaction with $294.0 million of borrowings under our credit agreement and $150.4 million of cash on hand. The purchase price is subject to a balance sheet settlement process with a nine month claims run-out period. This transaction is more fully described in Note 3 to the condensed consolidated financial statements.

 

On April 1, 2004, we acquired Ochsner Health Plan, or Ochsner, from the Ochsner Clinic Foundation for $157.1 million in cash. Ochsner, a Louisiana health plan, added approximately 152,600 commercial medical members, primarily in fully insured large group accounts, and approximately 33,100 members in the Medicare Advantage program. This acquisition enabled us to enter a new market with significant market share which should facilitate new sales opportunities in this and surrounding markets, including Houston, Texas.

 

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Comparison of Results of Operations

 

The following discussion primarily deals with our results of operations for the three months ended March 31, 2005, or the 2005 quarter, and the three months ended March 31, 2004, or the 2004 quarter.

 

The following table presents certain financial data for our two segments:

 

    

For the three months

ended March 31,


    Change

 
     2005

    2004

    Dollars

    Percentage

 
     (in thousands, except ratios)        

Premium revenues:

                              

Fully insured

   $ 1,517,394     $ 1,617,120     $ (99,726 )   (6.2 )%

Specialty

     93,538       85,971       7,567     8.8 %
    


 


 


 

Total Commercial

     1,610,932       1,703,091       (92,159 )   (5.4 )%
    


 


 


 

Medicare Advantage

     983,141       706,318       276,823     39.2 %

TRICARE

     562,328       648,993       (86,665 )   (13.4 )%

Medicaid

     134,414       120,779       13,635     11.3 %
    


 


 


 

Total Government

     1,679,883       1,476,090       203,793     13.8 %
    


 


 


 

Total

   $ 3,290,815     $ 3,179,181     $ 111,634     3.5 %
    


 


 


 

Administrative services fees:

                              

Commercial

   $ 50,111     $ 41,696     $ 8,415     20.2 %

Government

     11,624       36,541       (24,917 )   (68.2 )%
    


 


 


 

Total

   $ 61,735     $ 78,237     $ (16,502 )   (21.1 )%
    


 


 


 

Income before income taxes:

                              

Commercial

   $ 49,463     $ 39,086     $ 10,377     26.5 %

Government

     72,224       63,687       8,537     13.4 %
    


 


 


 

Total

   $ 121,687     $ 102,773     $ 18,914     18.4 %
    


 


 


 

Medical expense ratios:

                              

Commercial

     82.2 %     83.5 %           (1.3 )

Government

     85.1 %     85.4 %           (0.3 )
    


 


         

Total

     83.7 %     84.4 %           (0.7 )
    


 


         

SG&A expense ratios:

                              

Commercial

     17.6 %     16.4 %           1.2  

Government

     10.8 %     12.1 %           (1.3 )
    


 


         

Total

     14.1 %     14.4 %           (0.3 )
    


 


         

 

Medical membership was as follows at March 31, 2005 and 2004:

 

               Change

 
     2005

   2004

   Members

    Percentage

 

Commercial segment medical members:

                      

Fully insured

   2,039,300    2,298,600    (259,300 )   (11.3 )%

ASO

   1,180,100    997,000    183,100     18.4 %
    
  
  

 

Total Commercial

   3,219,400    3,295,600    (76,200 )   (2.3 )%
    
  
  

 

Government segment medical members:

                      

Medicare Advantage

   449,900    333,200    116,700     35.0 %

TRICARE

   1,723,400    1,860,100    (136,700 )   (7.3 )%

TRICARE ASO

   1,148,400    1,057,900    90,500     8.6 %

Medicaid

   477,200    468,200    9,000     1.9 %
    
  
  

 

Total Government

   3,798,900    3,719,400    79,500     2.1 %
    
  
  

 

Total medical membership

   7,018,300    7,015,000    3,300     0.0 %
    
  
  

 

 

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Summary

 

Net income was $109.8 million, or $0.67 per diluted share in the 2005 quarter compared to $67.8 million, or $0.41 per diluted share in the 2004 quarter. The 2005 quarter included the beneficial effect of an effective tax rate of approximately 9.8% compared to 34.0% in the 2004 quarter, primarily due to the resolution of a contingent gain during the 2005 quarter in connection with the expiration of the statute of limitation on a tax position related to the 2000 tax year. In addition, enrollment growth in our Medicare Advantage products combined with improved Commercial segment pretax margin contributed to the increase in net income.

 

Premium Revenues and Medical Membership

 

Premium revenues increased 3.5% to $3.29 billion for the 2005 quarter, compared to $3.18 billion for the 2004 quarter. Higher premium revenues resulted primarily from enrollment growth in our Medicare Advantage products partially offset by a decrease in fully-insured commercial membership.

 

Commercial segment premium revenues decreased 5.4% to $1.61 billion for the 2005 quarter, compared to $1.70 billion for the 2004 quarter. This decrease resulted from an 11.3% reduction of fully-insured membership partially offset by increases in per member premiums of approximately 8% on our fully insured commercial group business. Our fully insured commercial medical membership decreased 11.3%, or 259,300 members, to 2,039,300 at March 31, 2005. The decrease is primarily due to the relinquishment of an 89,000-member unprofitable account on January 1, 2005 and continued attrition due to the ongoing competitive environment within the small to mid-market group fully-insured accounts, partially offset by membership gains in the individual and consumer-choice product lines. We expect fully insured commercial group per member premiums to increase in the 8% to 10% range for 2005.

 

Government segment premium revenues increased 13.8% to $1.68 billion for the 2005 quarter, compared to $1.48 billion for the 2004 quarter. This increase primarily was attributable to our Medicare Advantage operations. Medicare Advantage membership was 449,900 at March 31, 2005, compared to 333,200 at March 31, 2004, an increase of 116,700 members, or 35.0%, due to the CarePlus and Ochsner acquisitions combined with expanded participation in various Medicare Advantage programs. The February 16, 2005 CarePlus acquisition added 50,400 members and the April 1, 2004 Ochsner acquisition added 33,100 members. Per member premiums for our Medicare Advantage business increased in the 10% to 12% range for the 2005 quarter, including the partial-quarter impact of higher reimbursement associated with the acquired CarePlus membership. For 2005, we expect premium increases per member in the range of 11% to 13%. We anticipate Medicare Advantage enrollment of approximately 480,000 to 500,000 by December 31, 2005. TRICARE premium revenues decreased 13.4% for the 2005 quarter reflecting the transition to the new South Region contract, which covered less benefits and services versus the previous contracts.

 

Administrative Services Fees

 

Our consolidated administrative services fees for the 2005 quarter were $61.7 million, a decrease of $16.5 million from $78.2 million for the 2004 quarter.

 

For the Commercial segment, administrative services fees increased $8.4 million, or 20.2%, from $41.7 million for the 2004 quarter to $50.1 million for the 2005 quarter. This increase corresponds to the higher level of ASO membership at March 31, 2005, which was 1,180,100 members, compared to 997,000 at March 31, 2004, an increase of 18.4%.

 

Administrative services fees for the Government segment decreased $24.9 million, or 68.2%, from $36.5 million for the 2004 quarter to $11.6 million for the 2005 quarter. This decline resulted from the transition to the new South Region contract which carved out certain government programs including the administration of pharmacy and medical benefits to senior members over the age of 65. We stopped providing services under these separate programs beginning June 1, 2004.

 

Investment and Other Income

 

Investment and other income totaled $34.7 million for the 2005 quarter, an increase of $5.2 million from $29.5 million for the 2004 quarter. The increase in investment income of $2.8 million resulted from higher interest rates and average invested balances. The increase in other income of $2.4 million primarily resulted from revenues associated with ancillary TRICARE service contracts.

 

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Medical Expense

 

Total medical expenses as a percentage of premium revenues, or medical expense ratio (MER), for the 2005 quarter were 83.7%, decreasing 70 basis points from 84.4% for the 2004 quarter.

 

The Commercial segment’s MER for the 2005 quarter was 82.2%, decreasing 130 basis points from the 2004 quarter of 83.5%. The 130 basis point decrease primarily was due to the absence of the unprofitable 89,000-member large group account that lapsed on January 1, 2005, and changing membership mix to lower MER individual and consumer-choice members. Fully insured commercial group medical cost trends are expected to rise in the range of 8% to 10% for 2005.

 

The Government segment’s MER for the 2005 quarter was 85.1%, decreasing 30 basis points from the 2004 quarter of 85.4%. The 30 basis point improvement primarily was attributable to the increase in Medicare revenues as a percentage of the total revenues. Medicare medical cost trends are expected to increase in the range of 11% to 13% for 2005, commensurate with the increase in per member premiums.

 

SG&A Expense

 

Total selling, general and administrative, or SG&A, expenses as a percentage of premium revenues and administrative services fees, or SG&A expense ratio, for the 2005 quarter was 14.1%, decreasing 30 basis points from the 2004 quarter of 14.4% as the increase in premium revenues outpaced administrative expense trends despite increased spending on new Medicare opportunities.

 

The Commercial segment SG&A expense ratio increased 120 basis points from 16.4% to 17.6% for the 2005 quarter versus the 2004 quarter. The Government segment SG&A expense ratio decreased 130 basis points from 12.1% to 10.8% for the 2005 quarter versus the 2004 quarter. The mix shift to a greater percentage of ASO members and lower Commercial segment premiums resulted in the higher Commercial segment SG&A expense ratio. The decrease in the Government segment SG&A expense ratio was attributable to Medicare premium increases outpacing SG&A expense increases. We continue to anticipate our consolidated SG&A expense ratio to be in the range of 13.5% to 14.5% for the full year of 2005 as we continue to balance the scope of the Medicare opportunity with the corresponding required spending.

 

Depreciation and amortization for the 2005 quarter totaled $29.2 million compared to $26.3 million for the 2004 quarter, an increase of $2.9 million, or 11.2%. Amortization of other intangible assets increased $2.0 million as a result of intangible assets recorded in connection with the Ochsner and CarePlus acquisitions.

 

Interest Expense

 

Interest expense was $8.5 million for the 2005 quarter, compared to $4.7 million for the 2004 quarter, an increase of $3.8 million. This increase primarily resulted from higher interest rates and higher average outstanding debt, due to the borrowing of $294 million under our credit agreement to finance the February 16, 2005 CarePlus acquisition.

 

Income Taxes

 

On an interim basis, the provision for income taxes is provided for at the anticipated effective tax rate for the year. Our effective tax rate for the 2005 quarter was approximately 9.8%, compared to 34.0% for the 2004 quarter. The effective tax rate for the 2005 quarter reflects the favorable impact from the resolution of a contingent gain in the 2005 quarter in connection with the expiration of the statute of limitation on a tax position related to the 2000 tax year. We expect our effective tax rate will be in the range of 34% to 36% for the remaining three 2005 quarters and approximately 30% for the year.

 

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Membership

 

The following table presents our medical and specialty membership at March 31, 2005, and at the end of each quarter in 2004:

 

     2005

   2004

     March 31

   Dec. 31

   Sept. 30

   June 30

   March 31

Medical Membership:

                        

Commercial segment:

                        

Fully insured

   2,039,300    2,286,500    2,296,400    2,407,700    2,298,600

ASO

   1,180,100    1,018,600    1,018,800    996,700    997,000
    
  
  
  
  

Total Commercial

   3,219,400    3,305,100    3,315,200    3,404,400    3,295,600
    
  
  
  
  

Government segment:

                        

Medicare Advantage

   449,900    377,200    371,300    367,900    333,200

TRICARE

   1,723,400    1,789,400    1,138,600    1,856,900    1,860,100

TRICARE ASO

   1,148,400    1,082,400    674,700    786,000    1,057,900

Medicaid

   477,200    478,600    475,800    466,400    468,200
    
  
  
  
  

Total Government

   3,798,900    3,727,600    2,660,400    3,477,200    3,719,400
    
  
  
  
  

Total medical members

   7,018,300    7,032,700    5,975,600    6,881,600    7,015,000
    
  
  
  
  

Specialty Membership:

                        

Commercial segment

   1,824,100    1,708,200    1,714,300    1,691,400    1,703,200
    
  
  
  
  

 

Liquidity

 

Our primary sources of cash include receipts of premiums, administrative services fees, investment income, and proceeds from the sale or maturity of our investment securities and from borrowings. Our primary uses of cash include disbursements for claims payments, administrative expenses, interest expense, and taxes, purchases of investment securities and capital expenditures and payments on borrowings. Because premiums generally are collected in advance of claim payments by a period of up to several months in many instances, our business should normally produce strong cash flows during a period of increasing enrollment. Conversely, cash flows would be negatively impacted during a period of shrinking enrollment.

 

Cash and cash equivalents decreased to $560.3 million at March 31, 2005 from $580.1 million at December 31, 2004. The change in cash and cash equivalents for the three months ended March 31, 2005 and 2004 is summarized as follows:

 

     2005

    2004

 
     (in thousands)  

Net cash provided by (used in) operating activities

   $ 99,228     $ (40,055 )

Net cash used in investing activities

     (451,322 )     (476,128 )

Net cash provided by financing activities

     332,279       2,426  
    


 


Decrease in cash and cash equivalents

   $ (19,815 )   $ (513,757 )
    


 


 

Cash Flow from Operating Activities

 

The comparison of our operating cash flows for the 2005 and 2004 quarters were significantly impacted by the timing of the monthly Medicare Advantage premium remittance. We received three monthly Medicare Advantage premium receipts during the 2005 quarter compared to only two premium receipts received during the 2004 quarter because the January 1, 2004 premium receipt of $211.9 million was received early in December 2003. In addition, there were no corresponding premium receipts for the February CarePlus Medicare Advantage revenues of $19.8 million because these premium receipts were received prior to the February 16, 2005 acquisition date.

 

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Other than the impact from the timing of the Medicare Advantage premium receipts, our operating cash flows for the 2005 quarter compared to the 2004 quarter were negatively impacted by declining fully-insured commercial enrollment. Comparisons of our operating cash flows also are impacted by changes in our working capital. The most significant drivers of changes in our working capital are typically the timing of receipts for premiums and administrative services fees and payments of medical expenses. We illustrate these changes with the following summary of receivables and medical and other expenses payable.

 

The detail of total net receivables was as follows at March 31, 2005 and December 31, 2004:

 

    

March 31,

2005


   

December 31,

2004


    Change

 
     (in thousands)  

TRICARE:

                        

Base receivable

   $ 405,482     $ 396,355     $ 9,127  

Bid price adjustments (BPAs)

     9,177       25,601       (16,424 )

Change orders

     11,602       6,021       5,581  
    


 


 


TRICARE subtotal

     426,261       427,977       (1,716 )

Commercial and other

     199,283       186,144       13,139  

Allowance for doubtful accounts

     (37,215 )     (34,506 )     (2,709 )
    


 


 


Total net receivables

   $ 588,329     $ 579,615       8,714  
    


 


       

Reconciliation to cash flow statement:

                        

Receivables from acquisition

                     (2,289 )
                    


Change in receivables in cash flow statement

                   $ 6,425  
                    


 

Under the TRICARE South region contract reimbursement model, claims paid by us are reimbursed by the federal government generally within 30 business days. The delivery of health care services results in a lag between the time the service is provided and ultimately reimbursed by the federal government, typically three months. Thus, TRICARE base receivables are generally collected over a three to four month period. Likewise, TRICARE medical claims payable are generally paid over the same three to four month period.

 

The detail of medical and other expenses payable was as follows at March 31, 2005 and December 31, 2004:

 

    

March 31,

2005


  

December 31,

2004


   Change

 
     (in thousands)  

IBNR (1)

   $ 1,228,360    $ 1,164,518    $ 63,842  

Reported claims in process (2)

     92,030      97,801      (5,771 )

Other medical expenses payable (3)

     225,660      159,691      65,969  
    

  

  


Total medical and other expenses payable

   $ 1,546,050    $ 1,422,010      124,040  
    

  

        

Reconciliation to cash flow statement:

                      

Medical and other expenses payable from acquisition

                   (37,375 )
                  


Change in medical and other expenses payable in cash flow statement

                 $ 86,665  
                  



(1) IBNR represents an estimate of medical expenses payable for claims incurred but not reported (IBNR) at the balance sheet date. The level of IBNR is primarily impacted by membership levels, medical claim trends and the receipt cycle time, which represents the length of time between when a claim is initially incurred and when the claim form is received (i.e. a shorter time span results in a lower IBNR).
(2) Reported claims in process represents the estimated valuation of processed claims that are in the post claim adjudication process, which consists of administrative functions such as audit and check batching and handling.
(3) Other medical expenses payable includes capitation and pharmacy payables. The balance due to our pharmacy benefit administrator fluctuates due to bi-weekly payments and the month-end cutoff.

 

Medical and other expenses payable primarily increased during the 2005 quarter due to medical claims inflation.

 

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Cash Flow from Investing Activities

 

During the 2005 quarter, we paid $440.2 million to acquire CarePlus, net of $92.1 million of cash acquired. In April 2005, we paid CarePlus transaction costs of approximately $4.2 million.

 

Our ongoing capital expenditures primarily relate to our technology initiatives and administrative facilities necessary for activities such as claims processing, billing and collections, medical utilization review, and customer service. Total capital expenditures, excluding acquisitions, were $36.2 million for the 2005 quarter and $22.7 million for the 2004 quarter. Excluding acquisitions, we expect our total capital expenditures in 2005 to be approximately $115 million, most of which will be used for our technology initiatives and improvement of administrative facilities.

 

During the 2004 quarter, proceeds from the sale of the Jacksonville service center building increased investing cash flows $14.8 million.

 

Cash Flow from Financing Activities

 

During the 2005 quarter, we borrowed $294 million under our 5-year $600 million credit agreement to finance the CarePlus acquisition. Since the CarePlus acquisition, we have repaid $25 million under the credit agreement. The remainder of the cash provided by financing activities in the 2005 and 2004 quarters resulted primarily from the change in the securities lending payable, the change in the book overdraft, and proceeds from stock option exercises.

 

Long-term Debt

 

Long-term debt outstanding was as follows at March 31, 2005 and December 31, 2004:

 

    

March 31,

2005


   

December 31,

2004


     (in thousands)

Long-term debt:

              

6.30% senior, unsecured notes due Aug. 1, 2018, net of unamortized discount of $766 at March 31, 2005 and $780 at December 31, 2004

   $ 299,234     $ 299,220

7.25% senior, unsecured notes due Aug. 1, 2006, net of unamortized discount of $195 at March 31, 2005 and $231 at December 31, 2004

     299,805       299,769

Fair value of interest rate swap agreements

     (716 )     17,082

Deferred gain from interest rate swap exchange

     13,822       16,338
    


 

Total senior notes

     612,145       632,409

Credit agreement

     269,000       —  

Other long-term borrowings

     4,126       4,287
    


 

Total long-term debt

   $ 885,271     $ 636,696
    


 

 

Swap Agreements

 

In order to hedge the risk of changes in the fair value of our $300 million 6.30% senior notes and our $300 million 7.25% senior notes attributable to fluctuations in interest rates, we entered into interest rate swap agreements. Interest rate swap agreements, which are considered derivatives, are contracts that exchange interest payments on a specified principal amount, or notional amount, for a specified period. The interest rate swap agreements, which have the same critical terms as our 6.30% senior notes and our 7.25% senior notes, are designated fair value hedges. Changes in the fair value of the 6.30% or 7.25% senior notes and the swap agreements due to changing interest rates are assumed to offset each other completely, resulting in no impact to earnings from hedge ineffectiveness. Our swap agreements are recognized in our consolidated balance sheet at fair value with an equal and offsetting adjustment to the carrying value of our senior notes. The fair value of our interest rate swap agreements are estimated based on quoted market prices of comparable agreements, and reflect the amounts we would receive (or pay) to terminate the agreements at the reporting date.

 

Our interest rate swap agreements exchange the fixed interest rate under our 6.30% and 7.25% senior notes for a variable interest rate based on LIBOR. At March 31, 2005, the effective interest rate was 4.00% for the 6.30% senior notes and 4.83% for the 7.25% senior notes, including the amortization of the deferred swap gain. The $300 million swap agreements for the 6.30% senior notes mature on August 1, 2018, and the $300 million swap agreements for the 7.25% senior notes mature on August 1, 2006, and each has the same critical terms as the related senior notes.

 

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At March 31, 2005, the fair value of our swap agreements related to the 6.30% senior notes was in our favor by $8.3 million and is included in other long-term assets and the fair value of our swap agreements related to the 7.25% senior notes was out of our favor by $9.0 million and is included in other long-term liabilities. Likewise, the carrying value of our senior notes has been decreased $0.7 million to reflect their fair value. The counterparties to our swap agreements are major financial institutions with which we also have other financial relationships.

 

In June 2003, we recorded a deferred gain and received proceeds of $31.6 million in exchange for new swap agreements discussed above related to our 7.25% senior notes. The corresponding deferred swap gain of $31.6 million is being amortized to reduce interest expense over the remaining term of the 7.25% senior notes. Amortization of the deferred swap gain reduced interest expense $2.5 million for the three months ended March 31, 2005 and $2.4 million for the three months ended March 31, 2004.

 

Credit Agreement

 

On September 29, 2004, we entered into a 5-year $600 million unsecured revolving credit agreement which will expire in September 2009. Under the agreement, at our option, we can borrow on either a competitive advance basis or a revolving credit basis. The revolving credit portion of the agreement bears interest at either a fixed rate or floating rate based on LIBOR plus a spread. The spread, which varies depending on our credit ratings, ranges from 50 to 112.5 basis points. We also pay an annual facility fee regardless of utilization. This facility fee, currently 15 basis points, may fluctuate between 12.5 and 37.5 basis points, depending upon our credit ratings. In addition, a utilization fee of 12.5 basis points is payable for any day in which borrowings under the facility exceed 50% of the total $600 million commitment. The competitive advance portion of any borrowings will bear interest at market rates prevailing at the time of borrowing on either a fixed rate or a floating rate basis, at our option.

 

The 5-year $600 million credit agreement contains customary restrictive and financial covenants as well as customary events of default, including financial covenants regarding the maintenance of net worth, minimum interest coverage, and maximum leverage ratios. At March 31, 2005, we were in compliance with all applicable financial covenant requirements. The terms of this credit agreement also include standard provisions related to conditions of borrowing, including a customary material adverse effect clause which could limit our ability to borrow. We have not experienced a material adverse effect, and we know of no circumstances or events which would be reasonably likely to result in a material adverse effect. We do not believe the material adverse effect clause poses a material funding risk to Humana in the future. We have other relationships, including financial advisory and banking, with some of the parties to the credit agreement.

 

In addition, we have secured letters of credit of $5.6 million under the credit agreement. No amounts have ever been drawn on these letters of credit. As of March 31, 2005, we have $325.4 million of remaining borrowing capacity under the credit agreement, after taking into account net borrowings related to the CarePlus acquisition.

 

Commercial Paper Program

 

We maintain and may issue short-term debt securities under a commercial paper program when market conditions allow. The program is backed by our credit agreement described above. Aggregate borrowings under both the credit agreement and commercial paper program generally will not exceed $600 million.

 

At March 31, 2005, we had no commercial paper borrowings outstanding.

 

Other Borrowings

 

Other borrowings of $4.1 million at March 31, 2005 represent financing for the renovation of a building, bear interest at 2% per annum, are collateralized by the building, and are payable in various installments through 2014.

 

Shelf Registration

 

Our universal shelf registration with the Securities and Exchange Commission allows us to register debt or equity securities, from time to time, with the amount, price and terms to be determined at the time of the sale. We have up to $300 million remaining from a total of $600 million under the universal shelf registration. The universal shelf registration allows us to use the net proceeds from any future sales of our securities for our operations and for other general corporate purposes, including repayment or refinancing of borrowings, working capital, capital expenditures, investments, acquisitions, or the repurchase of our outstanding securities.

 

 

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Regulatory Requirements

 

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

 

As of March 31, 2005, we maintained aggregate statutory capital and surplus of $1,256.8 million in our state regulated health insurance subsidiaries. Each of these subsidiaries was in compliance with applicable statutory requirements which aggregated $738.2 million. Although the minimum required levels of equity are largely based on premium volume, product mix, and the quality of assets held, minimum requirements can vary significantly at the state level. Certain states rely on risk-based capital requirements, or RBC, to define the required levels of equity. RBC is a model developed by the National Association of Insurance Commissioners to monitor an entity’s solvency. This calculation indicates recommended minimum levels of required capital and surplus and signals regulatory measures should actual surplus fall below these recommended levels. If RBC were adopted by all states at March 31, 2005, each of our subsidiaries would be in compliance and we would have $458.9 million of aggregate capital and surplus above any of the levels that require corrective action under RBC.

 

Cautionary Statements

 

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

 

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

 

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

 

These factors may include:

 

    increased use of medical facilities and services, including prescription drugs;

 

    increased cost of such services;

 

    the Company’s membership mix;

 

    variances in actual versus estimated levels of cost associated with new products, benefits or lines of business, product changes or benefit level changes;

 

    membership in markets lacking adequate provider networks;

 

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    changes in the demographic characteristics of an account or market;

 

    termination of capitation arrangements resulting in the transfer of membership to fee-for-service arrangements;

 

    changes or reductions of our utilization management functions such as preauthorization of services, concurrent review or requirements for physician referrals;

 

    possible changes in our pharmacy rebate program with drug manufacturers;

 

    catastrophes, including acts of terrorism, epidemics, or severe weather;

 

    the introduction of new or costly treatments, including new technologies;

 

    medical cost inflation; and

 

    new government mandated benefits or other regulatory changes.

 

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

 

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

 

We are in a highly competitive industry. Many of our competitors are more established in the health care industry and have a larger market share and greater financial resources than we do in some markets. In addition, other companies may enter our markets in the future, including emerging competitors in the Medicare Advantage program and in consumer-choice health plans, such as high deductible health plans with Health Savings Accounts (“HSA”). We believe that barriers to entry in many markets are not substantial, so the addition of new competitors can occur relatively easily, and customers enjoy significant flexibility in moving between competitors. Contracts for the sale of commercial products are generally bid upon or renewed annually. While health plans compete on the basis of many factors, including service and the quality and depth of provider networks, we expect that price will continue to be a significant basis of competition. In addition to the challenge of controlling health care costs, we face intense competitive pressure to contain premium prices. Factors such as business consolidations, strategic alliances, legislative reform and marketing practices create pressure to contain premium price increases, despite being faced with increasing medical costs. The commercial pricing environment, particularly in the 2 to 300 member groups, is extremely competitive, and several of our competitors, including public and not-for-profit companies, are pricing aggressively to gain market share.

 

Premium increases, introduction of new product designs, and our relationship with our providers in various markets, among other issues, could also affect our membership levels. Other actions that could affect membership levels include the possible exit of or entrance to Medicare Advantage or Commercial markets.

 

To determine the fixed monthly payments per member to pay to managed care plans, CMS has implemented a risk adjustment model that uses diagnosis data from ambulatory treatment settings (hospital outpatient department and physician visits). CMS has also redesigned its data collection and processing system to reduce administrative data burden on Medicare health plans. In 2004, the portion of risk adjusted payment was increased to 30%, from 10% in 2003. The 100% phase-in of risk adjusted payment will be completed in 2007; the portion of risk adjusted payment will increase to 50% in 2005 and 75% in 2006.

 

Under the new risk adjustment methodology, Humana and all managed care organizations must collect, capture and submit the necessary diagnosis code information to CMS twice a year. As a result of this process and the phasing in of the risk adjustment methodology described above, our CMS monthly payments per member may change materially, either favorably or unfavorably.

 

If we do not compete effectively in our markets, if we set rates too high or too low in highly competitive markets to keep or increase our market share, if membership does not increase as we expect, or if it declines, or if we lose accounts with favorable medical cost experience while retaining or increasing membership in accounts with unfavorable medical cost experience, our business and results of operations could be materially adversely affected.

 

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

 

Our future performance depends in large part upon our management team’s ability to execute our strategy to position the Company for the future. This strategy includes the growth of our Commercial segment business, with emphasis on our ASO and individual products, introduction of new products and benefit designs, including our Smart, consumer-choice products, opportunities created with the new Medicare Advantage products, the adoption of new technologies and the integration of acquired businesses and contracts. We believe that by combining our abilities in product design, clinical programs and consumer engagement, we can achieve cost savings for our customers and our company. There can be no assurance that we will be able to successfully implement our operational and strategic initiatives that are intended to position the Company for future growth or that the products we design will be accepted. Failure to implement this strategy or to contain our administrative expenses in line with our membership may result in a material adverse effect on our financial position, results of operations and cash flows.

 

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

 

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

 

We depend on independent third parties for significant portions of our systems-related support, equipment, facilities, and certain data, including data center operations, data network, voice communication services and pharmacy data processing. This dependence makes our operations vulnerable to such third parties’ failure to perform adequately under the contract, due to internal or external factors. We are in the process of changing our pharmacy benefit manager. A change in service providers could result in a decline in service quality and effectiveness or less favorable contract terms which could adversely affect our operating results.

 

We rely on our agreements with customers, confidentiality agreements with employees, and our trade secrets and copyrights to protect our proprietary rights. These legal protections and precautions may not prevent misappropriation of our proprietary information. In addition, substantial litigation regarding intellectual property rights exists in the software industry. We expect software products to be increasingly subject to third-party infringement claims as the number of products and competitors in this area grows.

 

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

 

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

 

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

 

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

 

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

 

We, together with some of our competitors in the health benefits business are defendants in a number of purported class action lawsuits. These include an action originally filed against us and nine of our competitors that purports to be brought on behalf of health care providers. Two companies have now settled this action. This suit alleges breaches of federal statutes, including ERISA and RICO. Depending upon the outcome of these cases, these lawsuits may cause or force changes in the practices of the managed care industry.

 

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

 

    claims relating to the methodologies for calculating premiums;

 

    claims relating to the denial of health care benefits;

 

    challenges to the use of some software products used in administering claims;

 

    medical malpractice actions based on our medical necessity decisions or brought against us on the theory that we are liable for our providers’ alleged malpractice;

 

    allegations of anti-competitive and unfair business activities;

 

    provider disputes over compensation and termination of provider contracts;

 

    disputes related to self-funded business, including actions alleging claim administration errors;

 

    claims related to the failure to disclose some business practices; and

 

    claims relating to customer audits and contract performance.

 

In some cases, substantial non-economic or punitive damages as well as treble damages under the federal False Claims Act, RICO and other statutes may be sought. While we currently have insurance coverage for some of these potential liabilities, other potential liabilities may not be covered by insurance, insurers may dispute coverage or the amount of insurance may not be enough to cover the damages awarded. Additionally, the cost of business insurance coverage has increased significantly. As a result, we have increased the amount of risk that we self-insure, particularly with respect to matters incidental to our business. We believe that we are adequately insured for claims in excess of our self-insurance. However, some types of damages, like punitive damages, may not be covered by insurance, particularly in those jurisdictions in which coverage of punitive damages is prohibited. Insurance coverage for all or some forms of liability may become unavailable or prohibitively expensive in the future.

 

A description of material legal actions in which we are currently involved is included under “Legal Proceedings” in Note 9 to the condensed consolidated financial statements. We cannot predict the outcome of these suits with certainty, and we are incurring expenses in the defense of these matters. Therefore, these legal actions could have a material adverse effect on our financial position, results of operations and cash flows.

 

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

 

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

 

    At March 31, 2005, under one of our contracts with the Centers for Medicare and Medicaid Services, or CMS, we provided health insurance coverage to approximately 233,500 members in Florida. This contract accounted for approximately 17% of our total premiums and ASO fees for the three months ended March 31, 2005. The loss of this and other CMS contracts or significant changes in the Medicare Advantage program as a result of legislative or administrative action, including reductions in payments to us or increases in benefits to members without corresponding increases in payments, may have a material adverse effect on our financial condition, results of operations and cash flows;

 

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    At March 31, 2005, our TRICARE business, which accounted for approximately 17% of our total premiums and ASO fees during the three months ended March 31, 2005, primarily consisted of the South Region contract. The South Region contract is a five-year contract, subject to annual renewals at the Government’s option that covers approximately 2.9 million beneficiaries. This contract also is generally subject to frequent change from events and circumstances such as the escalated conflict in the Middle East. These changes may include a reduction or increase in the number of persons enrolled or eligible to enroll, in the revenue we receive or in our administrative or health care costs. In the event government reimbursements were to decline from projected amounts, our failure to reduce the health care costs associated with these programs could have a material adverse effect on our business. The loss of our current TRICARE contract would have a material adverse effect on our financial position, results of operations and cash flows;

 

    At March 31, 2005, under our contract with the Puerto Rico Health Insurance Administration, we provided health insurance coverage to approximately 392,600 Medicaid members in Puerto Rico. This contract, which expires June 30, 2005 accounted for approximately 3% of our total premiums and ASO fees for the year ended December 31, 2004. Due to recent changes in leadership and policy revisions under consideration, the government of Puerto Rico has decided to delay the bid process for new contracts. We are currently negotiating the terms of contract extensions for a period of up to one year. At this time we are unable to predict the ultimate impact that any government policy revisions might have on our Medicaid contracts in Puerto Rico. The loss of this contract or significant changes in the Puerto Rico Medicaid program as a result of legislative or administrative action, including reductions in payments to us or increases in benefits to members without corresponding increases in payments, may have a material adverse effect on our financial condition, results of operations and cash flows;

 

    changes to these government programs in the future may also affect our ability or willingness to participate in these programs;

 

    higher comparative medical costs;

 

    government regulatory and reporting requirements;

 

    higher marketing and advertising costs per member as a result of marketing to individuals as opposed to groups; and

 

    the possibility of temporary or permanent suspension from participating in government health care programs, including Medicare and Medicaid, if we are convicted of fraud or other criminal conduct in the performance of a health care program or if there is an adverse decision against us under the federal False Claims Act.

 

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

 

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

 

    regulation relating to minimum net worth;

 

    licensing requirements;

 

    approval of policy language and benefits;

 

    mandated benefits and processes;

 

    provider compensation arrangements;

 

    member disclosure;

 

    approval of entry, withdrawal or re-entry into a state or market;

 

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    premium rates; and

 

    periodic examinations by state and federal agencies.

 

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

 

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

 

    mandatory benefits and products;

 

    rules tightening time periods in which claims must be paid;

 

    medical malpractice reform;

 

    defining medical necessity;

 

    health insurance access;

 

    provider compensation and contract language;

 

    disclosure of provider fee schedules and other data about payments to providers, sometimes called transparency;

 

    product flexibility and use of innovative technology;

 

    disclosure of provider quality information;

 

    health plan liability to members who fail to receive appropriate care;

 

    disclosure and composition of physician networks;

 

    formation of regional/national association health plans for small employers;

 

    adding further restrictions and administrative requirements on the use, retention, transmission, processing, production and disclosure of personally identifiable health information;

 

    physicians’ ability to collectively negotiate contract terms with carriers, including fees; and

 

    mental health parity.

 

All of these proposals could apply to us.

 

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

 

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

 

The use of individually identifiable data by our business is regulated at federal and state levels. These laws and rules are changed frequently by legislation or administrative interpretation. Various state laws address the use and maintenance of individually identifiable health data. Most are derived from the privacy provisions in the federal Gramm-Leach-Bliley Act and the Health Insurance Portability and Accountability Act of 1996, or HIPAA. HIPAA includes administrative provisions directed at simplifying electronic data interchange through standardizing transactions, establishing uniform health care provider, payer, and employer identifiers and seeking protections for confidentiality and security of patient data.

 

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Regulations issued in February 2003 set standards for the security of electronic health information. Violations of these rules will subject us to significant penalties. Compliance with HIPAA regulations requires significant systems enhancements, training and administrative effort. The final rules do not provide for complete federal preemption of state laws, but rather preempt all inconsistent state laws unless the state law is more stringent. HIPAA could also expose us to additional liability for violations by our business associates.

 

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

 

We are also subject to various governmental audits and investigations. These can include audits and investigations by state attorneys general, CMS, the Office of the Inspector General of Health and Human Services, the Office of Personnel Management, the Department of Justice, the Department of Labor, the Defense Contract Audit Agency, and state Departments of Insurance and Departments of Health. Several Attorneys General are currently investigating the practices of insurance brokers, including those of certain of the companies in the health care industry. All of these activities could result in the loss of licensure or the right to participate in various programs, or the imposition of fines, penalties and other sanctions. In addition, disclosure of any adverse investigation or audit results or sanctions could negatively affect our industry or our reputation in various markets and make it more difficult for us to sell our products and services.

 

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

 

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

 

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

 

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

 

Our ability to obtain funds from our subsidiaries is restricted.

 

Because we operate as a holding company, we are dependent upon dividends and administrative expense reimbursements from our subsidiaries to fund the obligations of Humana Inc., the parent company. These subsidiaries generally are regulated by states’ Departments of Insurance. In most states, we are required to seek prior approval by these state regulatory authorities before we transfer money or pay dividends from these subsidiaries that exceed specified amounts, or, in some states, any amount. In addition, we normally notify the state Departments of Insurance prior to making payments that do not require approval. We are also required by law to maintain specific prescribed minimum amounts of capital in these subsidiaries.

 

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Debt ratings are an important factor in our competitive position.

 

Claims paying ability, financial strength, and debt ratings by recognized rating organizations have become an increasingly important factor in establishing the competitive position of insurance companies. Ratings information is broadly disseminated and generally used throughout the industry. We believe our claims paying ability and financial strength ratings are an important factor in marketing our products to certain of our customers, and our debt ratings impact both the cost and availability of future borrowings. Each of the rating agencies reviews its ratings periodically and there can be no assurance that current ratings will be maintained in the future. Our ratings reflect each rating agency’s opinion of our financial strength, operating performance, and ability to meet our debt obligations or obligations to policyholders, but are not evaluations directed toward the protection of investors in our common stock and should not be relied upon as such. Downgrades in our ratings, should they occur, may adversely affect our business, financial condition and results of operations.

 

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

 

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

 

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Item 3. Quantitative and Qualitative Disclosure about Market Risk

 

No material changes have occurred in our exposures to market risk since the date of our Annual Report on Form 10-K for the fiscal year ended December 31, 2004.

 

Item 4. Controls and Procedures

 

Under the supervision and with the participation of our Chief Executive Officer, or CEO, our Chief Financial Officer, or CFO, and our principal accounting officer, we carried out an evaluation of the effectiveness of the design and operation of our disclosure controls and procedures for the quarter ended March 31, 2005.

 

Based on our evaluation, our CEO, CFO and principal accounting officer concluded that our disclosure controls and procedures are effective, with reasonable assurance, in timely alerting them to material information required to be included in our periodic SEC reports.

 

As permitted by the Securities and Exchange Commission, our evaluation did not include the disclosure controls and procedures of the acquired operations of CarePlus Health Plans of Florida (CarePlus), which is included in the Company’s consolidated financial statements as of March 31, 2005 and for the period from February 17, 2005 through March 31, 2005. Consolidated operations of CarePlus constituted approximately $533.6 million, or 9% of the Company’s total assets as of March 31, 2005, and approximately $67.3 million, or 2% of the Company’s revenues for the period from February 17, 2005 through March 31, 2005.

 

Changes to certain financial processes, information technology systems, and other components of internal control over financial reporting in regards to the February 2005 acquisition of CarePlus may occur and will be evaluated by management as such integration activities are implemented. Other than the acquisition described above, there has been no change in the Company’s internal control over financial reporting that occurred during the Company’s last fiscal quarter that has materially affected, or is reasonably likely to materially affect, the Company’s internal control over financial reporting.

 

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Part II. Other Information

 

Item 1: Legal Proceedings

 

For a description of the litigation and legal proceedings pending against us, see Legal Proceedings in Note 9 to the condensed financial statements beginning on page 13 of this Form 10-Q.

 

Item 2: Changes in Securities, Use of Proceeds and Issuer Purchases of Equity Securities

 

There were no shares purchased in the open market under an authorized program for the quarter ended March 31, 2005. The last authorized repurchase program expired in January 2005. We repurchased 46,004 shares in connection with employee equity-based compensation plans.

 

Item 3: Defaults Upon Senior Securities

 

None.

 

Item 4: Submission of Matters to a Vote of Security Holders

 

  (a) The regular annual meeting of the stockholders of Humana Inc. was held in Louisville, Kentucky on April 26, 2005, for the purpose of voting on the proposal described below.

 

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

 

  (c) One proposal was submitted to a vote of security holders as follows:

 

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

 

Name


   For

   Withheld

David A. Jones, Jr.

   138,128,052    3,620,875

Frank A. D’Amelio

   137,091,208    4,657,719

W. Roy Dunbar

   139,541,189    2,207,738

John R. Hall

   138,153,859    3,595,068

Kurt J. Hilzinger

   137,098,972    4,649,955

Michael B. McCallister

   138,217,574    3,531,353

W. Ann Reynolds, Ph.D.

   138,013,254    3,735,673

 

Item 5: Other Information

 

In accordance with the company’s retirement-age policy, Humana’s co-founder and chairman of the board, David A. Jones, and Michael E. Gellert retired from the board of directors. Mr. Jones, who had been chairman since he co-founded Humana with the late Wendell Cherry in 1961, and Mr. Gellert, who had served as a board member since 1968 and as a member of the board’s executive committee since 1993, retired after the 2005 annual meeting of shareholders. David A. Jones, Jr., who has served as vice chairman of Humana’s board of directors since 1996 was appointed chairman of the board.

 

Item 6: Exhibits

 

  (a) Exhibit Index:

 

  12 Computation of ratio of earnings to fixed charges.

 

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

 

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

 

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

 

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Part II. Other Information, continued

 

  (b) Reports on Form 8-K

 

  (1) On February 7, 2005, we furnished a report regarding our fourth quarter of 2004 earnings release.

 

  (2) On February 16, 2005, we filed a report regarding the completion of the acquisition of CarePlus Health Plans.

 

  (3) On April 5, 2005, we filed a report regarding the amendment of the TRICARE contract.

 

  (4) On April 29, 2005, we filed a report regarding the compensation of the chairman of Company’s Board of Directors and the election of a new director.

 

  (5) On May 2, 2005, we furnished a report regarding our first quarter of 2005 earnings release.

 

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SIGNATURES

 

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

 

        HUMANA INC.
        (Registrant)
Date:  

May 5, 2005


  By:  

/S/ STEVEN E. MCCULLEY


            Steven E. McCulley
            Vice President
            And Controller
            (Principal Accounting Officer)
Date:  

May 5, 2005


  By:  

/S/ ARTHUR P. HIPWELL


            Arthur P. Hipwell
            Senior Vice President and
            General Counsel

 

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