Table of Contents

 

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 


Form 10-K

 

(Mark One)

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

 

  For the fiscal year ended December 31, 2004

 

or

 

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

 

  For the transition period from                     to                    

 

Commission file number: 000-33395

 

Centene Corporation

(Exact name of registrant as specified in its charter)

 

Delaware   42-1406317
(State or other jurisdiction of
incorporation or organization)
  (I.R.S. Employer
Identification Number)
7711 Carondelet Avenue, Suite 800
St. Louis, Missouri
  63105
(Address of principal executive offices)   (Zip Code)

 

Registrant’s telephone number, including area code: (314) 725-4477

 


 

Securities registered pursuant to Section 12(b) of the Act:

 

Common Stock, $0.001 Par Value   New York Stock Exchange
Title of Each Class   Name of Each Exchange on Which Registered

 

Securities registered pursuant to Section 12(g) of the Act:

None

(Title of Each Class)

 


 

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

 

Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the best of registrant’s knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K.  ¨

 

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

 

The aggregate market value of the voting and non-voting common equity held by non-affiliates of the registrant, based upon the last reported sale price of the common stock on the New York Stock Exchange on June 30, 2004, was $760,859,808.

 

As of January 31, 2005 the registrant had 41,451,131 shares of common stock outstanding.

 

DOCUMENTS INCORPORATED BY REFERENCE

 

Portions of the Proxy Statement for the registrant’s 2005 annual meeting of stockholders are incorporated by reference in Part II, Item 5 and Part III, Items 10, 11, 12, 13 and 14.

 


 

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TABLE OF CONTENTS

 

          Page

Part I     

Item 1.

  

Business

   3

Item 2.

  

Properties

   17

Item 3.

  

Legal Proceedings

   17

Item 4.

  

Submission of Matters to a Vote of Security Holders

   17
Part II     

Item 5.

  

Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities

   18

Item 6.

  

Selected Financial Data

   19

Item 7.

  

Management’s Discussion and Analysis of Financial Condition and Results of Operations

   20

Item 7A.

  

Quantitative and Qualitative Disclosures About Market Risk

   43

Item 8.

  

Financial Statements and Supplementary Data

   44

Item 9.

  

Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

   44

Item 9A.

  

Controls and Procedures

   44

Item 9B.

  

Other Information

   45
Part III     

Item 10.

  

Directors and Executive Officers of the Registrant

   46

Item 11.

  

Executive Compensation

   47

Item 12.

  

Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

   47

Item 13.

  

Certain Relationships and Related Transactions

   47

Item 14.

  

Principal Accountant Fees and Services

   47
Part IV     

Item 15.

  

Exhibits and Financial Statement Schedules

   48

Signatures

   75
    

76

 

“CENTENE,” “NURSEWISE” and “START SMART FOR YOUR BABY” are our registered service marks, and “CONNECTIONS” is our trademark. This filing also contains trademarks, service marks and trade names of other companies.

 

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PART I

 

Item 1. Business

 

OVERVIEW

 

We are a multi-line managed care organization that provides Medicaid and Medicaid-related programs to organizations and individuals through government subsidized programs, including Medicaid, Supplemental Security Income (SSI) and the State Children’s Health Insurance Program (SCHIP). In addition, we provide specialty services including behavioral health, nurse triage and treatment compliance to our own and other healthcare organizations. We have health plans in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin. We also provide specialty services in each of the states where we have health plans as well as free-standing programs in Arizona, California and Colorado. We believe our local approach to managing our subsidiaries, including provider and member services, enables us to provide accessible, high quality, culturally-sensitive healthcare services to our communities. Our disease management, educational and other initiatives are designed to help members best utilize the healthcare system to ensure they receive appropriate, medically necessary services and effective management of routine, severe and chronic health problems. We combine our decentralized local approach for care with a centralized infrastructure of support functions such as finance, information systems and claims processing.

 

We were organized in Wisconsin in 1993 and reincorporated in Delaware in 2001. We initially were formed to serve as a holding company for a Medicaid managed care line of business that has been operating in Wisconsin since 1984. Our corporate office is located at 7711 Carondelet Avenue, Suite 800, St. Louis, Missouri 63105, and our telephone number is (314) 725-4477.

 

We maintain a website with the address www.centene.com. We are not including the information contained on our website as part of, or incorporating it by reference into, this filing. We make available, free of charge through our website, our Section 16 filings, annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K, and any amendments to these reports filed or furnished pursuant to Section 13(a) or 15(d) of the Exchange Act as soon as reasonably practicable after we electronically file such material with, or furnish such material to, the SEC.

 

INDUSTRY

 

Established in 1965, Medicaid is the largest publicly funded program in the United States, providing health insurance to low-income families and individuals with disabilities. Authorized by Title XIX of the Social Security Act, Medicaid is an entitlement program funded jointly by the federal and state governments and administered by the states. Each state establishes its own eligibility standards, benefit packages, payment rates and program administration within federal standards. As a result, there are 56 Medicaid programs—one for each state, each territory and the District of Columbia. The National Association of State Budget Officers estimates the total Medicaid market was approximately $310 billion in 2004 and the federal Centers for Medicare and Medicaid Services, or CMS, estimate the market will grow to over $400 billion by fiscal year 2007. Medicaid eligibility is based on a combination of income and asset requirements subject to federal guidelines, often determined by an income level relative to the federal poverty level. The number of persons covered by Medicaid increased from 23 million in 1989 to over 50 million in 2003. Historically, children have represented the largest eligibility group.

 

SSI beneficiaries receive the majority of their healthcare needs through Medicaid. SSI beneficiaries are people with chronic physical disabilities or behavioral health impairments. State Medicaid expenditures related to the SSI population represent a growing percentage of all Medicaid related expenses.

 

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The Balanced Budget Act of 1997 created SCHIP to help states expand coverage primarily to children whose families earn too much to qualify for Medicaid, yet not enough to afford private health insurance. SCHIP is the single largest expansion of health insurance coverage for children since the enactment of Medicaid and some states include the parents of these children in their SCHIP programs.

 

Costs related to the largest eligibility group, children, are primarily composed of pediatrics, OB/GYN and family care. These costs tend to be more predictable than other healthcare issues which predominantly affect the adult population. Additionally, behavioral health issues represent a growing component of total Medicaid expenditures.

 

While Medicaid programs have directed funds to many individuals who could not afford or otherwise maintain health insurance coverage, they did not initially address the inefficient and costly manner in which the Medicaid population tends to access healthcare. Medicaid recipients typically have not sought preventive care or routine treatment for chronic conditions, such as asthma and diabetes. Rather, they have sought healthcare in hospital emergency rooms, which tend to be more expensive. As a result, many states have found that the costs of providing Medicaid benefits have increased while the medical outcomes for the recipients remained unsatisfactory.

 

Since the early 1980s, increasing healthcare costs, combined with significant growth in the number of Medicaid recipients, have led many states to establish Medicaid managed care initiatives. Continued pressure on states’ Medicaid budgets should cause public policy to recognize the value of managed care as a means of delivering quality health care and effectively controlling costs. A growing number of states, including each of the seven states in which we operate, have mandated that their Medicaid recipients enroll in managed care plans. Currently, 42 states have mandated managed care for some or all of their Medicaid recipients and other states are considering moving to a mandated managed care approach.

 

In addition, several states have initiated specialized programs that focus on specific, chronic diseases. Often, chronic diseases like diabetes and asthma can be treated more successfully and efficiently when a comprehensive treatment plan is properly executed. Such a plan includes not only timely and appropriate medical care, but requires that the patient maintain an appropriate diet and exercise regimen, take medicines as prescribed, keep appointments with doctors, and monitor their health status.

 

Historically, commercial managed care organizations contracted with states to provide healthcare benefits to Medicaid enrollees. Many of these organizations encountered difficulties in adapting their commercial approaches and infrastructures to address the Medicaid market in a cost-effective manner. Some commercial plans have chosen to exit all or a portion of their Medicaid markets. As a result, a significant market opportunity exists for managed care organizations with operations and programs focused on the distinct socio-economic, cultural and healthcare needs of the Medicaid, SSI and SCHIP populations. We believe our approach and strategy enable us to be a growing participant in this market.

 

OUR APPROACH

 

Our multi-line managed care approach is based on the following key attributes:

 

    Multi-Business Lines. We have provided benefits to Medicaid recipients for over 20 years. We are completing the second year of a longer term program to broaden our service offerings to address areas that we believe have been traditionally underserved by Medicaid managed care organizations. In 2003 we acquired Group Practice Affiliates, LLC (GPA), a behavioral health services company which we renamed Cenpatico Behavioral Health (Cenpatico). In 2003 we also purchased assets of ScriptAssist, a treatment compliance company. These businesses marked our entry into the Specialty Services segment. We believe these and other business lines will allow us to expand our services and diversify our sources of revenue.

 

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    Medicaid Expertise. Over the last 20 years, we have developed a specialized Medicaid expertise that has helped us establish and maintain strong relationships with our constituent communities of members, providers and state governments. We have implemented programs developed to achieve savings for state governments and improve medical outcomes for members by reducing inappropriate emergency room use, inpatient days and high cost interventions, as well as by managing care of chronic illnesses. We do this primarily by supplying nurse case managers who support our provider network in implementing disease management programs and by supplying incentives for our provider network to provide preventive care on a regular basis. We recruit and train staff and providers who are attentive to the needs of our members and who are experienced in working with culturally diverse, low-income Medicaid populations. Our experience in working with state regulators helps us to implement and deliver our programs and services efficiently and affords us opportunities to provide input regarding Medicaid industry practices and policies in the states in which we operate.

 

    Localized Services, Support and Branding. We provide access to services through local networks of providers and staff that focus on the cultural norms of their individual communities. Our systems and procedures have been designed to address these community-specific challenges through outreach, education, transportation and other member support activities. For example, our community outreach programs work with our members and their communities to promote health and self-improvement through employment and education on how best to access care. Our behavioral health company operates school programs in Arizona which provide special education programs directly in local schools. We use locally recognized company names, and we tailor our materials and processes to meet the needs of the communities we serve. Our approach to community-based service results in local accountability and improved access.

 

    Collaborative Approach With States. Our approach is to work with state agencies on redefining benefits, eligibility requirements and provider fee schedules in order to maximize the number of uninsured individuals covered through Medicaid, SSI and SCHIP and expand the types of benefits offered. Our approach is to do this while maintaining adequate levels of provider compensation and protecting our margins.

 

    Physician-Driven Approach Within Our Health Plans. We have implemented a physician-driven approach in which our contracted physicians are actively engaged in developing and implementing our healthcare delivery policies and strategies. Our local boards of directors, which help shape the character and quality of our organization, have significant provider representation in each of our principal geographic markets. This approach is designed to eliminate unnecessary costs, improve service to our members and simplify the administrative burdens on our providers. It has enabled us to strengthen our provider networks through improved physician recruitment and retention that, in turn, have helped to increase our membership base.

 

    Efficiency of Business Model. We have designed our business model to allow us to readily add new members in our existing markets, expand into new regions in which we choose to operate and more fully develop our services. The combination of our decentralized local approach to operating our subsidiaries and our centralized finance, information systems and claims processing allows us to quickly and economically integrate new business opportunities in both Medicaid and specialty services.

 

    Specialized Systems and Technology. Through our specialized information systems we are able to strengthen our relationships with providers and states which helps us to grow our membership base. These systems also help us identify needs for new healthcare and specialty programs. Physicians can use our claims, utilization and membership data to manage their practices more efficiently, and they also benefit from our timely and accurate payments. State agencies can use data from our information systems to demonstrate that their Medicaid populations receive quality healthcare in an efficient manner. Our ScriptAssist program uses specialized software and psychological-based tools to predict treatment compliance in an efficient and scalable manner.

 

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OUR STRATEGY

 

Our objective is to become the leading multi-line Medicaid and Medicaid-related managed care organization. We intend to achieve this objective by implementing the following key components of our strategy:

 

    Diversify Our Business Lines. We seek to broaden our business lines into areas that complement our business to enable us to grow our revenue stream. In 2003 we acquired Cenpatico, a behavioral health services company, and purchased assets of ScriptAssist, a treatment compliance company. In addition to the services provided through these acquisitions and NurseWise, our 24-hour telephone triage service, we are considering services such as disease management and other Medicaid-related, fee-for-service lines of business that would complement our core business. We believe we have opportunities to offer these services to other managed care organizations and states.

 

    Address Emerging State Needs. We are working to assist the states in which we operate in addressing the challenges they face in these difficult economic times. We seek to assist the states in balancing premium rates, benefit levels, member eligibility, policies and practices, and provider compensation. For example, in 2004 Cenpatico was awarded a behavioral health contract to serve approximately 34,000 SCHIP members in Kansas effective January 1, 2005. By helping states structure an appropriate level and range of Medicaid, SCHIP and specialty services, we seek to ensure that we are able to continue to provide those services on terms that protect our targeted gross margins, provide an acceptable return to our stockholders and grow our business.

 

    Increase Penetration of Existing State Markets. We intend to continue to increase our Medicaid membership in states in which we currently operate through alliances with key providers, outreach efforts, development and implementation of community-specific products and acquisitions. For example, we were awarded a SCHIP Exclusive Provider Organization (EPO) contract, effective September 1, 2004. Through this contract we serve approximately 87,500 SCHIP members in Texas. Also, in Indiana, where the state assigns members to physicians, we increased our membership in 2004 by attracting additional physicians. We may also increase membership by acquiring Medicaid businesses, contracts and other related assets from our competitors in our existing markets. For example, we purchased Medicaid-related contracts from HMO Blue Texas in 2003 and purchased Texas Universities Health Plan’s SCHIP contracts in 2002.

 

    Develop and Acquire Additional State Markets. We continue to leverage our experience to identify and develop new markets by seeking both to acquire existing businesses and to build our own operations. We expect to focus our expansion on states where Medicaid recipients are mandated to enroll in managed care organizations. For example, we entered the Kansas and Missouri markets effective December 1, 2004 through our acquisitions of FirstGuard, Inc. and FirstGuard Health Plan, Inc. (collectively, FirstGuard). We also entered the Ohio market effective January 1, 2004 through our acquisition of Medicaid-related assets from Family Health Plan, Inc. In December 2002 we entered the New Jersey market through our acquisition of University Health Plans, Inc., or UHP.

 

    Leverage Our Established Infrastructure to Enhance Operating Efficiencies. We intend to continue to invest in our infrastructure to further drive efficiencies in our operations and to add functionality to improve the service we provide to our members and other organizations at a low cost. Our centralized functions enable us to add members and markets quickly and economically. We have initiated a new claims processing facility in Montana to accommodate our planned growth initiatives providing geographic diversity for this centralized function.

 

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MEDICAID MANAGED CARE

 

Health Plans

 

We have regulated subsidiaries offering healthcare services in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin. We have never been denied a contract renewal from a state in which we do business. The table below provides summary data for the markets we currently serve.

 

    Indiana

  Kansas

  Missouri

  New
Jersey


  Ohio

  Texas

  Wisconsin

Local Health Plan Name

  Coordinated Care
Corporation

Indiana
  FirstGuard
Health Plan
  FirstGuard
Health Plan
  University
Health
Plans
  Buckeye
Community
Health Plan
  Superior
HealthPlan
  Managed
Health
Services

First Year of Operations

  1995   1999   1997   1994   2004   1999   1984

Counties Licensed at January 31, 2005

  92   105   9   20   9   254   24

Membership at December 31, 2004

  150,600   94,200   41,200   52,800   23,800   244,300   165,800

 

States

 

Our ability to establish and maintain a leadership position in the markets we serve results primarily from our demonstrated success in providing quality care while reducing and managing costs, and from our customer-focused approach to working with state governments. Among the benefits we are able to provide to the states with which we contract are:

 

•      significant cost savings compared to fee-for-service

 

•      timely payment of provider claims

•      data-driven approaches to balance cost and verify eligibility

 

•      cost saving outreach and specialty programs

•      establishment of realistic and meaningful expectations for quality deliverables

 

•      responsible collection and dissemination of encounter data

•      managed care expertise in government subsidized programs

 

•      timely and accurate reporting

•      improved medical outcomes

   

 

Member Programs and Services

 

We recognize the importance of member-focused services in the delivery of quality managed care services. Our locally based staff assist members in accessing care, coordinating referrals to related health and social services and addressing member concerns and questions. While covered healthcare benefits vary from state to state, our health plans generally provide the following services:

 

•      primary and specialty physician care

 

•      after hours nurse advice line

•      inpatient and outpatient hospital care

 

•      transportation assistance

•      emergency and urgent care

 

•      health status calls to coordinate care

•      prenatal care

 

•      vision care

•      laboratory and x-ray services

 

•      dental care

•      home health and durable medical equipment

 

•      immunizations

•      behavioral health and substance abuse services

 

•      prescriptions and limited over-the-counter drugs

 

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We also provide the following education and outreach programs to inform and assist members in accessing quality, appropriate healthcare services in an efficient manner:

 

    CONNECTIONS is designed to create a link between the member and the provider and help identify potential challenges or risk elements to a member’s health, such as abuse risks, nutritional challenges and health education shortcomings. CONNECTIONS representatives also contact new members by phone or mail to discuss managed care, the Medicaid program and our services. Our CONNECTIONS representatives make home visits, conduct educational programs and represent our health plans at community events such as health fairs.

 

    Start Smart For Your Baby is a prenatal and infant health program designed to increase the percentage of pregnant women receiving early prenatal care, reduce the incidence of low birth weight babies, identify high risk pregnancies, increase participation in the federal Women, Infant and Children program, and increase well-child visits. The program includes risk assessments, education through face-to-face meetings and materials, behavior modification plans, assistance in selecting a provider for the infant and scheduling newborn follow-up visits.

 

    EPSDT Case Management is a preventive care program designed to educate our members on the benefits of Early and Periodic Screening, Diagnosis and Treatment, or EPSDT, services. We have a systematic program of communicating, tracking, outreach, reporting and follow-through that promotes state EPSDT programs.

 

    Disease Management Programs are designed to help members understand their disease and treatment plan, and improve or maintain their quality of life. These programs address medical conditions that are common within the Medicaid population such as asthma, diabetes and prenatal care. Our SSI program uses a proprietary assessment tool that effectively identifies barriers to care, unmet functional needs, available social supports and the existence of behavioral health conditions that impede a member’s ability to maintain health status. Care coordinators develop individual care plans with the member and healthcare providers ensuring the full integration of behavioral, social and acute care services. These care plans, while specific to an SSI member, incorporate “Condition Specific” practices in collaboration with physician partners and community resources.

 

Providers

 

For each of our service areas, we establish a provider network consisting of primary and specialty care physicians, hospitals and ancillary providers. As of January 31, 2005, our health plans had the following numbers of physicians and hospitals:

 

    

Primary Care

Physicians


  

Specialty Care

Physicians


   Hospitals

Indiana

   555    1,064    34

Kansas

   1,381    3,184    153

Missouri

   410    1,624    38

New Jersey

   1,553    5,635    81

Ohio

   156    540    6

Texas

   4,426    7,915    278

Wisconsin

   1,812    3,083    60

 

The primary care physician is a critical component in care delivery, management of costs and the attraction and retention of new members. Primary care physicians include family and general practitioners, pediatricians, internal medicine physicians and OB/GYNs. Specialty care physicians provide medical care to members generally upon referral by the primary care physicians.

 

We work with physicians to help them operate efficiently by providing financial and utilization information, physician and patient educational programs and disease and medical management programs. In addition, we adhere to a prompt payment policy. Our programs are also designed to help the physicians coordinate care outside of their offices.

 

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We believe our collaborative approach with physicians gives us a competitive advantage in entering new markets. Our physicians serve on local committees that assist us in implementing preventive care programs, managing costs and improving the overall quality of care delivered to our members. The following are among the services we provide to support physicians:

 

    Customized Utilization Reports provide our contracted physicians with information that enables them to run their practices more efficiently and focuses them on specific patient needs. For example, quarterly detail reports update physicians on their status within their risk pools. Equivalency reports provide physicians with financial comparisons of capitated versus fee-for-service arrangements.

 

    Case Management Support helps the physician coordinate specialty care and ancillary services for patients with complex conditions and direct members to appropriate community resources to address both their health and socio-economic needs.

 

    Web-based Claims and Eligibility Resources have been implemented in selected markets to provide physicians with on-line access to perform claims and eligibility inquiries.

 

Our contracted physicians also benefit from several of the services offered to our members, including the CONNECTIONS, EPSDT case management and disease management programs. For example, the CONNECTIONS staff facilitate doctor/patient relationships by connecting members with physicians, the EPSDT programs encourage routine checkups for children with their physicians and the disease management programs assist physicians in managing their patients with chronic disease.

 

We provide access to healthcare services for our members primarily through contracts with our providers. Our contracts with primary and specialty care physicians and hospitals usually are for one to two-year periods and renew automatically for successive one-year terms, but generally are subject to termination by either party upon 90 to 120 days’ prior written notice. In the absence of a contract, we typically pay providers at state Medicaid reimbursement levels. We pay physicians under a capitated or fee-for-service arrangement.

 

    Under our capitated contracts, primary care physicians are paid a monthly capitation rate for each of our members assigned to his or her practice and are at risk for all costs related to primary and specialty physician and emergency room services. In return for this payment, these physicians provide all primary care and preventive services, including primary care office visits and EPSDT services. If these physicians also provide non-capitated services to their assigned members, they may bill and be paid under fee-for-service arrangements at Medicaid rates.

 

    Under our fee-for-service contracts with physicians, particularly specialty care physicians, we pay the physicians a negotiated fee for covered services. This model is characterized as having no financial risk for the physician.

 

Some of our health plans utilize Cenpatico to provide behavioral health services. We also contract with ancillary providers on a negotiated fee arrangement for physical therapy, mental health and chemical dependency care, home healthcare, vision care, diagnostic laboratory tests, x-ray examinations, ambulance services and durable medical equipment. Additionally, we contract with dental vendors in markets where routine dental care is a covered benefit. In our health plans, where prescription and limited over-the-counter drugs are a covered benefit, we have a fee-for-service arrangement with a national pharmacy vendor that provides a pharmacy network.

 

Quality Management

 

Our medical management programs focus on improving quality of care in areas that have the greatest impact on our members. We employ strategies, including disease management and complex case management, that are fine-tuned for implementation in our individual markets by a system of physician committees chaired by local physician leaders. This process promotes physician participation and support, both critical factors in the success of any clinical quality improvement program.

 

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We have implemented specialized information systems to support our medical quality management activities. Information is drawn from our data warehouse, clinical databases and our membership and claims processing system, as sources to identify opportunities to improve care and to track the outcomes of the interventions implemented to achieve those improvements. Some examples of these intervention programs include:

 

    a prenatal case management program aimed at helping women with high-risk pregnancies deliver full-term, healthy infants;

 

    a program to reduce the number of inappropriate emergency room visits; and

 

    a disease management program to improve the ability of those with asthma and their families to control their disease and thereby reduce the need for emergency room visits and hospitalizations.

 

We provide reporting on a regular basis using our data warehouse. State and Health Employer Data and Information Set, or HEDIS, reporting constitutes the core of the information base that drives our clinical quality performance efforts. This reporting is monitored by Plan Quality Improvement Committees and our corporate medical management team. Additionally, during 2004, Cenpatico received full accreditation under the Health Plan Standards of the Utilization Review Accreditation Committee, also known as URAC. The accreditation is effective January 1, 2005 through January 1, 2007.

 

In order to ensure the quality of our provider networks, we verify the credentials and background of our providers using standards that are supported by the National Committee for Quality Assurance.

 

Management Information Systems

 

The ability to access data and translate it into meaningful information is essential to operating across a multi-state service area in a cost-effective manner. Our centralized information systems located in St. Louis, Missouri, support our core processing functions under a set of integrated databases and are designed to be both replicable and scalable to accommodate internal growth and growth from acquisitions. We have the ability to leverage the platform we have developed for our existing states for configuration into new states or health plan acquisitions.

 

This integrated approach helps to assure that consistent sources of claim and member information are provided across all of our health plans. Our membership and claims processing system is capable of expanding to support additional members in an efficient manner as needed.

 

We have a disaster recovery and business resumption plan developed and implemented in conjunction with a third party. This plan allows us complete access to the business resumption centers and hot-site facilities provided by the plan.

 

SPECIALTY SERVICES

 

In 2003 we entered the specialty services market. Our specialty services are provided primarily through the following interrelated businesses:

 

    Cenpatico manages behavioral healthcare for members via a contracted network of providers. Cenpatico works with providers to determine the best course of treatment for a given diagnosis and helps ensure members and their providers are aware of the full array of services available. Our networks feature a range of services so that patients can be treated at an appropriate level of care. We also run school-based programs in Arizona that focus on students with special education needs.

 

   

ScriptAssist is a treatment compliance program that uses psychological-based tools to predict which patients are likely to cease taking their medications, and then to motivate those at-risk patients to adhere

 

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to their doctors’ advice. Patients with chronic medical conditions frequently fail to take their medications properly, if at all. This generally results in increased hospital costs and poor outcomes for the patients. ScriptAssist uses registered nurses to educate patients about the reasons for the medications they were prescribed, to provide accurate information about side effects and risks of such medications, and to keep the doctors informed of the patients’ progress between visits.

 

    NurseWise provides a toll-free nurse triage line 24 hours per day, 7 days per week, 52 weeks per year. Our members call one number and reach customer service representatives and bilingual nursing staff who provide health education, triage advice and offer continuous access to health plan functions. Additionally, our representatives verify eligibility, confirm primary care provider assignments and provide benefit and network referral coordination for members and providers after business hours. Our staff can arrange for urgent pharmacy refills, transportation and qualified behavioral health professionals for crisis stabilization assessments. Call volume is based on membership levels and seasonal variation. In recent months, NurseWise call volume has ranged from 13,000 to 20,000 calls per month. In addition, NurseWise, through our Ohio plan, has been awarded a contract to serve approximately 1,900 SSI members in Stark County, Ohio through the Enhanced Care Management Program.

 

Our entry into the behavioral health field allows us to continue to offer solutions to the states in which we have health plans as well as other states where behavioral health for Medicaid recipients has been underserved.

 

CORPORATE COMPLIANCE

 

Our Corporate Ethics and Compliance Programs were first established in 1998 and provide methods by which we further enhance operations, safeguard against fraud and abuse, improve access to quality care and help assure that our values are reflected in everything we do.

 

The two primary standards by which corporate compliance programs in the healthcare industry are measured are the 1991 Federal Organizational Sentencing Guidelines and the “Compliance Program Guidance” series issued by the Office of the Inspector General, or OIG, of the Department of Health and Human Services.

 

Our program contains each of the seven elements suggested by the Sentencing Guidelines and the OIG guidance. These key components are:

 

    written standards of conduct;

 

    designation of a corporate compliance officer and compliance committee;

 

    effective training and education;

 

    effective lines for reporting and communication;

 

    enforcement of standards through disciplinary guidelines and actions;

 

    internal monitoring and auditing; and

 

    prompt response to detected offenses and development of corrective action plans.

 

Our internal Corporate Compliance website, accessible by all employees, contains our Business Ethics and Conduct Policy; our Mission, Values and Philosophies and Compliance Programs; a company-wide policy and procedure database and our toll-free hotline to allow employees or other persons to report suspected incidents of fraud, abuse or other violations of our corporate compliance program. The audit committee and the board of directors review the incident log on a quarterly basis.

 

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COMPETITION

 

In the Medicaid business, our principal competitors for state contracts, members and providers consist of the following types of organizations:

 

    Primary Care Case Management Programs are programs established by the states through contracts with primary care providers. Under these programs, physicians provide primary care services to Medicaid recipients, as well as limited medical management oversight.

 

    National and Regional Commercial Managed Care Organizations have Medicaid members in addition to members in private commercial plans.

 

    Medicaid Managed Care Organizations focus solely on providing healthcare services to Medicaid recipients. The vast majority of these operate in one city or state and are owned by providers, primarily hospitals. Their membership is small relative to the infrastructure that is required for them to do business. Such organizations include behavioral health managed care organizations and disease management entities that may vie for Medicaid contracts. There are a few multi-state Medicaid-only organizations that tend to be larger in size and, therefore, are able to leverage their infrastructure over larger memberships.

 

We will continue to face varying levels of competition as we expand in our existing service areas or enter new markets as federal regulations require at least two competitors in each service area. Healthcare reform proposals may cause a number of commercial managed care organizations already in our service areas to decide to enter or exit the Medicaid market. The licensing requirements and bidding and contracting procedures in some states, however, present barriers to entry into the Medicaid managed healthcare industry.

 

We compete with other managed care organizations for state contracts. In order to grant a contract, state governments consider many factors. These factors include quality of care, financial requirements, an ability to deliver services and establish provider networks and infrastructure.

 

We also compete to enroll new members and retain existing members. People who wish to enroll in a managed healthcare plan or to change healthcare plans typically choose a plan based on the quality of care and services offered, ease of access to services, a specific provider being part of the network and the availability of supplemental benefits. In certain markets, where recipients select a physician instead of a health plan, we are able to grow our membership by adding new physicians to our provider base.

 

We also compete with other managed care organizations to enter into contracts with physicians, physician groups and other providers. We believe the factors that providers consider in deciding whether to contract with us include existing and potential member volume, reimbursement rates, medical management programs, speed of reimbursement and administrative service capabilities.

 

Competition for specialty services consists of specialized programs that focus on specific chronic diseases and are often administered by companies that developed comprehensive care guidelines and patient support services appropriate to each specific disease or disorder. High cost and high-risk conditions offer the best return on investment in these programs and a number of companies compete for these contracts. Managed care organizations have long had disease specific initiatives, but such programs are now offered by pharmacy benefit managers, pharmaceutical makers and a number of specialty companies.

 

FINANCIAL INFORMATION

 

All of our revenue is derived from operations within the United States. Our managed care subsidiaries in Indiana, New Jersey, Texas and Wisconsin have revenues from their respective state governments that each exceeded 10% of consolidated revenues in 2004. Other financial information about our segments is found in Note 20 of our Notes to Consolidated Financial Statements included elsewhere in this Form 10-K.

 

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REGULATION

 

Our healthcare and specialty operations are regulated at both state and federal levels. Government regulation of the provision of healthcare products and services is a changing area of law that varies from jurisdiction to jurisdiction. Regulatory agencies generally have discretion to issue regulations and interpret and enforce laws and rules. Changes in applicable laws and rules also may occur periodically.

 

Our regulated subsidiaries are licensed to operate as health maintenance organizations and/or insurance companies in their respective states. In each of the jurisdictions in which we operate, we are regulated by the relevant health, insurance and/or human services departments that oversee the activities of managed care organizations providing or arranging to provide services to Medicaid enrollees.

 

The process for obtaining authorization to operate as a managed care organization is lengthy and involved and requires demonstration to the regulators of the adequacy of the health plan’s organizational structure, financial resources, utilization review, quality assurance programs, complaint procedures, provider network adequacy and procedures for covering emergency medical conditions. Under both state managed care organization statutes and state insurance laws, our health plan subsidiaries must comply with minimum statutory capital requirements and other financial requirements, such as deposit and reserve requirements. Insurance regulations may also require prior state approval of acquisitions of other managed care organizations’ businesses and the payment of dividends, as well as notice for loans or the transfer of funds. Our subsidiaries are also subject to periodic reporting requirements. In addition, each health plan must meet criteria to secure the approval of state regulatory authorities before implementing operational changes, including the development of new product offerings and, in some states, the expansion of service areas.

 

States have adopted a number of new regulations that may affect our business and results of operations. These regulations in certain states include:

 

    premium and maintenance taxes;

 

    stringent prompt-pay laws;

 

    disclosure requirements regarding provider fee schedules and coding procedures; and

 

    programs to monitor and supervise the activities and financial solvency of provider groups.

 

Medicaid

 

In order to be a Medicaid managed care organization in each of the states in which we operate, we must operate under a contract with the state’s Medicaid agency. States generally use either a formal proposal process, reviewing a number of bidders, or award individual contracts to qualified applicants that apply for entry to the program. We receive monthly payments based on specified capitation rates determined on an actuarial basis. These rates differ by membership category and by state depending on the specific coverages and policies adopted by each state. In 2004, the premium revenue received per member per month ranged from $73 to $415 based on line of business and covered services.

 

During 2004, we entered into a contract with the Indiana Office of Medicaid Policy and Planning and Office of the Children’s Health Insurance Program to provide Indiana Medicaid and Indiana Children’s Health Insurance Program services through our subsidiary, Coordinated Care Corporation Indiana, Inc. The contract commenced January 1, 2005 and has a scheduled termination date of December 31, 2006. This contract may be terminated by the State without cause upon sixty days prior written notice. We have held a contract with the State of Indiana since 1993.

 

With the acquisition of FirstGuard, we have a contract with the State of Kansas, Department of Social and Rehabilitation Services to provide Medicaid and SCHIP services. The contract commenced on July 1, 2001 and had an initial scheduled termination date of June 30, 2003, but has been renewed through June 30, 2005. The

 

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agreement is renewable for one additional twelve-month period. The contract may be terminated by the State for event of default or significant change in circumstances. FirstGuard has held a contract with the State of Kansas since 1999.

 

Additionally, with the acquisition of FirstGuard, we have a contract with the State of Missouri, Office of Administration, Division of Purchasing and Materials Management to provide Medicaid and SCHIP services. The contract commenced on January 1, 2004 and had an initial scheduled termination date of December 31, 2004, but has been renewed through December 31, 2005. The agreement is renewable for one additional twelve-month period. The contract may be terminated by the State for event of default or significant change in circumstances. FirstGuard has held a contract with the State of Missouri since 1997.

 

With the acquisition of UHP, we have a contract with the State of New Jersey Department of Human Services to provide Medicaid and SCHIP services. The contract commenced on July 1, 2002 and had an initial scheduled termination date of June 30, 2003, but has been renewed through June 30, 2005. The agreement is renewable annually for successive twelve-month periods. The contract may be terminated by the State for event of default or significant change in circumstances. UHP has held a contract with the State of New Jersey since 1994.

 

We have entered into a contract with the Ohio Department of Job and Family Services to provide Medicaid services through our subsidiary, Buckeye Community Health Plan. The contract commenced July 1, 2004 and has a scheduled termination date of June 30, 2005. The agreement is renewable annually for successive twelve-month periods. The contract may be terminated by the State for event of default. We are paid based on specified capitation rates for our services. We have held a contract with the State of Ohio since January 2004.

 

We presently are party to several contracts with the Texas Health and Human Services Commission to provide Medicaid and SCHIP managed care services in our Texas markets through our Superior HealthPlan, Inc. subsidiary. Our current Texas Medicaid and SCHIP contracts commenced September 1, 2004 and have scheduled termination dates of August 31, 2005. The contracts generally may be terminated upon any event of default or in the event state or federal funding for Medicaid programs is no longer available. We have held a contract with the State of Texas since 1999.

 

We have entered into an Exclusive Provider Organization (EPO) contract with the Texas Health and Human Services Commission to provide SCHIP managed care services in Texas through our Bankers Reserve subsidiary, d/b/a Superior HealthPlan Network. The contract commenced on September 1, 2004 and is scheduled to end on August 31, 2007. Upon mutual consent the agreement is renewable for a period or periods, but the contract term may not exceed six years. The contract generally may be terminated upon any event of default or in the event state or federal funding for Medicaid programs is no longer available. We have held a contract with the State of Texas since 1999.

 

We have entered into a contract with the Wisconsin Department of Health and Family Services to provide Medicaid services. The contract commenced May 1, 2004 and has a scheduled termination date of December 31, 2005. This contract is renewable for an additional one-year term. The contract can be terminated if a change in state or federal laws, rules or regulations materially affects either party’s rights or responsibilities under the contract. We have held a contract with the State of Wisconsin for 20 years.

 

We have also entered into an agreement with Network Health Plan of Wisconsin, Inc. pursuant to which Network Health Plan subcontracts to us its Medicaid services under its contract with the State of Wisconsin. The agreement commenced January 1, 2001 and has a scheduled termination of December 31, 2011. The agreement renews automatically for successive five-year terms and can be terminated by either party upon two-years notice prior to the end of the then current term. The agreement may also be terminated if a change in state or federal laws, rules or regulations materially affects either party’s rights or responsibilities under the contract, or if Network Health Plan’s contract with the State of Wisconsin is terminated.

 

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Our contracts with the states and regulatory provisions applicable to us generally set forth in great detail the requirements for operating in the Medicaid sector, including provisions relating to:

 

•      eligibility, enrollment and disenrollment processes;

  

•      health education and wellness and prevention programs;

•      covered services;

  

•      timeliness of claims payment;

•      eligible providers;

  

•      financial standards;

•      subcontractors;

  

•      safeguarding of member information;

•      record-keeping and record retention;

  

•      fraud and abuse detection and reporting;

•      periodic financial and informational reporting;

  

•      grievance procedures; and

•      quality assurance;

  

•      organization and administrative systems.

 

A health plan’s compliance with these requirements is subject to monitoring by state regulators and by CMS. A health plan is also subject to periodic comprehensive quality assurance evaluations by a third-party reviewing organization and generally by the insurance department of the jurisdiction that licenses the health plan. A health plan must also submit reports to various regulatory agencies, including quarterly and annual statutory financial statements and utilization reports.

 

HIPAA

 

In 1996, Congress enacted the Health Insurance Portability and Accountability Act of 1996, or HIPAA. The Act is designed to improve the portability and continuity of health insurance coverage and simplify the administration of health insurance claims. Among the main requirements of HIPAA are standards for the processing of health insurance claims and related transactions.

 

The regulation’s requirements apply to transactions conducted using “electronic media.” Since “electronic media” is defined broadly to include “transmissions that are physically moved from one location to another using magnetic tape, disk or compact disk media,” many communications are considered to be electronically transmitted. Under the HIPAA regulations, health plans are required to have the capacity to accept and send all covered transactions in a standardized electronic format. The regulations set forth other rules that apply specifically to health plans as follows:

 

    a plan may not delay processing of a standard transaction (that is, it must complete transactions using the new standards at least as quickly as it had prior to implementation of the new standards);

 

    there should be “no degradation in the transmission of, receipt of, processing of, and response to” a standard transaction as compared to the handling of a non-standard transaction;

 

    if a plan uses a healthcare clearinghouse to process a standard request, the other party to the transaction may not be charged more or otherwise disadvantaged as a result of using the clearinghouse;

 

    a plan may not reject a standard transaction on the grounds that it contains data that is not needed or used by the plan;

 

    a plan may not adversely affect (or attempt to adversely affect) the other party to a transaction for requesting a standard transaction; and

 

    if a plan coordinates benefits with another plan, then upon receiving a standard transaction, it must store the coordination of benefits data required to forward the transaction to the other plan.

 

HIPAA regulations also protect the privacy of medical records and other personal health information maintained and used by healthcare providers, health plans and healthcare clearinghouses. We have implemented

 

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processes, policies and procedures to comply with the HIPAA privacy regulations, including educating and training for employees. In addition, the corporate privacy officer and health plan privacy officials serve as resources to employees to address any questions or concerns they may have. Among numerous other requirements, the privacy regulations:

 

    limit certain uses and disclosures of private health information, and require patient authorizations for such uses and disclosures of private health information;

 

    give patients new rights to access their medical records and to know who else has accessed them;

 

    limit most disclosure of health information to the minimum needed for the intended purpose;

 

    establish procedures to ensure the protection of private health information;

 

    establish new requirements for access to records by researchers and others; and

 

    establish new criminal and civil sanctions for improper use or disclosure of health information.

 

The preemption provisions of HIPAA provide that the federal standards will not preempt state laws that are more stringent than the related federal requirements. In addition, the Secretary of HHS may grant exceptions allowing state laws to prevail if one or more of a number of conditions are met, including but not limited to the following:

 

    the state law is necessary to prevent fraud and abuse related to the provision of and payment for healthcare;

 

    the state law is necessary to ensure appropriate state regulation of insurance and health plans;

 

    the state law is necessary for state reporting on healthcare delivery or costs; or

 

    the state law addresses controlled substances.

 

In February 2003, HHS published final regulations relating to the security of electronic individually identifiable health information. These rules require healthcare providers, health plans and healthcare clearinghouses to implement administrative, physical and technical safeguards to ensure the privacy and confidentiality of such information when it is electronically stored, maintained or transmitted through such devices as user authentication mechanisms and system activity audits. The compliance deadline for the security regulations is April 21, 2005.

 

Patients’ Rights Legislation

 

The United States Senate and House of Representatives passed different versions of patients’ rights legislation in June and August 2001, respectively. Both versions included provisions that specifically apply protections to participants in federal healthcare programs, including Medicaid beneficiaries. Although no version of this type of federal legislation has yet to become law, patients’ rights legislation is frequently proposed in Congress. If enacted, this type of legislation could expand our potential exposure to lawsuits and increase our regulatory compliance costs. Depending on the final form of any patients’ rights legislation, such legislation could, among other things, expose us to liability for economic and punitive damages for making determinations that deny benefits or delay beneficiaries’ receipt of benefits as a result of our medical necessity or other coverage determinations. We cannot predict when or whether patients’ rights legislation will be enacted into law or, if enacted, what final form such legislation might take.

 

Other Fraud and Abuse Laws

 

Investigating and prosecuting healthcare fraud and abuse became a top priority for law enforcement entities in the last decade. The focus of these efforts has been directed at participants in public government healthcare programs such as Medicaid. The laws and regulations relating to Medicaid fraud and abuse and the contractual requirements applicable to plans participating in these programs are complex and changing and may require substantial resources.

 

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EMPLOYEES

 

As of January 31, 2005, we had approximately 1,200 employees. Our employees are not represented by a union. We believe our relationships with our employees are good.

 

Item 2. Properties

 

In 2003, we acquired the building in St. Louis, Missouri which houses our corporate headquarters. In 2004 we acquired additional property contiguous to our corporate headquarters building for future growth and expansion, and approximately 24 acres of land in Montana in connection with a new claims processing facility.

 

We lease space in each of the areas where our health plans and specialty companies operate. We are required by various insurance and regulatory authorities to have offices in the service areas where we provide benefits. We believe our current facilities are adequate to meet our operational needs for the foreseeable future.

 

Item 3. Legal Proceedings

 

Aurora Health Care, Inc. (Aurora) provides medical professional services under a contract with our Wisconsin health plan subsidiary. In May 2003, Aurora filed a lawsuit in the Milwaukee County Circuit Court claiming we had failed to adequately reimburse Aurora for services rendered during the period from 1998 to the present. In 2004 the Court dismissed the claim as filed, but allowed Aurora to replead and seek a declaratory ruling clarifying the contract with respect to reimbursement for ambulatory surgery services. Although the exact amount of the dispute has not been determined, Aurora claims it exceeds $8 million. We continue to dispute the claim and plan to defend against this matter.

 

We are routinely subject to legal proceedings in the normal course of business. While the ultimate resolution of such matters are uncertain, we do not expect the result of these matters to have a material effect on our financial position or results of operations.

 

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

 

None.

 

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PART II

 

Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities

 

Market for Common Stock; Dividends

 

Our common stock has been traded and quoted on the New York Stock Exchange under the symbol “CNC” since October 16, 2003. From December 13, 2001 until October 15, 2003 our common stock was traded and quoted on the Nasdaq National Market under the symbol “CNTE”. All share and per share information presented below has been adjusted for a two-for-one stock split effected in the form of a 100% stock dividend paid December 17, 2004 to stockholders of record on November 24, 2004 and a three-for-two stock split effected in the form of a 50% stock dividend paid July 11, 2003 to stockholders of record on June 20, 2003.

 

     2004 Stock Price

   2003 Stock Price

     High

   Low

   High

   Low

First Quarter

   $ 16.48    $ 13.05    $ 11.62    $ 7.45

Second Quarter

     19.55      14.68      13.22      9.39

Third Quarter

     22.10      17.65      15.80      12.28

Fourth Quarter

     30.10      20.43      17.85      13.49

 

As of January 31, 2005 there were 29 holders of record of our common stock.

 

We have never declared any cash dividends on our capital stock and currently anticipate that we will retain any future earnings for the development, operation and expansion of our business.

 

Securities Authorized for Issuance Under Equity Compensation Plans

 

Information concerning our equity compensation plans will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Equity Compensation Plan Information.” This portion of our Proxy Statement is incorporated herein by reference.

 

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Item 6. Selected Financial Data

 

The following selected consolidated financial data should be read in connection with the consolidated financial statements and related notes and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” appearing elsewhere in this filing. The data for the years ended December 31, 2004, 2003 and 2002 and as of December 31, 2004 and 2003 are derived from consolidated financial statements included elsewhere in this filing. The data for the years ended December 31, 2001 and 2000 and as of December 31, 2002, 2001 and 2000 are derived from audited consolidated financial statements not included in this filing.

 

    Year Ended December 31,

 
    2004

    2003

    2002

    2001

    2000

 
    (In thousands, except share data)  

Statement of Earnings Data:

                                       

Revenues:

                                       

Premiums

  $ 991,673     $ 759,763     $ 461,030     $ 326,184     $ 216,414  

Services

    9,267       9,967       457       385       4,936  
   


 


 


 


 


Total revenues

    1,000,940       769,730       461,487       326,569       221,350  
   


 


 


 


 


Expenses:

                                       

Medical costs

    800,476       626,192       379,468       270,151       182,495  

Cost of services

    8,065       8,323       341       329       135  

General and administrative expenses

    127,863       88,288       50,072       37,617       32,200  
   


 


 


 


 


Total operating expenses

    936,404       722,803       429,881       308,097       214,830  
   


 


 


 


 


Earnings from operations

    64,536       46,927       31,606       18,472       6,520  

Other income (expense):

                                       

Investment and other income

    6,431       5,160       9,575       3,916       1,784  

Interest expense

    (680 )     (194 )     (45 )     (362 )     (611 )

Equity in losses from joint ventures

    —         —         —         —         (508 )
   


 


 


 


 


Earnings before income taxes

    70,287       51,893       41,136       22,026       7,185  

Income tax expense (benefit)

    25,975       19,504       15,631       9,131       (543 )

Minority interest

    —         881       116       —         —    
   


 


 


 


 


Net earnings

    44,312       33,270       25,621       12,895       7,728  

Accretion of redeemable preferred stock

    —         —         —         (467 )     (492 )
   


 


 


 


 


Net earnings attributable to common stockholders

  $ 44,312     $ 33,270     $ 25,621     $ 12,428     $ 7,236  
   


 


 


 


 


Net earnings per common share:

                                       

Basic

  $ 1.09     $ 0.93     $ 0.82     $ 2.99     $ 2.68  

Diluted

  $ 1.02     $ 0.87     $ 0.73     $ 0.54     $ 0.38  

Weighted average common shares outstanding:

                                       

Basic

    40,820,909       35,704,426       31,432,080       4,156,198       2,704,578  

Diluted

    43,616,445       38,422,152       34,932,232       24,058,492       20,458,786  
    December 31,

 
    2004

    2003

    2002

    2001

    2000

 
    (In thousands)  

Balance Sheet Data:

       

Cash and cash equivalents

  $ 84,105     $ 64,346     $ 59,656     $ 88,867     $ 19,023  

Investments

    211,070       199,971       89,237       22,288       21,859  

Total assets

    527,934       362,692       210,327       131,366       66,017  

Medical claims liabilities

    165,980       106,569       91,181       59,565       45,805  

Debt

    47,459       8,195       —         —         4,000  

Redeemable convertible preferred stock

    —         —         —         —         18,878  

Total stockholders’ equity (deficit)

    271,312       220,115       102,183       64,089       (8,834 )

 

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Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations

 

The following discussion of our financial condition and results of operations should be read in conjunction with our consolidated financial statements and the related notes included elsewhere in this filing. The discussion contains forward-looking statements that involve known and unknown risks and uncertainties, including those set forth below under “Factors That May Affect Future Results and The Trading Price of Our Common Stock.”

 

OVERVIEW

 

We are a multi-line managed care organization that provides Medicaid and Medicaid-related programs to organizations and individuals through government subsidized programs, including Medicaid, Supplemental Security Income (SSI) and the State Children’s Health Insurance Program (SCHIP). We have health plans in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin. We also provide specialty services in each of the states where we have health plans as well as free-standing programs in Arizona, California and Colorado. These specialty services include behavioral health, nurse triage and treatment compliance.

 

We have organized this Management’s Discussion and Analysis to address the following:

 

    Recent Acquisitions;

 

    Critical Accounting Policies;

 

    Revenue and Expense Discussion and Key Metrics;

 

    Results of Operations;

 

    Liquidity and Capital Resources;

 

    Regulatory Capital and Dividend Restrictions.

 

RECENT ACQUISITIONS

 

Effective December 1, 2004, we acquired FirstGuard, Inc. and FirstGuard Health Plan, Inc., or FirstGuard, for a purchase price of approximately $96.1 million. FirstGuard serves approximately 135,000 members in Kansas and Missouri. The results of operations of this entity are included in our consolidated financial statements beginning December 1, 2004. The preliminary purchase price allocation resulted in estimated identifiable intangible assets of $8.0 million and goodwill of $86.8 million. The estimated identifiable intangible assets are being amortized over an estimated life of ten years.

 

Effective January 1, 2004, we commenced operations in Ohio through the acquisition of the Medicaid-related assets of Family Health Plan, Inc. for a purchase price of $6.9 million. We are currently serving 23,800 members in Toledo, Ohio. The results of operations of this entity are included in our consolidated financial statements beginning January 1, 2004. The purchase price allocation resulted in identified intangible assets of $1.8 million, representing purchased contract rights, provider network and a non-compete agreement, and goodwill of $5.1 million. The contract rights, provider network and non-compete agreement are being amortized over periods ranging from five to ten years.

 

Effective August 1, 2003, we acquired the Medicaid-related contract rights of HMO Blue Texas in the San Antonio, Texas market. This transaction allows us to serve approximately 17,000 additional members in the state. The purchase price of $1.0 million was allocated to acquired contracts. The contracts are being amortized over a period of five years, the expected period of benefit.

 

During 2003, we acquired a 100% ownership interest in Group Practice Affiliates, LLC, a behavioral healthcare services company (63.7% in March 2003 and 36.3% in August 2003). In September 2004, we renamed this subsidiary Cenpatico Behavioral Health, LLC, or Cenpatico. This acquisition is consistent with our

 

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strategy to provide diversified medical services to the managed Medicaid population. We paid an aggregate purchase price of $1.8 million for Cenpatico, assumed net liabilities of $1.9 million and recorded goodwill of $3.7 million related to the acquisition.

 

In March 2003, we purchased certain assets of ScriptAssist, a treatment compliance company. We are administering the purchased contracts under the ScriptAssist name. ScriptAssist uses various approaches and medical expertise to promote adherence to prescription drugs. The asset acquisition is consistent with our strategy to provide diversified medical services to the managed Medicaid population. The purchase price of $563,000 was allocated to acquired contracts. We are amortizing the contracts over five years, the expected period of benefit.

 

On December 1, 2002, we acquired 80% of the outstanding capital stock of University Health Plans, Inc., or UHP, from University of Medicine and Dentistry of New Jersey. In October 2003 we exercised our option to purchase the remaining 20%. UHP is a managed health plan operating in 20 counties in New Jersey. We paid an aggregate purchase price of $13.3 million for our interest in UHP. The purchase price allocation resulted in intangible assets of $3.8 million representing provider contracts and purchased contract rights, which are being amortized over 10 years, and goodwill of $5.0 million.

 

In June 2002, we entered into an agreement with Texas Universities Health Plan Inc. to purchase the SCHIP contracts in three Texas service areas, thereby adding approximately 24,000 members to our Texas health plan. The cash purchase price of $595,000 was recorded as purchased contract rights, which are being amortized over five years, the expected period of benefit.

 

With our acquisition of Cenpatico and our purchase of ScriptAssist assets, we began operating in two segments: Medicaid Managed Care and Specialty Services. The Medicaid Managed Care segment consists of our regulated subsidiaries, including all of the functions needed to operate them. The Specialty Services segment consists of our specialty services, including our behavioral health, nurse triage and treatment compliance functions.

 

CRITICAL ACCOUNTING POLICIES

 

Our significant accounting policies are more fully described in Note 3 to our annual consolidated financial statements included elsewhere herein. Our accounting policies regarding medical claims liabilities and intangible assets are particularly important to the portrayal of our financial position and results of operations and require the application of significant judgment by our management. As a result, they are subject to an inherent degree of uncertainty.

 

Medical Claims Liabilities

 

Our medical claims liabilities include claims reported but not yet paid, estimates for claims incurred but not reported, or IBNR, and estimates for the costs necessary to process unpaid claims. We, together with our independent actuaries, estimate medical claims liabilities using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors. These estimates are continually reviewed each period and adjustments based on actual claim submissions and additional facts and circumstances are reflected in the period known.

 

Our management uses its judgment to determine the assumptions to be used in the calculation of the required estimates. In developing our estimate for IBNR, we apply various estimation methods depending on the claim type and the period for which claims are being estimated. For more recent periods, incurred non-inpatient claims are estimated based on historical per member per month claims experience adjusted for known factors. Incurred hospital claims are estimated based on authorized days and historical per diem claim experience adjusted for known factors. For older periods, we utilize an estimated completion factor based on our historical experience to develop IBNR estimates. The completion factor is an actuarial estimate of the percentage of claims incurred during a given period that have been adjudicated as of the reporting period to the estimate of the total ultimate incurred costs. These approaches are consistently applied to each period presented.

 

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The completion factor, claims per member per month and per diem cost trend factors are the most significant factors affecting the IBNR estimate. The following table illustrates the sensitivity of these factors and the estimated potential impact on our operating results caused by changes in these factors based on December 31, 2004 data:

 

Completion Factors (a):

        Cost Trend Factors (b):

(Decrease)
Increase
in Factors


   Increase
(Decrease) in
Medical Claims
Liabilities


        (Decrease)
Increase
in Factors


   Increase
(Decrease) in
Medical Claims
Liabilities


     (in thousands)              (in thousands)
(3)%    $ 17,000          (3)%    $ (4,700)
(2)%      11,200          (2)%      (3,100)
(1)%      5,600          (1)%      (1,600)
 1%       (5,400)          1%       1,600 
 2%       (10,800)          2%       3,200 
 3%       (16,000)          3%       4,800 

 

(a) Reflects estimated potential changes in medical claims liabilities caused by changes in completion factors.
(b) Reflects estimated potential changes in medical claims liabilities caused by changes in cost trend factors for the most recent periods.

 

While we believe these estimates are appropriate, it is possible future events could require us to make significant adjustments for revisions to these estimates. For example, a 1% increase or decrease in our estimated medical claims liabilities would have affected net earnings by $1.0 million for the year ended December 31, 2004. The estimates are based on our historical experience, terms of existing contracts, our observance of trends in the industry, information provided by our customers and information available from other outside sources, as appropriate.

 

The change in medical claims liabilities is summarized as follows (in thousands):

 

     Year Ended December 31,

 
     2004

    2003

    2002

 

Balance, January 1

   $ 106,569     $ 91,181     $ 59,565  

Acquisitions

     24,909       335       16,230  

Incurred related to:

                        

Current year

     816,418       645,482       396,715  

Prior years

     (15,942 )     (19,290 )     (17,247 )
    


 


 


Total incurred

     800,476       626,192       379,468  
    


 


 


Paid related to:

                        

Current year

     681,780       544,309       324,210  

Prior years

     84,194       66,830       39,872  
    


 


 


Total paid

     765,974       611,139       364,082  
    


 


 


Balance, December 31

   $ 165,980     $ 106,569     $ 91,181  
    


 


 


Claims inventory, December 31

     150,000       131,000       151,000  

Days in claims liability (a)

     66.5       59.0       71.8  

 

(a) Days in claims liability is a calculation of medical claims liabilities at the end of the period divided by average expense per calendar day for the fourth quarter of each year. Acquisitions in the last quarter of 2004 and 2002 contributed to an increase in our days in claims liability calculation.

 

Acquisitions in 2004 include reserves acquired in connection with our acquisition of FirstGuard. Acquisitions in 2003 and 2002 include reserves acquired in connection with our acquisition of UHP.

 

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Medical claims are usually paid within a few months of the member receiving service from the physician or other healthcare provider. As a result, these liabilities generally are described as having a “short-tail”, which causes less than 10% of our medical claims liabilities as of the end of any given year to be outstanding the following year. Management expects that substantially all the development of the estimate of medical claims liabilities as of December 31, 2004 will be known by the end of 2005.

 

Actuarial Standards of Practice generally require that medical claims liabilities estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amounts ultimately settled will be less than the estimate that satisfies the Actuarial Standards of Practice.

 

Changes in estimates of incurred claims for prior years were attributable to favorable development in all of our markets, including changes in medical utilization and cost trends. These changes in medical utilization and cost trends can be attributable to our “margin protection” programs and changes in our member demographics. For example, our membership increased 38.3% during the fourth quarter of 2002. This member growth led to changes in our medical utilization and cost trends that were subject to estimates at December 31, 2002. For all of our membership, we routinely implement new or modified policies that we refer to as our “margin protection” programs that assist with the control of medical utilization and cost trends such as emergency room policies. While we try to predict the savings from these programs, actual savings have proven to be better than anticipated, which has contributed to the favorable development of our medical claims liabilities.

 

Intangible Assets

 

We have made several acquisitions since 2002 that have resulted in our recording of intangible assets. These intangible assets primarily consist of non-compete agreements, purchased contract rights, provider contracts and goodwill. At December 31, 2004 we have outstanding $101.6 million of goodwill and $14.4 million of net other intangible assets. Non-compete agreements are amortized using the straight-line method over 60 months. Purchased contract rights are amortized using the straight-line method over periods ranging from 60 to 120 months. Provider contracts are amortized using the straight-line method over 120 months.

 

Our management evaluates whether events or circumstances have occurred that may affect the estimated useful life or the recoverability of the remaining balance of goodwill and other identifiable intangible assets. If the events or circumstances indicate that the remaining balance of the intangible asset and goodwill may be permanently impaired, the potential impairment will be measured based upon the difference between the carrying amount of the intangible asset and goodwill and the fair value of such asset determined using the estimated future discounted cash flows generated from the use and ultimate disposition of the respective acquired entity. Our management must make assumptions and estimates, such as the discount factor, future utility and other internal and external factors, in determining the estimated fair values. While we believe these assumptions and estimates are appropriate, other assumptions and estimates could be applied and might produce significantly different results.

 

Goodwill is reviewed at each year-end for impairment. In addition, we will perform an impairment analysis of other intangible assets based on other factors. These factors would include significant changes in membership, state funding, medical contracts and provider networks and contracts. We did not recognize any impairment losses during the three years ended December 31, 2004.

 

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REVENUE AND EXPENSE DISCUSSION AND KEY METRICS

 

Revenues and Revenue Recognition

 

We generate revenues in our Medicaid Managed Care segment primarily from premiums we receive from the states in which we operate to provide health benefits to our members. We receive a fixed premium per member per month pursuant to our state contracts. We generally receive premium payments during the month we provide services and recognize premium revenue during the period in which we are obligated to provide services to our members. Revenues are recorded based on membership and eligibility data provided by the states, which may be adjusted by the states for updates to this data. These adjustments are immaterial in relation to total revenue recorded and are reflected in the period known, typically within two months.

 

Our Specialty Services companies generate revenues from a variety of sources. Our behavioral health company generates revenue via capitation payments from our health plans and others. It also receives fees for the direct provision of care and certain school programs in Arizona. Our treatment compliance program receives fee income from the manufacturers of pharmaceuticals. Our nurse triage line receives fees from health plans, physicians and other organizations for providing continuous access to nurse advisors.

 

Premiums collected in advance are recorded as unearned revenue. Premiums due to us are recorded as premium and related receivables and are recorded net of an allowance based on historical trends and our management’s judgment on the collectibility of these accounts. As we generally receive premiums during the month in which services are provided, the allowance is typically not significant in comparison to total premium revenue and does not have a material impact on the presentation of our financial condition or results of operations.

 

The primary drivers of our increasing revenue have been membership growth in our Medicaid Managed Care segment. We have increased our membership through internal growth and acquisitions. From December 31, 2002 to December 31, 2004, we increased our membership by 88.6%. The following table sets forth our membership by state:

 

     December 31,

     2004

   2003

   2002

Indiana

   150,600    119,400    105,700

Kansas

   94,200    —      —  

Missouri

   41,200    —      —  

New Jersey

   52,800    54,000    52,900

Ohio

   23,800    —      —  

Texas

   244,300    158,400    118,000

Wisconsin

   165,800    157,800    133,000
    
  
  

Total

   772,700    489,600    409,600
    
  
  

 

The following table sets forth our membership by line of business:

 

     December 31,

     2004

   2003

   2002

Medicaid

   580,200    411,800    336,100

SCHIP

   182,100    68,400    65,900

SSI

   10,400    9,400    7,600
    
  
  

Total

   772,700    489,600    409,600
    
  
  

 

In 2004, we entered the Kansas and Missouri markets through our acquisition of FirstGuard and the Ohio market with our acquisition of the Medicaid-related assets of Family Health Plan, Inc. We increased our Texas membership by approximately 87,500 members from the EPO contract award effective September 1, 2004. Our membership increased in Indiana and Wisconsin from additions to our provider network, increases in counties served and growth in the overall number of Medicaid beneficiaries.

 

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In 2003, our membership increased by 17,000 members in Texas due to the purchase of contract rights from HMO Blue Texas. Our membership increased in all our markets from additions to our provider network, increases in counties served and growth in the overall number of Medicaid beneficiaries.

 

In 2002, our membership increased by 24,000 members in Texas due to the purchase of SCHIP contract rights from Texas Universities Health Plan. In addition, two smaller plans exited the Austin, Texas market. As a result, our Texas plan increased its membership by 28,000 members. This increase includes approximately 12,000 members that we managed for the state of Texas on an interim basis. We entered the New Jersey market through our acquisition of UHP. Membership increases in our Wisconsin and Indiana markets resulted from additions to our provider network and growth in the overall number of Medicaid beneficiaries.

 

Operating Expenses

 

Our operating expenses include medical costs, cost of services, and general and administrative expenses.

 

Our medical costs include payments to physicians, hospitals, and other providers for healthcare and specialty product claims. Medical costs also include estimates of medical expenses incurred but not yet reported, or IBNR. Monthly, we estimate our IBNR based on a number of factors, including inpatient hospital utilization data and prior claims experience. As part of this review, we also consider the costs to process medical claims and estimates of amounts to cover uncertainties related to fluctuations in physician billing patterns, membership, products and inpatient hospital trends. These estimates are adjusted as more information becomes available. We utilize the services of independent actuaries who are contracted to review our estimates quarterly. While we believe that our process for estimating IBNR is actuarially sound, we cannot assure you that healthcare claim costs will not materially differ from our estimates.

 

Our results of operations depend on our ability to manage expenses related to health benefits and to accurately predict costs incurred. Our health benefits ratio represents medical costs as a percentage of premium revenues and reflects the direct relationship between the premium received and the medical services provided. The table below depicts our health benefits ratios by member category and in total:

 

       Year Ended December 31,

 
       2004

     2003

     2002

 

Medicaid and SCHIP

     80.4 %    81.7 %    82.2 %

SSI

     93.8      102.5      100.7  

Total

     80.7      82.4      82.3  

 

Our Medicaid and SCHIP ratio decreased in 2004 from 2003 due primarily to initiatives to reduce inappropriate emergency room usage and to establish preferred drug lists such as generics. The addition of the SSI members resulting from our acquisition in New Jersey in December 2002 caused our total health benefits ratio to increase slightly in 2003. The health benefits ratio for SSI is affected by a low membership base and is subject to greater volatility as a percentage of premiums (although relatively immaterial in total dollars to total medical costs).

 

Our cost of services expenses include all direct costs to support the local functions responsible for generation of our services revenues. These expenses primarily consist of the salaries and wages of the physicians, clinicians, therapists and teachers who provide the services and expenses related to facilities and equipment used to provide services.

 

Our general and administrative expenses primarily reflect wages and benefits and other administrative costs related to health plans, specialty companies and our centralized functions that support all of our business units. The major centralized functions are claims processing, information systems and finance. Premium taxes are classified as general and administrative expenses. Our general and administrative expense ratio represents

 

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general and administrative expenses as a percentage of total revenues and reflects the relationship between revenues earned and the costs necessary to drive those revenues. The following table sets forth the general and administrative expense ratios by business segment and in total:

 

       Year Ended December 31,

 
       2004

     2003

     2002

 

Medicaid Managed Care

     10.7 %    10.3 %    10.9 %

Specialty Services

     52.3      38.2      —    

Total

     12.8      11.5      10.9  

 

The increase in the Medicaid Managed Care general and administrative expenses ratio in 2004 reflects the impact of premium taxes enacted in September 2003 in Texas and July 2004 in New Jersey. These taxes totaled $5.5 million in 2004 and $1.4 in 2003 and had the effect of increasing our general and administrative expenses ratio by 0.5% in 2004 and 0.2% in 2003. Additionally, the 2004 results include 1) start-up costs associated with the Texas EPO contract, our claims processing facility in Montana and FirstGuard, 2) severance costs related to job eliminations, and 3) higher compensation costs related to our performance bonus plans.

 

The Specialty Services ratio may vary depending on the various contracts and nature of the services provided and will have a higher general and administrative expense ratio than the Medicaid Managed Care segment. The 2004 results were affected by expenses associated with transitioning certain activities within Specialty Services, including closing costs of our clinic facilities in Texas and California as Cenpatico fully transitions to a third-party service model for behavioral health services, due diligence costs related to a potential transaction we decided not to pursue, and costs related to investing in new business opportunities.

 

Other Income (Expense)

 

Other income (expense) consists principally of investment and other income and interest expense.

 

    Investment income is derived from our cash, cash equivalents and investments. Information about our investments is included below under “Liquidity and Capital Resources.”

 

    Interest expense reflects interest on the borrowings under our credit facility, fees in conjunction with our credit facility and mortgage interest.

 

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RESULTS OF OPERATIONS

 

Year Ended December 31, 2004 Compared to Year Ended December 31, 2003

 

Summarized comparative financial data for 2004 and 2003 are as follows ($ in millions):

 

     2004

   2003

   % Change
2003-2004


 

Premium revenue

   $ 991.7    $ 759.7    30.5 %

Services revenue

     9.2      10.0    (7.0 )%
    

  

  

Total revenues

     1,000.9      769.7    30.0 %

Medical costs

     800.5      626.2    27.8 %

Cost of services

     8.1      8.3    (3.1 )%

General and administrative expenses

     127.8      88.3    44.8 %
    

  

  

Earnings from operations

     64.5      46.9    37.5 %

Investment and other income, net

     5.8      5.0    15.8 %
    

  

  

Earnings before income taxes

     70.3      51.9    35.4 %

Income tax expense

     26.0      19.5    33.2 %

Minority interest

     —        .9    —    
    

  

  

Net earnings

   $ 44.3    $ 33.3    33.2 %
    

  

  

Diluted earnings per common share

   $ 1.02    $ 0.87    17.2 %
    

  

  

 

Revenues

 

Total revenues for the year ended December 31, 2004 increased 30.0% from the comparable period in 2003. This increase was due to organic growth in our existing markets; the addition of EPO members in Texas, effective September 1, 2004; the acquisition of the Medicaid related assets of Family Health Plan, effective January 1, 2004; and the acquisition of FirstGuard, effective December 1, 2004. Additionally, we received premium rate increases ranging from 2.3% to 5.3%, or 4.4% on a composite basis across our markets.

 

Operating Expenses

 

Medical costs increased 27.8% due to the growth in our membership as discussed above. Our health benefits ratio decreased to 80.7% from 82.4% primarily due to continued improvements in our initiatives to reduce emergency room usage and to establish preferred drug lists throughout all our markets.

 

General and administrative expenses increased 44.8% primarily due to expenses for additional staff to support our membership growth, expansion into the Specialty Services segment, the effect of a premium tax in two states and start-up costs related to our acquisition of FirstGuard, the EPO contract and our claims processing facility in Montana.

 

Other Income

 

Investment and other income increased 15.8% as a result of higher average investment balances and an increase in market interest rates partially offset by higher interest expense from increased borrowings under our credit facility and mortgages.

 

Income Tax Expense

 

Our effective tax rate in 2004 was 37.0%, compared to 37.6% in 2003. The decrease was primarily due to a lower effective state tax rate.

 

Earnings Per Share and Shares Outstanding

 

Our earnings per share calculations reflect an increase in the weighted average shares outstanding in 2004 primarily resulting from the follow-on offering of 6,900,000 common shares sold in August 2003.

 

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Year Ended December 31, 2003 Compared to Year Ended December 31, 2002

 

Summarized comparative financial data for 2003 and 2002 are as follows ($ in millions):

 

     2003

   2002

   % Change
2002-2003


 

Premium revenue

   $ 759.7    $ 461.0    64.8 %

Services revenue

     10.0      .5    —    
    

  

  

Total revenues

     769.7      461.5    66.8 %

Medical costs

     626.2      379.5    65.0 %

Cost of services

     8.3      .3    —    

General and administrative expenses

     88.3      50.1    76.3 %
    

  

  

Earnings from operations

     46.9      31.6    48.5 %

Investment and other income, net

     5.0      9.5    (47.9 )%
    

  

  

Earnings before income taxes

     51.9      41.1    26.1 %

Income tax expense

     19.5      15.6    24.8 %

Minority interest

     .9      .1    —    
    

  

  

Net earnings

   $ 33.3    $ 25.6    29.9 %
    

  

  

Diluted earnings per common share

   $ 0.87    $ 0.73    19.2 %
    

  

  

 

Revenues

 

Premiums for the year ended December 31, 2003 increased 64.8% from the comparable period in 2002. This increase was due to organic growth in our existing markets, changes in our member mix by product category, the purchase of the Texas contracts and the addition of our New Jersey membership through our acquisition of UHP, effective December 1, 2002. In addition, we received premium rate increases ranging from 1.0% to 7.5%, or 4.6% on a composite basis across our markets.

 

Services revenues increased due to an increase in our non-risk SSI membership in our Texas market and the addition of services revenues of Cenpatico beginning March 1, 2003.

 

Operating Expenses

 

Medical costs increased 65.0% due to the growth in our membership as discussed above. Our Medicaid and SCHIP health benefits ratio decreased to 81.7% from 82.2% due in part to our initiatives to reduce emergency room usage and to establish preferred drug lists.

 

Cost of services increased due to the inclusion of direct costs related to the services revenues of Cenpatico beginning March 1, 2003.

 

General and administrative expenses increased 76.3% primarily due to expenses for additional staff to support our membership growth and expansion into the Specialty Services segment. Additionally, general and administrative expenses increased as a result of the institution of a premium tax, tax planning costs incurred during the year and Ohio start-up costs.

 

Other Income

 

Other income (expense) in 2002 included a one-time dividend of $5.1 million from a captive insurance company in which we maintained an investment. Excluding this one-time gain, other income increased from 2002 with higher investment balances in 2003 partially offset by a lower interest rate environment and interest expense on our corporate headquarters’ mortgage.

 

Income Tax Expense

 

Our effective tax rate in 2003 was 37.6%, compared to 38.0% in 2002. The decrease was primarily due to increased levels of tax-exempt interest income and a lower effective state tax rate.

 

Earnings Per Share and Shares Outstanding

 

Our earnings per share calculations reflect an increase in the weighted average shares outstanding in 2003 primarily resulting from the follow-on offering of 6,900,000 common shares sold in August 2003.

 

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LIQUIDITY AND CAPITAL RESOURCES

 

Our operating activities provided cash of $99.4 million in 2004, $56.0 million in 2003 and $39.7 million in 2002. The increases were due primarily to continued profitability, increases in membership and increases in medical claims liabilities.

 

Our investing activities used cash of $122.5 million in 2004, $140.7 million in 2003 and $79.7 million in 2002. During 2004, our investing activities primarily consisted of the acquisition of FirstGuard. In 2003 and 2002, the largest component of investing activities related to increases in our investment portfolio as a result of our stock offerings in those years. Our investment policies are designed to provide liquidity, preserve capital and maximize total return on invested assets within our investment guidelines. Net cash provided by and used in investing activities will fluctuate from year to year due to the timing of investment purchases, sales and maturities. As of December 31, 2004, our investment portfolio consisted primarily of fixed-income securities with an average duration of 1.8 years. Cash is invested in investment vehicles such as municipal bonds, corporate bonds, insurance contracts, commercial paper and instruments of the U.S. Treasury. The states in which we operate prescribe the types of instruments in which our regulated subsidiaries may invest their cash.

 

Our financing activities provided cash of $42.8 million in 2004, $89.4 million in 2003 and $10.8 million in 2002. During 2004, our financing activities primarily consisted of borrowings under our credit facility. These borrowings were used primarily for our investing activities in conjunction with the acquisition of FirstGuard. During 2003, our financing cash flows primarily consisted of the proceeds from the issuance of common stock through our public offering completed in August 2003. During 2002, financing cash flows primarily consisted of the issuance of common stock through our offering completed in June 2002.

 

We spent $14.7 million and $6.6 million in 2004 and 2003, respectively, on capital assets consisting primarily of new software, software and hardware upgrades, and furniture, equipment and leasehold improvements related to office and market expansions. In 2002, we purchased $3.9 million of furniture, equipment and leasehold improvements. We anticipate spending $16.8 million on additional capital expenditures in 2005 related to office and market expansions and system upgrades.

 

During 2004, we purchased the property adjacent to our corporate headquarters in St. Louis, Missouri for an aggregate purchase price of $10.3 million. This property will be used for the future expansion of our corporate offices. We financed a portion of the purchase price through a $5.5 million non-recourse mortgage loan arrangement. In July 2003, we purchased the building in which our corporate headquarters is located for an aggregate purchase price of $12.6 million. We financed a portion of the purchase price through an $8.0 million non-recourse mortgage loan arrangement. During 2004, we renewed this mortgage at the original principal amount of $8.0 million. The mortgage agreements bear interest at the prevailing prime rate less .25%. At December 31, 2004, our mortgages bore interest at 5.0%.

 

At December 31, 2004, we had working capital, defined as current assets less current liabilities, of $22.1 million as compared to $(18.5) million at December 31, 2003. Our working capital is sometimes negative due to our efforts to increase investment returns through purchases of investments that have maturities of greater than one year and, therefore, are classified as long-term. Our investment policies are also designed to provide liquidity and preserve capital. We manage our short-term and long-term investments to ensure that a sufficient portion is held in investments that are highly liquid and can be sold to fund working capital as needed.

 

Cash, cash equivalents and short-term investments were $178.4 million at December 31, 2004 and $79.5 million at December 31, 2003. Long-term investments were $139.0 million at December 31, 2004 and $205.2 million at December 31, 2003, including restricted deposits of $22.2 million and $20.4 million, respectively. Cash and investments held by our unregulated entities totaled $46.0 million and $126.7 million at December 31, 2004 and 2003, respectively.

 

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In September 2004, we executed a five-year $100 million Revolving Credit Agreement with various financial institutions and LaSalle Bank National Association as administrative agent and arranger. Borrowings under the agreement bear interest based upon LIBOR rates, the Federal Funds Rate or the Prime Rate. The agreement is secured by the common stock and membership interests of our subsidiaries. The agreement contains non-financial and financial covenants, including requirements of minimum fixed charge coverage ratios, minimum debt-to-EBITDA ratios and minimum tangible net worth. The agreement will expire in September 2009 or on an earlier date in the instance of a default as defined in the agreement. In conjunction with this agreement, we cancelled our prior existing $50 million credit facility. As of December 31, 2004, we had $34 million outstanding under the agreement and were in compliance with all covenants.

 

In January 2005, we executed a definitive agreement, subject to regulatory approvals, to acquire the Medicaid-related assets of SummaCare, Inc. for approximately $31 million plus transaction costs. The purchase price will consist of approximately $22 million in cash and $9 million in common stock. The acquisition is expected to close in the second quarter of 2005.

 

Based on our operating plan, we expect that our available cash, cash equivalents and investments, cash from our operations and cash available under our credit facility will be sufficient to finance our operations, the planned acquisition of SummaCare, Inc. and capital expenditures for at least 12 months from the date of this filing.

 

Our principal contractual obligations at December 31, 2004 consisted of medical claims liabilities, borrowings from our credit facility and mortgages, operating leases and purchase obligations. The purchase obligations consist primarily of software purchase and maintenance contracts in addition to development agreements pertaining to our Montana claims facility and the future expansion of our corporate headquarters. The contractual obligations over the next five years and beyond are as follows (in thousands):

 

     Payments Due by Period

     Total

   Less Than
1 Year


   1-3
Years


   3-5
Years


   More Than
5 Years


Medical claims liabilities

   $ 165,980    $ 165,980    $ —      $ —      $ —  

Debt

     47,459      486      972      34,972      11,029

Operating leases

     33,521      6,766      11,244      7,898      7,613

Purchase obligations

     9,049      2,805      3,919      75      2,250
    

  

  

  

  

Total

   $ 256,009    $ 176,037    $ 16,135    $ 42,945    $ 20,892
    

  

  

  

  

 

REGULATORY CAPITAL AND DIVIDEND RESTRICTIONS

 

Our Medicaid Managed Care operations are conducted through our subsidiaries. As managed care organizations, these subsidiaries are subject to state regulations that, among other things, require the maintenance of minimum levels of statutory capital, as defined by each state, and restrict the timing, payment and amount of dividends and other distributions that may be paid to us. Generally, the amount of dividend distributions that may be paid by a regulated subsidiary without prior approval by state regulatory authorities is limited based on the entity’s level of statutory net income and statutory capital and surplus.

 

Our subsidiaries are required to maintain minimum capital requirements prescribed by various regulatory authorities in each of the states in which we operate. As of December 31, 2004, our regulated subsidiaries had aggregate statutory capital and surplus of $123.6 million, compared with the required minimum aggregate statutory capital and surplus requirements of $65.1 million.

 

The National Association of Insurance Commissioners has adopted rules which set minimum risk-based capital requirements for insurance companies, managed care organizations and other entities bearing risk for healthcare coverage. As of December 31, 2004, our Indiana, Ohio, Texas and Wisconsin health plans were in

 

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compliance with risk-based capital requirements enacted in these states. If adopted by Kansas, Missouri or New Jersey, risk-based capital requirements may increase the minimum capital required for these subsidiaries. We continue to monitor the requirements in Kansas, Missouri and New Jersey and do not expect that they will have a material impact on our results of operations, financial position or cash flows. Acquisitions in new states or new markets in existing states may require additional capital funding for our regulated subsidiaries.

 

RECENT ACCOUNTING PRONOUNCEMENTS

 

In December 2004, SFAS No. 123 (revised 2004), “Share Based Payment,” was issued. This Statement focuses primarily on accounting for transactions in which an entity obtains employee services in share-based payment transactions. This Statement requires public entities to measure the cost of employee services received in exchange for an award of equity instruments based on the grant-date fair value of the award. The grant date fair value of employee share options and similar instruments will be estimated using option-pricing models adjusted for the unique characteristics of those instruments. That cost will be recognized over the period during which an employee is required to provide service in exchange for the award. This Statement is required to be adopted by July 1, 2005. The effect of expensing stock options in accordance with the original SFAS No. 123 is presented in Note 3 of our Notes to Consolidated Financial Statements under the heading Stock Based Compensation included elsewhere in this Form 10-K. After the adoption of SFAS No. 123 (revised 2004) the level of stock compensation expense may differ depending on the fair value method and assumptions utilized.

 

In January 2003, FASB Interpretation No. 46, “Consolidation of Variable Interest Entities, an Interpretation of ARB 51,” was issued. The primary objectives of this interpretation, as amended, are to provide guidance on the identification and consolidation of variable interest entities, or VIEs, which are entities for which control is achieved through means other than through voting rights. We have completed an analysis of this Interpretation and have determined that we do not have any VIEs.

 

In November 2002, FASB Interpretation No. 45, “Guarantor’s Accounting and Disclosure Requirements for Guarantees, Including Indirect Guarantees of Indebtedness of Others an Interpretation of SFAS No. 5, 57, and 107 and Rescission of FASB Interpretation No. 34,” was issued. This interpretation clarifies the requirements of SFAS No. 5, “Accounting for Contingencies,” relating to a guarantor’s accounting for, and disclosure of, the issuance of certain types of guarantees. The adoption of FASB Interpretation No. 45 did not have a significant impact on our net income or equity.

 

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FORWARD-LOOKING STATEMENTS

 

This filing contains forward-looking statements that relate to future events or our future financial performance. We have attempted to identify these statements by terminology including “believe,” “anticipate,” “plan,” “expect,” “estimate,” “intend,” “seek,” “goal,” “may,” “will,” “should,” “can,” “continue” or the negative of these terms or other comparable terminology. These statements include statements about our market opportunity, our growth strategy, competition, expected activities and future acquisitions, investments and the adequacy of our available cash resources. These statements may be found in the sections of this filing entitled “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and “Business.” Readers are cautioned that matters subject to forward-looking statements involve known and unknown risks and uncertainties, including economic, regulatory, competitive and other factors that may cause our or our industry’s actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements. These statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions.

 

Actual results may differ from projections or estimates due to a variety of important factors. Our results of operations and projections of future earnings depend in large part on accurately predicting and effectively managing health benefits and other operating expenses. A variety of factors, including competition, changes in healthcare practices, changes in federal or state laws and regulations or their interpretations, inflation, provider contract changes, new technologies, government-imposed surcharges, taxes or assessments, reduction in provider payments by governmental payers, major epidemics, disasters and numerous other factors affecting the delivery and cost of healthcare, such as major healthcare providers’ inability to maintain their operations, may in the future affect our ability to control our medical costs and other operating expenses. Governmental action or business conditions could result in premium revenues not increasing to offset any increase in medical costs and other operating expenses. Once set, premiums are generally fixed for one-year periods and, accordingly, unanticipated costs during such periods cannot be recovered through higher premiums. The expiration, cancellation or suspension of our Medicaid managed care contracts by the state governments would also negatively affect us. Due to these factors and risks, we cannot give assurances with respect to our future premium levels or our ability to control our future medical costs.

 

FACTORS THAT MAY AFFECT FUTURE RESULTS AND THE

TRADING PRICE OF OUR COMMON STOCK

 

You should carefully consider the risks described below before making an investment decision. The trading price of our common stock could decline due to any of these risks, in which case you could lose all or part of your investment. You should also refer to the other information in this filing, including our consolidated financial statements and related notes. The risks and uncertainties described below are those that we currently believe may materially affect our company. Additional risks and uncertainties that we are unaware of or that we currently deem immaterial also may become important factors that affect our company.

 

Risks Related to Being a Regulated Entity

 

Reduction in Medicaid, SCHIP and SSI Funding Could Substantially Reduce Our Profitability.

 

Most of our revenues come from Medicaid, SCHIP and SSI premiums. The base premium rate paid by each state differs, depending on a combination of factors such as defined upper payment limits, a member’s health status, age, gender, county or region, benefit mix and member eligibility categories. Future levels of Medicaid, SCHIP and SSI funding and premium rates may be affected by continued government efforts to contain medical costs and may further be affected by state and federal budgetary constraints. For example, in August 2004, the Centers for Medicare & Medicaid Services, or CMS, proposed a rule requiring states to estimate improper payments made under their Medicaid and SCHIP programs, report such overpayments to Congress, and, if

 

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necessary, take actions to reduce erroneous payments. In February 2005, the Bush administration called for changes in Medicaid that would cut payments for prescription drugs and give states new power to reduce or reconfigure benefits. Changes to Medicaid, SCHIP and SSI programs could reduce the number of persons enrolled or eligible, reduce the amount of reimbursement or payment levels, or increase our administrative or healthcare costs under those programs. States periodically consider reducing or reallocating the amount of money they spend for Medicaid, SCHIP and SSI. Over the past two years, the majority of states have implemented measures to restrict Medicaid, SCHIP and SSI costs and eligibility. We believe that reductions in Medicaid, SCHIP and SSI payments could substantially reduce our profitability. Further, our contracts with the states are subject to cancellation by the state after a short notice period in the event of unavailability of state funds.

 

If Our Medicaid and SCHIP Contracts are Terminated or are Not Renewed, Our Business Will Suffer.

 

We provide managed care programs and selected services to individuals receiving benefits under federal assistance programs, including Medicaid, SSI and SCHIP. We provide those healthcare services under contracts with regulatory entities in the areas in which we operate. The contracts expire on various dates between June 30, 2005 and August 31, 2007. Our contracts may be terminated if we fail to perform up to the standards set by state regulatory agencies. In addition, the Indiana contract under which we operate can be terminated by the state without cause. Our contracts are generally intended to run for two years and may be extended for one or two additional years if the state or its contractor elects to do so. When our contracts expire, they may be opened for bidding by competing healthcare providers. There is no guarantee that our contracts will be renewed or extended. If any of our contracts are terminated, not renewed, or renewed on less favorable terms, our business will suffer, and our operating results may be materially affected.

 

Changes in Government Regulations Designed to Protect Providers and Members Rather Than Our Stockholders Could Force Us to Change How We Operate and Could Harm Our Business.

 

Our business is extensively regulated by the states in which we operate and by the federal government. The applicable laws and regulations are subject to frequent change and generally are intended to benefit and protect health plan providers and members rather than stockholders. Changes in existing laws and rules, the enactment of new laws and rules or changing interpretations of these laws and rules could, among other things:

 

    force us to restructure our relationships with providers within our network;

 

    require us to implement additional or different programs and systems;

 

    mandate minimum medical expense levels as a percentage of premiums revenues;

 

    restrict revenue and enrollment growth;

 

    require us to develop plans to guard against the financial insolvency of our providers;

 

    increase our healthcare and administrative costs;

 

    impose additional capital and reserve requirements; and

 

    increase or change our liability to members in the event of malpractice by our providers.

 

For example, Congress has considered various forms of patient protection legislation commonly known as the Patients’ Bill of Rights and the legislation is frequently proposed in Congress. We cannot predict the impact of this legislation, if adopted, on our business.

 

Regulations May Decrease the Profitability of Our Health Plans.

 

Our Texas plan is required to pay a rebate to the state in the event profits exceed established levels. Similarly, our New Jersey plan is required to pay a rebate to the state in the event its health benefits ratio is less than 80%. These regulatory requirements, changes in these requirements or the adoption of similar requirements

 

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by our other regulators may limit our ability to increase our overall profits as a percentage of revenues. The states of Indiana, New Jersey and Texas have implemented prompt-payment laws and are enforcing penalty provisions for failure to pay claims in a timely manner. Failure to meet these requirements can result in financial fines and penalties. In addition, states may attempt to reduce their contract premium rates if regulators perceive our health benefits ratio as too low. Any of these regulatory actions could harm our operating results.

 

Also, on January 18, 2002, CMS published a final rule that removed a provision contained in the federal Medicaid reimbursement regulations permitting states to reimburse non-state government-owned or operated hospitals for inpatient and outpatient hospital services at amounts up to 150% of a reasonable estimate of the amount that would be paid for the services furnished by these hospitals under Medicaid payment principles. The upper payment limit was reduced to 100% of Medicare payments for comparable services. This development in federal regulation decreased the profitability of our health plans.

 

Failure to Comply With Government Regulations Could Subject Us to Civil and Criminal Penalties.

 

Federal and state governments have enacted fraud and abuse laws and other laws to protect patients’ privacy and access to healthcare. Violation of these and other laws or regulations governing our operations or the operations of our providers could result in the imposition of civil or criminal penalties, the cancellation of our contracts to provide services, the suspension or revocation of our licenses or our exclusion from participating in the Medicaid, SSI and SCHIP programs. If we were to become subject to these penalties or exclusions as the result of our actions or omissions or our inability to monitor the compliance of our providers, it would negatively affect our ability to operate our business. For example, failure to pay our providers promptly could result in the imposition of fines and other penalties. In some states, we may be subject to regulation by more than one governmental authority, which may impose overlapping or inconsistent regulations.

 

The Health Insurance Portability and Accountability Act of 1996, or HIPAA, broadened the scope of fraud and abuse laws applicable to healthcare companies. HIPAA created civil penalties for, among other things, billing for medically unnecessary goods or services. HIPAA established new enforcement mechanisms to combat fraud and abuse. Further, HIPAA imposes civil and, in some instances, criminal penalties for failure to comply with specific standards relating to the privacy, security and electronic transmission of most individually identifiable health information. It is possible that Congress may enact additional legislation in the future to increase penalties and to create a private right of action under HIPAA, which could entitle patients to seek monetary damages for violations of the privacy rules.

 

We Will Incur Significant Increased Costs As a Result of Compliance With New Government Regulations And Our Management Will Be Required to Devote Substantial Time To Compliance.

 

On February 20, 2003 HHS published the final HIPAA health data security regulations. Compliance with the security regulations is required by April 21, 2005. These regulations will require covered entities to implement administrative, physical and technical safeguards to protect electronic health information maintained or transmitted by the organization.

 

The issuance of future judicial or regulatory guidance regarding the interpretation of regulations, the states’ ability to promulgate stricter rules, and continuing uncertainty regarding many aspects of the regulations’ implementation may make compliance with the relatively new regulatory landscape difficult. For example, our existing programs and systems may not enable us to comply in all respects with the new security regulations. In order to comply with the regulatory requirements, we will be required to employ additional or different programs and systems. Further, compliance with these regulations could require changes to many of the procedures we currently use to conduct our business, which may lead to additional costs that we have not yet identified. We do not know whether, or the extent to which, we will be able to recover from the states our costs of complying with these new regulations. The new regulations and the related compliance costs could have a material adverse effect on our business.

 

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In addition, the Sarbanes-Oxley Act, as well as rules subsequently implemented by the SEC and the New York Stock Exchange, have imposed various requirements on public companies, including requiring changes in corporate governance practices. Our management and other personnel will need to devote a substantial amount of time to these new compliance initiatives. Moreover, these rules and regulations will increase our legal and financial compliance costs and will make some activities more time-consuming and costly.

 

The Sarbanes-Oxley Act requires, among other things, that we maintain effective internal control over financial reporting. In particular, we must perform system and process evaluation and testing of our internal controls over financial reporting to allow management to report on, and our independent registered public accounting firm to attest to, our internal controls over our financial reporting as required by Section 404 of the Sarbanes-Oxley Act. Our testing, or the subsequent testing by our independent registered public accounting firm, may reveal deficiencies in our internal controls over financial reporting that are deemed to be material weaknesses. Our compliance with Section 404 will require that we incur substantial accounting expense and expend significant management efforts. Moreover, if we are not able to comply with the requirements of Section 404 in a timely manner, or if we or our independent registered public accounting firm identifies deficiencies in our internal control over financial reporting that are deemed to be material weaknesses, the market price of our stock could decline and we could be subject to sanctions or investigations by the NYSE, SEC or other regulatory authorities, which would require additional financial and management resources.

 

Changes in Healthcare Law May Reduce Our Profitability.

 

Numerous proposals relating to changes in healthcare law have been introduced, some of which have been passed by Congress and the states in which we operate or may operate in the future. Changes in applicable laws and regulations are continually being considered, and interpretations of existing laws and rules may also change from time to time. We are unable to predict what regulatory changes may occur or what effect any particular change may have on our business. For example, these changes could reduce the number of persons enrolled or eligible for Medicaid and reduce the reimbursement or payment levels for medical services. More generally, we are unable to predict whether new laws or proposals will favor or hinder the growth of managed healthcare. Legislation or regulations that require us to change our current manner of operation, provide additional benefits or change our contract arrangements may seriously harm our operations and financial results.

 

If a State Fails to Renew its Federal Waiver Application for Mandated Medicaid Enrollment into Managed Care or Such Application is Denied, Our Membership in That State Will Likely Decrease.

 

States may only mandate Medicaid enrollment into managed care under federal waivers or demonstrations. Waivers and programs under demonstrations are approved for two-year periods and can be renewed on an ongoing basis if the state applies. We have no control over this renewal process. If a state does not renew its mandated program or the federal government denies the state’s application for renewal, our business would suffer as a result of a likely decrease in membership.

 

Changes in Federal Funding Mechanisms May Reduce Our Profitability.

 

The Bush Administration has proposed a major long-term change in the way Medicaid and SCHIP are funded. The proposal, if adopted, would allow states to elect to receive, instead of federal matching funds, combined Medicaid-SCHIP “allotments” for acute and long-term healthcare for low-income, uninsured persons. Participating states would be given flexibility in designing their own health insurance programs, subject to federally-mandated minimum coverage requirements. It is uncertain whether this proposal will be enacted, or if so, how it may change from a similar proposal initiated by the Bush Administration in February 2003. Accordingly, it is unknown whether or how many states might elect to participate or how their participation may affect the net amount of funding available for Medicaid and SCHIP programs. If such a proposal is adopted and decreases the number of persons enrolled in Medicaid or SCHIP in the states in which we operate or reduces the volume of healthcare services provided, our growth, operations and financial performance could be adversely affected.

 

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In April 2004, the Bush Administration adopted a new policy that seeks to reduce states’ use of accounting devices such as intergovernmental transfers for the states’ share of Medicaid program funding. By restricting the use of intergovernmental transfers as part of states’ Medicaid contributions, this policy, if continued, may restrict some states’ funding for Medicaid, which could adversely affect our growth, operations and financial performance.

 

In February 2005, the Bush Administration called for changes in Medicaid that would cut payments for prescription drugs and give states new power to reduce or reconfigure benefits. Any reduction or reconfiguration of state funding could adversely affect our growth, operations and financial performance.

 

Recent legislative changes in the Medicare program may also affect our business. For example, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, enacted in December 2003, will, upon taking effect in 2006, revise cost-sharing requirements for some beneficiaries and require states to reimburse the federal Medicare program for costs of prescription drug coverage provided to beneficiaries who are enrolled simultaneously in both the Medicaid and Medicare programs. These changes may reduce the availability of funding for some states’ Medicaid programs, which could adversely affect our growth, operations and financial performance.

 

If State Regulatory Agencies Require a Statutory Capital Level Higher than the State Regulations, We May Be Required to Make Additional Capital Contributions.

 

Our operations are conducted through our wholly owned subsidiaries, which include HMOs and managed care organizations, or MCOs. HMOs and MCOs are subject to state regulations that, among other things, require the maintenance of minimum levels of statutory capital, as defined by each state. Additionally, state regulatory agencies may require, at their discretion, individual HMO’s to maintain statutory capital levels higher than the state regulations. If this were to occur to one of our subsidiaries, we may be required to make additional capital contributions to the affected subsidiary. Any additional capital contribution made to one of the affected subsidiaries could have a material adverse effect on our liquidity and our ability to grow.

 

If We Are Unable to Participate in SCHIP Programs, Our Growth Rate May be Limited.

 

SCHIP is a federal initiative designed to provide coverage for low-income children not otherwise covered by Medicaid or other insurance programs. The programs vary significantly from state to state. Participation in SCHIP programs is an important part of our growth strategy. If states do not allow us to participate or if we fail to win bids to participate, our growth strategy may be materially and adversely affected.

 

If State Regulators Do Not Approve Payments of Dividends and Distributions by Our Subsidiaries to Us, We May Not Have Sufficient Funds to Implement Our Business Strategy.

 

We principally operate through our health plan subsidiaries. If funds normally available to us become limited in the future, we may need to rely on dividends and distributions from our subsidiaries to fund our operations. These subsidiaries are subject to regulations that limit the amount of dividends and distributions that can be paid to us without prior approval of, or notification to, state regulators. If these regulators were to deny our subsidiaries’ request to pay dividends to us, the funds available to our company as a whole would be limited, which could harm our ability to implement our business strategy.

 

Risks Related to Our Business

 

Receipt of Inadequate Premiums Would Negatively Affect Our Revenues and Profitability.

 

Nearly all of our revenues are generated by premiums consisting of fixed monthly payments per member. These premiums are fixed by contract, and we are obligated during the contract periods to provide healthcare services as established by the state governments. We use a large portion of our revenues to pay the costs of

 

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healthcare services delivered to our members. If premiums do not increase when expenses related to medical services rise, our earnings will be affected negatively. In addition, our actual medical services costs may exceed our estimates, which would cause our health benefits ratio, or our expenses related to medical services as a percentage of premium revenues, to increase and our profits to decline. In addition, it is possible for a state to increase the rates payable to the hospitals without granting a corresponding increase in premiums to us. If this were to occur in one or more of the states in which we operate, our profitability would be harmed.

 

Failure to Effectively Manage Our Medical Costs or Related Administrative Costs Would Reduce Our Profitability.

 

Our profitability depends, to a significant degree, on our ability to predict and effectively manage expenses related to health benefits. We have less control over the costs related to medical services than we do over our general and administrative expenses. Historically, our health benefits ratio has fluctuated. For example, over the last six years, our health benefits ratio has ranged from 80.7% to 88.9%. Because of the narrow margins of our health plan business, relatively small changes in our health benefits ratio can create significant changes in our financial results. Changes in healthcare regulations and practices, the level of use of healthcare services, hospital costs, pharmaceutical costs, major epidemics, new medical technologies and other external factors, including general economic conditions such as inflation levels, are beyond our control and could reduce our ability to predict and effectively control the costs of providing health benefits. We may not be able to manage costs effectively in the future. If our costs related to health benefits increase, our profits could be reduced or we may not remain profitable.

 

Failure to Accurately Predict Our Medical Expenses Could Negatively Affect Our Reported Results.

 

Our medical expenses include estimates of IBNR medical expenses. We estimate our IBNR medical expenses monthly based on a number of factors. Adjustments, if necessary, are made to medical expenses in the period during which the actual claim costs are ultimately determined or when criteria used to estimate IBNR change. We cannot be sure that our IBNR estimates are adequate or that adjustments to those estimates will not harm our results of operations. From time to time in the past, our actual results have varied from our estimates, particularly in times of significant changes in the number of our members. Our failure to estimate IBNR accurately may also affect our ability to take timely corrective actions, further harming our results.

 

Difficulties in Executing Our Acquisition Strategy Could Adversely Affect Our Business.

 

Historically, the acquisition of Medicaid businesses, contract rights and related assets of other health plans both in our existing service areas and in new markets has accounted for a significant amount of our growth. Many of the other potential purchasers of Medicaid assets have greater financial resources than we have. In addition, many of the sellers are interested either in (a) selling, along with their Medicaid assets, other assets in which we do not have an interest or (b) selling their companies, including their liabilities, as opposed to the assets of their ongoing businesses.

 

We generally are required to obtain regulatory approval from one or more state agencies when making acquisitions. In the case of an acquisition of a business located in a state in which we do not currently operate, we would be required to obtain the necessary licenses to operate in that state. In addition, even if we already operate in a state in which we acquire a new business, we would be required to obtain additional regulatory approval if the acquisition would result in our operating in an area of the state in which we did not operate previously, and we could be required to renegotiate provider contracts of the acquired business. We cannot assure you that we would be able to comply with these regulatory requirements for an acquisition in a timely manner, or at all. In deciding whether to approve a proposed acquisition, state regulators may consider a number of factors outside our control, including giving preference to competing offers made by locally owned entities or by not-for-profit entities. Furthermore, our credit facility may prohibit some acquisitions without the consent of our bank lender.

 

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In addition to the difficulties we may face in identifying and consummating acquisitions, we will also be required to integrate and consolidate any acquired business or assets with our existing operations. This may include the integration of:

 

    additional personnel who are not familiar with our operations and corporate culture;

 

    existing provider networks that may operate on different terms than our existing networks;

 

    existing members, who may decide to switch to another healthcare plan; and

 

    disparate administrative, accounting and finance, and information systems.

 

Accordingly, we may be unable to identify, consummate and integrate future acquisitions successfully or operate acquired businesses profitably. We also may be unable to obtain sufficient additional capital resources for future acquisitions. If we are unable to effectively execute our acquisition strategy, our future growth will suffer and our results of operations could be harmed.

 

If Competing Managed Care Programs are Unwilling to Purchase Specialty Services From Us, We May Not be Able to Successfully Implement Our Strategy of Diversifying Our Business Lines.

 

We are seeking to diversify our business lines into areas that complement our Medicaid business in order to grow our revenue stream and balance our dependence on Medicaid risk reimbursement. In 2003, for example, we acquired Cenpatico Behavioral Health, a behavioral health services company, and purchased contract and name rights of ScriptAssist, a treatment compliance company. In order to diversify our business, we must succeed in selling the services of our specialty subsidiaries not only to our managed care plans, but to programs operated by third-parties. Some of these third-party programs may compete with us in some markets, and they therefore may be unwilling to purchase specialty services from us. In any event, the offering of these services will require marketing activities that differ significantly from the manner in which we seek to increase revenues from our Medicaid programs. Our inability to market specialty services to other programs may impair our ability to execute our business strategy.

 

Failure to Achieve Timely Profitability in Any Business Would Negatively Affect Our Results of Operations.

 

Start-up costs associated with a new business can be substantial. For example, in order to obtain a certificate of authority in most jurisdictions, we must first establish a provider network, have systems in place and demonstrate our ability to obtain a state contract and process claims. If we were unsuccessful in obtaining the necessary license, winning the bid to provide service or attracting members in numbers sufficient to cover our costs, any new business of ours would fail. We also could be obligated by the state to continue to provide services for some period of time without sufficient revenue to cover our ongoing costs or recover start-up costs. The expenses associated with starting up a new business could have a significant impact on our results of operations if we are unable to achieve profitable operations in a timely fashion.

 

We Derive a Majority of Our Premium Revenues From Operations in a Small Number of States, and Our Operating Results Would be Materially Affected by a Decrease in Premium Revenues or Profitability in Any One of Those States.

 

Operations in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin have accounted for most of our premium revenues to date. If we were unable to continue to operate in each of those states or if our current operations in any portion of one of those states were significantly curtailed, our revenues could decrease materially. Our reliance on operations in a limited number of states could cause our revenue and profitability to change suddenly and unexpectedly depending on legislative actions, economic conditions and similar factors in those states. Our inability to continue to operate in any of the states in which we operate would harm our business.

 

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Competition May Limit Our Ability to Increase Penetration of the Markets That We Serve.

 

We compete for members principally on the basis of size and quality of provider network, benefits provided and quality of service. We compete with numerous types of competitors, including other health plans and traditional state Medicaid programs that reimburse providers as care is provided. Subject to limited exceptions by federally approved state applications, the federal government requires that there be choices for Medicaid recipients among managed care programs. Voluntary programs and mandated competition may limit our ability to increase our market share.

 

Some of the health plans with which we compete have greater financial and other resources and offer a broader scope of products than we do. In addition, significant merger and acquisition activity has occurred in the managed care industry, as well as in industries that act as suppliers to us, such as the hospital, physician, pharmaceutical, medical device and health information systems businesses. To the extent that competition intensifies in any market that we serve, our ability to retain or increase members and providers, or maintain or increase our revenue growth, pricing flexibility and control over medical cost trends may be adversely affected.

 

In addition, in order to increase our membership in the markets we currently serve, we believe that we must continue to develop and implement community-specific products, alliances with key providers and localized outreach and educational programs. If we are unable to develop and implement these initiatives, or if our competitors are more successful than we are in doing so, we may not be able to further penetrate our existing markets.

 

If We are Unable to Maintain Satisfactory Relationships With Our Provider Networks, Our Profitability Will be Harmed.

 

Our profitability depends, in large part, upon our ability to contract favorably with hospitals, physicians and other healthcare providers. Our provider arrangements with our primary care physicians, specialists and hospitals generally may be cancelled by either party without cause upon 90 to 120 days prior written notice. We cannot assure you that we will be able to continue to renew our existing contracts or enter into new contracts enabling us to service our members profitably.

 

From time to time providers assert or threaten to assert claims seeking to terminate noncancelable agreements due to alleged actions or inactions by us. Even if these allegations represent attempts to avoid or renegotiate contractual terms that have become economically disadvantageous to the providers, it is possible that in the future a provider may pursue such a claim successfully. In addition, we are aware that other managed care organizations have been subject to class action suits by physicians with respect to claim payment procedures, and we may be subject to similar claims. Regardless of whether any claims brought against us are successful or have merit, they will still be time-consuming and costly and could distract our management’s attention. As a result, we may incur significant expenses and may be unable to operate our business effectively.

 

We will be required to establish acceptable provider networks prior to entering new markets. We may be unable to enter into agreements with providers in new markets on a timely basis or under favorable terms.

 

If we are unable to retain our current provider contracts or enter into new provider contracts timely or on favorable terms, our profitability will be harmed.

 

Changes in Stock Option Accounting Rules May Have a Significant Adverse Affect on Our Operating Results.

 

We have a history of using broad based employee stock option programs to hire, incentivize and retain our workforce in a competitive marketplace. Statement of Financial Accounting Standards No. 123, “Accounting for Stock-Based Compensation,” allows companies the choice of either using a fair value method of accounting for

 

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options that would result in expense recognition for all options granted, or using an intrinsic value method, as prescribed by Accounting Principles Board Opinion No. 25, “Accounting for Stock Issued to Employees,” or APB 25, with a pro forma disclosure of the impact on net income (loss) of using the fair value option expense recognition method. We have previously elected to apply APB 25 and accordingly we generally have not recognized any expense with respect to employee stock options as long as such options are granted at exercise prices equal to the fair value of our common stock on the date of grant.

 

In December 2004, the Financial Accounting Standards Board issued SFAS No. 123 (revised 2004), “Share Based Payment,” which would require all companies to measure compensation cost for all share-based payments, including employee stock options, at fair value. This statement is effective for public companies for interim or annual periods beginning after June 15, 2005. We are currently evaluating the effect that the adoption of this Statement will have on our financial position and results of operations. We believe, however, that our adoption of this standard will adversely affect our operating results in future periods.

 

We May be Unable to Attract and Retain Key Personnel.

 

We are highly dependent on our ability to attract and retain qualified personnel to operate and expand our business. If we lose one or more members of our senior management team, including our chief executive officer, Michael F. Neidorff, who has been instrumental in developing our business strategy and forging our business relationships, our business and operating results could be harmed. Our ability to replace any departed members of our senior management or other key employees may be difficult and may take an extended period of time because of the limited number of individuals in the Medicaid managed care and specialty services industry with the breadth of skills and experience required to operate and successfully expand a business such as ours. Competition to hire from this limited pool is intense, and we may be unable to hire, train, retain or motivate these personnel.

 

Negative Publicity Regarding the Managed Care Industry May Harm Our Business and Operating Results.

 

The managed care industry has received negative publicity. This publicity has led to increased legislation, regulation, review of industry practices and private litigation in the commercial sector. These factors may adversely affect our ability to market our services, require us to change our services, and increase the regulatory burdens under which we operate. Any of these factors may increase the costs of doing business and adversely affect our operating results.

 

Claims Relating to Medical Malpractice Could Cause Us to Incur Significant Expenses.

 

Our providers and employees involved in medical care decisions may be subject to medical malpractice claims. In addition, some states, including Texas, have adopted legislation that permits managed care organizations to be held liable for negligent treatment decisions or benefits coverage determinations. Claims of this nature, if successful, could result in substantial damage awards against us and our providers that could exceed the limits of any applicable insurance coverage. Therefore, successful malpractice or tort claims asserted against us, our providers or our employees could adversely affect our financial condition and profitability. Even if any claims brought against us are unsuccessful or without merit, they would still be time-consuming and costly and could distract our management’s attention. As a result, we may incur significant expenses and may be unable to operate our business effectively.

 

Loss of Providers Due to Increased Insurance Costs Could Adversely Affect Our Business.

 

Our providers routinely purchase insurance to help protect themselves against medical malpractice claims. In recent years, the costs of maintaining commercially reasonable levels of such insurance have increased dramatically, and these costs are expected to increase to even greater levels in the future. As a result of the level

 

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of these costs, providers may decide to leave the practice of medicine or to limit their practice to certain areas, which may not address the needs of Medicaid participants. We rely on retaining a sufficient number of providers in order to maintain a certain level of service. If a significant number of our providers exit our provider networks or the practice of medicine generally, we may be unable to replace them in a timely manner, if at all, and our business could be adversely affected.

 

Growth in the Number of Medicaid-Eligible Persons During Economic Downturns Could Cause Our Operating Results and Stock Prices to Suffer if State and Federal Budgets Decrease or Do Not Increase.

 

Less favorable economic conditions may cause our membership to increase as more people become eligible to receive Medicaid benefits. During such economic downturns, however, state and federal budgets could decrease, causing states to attempt to cut healthcare programs, benefits and rates. We cannot predict the impact of changes in the United States economic environment or other economic or political events, including acts of terrorism or related military action, on federal or state funding of healthcare programs or on the size of the population eligible for the programs we operate. If federal funding decreases or remains unchanged while our membership increases, our results of operations will suffer.

 

Growth in the Number of Medicaid-Eligible Persons May be Countercyclical, Which Could Cause Our Operating Results to Suffer When General Economic Conditions are Improving.

 

Historically, the number of persons eligible to receive Medicaid benefits has increased more rapidly during periods of rising unemployment, corresponding to less favorable general economic conditions. Conversely, this number may grow more slowly or even decline if economic conditions improve. Therefore, improvements in general economic conditions may cause our membership levels to decrease, thereby causing our operating results to suffer, which could lead to decreases in our stock price during periods in which stock prices in general are increasing.

 

We Intend to Expand Our Medicaid Managed Care Business Primarily into Markets Where Medicaid Recipients are Required to Enroll in Managed Care Plans.

 

We expect to continue to focus our business in states in which Medicaid enrollment in managed care is mandatory. Currently, approximately two-thirds of the states require health plan enrollment for Medicaid eligible participants in all or a portion of their counties. The programs are voluntary in other states. Because we concentrate on markets with mandatory enrollment, we expect the geographic expansion of our Medicaid Managed Care segment to be limited to those states.

 

If We are Unable to Integrate and Manage Our Information Systems Effectively, Our Operations Could be Disrupted.

 

Our operations depend significantly on effective information systems. The information gathered and processed by our information systems assists us in, among other things, monitoring utilization and other cost factors, processing provider claims, and providing data to our regulators. Our providers also depend upon our information systems for membership verifications, claims status and other information.

 

Our information systems and applications require continual maintenance, upgrading and enhancement to meet our operational needs. Moreover, our acquisition activity requires frequent transitions to or from, and the integration of, various information systems. We regularly upgrade and expand our information systems capabilities. If we experience difficulties with the transition to or from information systems or are unable to properly maintain or expand our information systems, we could suffer, among other things, from operational disruptions, loss of existing members and difficulty in attracting new members, regulatory problems and increases in administrative expenses. In addition, our ability to integrate and manage our information systems may be impaired as the result of events outside our control, including acts of nature, such as earthquakes or fires, or acts of terrorists.

 

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We Rely on the Accuracy of Eligibility Lists Provided by State Governments. Inaccuracies in Those Lists Would Negatively Affect Our Results of Operations.

 

Premium payments to us are based upon eligibility lists produced by state governments. From time-to-time, states require us to reimburse them for premiums paid to us based on an eligibility list that a state later discovers contains individuals who are not in fact eligible for a government sponsored program or are eligible for a different premium category or a different program. Alternatively, a state could fail to pay us for members for whom we are entitled to payment. Our results of operations would be adversely affected as a result of such reimbursement to the state if we had made related payments to providers and were unable to recoup such payments from the providers.

 

We May Not be Able to Obtain or Maintain Adequate Insurance.

 

We maintain liability insurance, subject to limits and deductibles, for claims that could result from providing or failing to provide managed care and related services. These claims could be substantial. We believe that our present insurance coverage and reserves are adequate to cover currently estimated exposures. We cannot assure you that we will be able to obtain adequate insurance coverage in the future at acceptable costs or that we will not incur significant liabilities in excess of policy limits.

 

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Item 7A. Quantitative and Qualitative Disclosures About Market Risk

 

INVESTMENTS

 

As of December 31, 2004, we had short-term investments of $94.3 million and long-term investments of $139.0 million, including restricted deposits of $22.2 million. The short-term investments consist of highly liquid securities with maturities between three and 12 months. The long-term investments consist of municipal, corporate and U.S. Agency bonds, life insurance contracts and U.S. Treasury investments and have maturities greater than one year. Restricted deposits consist of investments required by various state statutes to be deposited or pledged to state agencies. Restricted deposits are classified as long-term regardless of the contractual maturity date due to the nature of the states’ requirements. Our investments are subject to interest rate risk and will decrease in value if market rates increase. Assuming a hypothetical and immediate 1% increase in market interest rates at December 31, 2004, the fair value of our fixed income investments would decrease by approximately $4.1 million. Declines in interest rates over time will reduce our investment income.

 

INFLATION

 

Although the general rate of inflation has remained relatively stable and healthcare cost inflation has stabilized in recent years, the national healthcare cost inflation rate still exceeds the general inflation rate. We use various strategies to mitigate the negative effects of healthcare cost inflation. Specifically, our health plans try to control medical and hospital costs through contracts with independent providers of healthcare services. Through these contracted care providers, our health plans emphasize preventive healthcare and appropriate use of specialty and hospital services.

 

While we currently believe our strategies to mitigate healthcare cost inflation will continue to be successful, competitive pressures, new healthcare and pharmaceutical product introductions, demands from healthcare providers and customers, applicable regulations or other factors may affect our ability to control the impact of healthcare cost increases.

 

COMPLIANCE COSTS

 

Federal and state regulations governing standards for electronic transactions, data security and confidentiality of patient information have been issued recently. Due to the uncertainty surrounding the regulatory requirements, we cannot be sure that the systems and programs that we have implemented will comply adequately with the regulations that are ultimately adopted. Implementation of additional systems and programs may be required. Further, compliance with these regulations would require changes to many of the procedures we currently use to conduct our business, which may lead to additional costs that we have not yet identified. We do not know whether, or the extent to which, we will be able to recover our costs of complying with these new regulations from the states.

 

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Item 8. Financial Statements and Supplementary Data

 

Our consolidated financial statements and related notes required by this item are set forth on the pages indicated in Item 15.

 

QUARTERLY SELECTED FINANCIAL INFORMATION

 

(In thousands, except share data and membership data)

(Unaudited)

 

     For the Quarter Ended

     March 31,
2004


   June 30,
2004


   September 30,
2004


   December 31,
2004


Total revenues

   $ 225,525    $ 233,608    $ 253,743    $ 288,064

Earnings from operations

     14,684      15,937      16,471      17,444

Earnings before income taxes

     16,104      17,172      18,028      18,983

Net earnings

   $ 10,138    $ 10,813    $ 11,351    $ 12,010

Per share data:

                           

Basic earnings per common share

   $ 0.25    $ 0.27    $ 0.28    $ 0.29

Diluted earnings per common share

   $ 0.24    $ 0.25    $ 0.26    $ 0.27

Period end membership

     522,400      533,300      641,600      772,700
     For the Quarter Ended

     March 31,
2003


   June 30,
2003


   September 30,
2003


   December 31,
2003


Total revenues

   $ 177,434    $ 186,232    $ 198,753    $ 207,311

Earnings from operations

     10,147      10,336      12,640      13,804

Earnings before income taxes

     11,094      11,589      13,814      15,396

Net earnings

   $ 7,161    $ 7,708    $ 8,704    $ 9,697

Per share data:

                           

Basic earnings per common share

   $ 0.22    $ 0.23    $ 0.24    $ 0.24

Diluted earnings per common share

   $ 0.20    $ 0.22    $ 0.22    $ 0.23

Period end membership

     419,300      438,700      467,100      489,600

 

Item 9. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure

 

None.

 

Item 9A. Controls and Procedures

 

Evaluation of Disclosure Controls and Procedures - Our management, with the participation of our chief executive officer and chief financial officer, evaluated the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) as of December 31, 2004. Based on this evaluation, our chief executive officer and chief financial officer concluded that, as of December 31, 2004, our disclosure controls and procedures were (1) designed to ensure that material information relating to us, including our consolidated subsidiaries, is made known to our chief executive officer and chief financial officer by others within those entities, particularly during the period in which this report was being prepared, and (2) effective, in that they provide reasonable assurance that information required to be disclosed by us in the reports that we file or submit under the Exchange Act are recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms.

 

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Management’s Report on Internal Control Over Financial Reporting - Our management is responsible for establishing and maintaining adequate internal control over financial reporting, as such term is defined in Exchange Act Rules 13a-15(f). Under the supervision and with the participation of our management, including our principal executive officer and principal financial officer, we conducted an evaluation of the effectiveness of our internal control over financial reporting based on the framework in Internal Control – Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission. Based on our evaluation under the framework in Internal Control—Integrated Framework, our management concluded that our internal control over financial reporting was effective as of December 31, 2004. Our management’s assessment of the effectiveness of our internal control over financial reporting as of December 31, 2004 has been audited by PricewaterhouseCoopers LLP, an independent registered public accounting firm, as stated in their report which is included herein.

 

Management has excluded the FirstGuard subsidiaries from its assessment of internal control over financial reporting as of December 31, 2004 because they were acquired by the Company in a purchase business combination effective December 1, 2004. The FirstGuard subsidiaries are wholly owned subsidiaries whose total assets and total revenues represent 29% and 2%, respectively, of the related consolidated financial statement amounts as of and for the year ended December 31, 2004.

 

Changes in Internal Control Over Financial Reporting - No change in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) occurred during the quarter ended December 31, 2004 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

 

Item 9B. Other Information

 

None.

 

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PART III

 

Item 10. Directors and Executive Officers of the Registrant

 

(a) Directors of the Registrant

 

Information concerning our directors will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Election of Directors.” This portion of the Proxy Statement is incorporated herein by reference.

 

(b) Executive Officers of the Registrant

 

The following table sets forth information regarding our executive officers, including their ages at January 31, 2005:

 

Name


   Age

  

Position


Michael F. Neidorff

   62   

Chairman, President and Chief Executive Officer

Joseph P. Drozda, Jr., M.D.

   59   

Executive Vice President, Operations

James D. Donovan, Jr.

   54   

Senior Vice President, New Products and New Markets

Marie J. Glancy

   46   

Senior Vice President, Government Relations

Carol E. Goldman

   47   

Senior Vice President, Chief Administration Officer

Cary D. Hobbs

   37   

Senior Vice President, Strategy and Business Implementation

William N. Scheffel

   51   

Senior Vice President and Controller

Brian G. Spanel

   49   

Senior Vice President and Chief Information Officer

Lisa M. Wilson

   40   

Senior Vice President, Investor Relations

Karey L. Witty

   40   

Senior Vice President, Chief Financial Officer, Secretary and Treasurer

 

Michael F. Neidorff has served as our President, Chief Executive Officer and Chairman of our board of directors since May 2004. From May 1996 to May 2004 Mr. Neidorff served as President, Chief Executive Officer and as a member of our board of directors. From May 1996 to November 2001, Mr. Neidorff also served as our Treasurer. From 1995 to 1996, Mr. Neidorff served as a Regional Vice President of Coventry Corporation, a publicly traded managed care organization, and as the President and Chief Executive Officer of one of its subsidiaries, Group Health Plan, Inc. From 1985 to 1995, Mr. Neidorff served as the President and Chief Executive Officer of Physicians Health Plan of Greater St. Louis, a subsidiary of United Healthcare Corp., a publicly traded managed care organization now known as UnitedHealth Group Incorporated.

 

Joseph P. Drozda, Jr., M.D. has served as our Executive Vice President, Operations since September 2003. Dr. Drozda served as our Senior Vice President, Medical Affairs from November 2000 through August 2003 and as our part-time Medical Director from January 2000 through October 2000. From June 1999 to October 2000, Dr. Drozda was self-employed as a consultant to managed care organizations, physician groups, hospital networks and employer groups on a variety of managed care delivery and financing issues.

 

James D. Donovan, Jr., MPH has served as our Senior Vice President, New Products and New Markets since September 2004. From September 1995 to March 2004, Mr. Donovan served as Chief Executive Officer of Amerigroup Texas, Inc., a subsidiary of Amerigroup Corporation. From 1973 to August 1995, Mr. Donovan served in a variety of roles for Kaiser Permanente Medical Care Program, a not-for-profit managed care organization.

 

Marie J. Glancy has served as our Senior Vice President, Government Relations since January 2005 and as our Vice President, Government Relations from July 2003 to December 2004. From 1996 to July 2003, Ms. Glancy served as a public policy executive for Deere and Company.

 

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Carol E. Goldman has served as Senior Vice President, Chief Administration Officer since July 2002. From September 2001 to June 2002, Ms. Goldman served as our Plan Director of Human Resources. From 1998 to August 2001, Ms. Goldman was Human Resources Manager at Mallinckrodt Inc., a medical device and pharmaceutical company.

 

Cary D. Hobbs has served as our Senior Vice President of Strategy and Business Implementation since January 2004, as our Vice President of Strategy and Business Implementation from September 2002 to December 2003 and as our Director of Business Implementation from 1997 to August 2002.

 

William N. Scheffel has served as our Senior Vice President and Controller since December 2003. From July 2002 to October 2003, Mr. Scheffel was a partner with Ernst & Young LLP. From 1975 to July 2002, Mr. Scheffel was with Arthur Andersen LLP. Mr. Scheffel is a Certified Public Accountant.

 

Brian G. Spanel has served as our Senior Vice President and Chief Information Officer since December 1996. From 1988 to 1996, Mr. Spanel served as President of GBS Consultants, a healthcare consulting and help desk software developer. From 1987 to 1988, Mr. Spanel was Director of Information Services for CompCare, a managed care organization.

 

Lisa M. Wilson has served as our Senior Vice President, Investor Relations since January 2005 and as our Vice President, Investor Relations from March 2004 to December 2004. Ms. Wilson has worked as a consultant for Centene since our initial public offering in 2001. From 1995 to March 2004, Ms. Wilson served as the founder and President of In-Site Communications, an investor relations firm in New York, New York.

 

Karey L. Witty has served as our Senior Vice President and Chief Financial Officer since August 2000, as our Secretary since February 2000 and as our Treasurer since November 2001. From March 1999 to August 2000, Mr. Witty served as our Vice President of Health Plan Accounting. From 1996 to March 1999, Mr. Witty was Controller of Heritage Health Systems, Inc., a healthcare company in Nashville, Tennessee. Mr. Witty is a Certified Public Accountant.

 

Information concerning our executive officers’ compliance with Section 16(a) of the Securities Exchange Act will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Section 16(a) Beneficial Ownership Reporting Compliance.” These portions of our Proxy Statement are incorporated herein by reference. Information concerning our audit committee financial expert and identification of our audit committee will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Information about Corporate Governance.” Information concerning our code of ethics will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Code of Business Conduct and Ethics.”

 

Item 11. Executive Compensation

 

Information concerning executive compensation will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Information About Executive Compensation.” This portion of the Proxy Statement is incorporated herein by reference. The sections entitled “Compensation Committee Report” and “Stock Performance Graph” in our 2005 Proxy Statement are not incorporated herein by reference.

 

Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters

 

Information concerning the security ownership of certain beneficial owners and management and our equity compensation plans will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Information About Stock Ownership” and “Equity Compensation Plan Information.” These portions of the Proxy Statement are incorporated herein by reference.

 

Item 13. Certain Relationships and Related Transactions

 

Information concerning certain relationships and related transactions will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Related Party Transactions.” This portion of our Proxy Statement is incorporated herein by reference.

 

Item 14. Principal Accountant Fees and Services

 

Information concerning principal accountant fees and services will appear in our Proxy Statement for our 2005 annual meeting of stockholders under “Independent Auditor Fees.” This portion of our Proxy Statement is incorporated herein by reference.

 

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Table of Contents

PART IV

 

Item 15. Exhibits and Financial Statement Schedules

 

(a) The following documents are filed as part of this report:

 

     Page

1. Consolidated Financial Statements

    

Report of Independent Registered Public Accounting Firm

   49

Consolidated Balance Sheets as of December 31, 2004 and 2003

   51

Consolidated Statements of Earnings for the Years Ended December 31, 2004, 2003 and 2002

   52

Consolidated Statements of Stockholders’ Equity for the Years Ended December 31, 2004, 2003 and 2002

   53

Consolidated Statements of Cash Flows for the Years Ended December 31, 2004, 2003 and 2002

   54

Notes to Consolidated Financial Statements

   55

2. Financial Statement Schedules

    

Report of Independent Registered Public Accounting Firm on Financial Statement Schedule

   70

Schedule II—Valuation and Qualifying Accounts

   71

3. Exhibits

    

The exhibits listed in the accompanying Exhibit Index are filed or incorporated by reference as part of this filing.

 

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REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM

 

To the Board of Directors and Stockholders of Centene Corporation:

 

We have completed an integrated audit of Centene Corporation’s 2004 consolidated financial statements and of its internal control over financial reporting as of December 31, 2004 and audits of its 2003 and 2002 consolidated financial statements in accordance with the standards of the Public Company Accounting Oversight Board (United States). Our opinions, based on our audits, are presented below.

 

Consolidated financial statements

 

In our opinion, the accompanying consolidated balance sheets and the related consolidated statements of earnings, stockholders’ equity and cash flows present fairly, in all material respects, the financial position of Centene Corporation and its subsidiaries at December 31, 2004 and 2003, and the results of their operations and their cash flows for each of the three years in the period ended December 31, 2004 in conformity with accounting principles generally accepted in the United States of America. These financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits of these statements in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit of financial statements includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, and evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion.

 

Internal control over financial reporting

 

Also, in our opinion, management’s assessment, included in Management’s Report on Internal Control Over Financial Reporting appearing under Item 9A, that the Company maintained effective internal control over financial reporting as of December 31, 2004 based on criteria established in Internal Control – Integrated Framework issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO), is fairly stated, in all material respects, based on those criteria. Furthermore, in our opinion, the Company maintained, in all material respects, effective internal control over financial reporting as of December 31, 2004, based on criteria established in Internal Control – Integrated Framework issued by the COSO. The Company’s management is responsible for maintaining effective internal control over financial reporting and for its assessment of the effectiveness of internal control over financial reporting. Our responsibility is to express opinions on management’s assessment and on the effectiveness of the Company’s internal control over financial reporting based on our audit. We conducted our audit of internal control over financial reporting in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether effective internal control over financial reporting was maintained in all material respects. An audit of internal control over financial reporting includes obtaining an understanding of internal control over financial reporting, evaluating management’s assessment, testing and evaluating the design and operating effectiveness of internal control, and performing such other procedures as we consider necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinions.

 

A company’s internal control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A company’s internal control over financial reporting includes those policies and procedures that (i) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the company; (ii) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance

 

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with generally accepted accounting principles, and that receipts and expenditures of the company are being made only in accordance with authorizations of management and directors of the company; and (iii) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the company’s assets that could have a material effect on the financial statements.

 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

 

As described in Management’s Report on Internal Control Over Financial Reporting, management has excluded the FirstGuard subsidiaries from its assessment of internal control over financial reporting as of December 31, 2004 because they were acquired by the Company in a purchase business combination during 2004. We have also excluded the FirstGuard subsidiaries from our audit of internal control over financial reporting. The FirstGuard subsidiaries are wholly-owned subsidiaries whose total assets and total revenues represent 29% and 2%, respectively, of the related consolidated financial statement amounts as of and for the year ended December 31, 2004.

 

/s/    PRICEWATERHOUSECOOPERS LLP

 

St. Louis, Missouri

February 24, 2005

 

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CENTENE CORPORATION AND SUBSIDIARIES

 

CONSOLIDATED BALANCE SHEETS

(In thousands, except share data)

 

     December 31,

     2004

    2003

ASSETS

              

Current assets:

              

Cash and cash equivalents

   $ 84,105     $ 64,346

Premium and related receivables, net of allowances of $462 and $607, respectively

     31,475       20,308

Short-term investments, at fair value (amortized cost $94,442 and $15,192, respectively)

     94,283       15,160

Other current assets

     14,429       10,487
    


 

Total current assets

     224,292       110,301

Long-term investments, at fair value (amortized cost $117,177 and $183,749, respectively)

     116,787       184,811

Restricted deposits, at fair value (amortized cost $22,295 and $20,201, respectively)

     22,187       20,364

Property, software and equipment

     43,248       23,106

Goodwill

     101,631       13,066

Other intangible assets

     14,439       6,294

Other assets

     5,350       4,750
    


 

Total assets

   $ 527,934     $ 362,692
    


 

LIABILITIES AND STOCKHOLDERS’ EQUITY

              

Current liabilities:

              

Medical claims liabilities

   $ 165,980     $ 106,569

Accounts payable and accrued expenses

     31,737       17,965

Unearned revenue

     3,956       3,673

Current portion of long-term debt and notes payable

     486       579
    


 

Total current liabilities

     202,159       128,786

Long-term debt

     46,973       7,616

Other liabilities

     7,490       6,175
    


 

Total liabilities

     256,622       142,577

Stockholders’ equity:

              

Common stock, $.001 par value; authorized 100,000,000 shares; issued and outstanding 41,316,122 and 40,263,848 shares, respectively

     41       40

Additional paid-in capital

     165,391       157,360

Accumulated other comprehensive income:

              

Unrealized (loss) gain on investments, net of tax

     (407 )     740

Retained earnings

     106,287       61,975
    


 

Total stockholders’ equity

     271,312       220,115
    


 

Total liabilities and stockholders’ equity

   $ 527,934     $ 362,692
    


 

 

See notes to consolidated financial statements.

 

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CENTENE CORPORATION AND SUBSIDIARIES

 

CONSOLIDATED STATEMENTS OF EARNINGS

(In thousands, except share data)

 

     Year Ended December 31,

 
     2004

     2003

     2002

 

Revenues:

                          

Premiums

   $ 991,673      $ 759,763      $ 461,030  

Services

     9,267        9,967        457  
    


  


  


Total revenues

     1,000,940        769,730        461,487  
    


  


  


Expenses:

                          

Medical costs

     800,476        626,192        379,468  

Cost of services

     8,065        8,323        341  

General and administrative expenses

     127,863        88,288        50,072  
    


  


  


Total operating expenses

     936,404        722,803        429,881  
    


  


  


Earnings from operations

     64,536        46,927        31,606  

Other income (expense):

                          

Investment and other income

     6,431        5,160        9,575  

Interest expense

     (680 )      (194 )      (45 )
    


  


  


Earnings before income taxes

     70,287        51,893        41,136  

Income tax expense

     25,975        19,504        15,631  

Minority interest

     —          881        116  
    


  


  


Net earnings

   $ 44,312      $ 33,270      $ 25,621  
    


  


  


Earnings per share:

                          

Basic earnings per common share

   $ 1.09      $ 0.93      $ 0.82  

Diluted earnings per common share

   $ 1.02      $ 0.87      $ 0.73  

Weighted average number of shares outstanding:

                          

Basic

     40,820,909        35,704,426        31,432,080  

Diluted

     43,616,445        38,422,152        34,932,232  

 

See notes to consolidated financial statements.

 

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CENTENE CORPORATION AND SUBSIDIARIES

 

CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY

(In thousands, except share data)

 

    Common Stock

                       
    $.001 Par
Value
Shares


   Amt

   Additional
Paid-in
Capital


   Unrealized
Gain
(Loss) on
Investments


    Retained
Earnings


    Total

 

Balance, December 31, 2001

  30,255,336    $ 30    $ 60,837    $ 135     $ 3,087     $ 64,089  

Net earnings

  —        —        —        —         25,621       25,621  

Change in unrealized investment gains, net of $559 tax

  —        —        —        952       —         952  
                                      


Comprehensive earnings

                                       26,573  

Common stock issued for stock options and employee stock purchase plan

  820,476      1      490      —         —         491  

Proceeds from stock offering

  1,411,486      1      10,317      —         —         10,318  

Stock compensation expense

  —        —        270      —         —         270  

Tax benefits related to stock options

  —        —        442      —         —         442  
   
  

  

  


 


 


Balance, December 31, 2002

  32,487,298    $ 32    $ 72,356    $ 1,087     $ 28,708     $ 102,183  

Net earnings

  —        —        —        —         33,270       33,270  

Change in unrealized investment gains, net of $(186) tax

  —        —        —        (347 )     —         (347 )
                                      


Comprehensive earnings

                                       32,923  

Common stock issued for stock options and employee stock purchase plan

  876,550      1      1,144      —         —         1,145  

Proceeds from stock offering

  6,900,000      7      81,306      —         —         81,313  

Stock compensation expense

  —        —        188      —         —         188  

Tax benefits related to stock options

  —        —        2,366      —         —         2,366  

Cash paid for fractional share impact of stock split

  —        —        —        —         (3 )     (3 )
   
  

  

  


 


 


Balance, December 31, 2003

  40,263,848    $ 40    $ 157,360    $ 740     $ 61,975     $ 220,115  

Net earnings

  —        —        —        —         44,312       44,312  

Change in unrealized investment gains, net of $(703) tax

  —        —        —        (1,147 )     —         (1,147 )
                                      


Comprehensive earnings

                                       43,165  

Common stock issued for stock options and employee stock purchase plan

  1,052,274      1      4,065      —         —         4,066  

Stock compensation expense

  —        —        650      —         —         650  

Tax benefits related to stock options

  —        —        3,316      —         —         3,316  
   
  

  

  


 


 


Balance, December 31, 2004

  41,316,122    $ 41    $ 165,391    $ (407 )   $ 106,287     $ 271,312  
   
  

  

  


 


 


 

See notes to consolidated financial statements.

 

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CENTENE CORPORATION AND SUBSIDIARIES

 

CONSOLIDATED STATEMENTS OF CASH FLOWS

(In thousands)

 

     Year Ended December 31,

 
     2004

    2003

    2002

 

Cash flows from operating activities:

                        

Net earnings

   $ 44,312     $ 33,270     $ 25,621  

Adjustments to reconcile net earnings to net cash provided by operating activities—

                        

Depreciation and amortization

     10,014       6,448       2,565  

Tax benefits related to stock options

     3,316       2,366       442  

Stock compensation expense

     650       188       270  

Minority interest

     —         (881 )     (116 )

Gain on sale of investments

     (138 )     (1,646 )     (649 )

Tax benefits of pre-acquisition net operating losses

     3,295       —         —    

Changes in assets and liabilities—

                        

Premium and related receivables

     (425 )     (2,364 )     (2,449 )

Other current assets

     (786 )     (3,180 )     (1,463 )

Deferred income taxes

     (1,638 )     772       (574 )

Other assets

     (728 )     223       857  

Medical claims liabilities

     34,501       15,053       15,386  

Unearned revenue

     283       3,673       (827 )

Accounts payable and accrued expenses

     6,483       1,531       1,468  

Other operating activities

     266       546       (872 )
    


 


 


Net cash provided by operating activities

     99,405       55,999       39,659  
    


 


 


Cash flows from investing activities:

                        

Purchase of property, software and equipment

     (25,009 )     (19,162 )     (3,918 )

Purchase of investments

     (254,358 )     (435,282 )     (192,371 )

Sales and maturities of investments

     243,623       319,564       127,706  

Acquisitions, net of cash acquired

     (86,739 )     (5,861 )     (11,096 )
    


 


 


Net cash used in investing activities

     (122,483 )     (140,741 )     (79,679 )
    


 


 


Cash flows from financing activities:

                        

Proceeds from issuance of common stock

     —         81,313       10,318  

Proceeds from exercise of stock options

     4,066       1,145       491  

Proceeds from borrowings

     45,860       8,581       —    

Reduction of long-term debt and notes payable

     (6,596 )     (386 )     —    

Other financing activities

     (493 )     (1,221 )     —    
    


 


 


Net cash provided by financing activities

     42,837       89,432       10,809  
    


 


 


Net increase (decrease) in cash and cash equivalents

     19,759       4,690       (29,211 )
    


 


 


Cash and cash equivalents, beginning of period

     64,346       59,656       88,867  
    


 


 


Cash and cash equivalents, end of period

   $ 84,105     $ 64,346     $ 59,656  
    


 


 


Interest paid

   $ 494     $ 176     $ 28  

Income taxes paid

   $ 20,518     $ 19,935     $ 16,433  

 

 

See notes to consolidated financial statements.

 

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CENTENE CORPORATION AND SUBSIDIARIES

 

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

(Dollars in thousands, except share data)

 

1. Organization and Operations

 

Centene Corporation (Centene or the Company) provides multi-line managed care programs and related services to individuals receiving benefits under government subsidized programs including Medicaid, Supplemental Security Income (SSI), and the State Children’s Health Insurance Program (SCHIP). Centene’s Medicaid Managed Care segment operates under its own state licenses in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin, and contracts with other managed care organizations to provide risk and non-risk management services. Centene’s Specialty Services segment contracts with Centene owned companies, as well as other healthcare organizations, to provide specialty services including behavioral health, nurse triage and treatment compliance.

 

In November 2004, the Company declared a two-for-one stock split effected in the form of a 100% stock dividend, payable December 17, 2004 to shareholders of record on November 24, 2004. In May 2004, the Company’s stockholders approved an increase in the authorized shares of common stock to 100,000,000 shares. In May 2003, the Company declared a three-for-two stock split effected in the form of a 50% stock dividend, payable July 11, 2003 to shareholders of record on June 20, 2003. All share, per share and stockholders’ equity amounts have been restated to reflect these stock splits and the increase in authorized shares.

 

2. Public Stock Offerings

 

In August 2003, the Company closed a follow-on public offering of 6,900,000 shares of common stock at $12.50 per share. Centene received net proceeds of $81,313 from this offering.

 

In June 2002, the Company closed a follow-on public offering whereby 15,838,516 shares were sold by selling stockholders and 1,411,486 shares were sold by the Company at $8.25 per share. Centene received net proceeds of $10,318 from this offering.

 

3. Summary of Significant Accounting Policies

 

Principles of Consolidation

 

The accompanying consolidated financial statements include the accounts of Centene Corporation and all majority owned subsidiaries. All material intercompany balances and transactions have been eliminated.

 

Estimates

 

The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

 

Cash and Cash Equivalents

 

Investments with original maturities of three months or less are considered to be cash equivalents. Cash equivalents consist of commercial paper, money market funds, repurchase agreements and bank savings accounts.

 

Investments

 

Short-term investments include securities with maturities between three months and one year. Long-term investments include securities with maturities greater than one year.

 

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Short-term and long-term investments are classified as available for sale and are carried at fair value based on quoted market prices. Unrealized gains and losses on investments available for sale are excluded from earnings and reported as a separate component of stockholders’ equity, net of income tax effects. Premiums and discounts are amortized or accreted over the life of the related security using the effective interest method. The Company monitors the difference between the cost and fair value of investments. Investments that experience a decline in value that is judged to be other than temporary are written down to fair value and a realized loss is recorded in investment and other income. To calculate realized gains and losses on the sale of investments, the Company uses the specific amortized cost of each investment sold. Realized gains and losses are recorded in investment and other income.

 

Restricted Deposits

 

Restricted deposits consist of investments required by various state statutes to be deposited or pledged to state agencies. These investments are classified as long-term, regardless of the contractual maturity date, due to the nature of the states’ requirements. The Company is required to annually adjust the amount of the deposit pledged to certain states.

 

Property, Software and Equipment

 

Property, software and equipment is stated at cost less accumulated depreciation. Capitalized software consists of certain costs incurred in the development of internal-use software, including external direct costs of materials and services and payroll costs of employees devoted to specific software development. Depreciation is calculated principally by the straight-line method over estimated useful lives ranging from 40 years for buildings, three to five years for software and computer equipment and five to seven years for furniture and equipment. Leasehold improvements are depreciated using the straight-line method over the shorter of the expected useful life or the remaining term of the lease ranging between one and ten years.

 

Intangible Assets

 

Intangible assets represent assets acquired in purchase transactions and consist of non-compete agreements, purchased contract rights, provider contracts and goodwill. Purchased contract rights are amortized using the straight-line method over periods ranging from 60 to 120 months. Provider contracts are amortized using the straight-line method over 120 months.

 

Goodwill is reviewed at each year-end for impairment. In addition, the Company will perform an impairment analysis of other intangible assets based on other factors. Such factors would include, but are not limited to, significant changes in membership, state funding, medical contracts and provider networks and contracts. An impairment loss is recognized if the carrying value of goodwill exceeds the implied fair value. The Company did not recognize any impairment losses for the periods presented.

 

Medical Claims Liabilities

 

Medical services costs include claims paid, claims adjudicated but not yet paid, estimates for claims received but not yet adjudicated, estimates for claims incurred but not yet received and estimates for the costs necessary to process unpaid claims.

 

The estimates of medical claims liabilities are developed using standard actuarial methods based upon historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors including product changes. These estimates are continually reviewed and adjustments, if necessary, are reflected in the period known. Management did not change actuarial methods during the years presented. Management believes the amount of medical claims payable is reasonable and adequate to cover the Company’s liability for unpaid claims as of December 31, 2004; however, actual claim payments may differ from established estimates.

 

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Revenue Recognition

 

The majority of the Company’s Medicaid Managed Care premium revenue is received monthly based on fixed rates per member as determined by state contracts. Some contracts allow for additional premium related to certain supplemental services provided such as maternity deliveries. Revenue is recognized as earned over the covered period of services. Revenues are recorded based on membership and eligibility data provided by the states, which may be adjusted by the states for updates to this membership and eligibility data. These adjustments are immaterial in relation to total revenue recorded and are reflected in the period known. Premiums collected in advance are recorded as unearned revenue.

 

The Specialty Services segment generates revenue from capitation payments to our behavioral health company from our health plans and others. It also receives fees for the direct provision of care and school programs in Arizona. The Company’s treatment compliance program receives fee income from the manufacturers of pharmaceuticals. The Company’s nurse line product receives fees from health plans, physicians and other organizations for providing continuous access to nurse advisors.

 

Revenues due to the Company are recorded as premium and related receivables and recorded net of an allowance for uncollectible accounts based on historical trends and management’s judgment on the collectibility of these accounts.

 

Significant Customers

 

Centene receives the majority of its revenues under contracts or subcontracts with state Medicaid managed care programs. The contracts, which expire on various dates between June 30, 2005 and August 31, 2007 are expected to be renewed. Contracts with the states of Indiana, New Jersey, Texas and Wisconsin each accounted for over 10% of the Company’s revenues for the year ended December 31, 2004.

 

Reinsurance

 

Centene’s Medicaid Managed Care subsidiaries have purchased reinsurance from third parties to cover eligible healthcare services. The current reinsurance agreements generally cover 90% of inpatient healthcare expenses in excess of annual deductibles of $75 to $200 per member, up to a lifetime maximum of $2,000. The subsidiaries are responsible for inpatient charges in excess of an average daily per diem.

 

Reinsurance recoveries were $3,730, $5,345 and $1,542 in 2004, 2003 and 2002, respectively. Reinsurance expenses were approximately $6,724, $6,185 and $3,981 in 2004, 2003 and 2002, respectively. Reinsurance recoveries, net of expenses, are included in medical costs.

 

Other Income (Expense)

 

Other income (expense) consists principally of investment income and interest expense. Investment income is derived from the Company’s cash, cash equivalents, restricted deposits and investments. For the year ended December 31, 2002, investment income included a $5,100 one-time dividend from a captive insurance company in which the Company maintained an investment.

 

Interest expense consists of borrowings under our credit facility, mortgage interest and credit facility fees.

 

Income Taxes

 

Deferred tax assets and liabilities are recorded for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the

 

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years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date of the tax rate change.

 

Stock Based Compensation

 

The Company accounts for stock based compensation plans in accordance with the intrinsic value based method of Accounting Principles Board Opinion No. 25. Compensation cost related to stock options issued to employees is calculated on the date of grant only if the current market price of the underlying stock exceeds the exercise price. Compensation expense for stock options and restricted stock unit awards is recognized on a straight-line basis over the vesting period, generally five years for stock options and five to ten years for restricted stock unit awards. The Company recognized $650, $188 and $270 during the years ended December 31, 2004, 2003 and 2002, respectively, for stock based compensation expense. Had compensation cost for the plans been determined based on the fair value method at the grant dates as specified in SFAS No. 123, the Company’s net earnings would have been reduced to the following pro forma amounts:

 

     2004

   2003

   2002

Net earnings

   $ 44,312    $ 33,270    $ 25,621

Pro-forma stock-based employee compensation expense determined under fair value based method, net of related tax effects

     3,490      2,261      1,556
    

  

  

Pro forma net earnings

   $ 40,822    $ 31,009    $ 24,065
    

  

  

Basic earnings per common share:

                    

As reported

   $ 1.09    $ 0.93    $ 0.82

Pro forma

     1.00      0.87      0.77

Diluted earnings per common share:

                    

As reported

   $ 1.02    $ 0.87    $ 0.73

Pro forma

     0.94      0.81      0.69

 

Additional information regarding the stock option plans is included in Note 14.

 

Reclassifications

 

Certain amounts in the consolidated financial statements have been reclassified to conform to the 2004 presentation. These reclassifications have no effect on net earnings or stockholders’ equity as previously reported.

 

Recent Accounting Pronouncements

 

In December 2004, SFAS No. 123 (revised 2004), “Share Based Payment,” was issued. This Statement focuses primarily on accounting for transactions in which an entity obtains employee services in share-based payment transactions. This Statement requires public entities to measure the cost of employee services received in exchange for an award of equity instruments based on the grant-date fair value of the award. The grant date fair value of employee share options and similar instruments will be estimated using option-pricing models adjusted for the unique characteristics of those instruments. That cost will be recognized over the period during which an employee is required to provide service in exchange for the award. This Statement is required to be adopted by the Company by July 1, 2005. The effect of expensing stock options in accordance with the original SFAS No. 123 is presented above under the heading Stock Based Compensation. After the adoption of SFAS No. 123 (revised 2004) the level of stock compensation expense may differ depending on the fair value method and assumptions utilized.

 

In January 2003, FASB Interpretation No. 46, “Consolidation of Variable Interest Entities, an Interpretation of ARB 51,” was issued. The primary objectives of this interpretation, as amended, are to provide guidance on

 

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the identification and consolidation of variable interest entities (VIEs) which are entities for which control is achieved through means other than through voting rights. The Company has completed an analysis of this Interpretation and has determined that it does not have any VIEs.

 

In November 2002, FASB Interpretation No. 45, “Guarantor’s Accounting and Disclosure Requirements for Guarantees, Including Indirect Guarantees of Indebtedness of Others an Interpretation of SFAS No. 5, 57, and 107 and Rescission of FASB Interpretation No. 34,” was issued. This interpretation clarifies the requirements of SFAS No. 5, “Accounting for Contingencies,” relating to a guarantor’s accounting for, and disclosure of, the issuance of certain types of guarantees. The adoption of FASB Interpretation No. 45 did not have a significant impact on the net income or equity of the Company.

 

4. Acquisitions

 

SummaCare

 

In January 2005, the Company announced a definitive agreement to acquire the Medicaid-related assets in Ohio of SummaCare, Inc. The purchase price of approximately $31,000 plus transaction costs will be allocated to the assets acquired and liabilities assumed according to estimated fair values. This transaction is anticipated to close in the second quarter of 2005 subject to regulatory approvals.

 

FirstGuard

 

The Company purchased FirstGuard Inc. and FirstGuard Health Plan, Inc. from Swope Community Enterprises (Swope) effective December 1, 2004. FirstGuard Inc.’s subsidiary, FirstGuard Health Plan Kansas, serves approximately 94,000 Medicaid and SCHIP members throughout the state of Kansas and FirstGuard Health Plan, Inc. serves approximately 41,000 Medicaid members in Missouri (collectively, FirstGuard). Prior to our acquisition of FirstGuard, FirstGuard, Inc. acquired the 20% interest in FirstGuard Health Plan Kansas, Inc. held by a third-party. Swope has indemnified Centene with respect to any claims arising out of the purchase of the 20% interest. Centene paid approximately $96,133 in cash and transaction costs. In accordance with terms in the agreement, the purchase price may be adjusted on certain conditions up to sixteen months after the acquisition date. The results of operations for FirstGuard are included in the consolidated financial statements since December 1, 2004.

 

The purchase price and costs associated with the acquisition exceeded the preliminary estimated fair value of the net tangible assets acquired by approximately $91,756. We have preliminarily allocated the excess purchase price over the fair value of the net tangible assets acquired to identifiable intangible assets of $8,000 and associated deferred tax liabilities of $3,040 and goodwill of approximately $86,796. The identifiable intangible assets have an estimated useful life of 10 years. The acquired goodwill is not deductible for income tax purposes. Our preliminary estimate of the fair value of the tangible assets/(liabilities) as of the acquisition date, which is subject to further refinement, is as follows:

 

Cash, cash equivalents and investments

   $ 51,004  

Premium and related receivables and other current assets

     13,511  

Property, software and equipment

     292  

Medical claims liabilities

     (24,909 )

Accounts payable and accrued expenses

     (7,235 )

Due to seller

     (28,286 )
    


Net tangible assets acquired

   $ 4,377  
    


 

The following unaudited pro forma information presents the results of operations of Centene and subsidiaries as if the FirstGuard acquisition described above had occurred at the beginning of each period

 

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presented. These pro forma results may not necessarily reflect the actual results of operations that would have been achieved, nor are they necessarily indicative of future results of operations.

 

     2004

   2003

Revenue

   $ 1,222,396    $ 1,003,107

Net earnings

     51,466      46,409

Diluted earnings per common share

   $ 1.18    $ 1.21

 

Family Health Plan

 

Effective January 1, 2004, the Company commenced operations in Ohio through the acquisition from Family Health Plan, Inc. of certain Medicaid-related assets for a purchase price of approximately $6,864. The cost to acquire the Medicaid-related assets has been allocated to the assets acquired and liabilities assumed according to estimated fair values.

 

The purchase price allocation resulted in identified intangible assets of $1,800, representing purchased contract rights, provider network and a non-compete agreement. The intangibles are being amortized over periods ranging from five to ten years. In addition, goodwill approximated $5,064 which is deductible for tax purposes.

 

HMO Blue Texas

 

Effective August 1, 2003, the Company acquired certain Medicaid-related contract rights of HMO Blue Texas in the San Antonio, Texas market for $1,045. The purchase price was allocated to acquired contracts, which are being amortized on a straight-line basis over a period of five years, the expected period of benefit.

 

Cenpatico Behavioral Health

 

During 2003, the Company acquired a 100% ownership interest in Group Practice Affiliates, LLC, a behavioral healthcare services company (63.7% in March 2003 and 36.3% in August 2003). In September 2004, the Company renamed the subsidiary Cenpatico Behavioral Health, LLC (Cenpatico). The consolidated financial statements include the results of operations of Cenpatico since March 1, 2003. The Company paid $1,800 and assumed net liabilities of approximately $1,939 for its purchase of Cenpatico. The cost to acquire the ownership interest has been allocated to the assets acquired and liabilities assumed according to estimated fair values. The allocation has resulted in goodwill of approximately $3,739. The goodwill is not deductible for tax purposes.

 

ScriptAssist

 

In March 2003, the Company purchased contract and name rights of ScriptAssist, LLC (ScriptAssist), a treatment compliance company. The purchase price of $563 was allocated to acquired contracts, which are being amortized on a straight-line basis over a period of five years, the expected period of benefit. The investor group who held membership interests in ScriptAssist included one of the Company’s executive officers.

 

University Health Plans

 

On December 1, 2002, the Company purchased 80% of the outstanding capital stock of University Health Plans, Inc. (UHP) in New Jersey. In October 2003, the Company exercised its option to purchase the remaining 20% of the outstanding capital stock. Centene paid a total purchase price of $13,258. The results of operations for UHP are included in the consolidated financial statements since December 1, 2002.

 

The acquisition of UHP resulted in identified intangible assets of $3,800, representing purchased contract rights and provider network. The intangibles are being amortized over a ten-year period. Goodwill of $5,027 is not deductible for tax purposes. Changes during 2003 to the preliminary purchase price allocation primarily consisted of the purchase of the remaining 20% of the outstanding stock and the recognition of intangible assets and related deferred tax liabilities.

 

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The following unaudited pro forma information presents the results of operations of Centene and subsidiaries as if the UHP acquisition described above had occurred as of January 1, 2002. These pro forma results may not necessarily reflect the actual results of operations that would have been achieved, nor are they necessarily indicative of future results of operations.

 

     2002

Revenue

   $ 567,048

Net earnings

     25,869

Diluted earnings per common share

   $ 0.74

 

Texas Universities Health Plan

 

In June 2002, the Company purchased SCHIP contracts in three Texas service areas. The cash purchase price of $595 was recorded as purchased contract rights, which are being amortized on a straight-line basis over five years, the expected period of benefit.

 

Bankers Reserve

 

In March 2002, the Company acquired Bankers Reserve Life Insurance Company of Wisconsin for a cash purchase price of $3,527. The Company allocated the purchase price to net tangible and identifiable intangible assets based on their fair value. Centene allocated $306 to identifiable intangible assets, representing the value assigned to acquired licenses, which are being amortized on a straight-line basis over a period of ten years. The Company accounted for this acquisition under the purchase method of accounting and accordingly, the consolidated results of operations include the results of the acquired Bankers Reserve business from the date of acquisition. Pro forma disclosures related to the acquisition have been excluded as immaterial.

 

As part of the acquisition, the Company acquired $5,200 of Separate Account assets and $5,200 of Separate Account liabilities. The acquired Separate Account assets and liabilities represent fixed rate annuity contracts with various maturity dates. Concurrent with the acquisition of Bankers Reserve, the Company entered into a 100% coinsurance reinsurance agreement with an unaffiliated party to reinsure the guaranteed cash value, annuity benefit, surrender benefit and death benefits associated with these contracts. The reinsurance premiums paid for this coverage equal the net administrative fee earned and received by the Company on the annuity contracts. Accordingly, there is no income statement impact to the Company as a result of acquiring the Separate Account assets and liabilities. The Separate Account balances, which are being liquidated and paid to insureds as annuities mature, do not have a minimum guarantee benefit beyond the cash surrender value of the policy. At December 31, 2004 Separate Account balances of $3,547 are included in Other assets and Other liabilities in the consolidated balance sheets.

 

5. Short-term and Long-term Investments and Restricted Deposits

 

Short-term and long-term investments and restricted deposits available for sale by investment type at December 31, 2004 consist of the following:

 

     December 31, 2004

     Amortized
Cost


   Gross
Unrealized
Gains


   Gross
Unrealized
Losses


    Estimated
Market
Value


U.S. Treasury securities and obligations of U.S. government corporations and agencies

   $ 53,171    $ 104    $ (317 )   $ 52,958

Corporate securities

     97,958      77      (473 )     97,562

State and municipal securities

     71,428      294      (335 )     71,387

Asset backed securities

     3,156      —        (7 )     3,149

Life insurance contracts

     8,201      —        —         8,201
    

  

  


 

Total

   $ 233,914    $ 475    $ (1,132 )   $ 233,257
    

  

  


 

 

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Substantially all of the investments in a gross unrealized loss position at December 31, 2004 have been in an unrealized loss position for less than 12 months. These investments had an estimated market value of $164,318 and amortized cost of $165,450 at December 31, 2004. The Company monitors these investments for other than temporary impairment. These investments have experienced a decline in value due to changes in market interest rates. Based on the credit quality of the investments and our intent and ability to hold these investments to recovery (which may be maturity), no other than temporary impairment has been recorded.

 

Short-term and long-term investments and restricted deposits available for sale by investment type at December 31, 2003 consist of the following:

 

     December 31, 2003

     Amortized
Cost


   Gross
Unrealized
Gains


   Gross
Unrealized
Losses


    Estimated
Market
Value


U.S. Treasury securities and obligations of U.S. government corporations and agencies

   $ 19,570    $ 163    $ —       $ 19,733

State and municipal securities

     198,695      1,344      (314 )     199,725

Corporate securities

     877      —        —         877
    

  

  


 

Total

   $ 219,142    $ 1,507    $ (314 )   $ 220,335
    

  

  


 

 

The contractual maturity of short-term and long-term investments and restricted deposits as of December 31, 2004, are as follows:

 

     Investments

   Restricted Deposits

     Amortized
Cost


   Estimated
Market
Value


   Amortized
Cost


   Estimated
Market
Value


One year or less

   $ 94,442    $ 94,283    $ 6,876    $ 6,846

One year through five years

     95,500      95,083      14,591      14,476

Five years through ten years

     21,677      21,704      828      865
    

  

  

  

Total

   $ 211,619    $ 211,070    $ 22,295    $ 22,187
    

  

  

  

 

Actual maturities may differ from contractual maturities due to call or prepayment options. Asset backed securities are included in the one year through five years category, and life insurance contracts are included in the five years through ten years category.

 

The Company recorded realized gains and losses on the sale of investments for the years ended December 31 as follows:

 

     2004

    2003

    2002

 

Gross realized gains

   $ 861     $ 1,859     $ 698  

Gross realized losses

     (723 )     (213 )     (49 )
    


 


 


Net realized gains

   $ 138     $ 1,646     $ 649  
    


 


 


 

Various state statutes require the Company’s managed care subsidiaries to deposit or pledge minimum amounts of investments to state agencies. Securities with a fair market value of $22,187 and $20,364 were deposited or pledged to state agencies by Centene’s managed care subsidiaries at December 31, 2004 and 2003, respectively. These investments are classified as long-term restricted deposits in the consolidated financial statements due to the nature of the states’ requirements.

 

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6. Property, Software and Equipment

 

Property, software and equipment consist of the following as of December 31:

 

     2004

    2003

 

Building

   $ 13,649     $ 10,971  

Land

     13,129       2,320  

Computer software

     10,976       4,878  

Computer hardware

     7,052       4,311  

Furniture and office equipment

     6,197       5,330  

Leasehold improvements

     4,321       3,663  
    


 


       55,324       31,473  

Less—accumulated depreciation

     (12,076 )     (8,367 )
    


 


Property, software and equipment, net

   $ 43,248     $ 23,106  
    


 


 

Depreciation expense for the years ended December 31, 2004, 2003 and 2002 was $5,149, $3,469 and $1,887, respectively.

 

7. Intangible Assets

 

Goodwill balances and the changes therein are as follows:

 

     Medicaid
Managed Care


    Specialty
Services


    Total

 

Balance as of December 31, 2002

   $ 5,022     $ —       $ 5,022  

Acquisitions

     2,628       3,895       6,523  

Purchase price allocation adjustments

     1,521       —         1,521  
    


 


 


Balance as of December 31, 2003

     9,171       3,895       13,066  

Acquisitions

     91,860       —         91,860  

Purchase price allocation adjustments

     (3,140 )     (155 )     (3,295 )
    


 


 


Balance as of December 31, 2004

   $ 97,891     $ 3,740     $ 101,631  
    


 


 


 

Purchase price allocation adjustments in 2004 were related to the realization of the tax benefits of pre-acquisition net operating loss carryforward amounts.

 

Other intangible assets at December 31 consist of the following:

 

                 Weighted
Average Life
in Years


     2004

    2003

    2004

   2003

Purchased contract rights

   $ 7,318     $ 6,492     7.2    7.9

Provider contracts

     1,900       1,400     10.0    10.0

Non-compete agreements

     300       —       5.0    —  

Estimated FirstGuard identifiable intangibles

     8,000       —       10.0    —  
    


 


 
  

Other intangible assets

     17,518       7,892     7.8    8.3

Less accumulated amortization

                         

Purchased contract rights

     (2,611 )     (1,446 )         

Provider contracts

     (342 )     (152 )         

Non-compete agreements

     (60 )     —             

Estimated FirstGuard identifiable intangibles

     (66 )     —             
    


 


        

Total accumulated amortization

     (3,079 )     (1,598 )         
    


 


        

Other intangible assets, net

   $ 14,439     $ 6,294           
    


 


        

 

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Amortization expense was $1,481, $986 and $367 for the years ended December 31, 2004, 2003 and 2002, respectively. The estimated amortization expense for 2005, 2006, 2007, 2008 and 2009 is approximately $2,200, $2,000, $1,900, $1,600 and $1,300, respectively.

 

8. Income Taxes

 

The consolidated income tax expense consists of the following for the years ended December 31:

 

     2004

    2003

   2002

 

Current:

                       

Federal

   $ 23,652     $ 16,776    $ 13,661  

State

     3,038       2,464      2,338  
    


 

  


Total current

     26,690       19,240      15,999  

Deferred

     (715 )     264      (368 )
    


 

  


Total expense

   $ 25,975     $ 19,504    $ 15,631  
    


 

  


 

The following is a reconciliation of the expected income tax expense at U.S. Federal statutory rates to Centene’s actual income tax expense for the years ended December 31:

 

     2004

    2003

    2002

 

Expected federal income tax expense

   $ 24,600     $ 18,163     $ 14,398  

State income taxes, net of federal income tax benefit

     1,975       1,602       1,520  

Tax exempt investment income

     (1,030 )     (916 )     (411 )

Other, net

     430       655       124  
    


 


 


Income tax expense

   $ 25,975     $ 19,504     $ 15,631  
    


 


 


 

Temporary differences that give rise to deferred tax assets and liabilities are presented below for the years ended December 31:

 

     2004

   2003

Medical claims liabilities and other accruals

   $ 8,696    $ 3,992

Allowance for doubtful accounts

     175      230

Depreciation and amortization

     541      720

Unearned revenue

     304      279

Unrealized loss on investments

     353      156
    

  

Total deferred tax assets

     10,069      5,377
    

  

Identified intangible assets

     4,286      1,288

Unrealized gain on investments

     41      472

Prepaid expenses

     1,027      409

Depreciation

     1,380      566
    

  

Total deferred tax liabilities

     6,734      2,735
    

  

Net deferred tax assets and liabilities

   $ 3,335    $ 2,642
    

  

 

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9. Medical Claims Liabilities

 

The change in medical claims liabilities is summarized as follows:

 

     2004

     2003

     2002

 

Balance, January 1

   $ 106,569      $ 91,181      $ 59,565  

Acquisitions

     24,909        335        16,230  

Incurred related to:

                          

Current year

     816,418        645,482        396,715  

Prior years

     (15,942 )      (19,290 )      (17,247 )
    


  


  


Total incurred

     800,476        626,192        379,468  
    


  


  


Paid related to:

                          

Current year

     681,780        544,309        324,210  

Prior years

     84,194        66,830        39,872  
    


  


  


Total paid

     765,974        611,139        364,082  
    


  


  


Balance, December 31

   $ 165,980      $ 106,569      $ 91,181  
    


  


  


 

Changes in estimates of incurred claims for prior years were attributable to favorable development in all of our markets, including changes in medical utilization and cost trends. These changes in medical utilization and cost trends can be attributable to our medical management programs and changes in our member demographics.

 

The Company had reinsurance recoverables related to medical claims liabilities of $953 and $1,590 at December 31, 2004 and 2003, respectively, included in premiums and other receivables.

 

10. Revolving Line of Credit

 

In September 2004, the Company executed a five-year $100 million Revolving Credit Agreement with various financial institutions and LaSalle Bank National Association as administrative agent and arranger. Borrowings under the agreement bear interest based upon LIBOR rates, the Federal Funds Rate or the Prime Rate. The agreement is secured by the common stock and membership interests of the Company’s subsidiaries. The agreement contains non-financial and financial covenants, including requirements of minimum fixed charge coverage ratios, minimum debt-to-EBITDA ratios and minimum tangible net worth. The agreement will expire in September 2009 or on an earlier date in the instance of a default as defined in the agreement. As of December 31, 2004, the Company was in compliance with all covenants. The outstanding borrowings at December 31, 2004 totaled $34,000, consisting of $30,000 bearing interest at 3.71% and $4,000 bearing interest at 5.25%.

 

11. Notes Payable and Long-term Debt

 

In August 2003, the Company borrowed $8,000 under a non-recourse mortgage loan arrangement to finance a portion of its purchase of its corporate headquarters’ building. This mortgage was refinanced in November 2004 in conjunction with taking an additional mortgage in the amount of $5,500 related to property purchased to support the Company’s expansion. The mortgages bear interest at the prevailing prime rate less .25%. At December 31, 2004 the mortgages bore interest at 5.00%. The mortgages are collateralized by the respective properties which had a net book value of $25,203 at December 31, 2004. The loans include a financial covenant requiring a minimum rolling twelve-month debt service coverage ratio. As of December 31, 2004, the Company was in compliance with this covenant. Maturities on the mortgages are as follows:

 

2005

   $ 486

2006

     486

2007

     486

2008

     486

2009

     486

2010

     11,029
    

Total

   $ 13,459
    

 

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In 2003, the Company issued a $581 promissory note payable as part of the acquisition of Cenpatico Behavioral Health. In 2004 this note was paid in full.

 

12. Stockholders’ Equity

 

As approved by the Company’s stockholders in May 2004, the Company has 10,000,000 authorized shares of preferred stock at $.001 par value and 100,000,000 authorized shares of common stock at $.001 par value. At December 31, 2004, there were no preferred shares outstanding.

 

13. Statutory Capital Requirements and Dividend Restrictions

 

Various state laws require Centene’s regulated subsidiaries to maintain minimum capital requirements as required by each state and restrict the amount of dividends that may be paid without prior regulatory approval. At December 31, 2004 and 2003, Centene’s subsidiaries had aggregate statutory capital and surplus of $123,600 and $64,700, respectively, compared with the required minimum aggregate statutory capital and surplus of $65,100 and $30,900, respectively. The Company received dividends from its managed care subsidiaries of $0, $6,000 and $4,000 during the years ended December 31, 2004, 2003 and 2002, respectively.

 

14. Stock Incentive Plans

 

The Company’s stock incentive plans allow for the granting of restricted stock awards and options to purchase common stock for key employees and other contributors to Centene. Both incentive options and nonqualified stock options can be awarded under the plans. Further, no option will be exercisable for longer than ten years after date of grant. The Plans have reserved 10,350,000 shares for option grants. Options granted generally vest over a five-year period beginning on the first anniversary of the date of grant and annually thereafter.

 

Option activity for the years ended December 31 is summarized below:

 

     2004

   2003

   2002

     Shares

    Weighted
Average
Exercise Price


   Shares

    Weighted
Average
Exercise Price


   Shares

    Weighted
Average
Exercise Price


Options outstanding, beginning of year

     5,438,058     $ 6.91      4,665,420     $ 3.13      4,268,820     $ 0.89

Granted

     2,006,500       20.86      1,992,578       13.00      1,467,000       8.28

Exercised

     (1,003,098 )     3.76      (877,786 )     1.13      (832,200 )     0.55

Canceled

     (258,444 )     10.63      (342,154 )     5.77      (238,200 )     3.66
    


 

  


 

  


 

Options outstanding, end of year

     6,183,016     $ 11.78      5,438,058     $ 6.91      4,665,420     $ 3.13
    


        


        


     

Weighted average remaining life

     7.8 years              7.6 years              7.4 years        

Weighted average fair value of options granted

   $ 12.25            $ 7.63            $ 5.03        

 

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The following table summarizes information about options outstanding as of December 31, 2004:

 

Options Outstanding


   Options Exercisable

Range of Exercise Prices


   Options
Outstanding


   Weighted Average
Remaining
Contractual Life


   Weighted Average
Exercise Price


   Options
Exercisable


   Weighted Average
Exercise Price


  $0.00 - $2.49

   1,468,212    4.5    $ 0.58    1,230,012    $ 0.59

  $2.50 - $4.99

   45,000    7.1      4.67    18,000      4.67

  $5.00 - $9.99

   1,082,768    7.6      8.00    319,868      7.59

$10.00 - $14.99

   1,539,380    8.7      13.28    298,573      13.19

$15.00 - $19.99

   1,205,656    9.3      17.32    38,600      15.65

$20.00 - $24.99

   37,000    9.8      22.34    —        —  

$25.00 - $29.99

   805,000    9.9      26.08    —        —  
    
  
  

  
  

     6,183,016    7.8    $ 11.78    1,905,053    $ 4.08
    
              
      

 

The fair value of each option grant is estimated on the date of the grant using an option pricing model with the following assumptions: no dividend yield; expected volatility of 57%, 53% and 54%; risk-free interest rate of 3.7%, 3.1% and 3.6% and expected lives of 6.0, 6.0 and 7.4 for the years ended December 31, 2004, 2003 and 2002, respectively.

 

In 2004 the Company granted 1,000,000 restricted stock units with a grant date fair market value per share of $24.60. The restricted stock units will vest as follows: 600,000 in 2009 and 80,000 each in 2010 to 2014.

 

During 2002, Centene implemented an employee stock purchase plan. The Company has reserved 900,000 shares of common stock and issued 20,676 shares, 18,428 shares and 5,376 shares in 2004, 2003 and 2002, respectively, related to the employee stock purchase plan.

 

15. Retirement Plan

 

Centene has a defined contribution plan which covers substantially all employees who work at least 1,000 hours in a twelve consecutive month period and are at least twenty-one years of age. Under the plan, eligible employees may contribute a percentage of their base salary, subject to certain limitations. Centene may elect to match a portion of the employee’s contribution. Company expense related to matching contributions to the plan were $822, $581 and $312 during the years ended December 31, 2004, 2003 and 2002, respectively.

 

16. Commitments

 

Centene and its subsidiaries lease office facilities and various equipment under non-cancelable operating leases. Rental expense was $5,482, $3,144 and $2,637 for the years ended December 31, 2004, 2003 and 2002, respectively. Annual non-cancelable minimum lease payments over the next five years and thereafter are as follows:

 

2005

   $ 6,766

2006

     6,087

2007

     5,157

2008

     4,276

2009

     3,622

Thereafter

     7,613
    

     $ 33,521
    

 

17. Contingencies

 

Aurora Health Care, Inc. (Aurora) provides medical professional services under a contract with the Company’s Wisconsin health plan subsidiary. In May 2003, Aurora filed a lawsuit in the Milwaukee County

 

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Circuit Court claiming the Company had failed to adequately reimburse Aurora for services rendered during the period from 1998 to the present. In 2004 the Court dismissed the claim as filed, but allowed Aurora to replead and seek a declaratory ruling clarifying the contract with respect to reimbursement for ambulatory surgery services. Although the exact amount of the dispute has not been determined, Aurora claims it exceeds $8,000. The Company continues to dispute the claim and plans to defend against this matter.

 

The Company is routinely subject to legal proceedings in the normal course of business. While the ultimate resolution of such matters are uncertain, the Company does not expect the results of these matters to have a material effect on its financial position or results of operations.

 

18. Risks and Uncertainties

 

The Company’s profitability depends in large part on accurately predicting and effectively managing medical services costs. The Company continually reviews its premium and benefit structure to reflect its underlying claims experience and revised actuarial data; however, several factors could adversely affect the medical services costs. Certain of these factors, which include changes in healthcare practices, inflation, new technologies, major epidemics, natural disasters and malpractice litigation, are beyond any health plan’s control and could adversely affect the Company’s ability to accurately predict and effectively control healthcare costs. Costs in excess of those anticipated could have a material adverse effect on the Company’s results of operations.

 

Financial instruments that potentially subject the Company to concentrations of credit and interest rate risks consist primarily of cash and cash equivalents, investments in marketable securities and accounts receivable. The Company invests its excess cash in interest bearing deposits with major banks, commercial paper, repurchase agreements, government and agency securities and money market funds. Investments in marketable securities are managed within guidelines established by the Company’s board of directors. The Company carries these investments at fair value.

 

Concentrations of credit risk with respect to accounts receivable are limited due to significant customers paying as services are rendered. Significant customers include the federal government and the states in which Centene operates. The Company has a risk of incurring loss if its allowance for doubtful accounts is not adequate.

 

As discussed in Note 3 to the consolidated financial statements, the Company has reinsurance agreements with insurance companies. The Company monitors the insurance companies’ financial ratings to determine compliance with standards set by state law. The Company has a credit risk associated with these reinsurance agreements to the extent the reinsurers are unable to pay valid reinsurance claims of the Company.

 

19. Earnings Per Share

 

The following table sets forth the calculation of basic and diluted net earnings per share for the years ended December 31:

 

     2004

   2003

   2002

Net earnings

   $ 44,312    $ 33,270    $ 25,621
    

  

  

Shares used in computing per share amounts:

                    

Weighted average number of common shares outstanding

     40,820,909      35,704,426      31,432,080

Dilutive effect of stock options and stock units (as determined by applying the treasury stock method)

     2,795,536      2,717,726      3,500,152
    

  

  

Weighted average number of common shares and potential dilutive common shares outstanding

     43,616,445      38,422,152      34,932,232
    

  

  

Basic earnings per common share

   $ 1.09    $ 0.93    $ 0.82

Diluted earnings per common share

   $ 1.02    $ 0.87    $ 0.73

 

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The calculation of diluted earnings per common share in 2003 excludes the impact of 1,317,820 shares related to stock options which are antidilutive.

 

20. Segment Information

 

With the acquisition of Cenpatico and the purchase of ScriptAssist assets on March 1, 2003, Centene began operating in two segments: Medicaid Managed Care and Specialty Services. The Medicaid Managed Care segment consists of Centene’s health plans including all of the functions needed to operate them. The Specialty Services segment consists of Centene’s specialty companies including behavioral health, nurse triage and treatment compliance functions.

 

Factors used in determining the reportable business segments include the nature of operating activities, existence of separate senior management teams, and the type of information presented to the Company’s chief operating decision maker to evaluate all results of operations.

 

Segment information as of and for the year ended December 31, 2004, follows:

 

     Medicaid
Managed Care


   Specialty
Services


    Eliminations

    Consolidated
Total


Revenue from external customers

   $ 993,304    $ 7,636     $ —       $ 1,000,940

Revenue from internal customers

     60,329      21,923       (82,252 )     —  
    

  


 


 

Total revenue

   $ 1,053,633    $ 29,559     $ (82,252 )   $ 1,000,940
    

  


 


 

Earnings before income taxes

   $ 71,820    $ (1,533 )   $ —       $ 70,287
    

  


 


 

Total assets

   $ 519,799    $ 8,135     $ —       $ 527,934
    

  


 


 

Depreciation expense

   $ 4,682    $ 467     $ —       $ 5,149
    

  


 


 

Capital expenditures

   $ 24,726    $ 283     $ —       $ 25,009
    

  


 


 

 

Segment information as of and for the year ended December 31, 2003, follows:

 

     Medicaid
Managed Care


   Specialty
Services


   Eliminations

    Consolidated
Total


Revenue from external customers

   $ 760,041    $ 9,689    $ —       $ 769,730

Revenue from internal customers

     14,839      12,374      (27,213 )     —  
    

  

  


 

Total revenue

   $ 774,880    $ 22,063    $ (27,213 )   $ 769,730
    

  

  


 

Earnings before income taxes

   $ 49,764    $ 2,129    $ —       $ 51,893
    

  

  


 

Total assets

   $ 353,145    $ 9,547    $ —       $ 362,692
    

  

  


 

Depreciation expense

   $ 2,966    $ 503    $ —       $ 3,469
    

  

  


 

Capital expenditures

   $ 18,666    $ 496    $ —       $ 19,162
    

  

  


 

 

The Company evaluates performance and allocates resources based on earnings before income taxes. The accounting policies are the same as those described in the “Summary of Significant Accounting Policies” included in Note 3.

 

21. Comprehensive Earnings

 

Differences between net earnings and total comprehensive earnings resulted from changes in unrealized gains on investments available for sale, as follows:

 

    

Year Ended

December 31,


 
     2004

    2003

 

Net earnings

   $ 44,312     $ 33,270  

Reclassification adjustment, net of tax

     (466 )     (529 )

Unrealized (losses) gains on investments available for sale, net of tax

     (681 )     182  
    


 


Total comprehensive earnings

   $ 43,165     $ 32,923  
    


 


 

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REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM ON FINANCIAL STATEMENT SCHEDULE

 

To the Board of Directors of Centene Corporation:

 

Our audits of the consolidated financial statements, of management’s assessment of the effectiveness of internal control over financial reporting and of the effectiveness of internal control over financial reporting referred to in our report dated February 24, 2005 appearing in this Annual Report on Form 10-K also included an audit of the financial statement schedule listed in Item 15(a)(2) of this Form 10-K. In our opinion, this financial statement schedule presents fairly, in all material respects, the information set forth therein when read in conjunction with the related consolidated financial statements.

 

/s/ PRICEWATERHOUSECOOPERS LLP

St. Louis, Missouri

February 24, 2005

 

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Table of Contents

Schedule II

 

CENTENE CORPORATION

 

SCHEDULE OF VALUATION AND QUALIFYING ACCOUNTS

(In thousands)

 

     Balance
Beginning
of Period


   Amounts
Charged to
Expense


    Write-offs of
Uncollectible
Receivables


    Balance
End of
Period


Allowance for Doubtful Receivables:

                             

Year ended December 31, 2002

   $ 3,879    $ (971 )   $ (2,689 )   $ 219

Year ended December 31, 2003

     219      472       (84 )     607

Year ended December 31, 2004

     607      407       (552 )     462

 

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Table of Contents

EXHIBIT INDEX

 

               INCORPORATED BY REFERENCE

EXHIBIT

NUMBER


  

DESCRIPTION


   FILED WITH
THIS
FORM 10-K


   FORM

   FILING DATE
WITH SEC


  

EXHIBIT

NUMBER


3.1

   Certificate of Incorporation of Centene Corporation         S-1    October 9, 2001    3.1

3.1a

   Certificate of Amendment to Certificate of Incorporation of Centene Corporation, dated November 8, 2001         S-1/A    November 13, 2001    3.2a

3.1b

   Certificate of Amendment to Certificate of Incorporation of Centene Corporation as filed with the Secretary of State of the State of Delaware         10-Q    July 26, 2004    3.1b

3.2

   By-laws of Centene Corporation         S-1    October 9, 2001    3.3

4.1

   Amended and Restated Shareholders’ Agreement, dated September 23, 1998         S-1    October 9, 2001    4.2

4.2

   Rights Agreement between Centene Corporation and Mellon Investor Services LLC, as Rights Agent, dated August 30, 2002         8-K    August 30, 2002    4.1

10.1

   Contract for Medicaid/ Badger Care HMO Services between Managed Health Services Insurance Corp. and Wisconsin Department of Health and Family Services.         10-Q    July 26, 2004    10.7

10.2

   Contract between the State of Kansas Department of Social and Rehabilitation Services and FirstGuard Health Plan Kansas, Inc.    X               

10.3

   Contract between the Office of the Medicaid Policy and Planning, the Office of the Children’s Health Insurance Program and Coordinated Care Corporation Indiana, Inc.    X               

10.4

   1994 Stock Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-83190         S-1    October 9, 2001    10.8

10.5

   1996 Stock Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-83190         S-1    October 9, 2001    10.9

10.6

   1998 Stock Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-83190         S-1    October 9, 2001    10.10

10.7

   1999 Stock Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-83190         S-1    October 9, 2001    10.11

10.8

   2000 Stock Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-83190         S-1    October 9, 2001    10.12

 

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Table of Contents

10.9

   2002 Employee Stock Purchase Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-90976         10-Q    April 29, 2002    10.5

10.9a

   First Amendment to 2002 Employee Stock Purchase Plan    X               

10.10

   2003 Stock Incentive Plan of Centene Corporation, shares which are registered on Form S-8 - File Number 333-108467         10-K    February 24, 2004    10.30

10.11

   Form of Incentive Stock Option Agreement of Centene Corporation         S-1    October 9, 2001    10.13

10.12

   Form of Non-statutory Stock Option Agreement of Centene Corporation         S-1    October 9, 2001    10.14

10.13

   Centene Corporation Non-Employee Directors Deferred Stock Compensation Plan         10-Q    October 25, 2004    10.1

10.14

   Credit Agreement dated as of September 14, 2004 among Centene Corporation, the various financial institutions party hereto and LaSalle Bank National Association         10-Q    October 25, 2004    10.2

10.15

   Executive Employment Agreement between Centene Corporation and Michael F. Neidorff, dated November 8, 2004         8-K    November 8, 2004    10.1

10.16

   Executive Employment Agreement between Centene Corporation and Joseph P. Drozda, M.D., dated October 1, 2001         10-Q    April 29, 2002    10.3

10.17

   Executive Employment Agreement between Centene Corporation and James D. Donovan, dated September 24, 2004         8-K    November 8, 2004    10.2

10.18

   Executive Employment Agreement between Centene Corporation and Carol E. Goldman dated July 1, 2002         10-Q    October 28, 2002    10.2

10.19

   Executive Employment Agreement between Centene Corporation and Marie J. Glancy, dated June 6, 2003    X          

10.20

   Executive Employment Agreement between Centene Corporation and Cary D. Hobbs, dated May 28, 2001         10-K    February 24, 2004    10.18

10.21

   Executive Employment Agreement between Centene Corporation and William N. Scheffel, dated December 1, 2003         10-K    February 24, 2004    10.19

10.22

   Executive Employment Agreement between Centene Corporation and Brian G. Spanel, dated September 26, 2001         S-1    October 9, 2001    10.16

10.23

   Executive Employment Agreement between Centene Corporation and Lisa M. Wilson, dated February 27, 2004    X          

 

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Table of Contents

10.24

   Executive Employment Agreement between Centene Corporation and Karey L. Witty, dated January 1, 2001         S-1    October 9, 2001    10.15

10.25

   Summary of Board of Director Compensation         8-K    February 11, 2005    10.1

10.26

   Summary of Executive Officer Compensation    X               

10.27

   Stock Purchase Agreement by and between Centene Corporation and Swope Community Enterprises, dated September 28, 2004         10-Q    October 24, 2004    10.3

10.28

   Lease Agreement between MHS Consulting Corporation and AVN Air, LLC, dated December 24, 2003         10-K    February 24, 2004    10.31

10.29

   Asset Sale and Purchase Agreement by and among Centene Corporation, Buckeye Community Health Plan, Mercy Health Partners, and Family Health Plan, Inc.         10-K    February 24, 2004    10.32

12.1

   Computation of ratio of earnings to fixed charges    X               

21

   List of subsidiaries    X               

23

   Consent of Independent Registered Public Accounting Firm incorporated by reference in each prospectus constituting part of the Registration Statements on Form S-3 (File Number 333-119944) and on Form S-8 (File Numbers 333-108467, 333-90976 and 333-83190)    X               

31.1

   Certification Pursuant to Rule 13a-14(a) and 15d-14(a) of the Exchange Act, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 (Chief Executive Officer)    X               

31.2

   Certification Pursuant to Rule 13a-14(a) and 15d-14(a) of the Exchange Act, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 (Chief Financial Officer)    X               

32.1

   Certification Pursuant to 18 U.S.C. Section 1350 (Chief Executive Officer)    X               

32.2

   Certification Pursuant to 18 U.S.C. Section 1350 (Chief Financial Officer)    X               

 

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SIGNATURES

 

Pursuant to the requirements of Section 13 or 15(d) 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, as of February 24, 2005.

 

CENTENE CORPORATION

By:

  /s/    MICHAEL F. NEIDORFF