e10vq
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Form 10-Q
(Mark One)
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þ |
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QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934 |
For the quarterly period ended June 30, 2008
Or
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o |
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
SECURITIES EXCHANGE ACT OF 1934 |
For the transition period from to
Commission file number: 001-31719
Molina Healthcare, Inc.
(Exact name of registrant as specified in its charter)
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Delaware
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13-4204626 |
(State or other jurisdiction of
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(I.R.S. Employer |
incorporation or organization)
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Identification No.) |
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200 Oceangate, Suite 100 |
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Long Beach, California
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90802 |
(Address of principal executive offices)
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(Zip Code) |
(562) 435-3666
(Registrants telephone number, including area code)
Indicate by check mark whether the registrant (1) has filed all reports required to be filed
by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file such reports), and (2) has been
subject to such filing requirements for the past 90 days.
Yes þ No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer or a smaller reporting company. See the definitions of large accelerated filer, accelerated filer
and smaller reporting company in Rule 12b-2 of the Exchange Act. (Check one):
Large accelerated filer o | Accelerated filer þ | Non-accelerated filer o (Do not check if a smaller reporting company) | Smaller reporting company o
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Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of
the Exchange Act). Yes o No þ
The number of shares of the issuers Common Stock, par value $0.001 per share, outstanding as
of July 25, 2008, was approximately 27,468,000.
MOLINA HEALTHCARE, INC.
Index
2
PART I FINANCIAL INFORMATION
Item 1: Financial Statements.
MOLINA HEALTHCARE, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
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June 30, |
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December 31, |
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2008 |
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2007 |
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(Unaudited) |
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(Amounts in thousands, except per-share data) |
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ASSETS
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Current assets: |
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Cash and cash equivalents |
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$ |
425,424 |
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$ |
459,064 |
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Investments |
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196,268 |
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242,855 |
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Receivables |
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113,597 |
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111,537 |
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Deferred income taxes |
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11,557 |
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8,616 |
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Prepaid expenses and other current assets |
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14,484 |
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12,521 |
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Total current assets |
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761,330 |
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834,593 |
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Property and equipment, net |
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59,191 |
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49,555 |
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Goodwill and intangible assets, net |
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204,182 |
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207,223 |
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Investments |
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66,786 |
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Restricted investments |
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29,875 |
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29,019 |
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Receivable for ceded life and annuity contracts |
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28,143 |
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29,240 |
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Other assets |
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22,247 |
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21,675 |
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Total assets |
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$ |
1,171,754 |
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$ |
1,171,305 |
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LIABILITIES AND STOCKHOLDERS EQUITY
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Current liabilities: |
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Medical claims and benefits payable |
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$ |
305,541 |
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$ |
311,606 |
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Accounts payable and accrued liabilities |
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61,872 |
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69,266 |
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Deferred revenue |
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50,170 |
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40,104 |
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Income taxes payable |
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11,137 |
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5,946 |
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Total current liabilities |
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428,720 |
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429,922 |
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Long-term debt |
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200,000 |
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200,000 |
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Deferred income taxes |
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5,297 |
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10,136 |
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Liability for ceded life and annuity contracts |
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28,143 |
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29,240 |
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Other long-term liabilities |
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17,139 |
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14,529 |
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Total liabilities |
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679,299 |
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680,827 |
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Stockholders equity: |
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Common stock, $0.001 par value; 80,000 shares
authorized, outstanding 27,453 shares at June
30, 2008 and 28,444 shares at December 31,
2007 |
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29 |
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28 |
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Preferred stock, $0.001 par value; 20,000
shares authorized, no shares issued and
outstanding |
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Additional paid-in capital |
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191,326 |
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185,808 |
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Accumulated other comprehensive (loss) income |
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(2,975 |
) |
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272 |
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Retained earnings |
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354,431 |
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324,760 |
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Treasury stock, at cost; 2,332 shares at June
30, 2008 and 1,201 shares at December 31, 2007 |
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(50,356 |
) |
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(20,390 |
) |
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Total stockholders equity |
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492,455 |
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490,478 |
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Total liabilities and stockholders equity |
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$ |
1,171,754 |
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$ |
1,171,305 |
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See accompanying notes.
3
CONSOLIDATED STATEMENTS OF INCOME
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Three Months Ended |
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Six Months Ended |
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June 30, |
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June 30, |
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2008 |
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2007 |
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2008 |
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2007 |
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(Amounts in thousands, except |
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net income per share) |
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(Unaudited) |
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Revenue: |
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Premium revenue |
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$ |
761,153 |
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$ |
607,127 |
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$ |
1,490,791 |
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$ |
1,163,362 |
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Investment income |
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5,338 |
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6,761 |
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12,742 |
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13,429 |
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Total revenue |
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766,491 |
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613,888 |
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1,503,533 |
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1,176,791 |
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Expenses: |
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Medical care costs |
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640,829 |
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516,865 |
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1,267,176 |
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993,342 |
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General and administrative expenses |
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87,074 |
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67,208 |
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165,166 |
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130,596 |
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Depreciation and amortization |
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8,330 |
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6,749 |
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16,482 |
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13,192 |
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Impairment charge on purchased software |
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782 |
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782 |
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Total expenses |
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736,233 |
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591,604 |
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1,448,824 |
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1,137,912 |
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Operating income |
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30,258 |
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22,284 |
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54,709 |
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38,879 |
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Interest expense |
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(2,307 |
) |
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(725 |
) |
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(4,579 |
) |
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(1,850 |
) |
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Income before income taxes |
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27,951 |
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21,559 |
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50,130 |
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37,029 |
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Provision for income taxes |
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11,435 |
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8,245 |
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20,459 |
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14,123 |
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Net income |
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$ |
16,516 |
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$ |
13,314 |
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$ |
29,671 |
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$ |
22,906 |
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Net income per share: |
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Basic |
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$ |
0.59 |
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$ |
0.47 |
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$ |
1.05 |
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$ |
0.81 |
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Diluted |
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$ |
0.59 |
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$ |
0.47 |
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$ |
1.05 |
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$ |
0.81 |
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Weighted average shares outstanding: |
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Basic |
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27,997 |
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28,233 |
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28,229 |
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28,192 |
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Diluted |
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28,044 |
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28,343 |
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28,324 |
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28,309 |
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See accompanying notes.
4
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
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Three Months Ended |
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Six Months Ended |
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June 30, |
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June 30, |
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2008 |
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2007 |
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2008 |
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2007 |
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(Amounts in thousands) |
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(Amounts in thousands) |
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(Unaudited) |
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(Unaudited) |
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Net income |
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$ |
16,516 |
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$ |
13,314 |
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$ |
29,671 |
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$ |
22,906 |
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Other comprehensive (loss) income, net of tax: |
|
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|
|
|
|
|
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|
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Unrealized (loss) gain on investments |
|
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(1,092 |
) |
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|
78 |
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(3,247 |
) |
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|
196 |
|
|
|
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|
|
|
|
|
|
|
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|
Other comprehensive (loss) income |
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(1,092 |
) |
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|
78 |
|
|
|
(3,247 |
) |
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|
196 |
|
|
|
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|
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Comprehensive income |
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$ |
15,424 |
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$ |
13,392 |
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$ |
26,424 |
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$ |
23,102 |
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See accompanying notes.
5
CONSOLIDATED STATEMENTS OF CASH FLOWS
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Six Months Ended |
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June 30, |
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2008 |
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2007 |
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(Amounts in thousands) |
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(Unaudited) |
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Operating activities |
|
|
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|
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Net income |
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$ |
29,671 |
|
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$ |
22,906 |
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Adjustments to reconcile net income to net cash provided by operating activities: |
|
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Depreciation and amortization |
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|
16,482 |
|
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|
13,192 |
|
Amortization of deferred financing costs |
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|
813 |
|
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|
475 |
|
Deferred income taxes |
|
|
(5,649 |
) |
|
|
(4,763 |
) |
Stock-based compensation |
|
|
3,587 |
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|
3,644 |
|
Changes in operating assets and liabilities: |
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Receivables |
|
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(2,060 |
) |
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|
4,526 |
|
Prepaid expenses and other current assets |
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|
(1,963 |
) |
|
|
(1,353 |
) |
Medical claims and benefits payable |
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|
(6,065 |
) |
|
|
13,191 |
|
Deferred revenue |
|
|
10,066 |
|
|
|
26,205 |
|
Accounts payable and accrued liabilities |
|
|
(10,620 |
) |
|
|
4,619 |
|
Income taxes |
|
|
5,191 |
|
|
|
5,232 |
|
|
|
|
|
|
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|
Net cash provided by operating activities |
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|
39,453 |
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|
87,874 |
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|
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Investing activities |
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Purchases of equipment |
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(17,098 |
) |
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(10,440 |
) |
Purchases of investments |
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|
(163,447 |
) |
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|
(42,816 |
) |
Sales and maturities of investments |
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|
137,805 |
|
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|
46,117 |
|
Increase in restricted cash |
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(856 |
) |
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(3,326 |
) |
Cash paid in business purchase transaction |
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(1,000 |
) |
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Increase in other assets |
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(2,177 |
) |
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|
(864 |
) |
Increase in other long-term liabilities |
|
|
2,610 |
|
|
|
4,484 |
|
|
|
|
|
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Net cash used in investing activities |
|
|
(44,163 |
) |
|
|
(6,845 |
) |
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Financing activities |
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Treasury stock purchases |
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(29,966 |
) |
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Repayment of amounts borrowed under credit facility |
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(15,000 |
) |
Payment of credit facility fees |
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|
(475 |
) |
Tax (expense) benefit from employee stock compensation recorded as additional paid-in capital |
|
|
(156 |
) |
|
|
642 |
|
Proceeds from exercise of stock options and employee stock purchases |
|
|
1,192 |
|
|
|
1,656 |
|
|
|
|
|
|
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Net cash used in financing activities |
|
|
(28,930 |
) |
|
|
(13,177 |
) |
|
|
|
|
|
|
|
Net (decrease) increase in cash and cash equivalents |
|
|
(33,640 |
) |
|
|
67,852 |
|
Cash and cash equivalents at beginning of period |
|
|
459,064 |
|
|
|
403,650 |
|
|
|
|
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Cash and cash equivalents at end of period |
|
$ |
425,424 |
|
|
$ |
471,502 |
|
|
|
|
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|
|
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|
|
|
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|
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|
Supplemental cash flow information |
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Cash paid during the period for: |
|
|
|
|
|
|
|
|
Income taxes |
|
$ |
20,307 |
|
|
$ |
9,715 |
|
|
|
|
|
|
|
|
Interest |
|
$ |
3,892 |
|
|
$ |
2,041 |
|
|
|
|
|
|
|
|
Schedule of non-cash investing and financing activities: |
|
|
|
|
|
|
|
|
Unrealized (loss) gain on investments |
|
$ |
(5,443 |
) |
|
$ |
312 |
|
Deferred taxes |
|
|
2,196 |
|
|
|
(116 |
) |
|
|
|
|
|
|
|
Net unrealized (loss) gain on investments |
|
$ |
(3,247 |
) |
|
$ |
196 |
|
|
|
|
|
|
|
|
Retirement of common stock used for stock-based compensation |
|
$ |
(366 |
) |
|
$ |
(117 |
) |
|
|
|
|
|
|
|
Accrued purchases of equipment |
|
$ |
1,595 |
|
|
$ |
354 |
|
|
|
|
|
|
|
|
Cumulative effect of adoption of Financial Interpretation No. 48, Accounting for
Uncertainty in Income Taxes |
|
$ |
|
|
|
$ |
445 |
|
|
|
|
|
|
|
|
Details of business purchase transaction: |
|
|
|
|
|
|
|
|
Fair value of assets acquired |
|
$ |
2,262 |
|
|
$ |
|
|
Common stock issued to seller |
|
|
(1,262 |
) |
|
|
|
|
|
|
|
|
|
|
|
Net cash paid in business purchase transaction |
|
$ |
1,000 |
|
|
$ |
|
|
|
|
|
|
|
|
|
Business purchase transactions adjustments: |
|
|
|
|
|
|
|
|
Accounts payable and accrued liabilities |
|
$ |
1,265 |
|
|
$ |
|
|
Deferred taxes |
|
|
65 |
|
|
|
873 |
|
|
|
|
|
|
|
|
Goodwill and intangible assets, net |
|
$ |
1,330 |
|
|
$ |
873 |
|
|
|
|
|
|
|
|
See accompanying notes.
6
MOLINA HEALTHCARE, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
June 30, 2008
1. Basis of Presentation
Organization and Operations
Molina Healthcare, Inc. (the Company) is a multi-state managed care organization
participating exclusively in government-sponsored health care programs for low-income persons, such
as the Medicaid program and the State Childrens Health
Insurance Program, or SCHIP. We also serve a small number of members who are dually eligible under both
the Medicaid and the Medicare programs, and commencing in January 2007 we
began to serve a small number of low-income Medicare members. We conduct our business primarily through nine licensed
health plans in the states of California, Michigan, Missouri, Nevada, New Mexico, Ohio, Texas,
Utah, and Washington. The health plans are locally operated by our respective wholly owned
subsidiaries in those nine states, each of which is licensed as a health maintenance organization,
or HMO.
Our results of operations include the results of the November 1, 2007 acquisition of Mercy
CarePlus, a Medicaid managed care organization based in St. Louis, Missouri.
Consolidated and Interim Financial Information
The condensed consolidated financial statements include the accounts of the Company and all
majority owned subsidiaries. In the opinion of management, all adjustments considered necessary for
a fair presentation of the results as of the date and for the interim periods presented, which
consist solely of normal recurring adjustments, have been included. All significant intercompany
balances and transactions have been eliminated in consolidation. The condensed consolidated results
of income for the current interim period are not necessarily indicative of the results for the
entire year ending December 31, 2008. Financial information related to subsidiaries acquired during
any year is included only for the period subsequent to their acquisition.
The unaudited condensed consolidated interim financial statements have been prepared under the
assumption that users of the interim financial data have either read or have access to our audited
consolidated financial statements for the fiscal year ended December 31, 2007. Accordingly, certain
disclosures that would substantially duplicate the disclosures contained in the December 31, 2007
audited consolidated financial statements have been omitted. These unaudited condensed consolidated
interim financial statements should be read in conjunction with our December 31, 2007 audited
financial statements. Certain 2007 amounts in the condensed consolidated statement of cash flows
regarding stock-based compensation have been reclassified to conform to the 2008 presentation.
2. Significant Accounting Policies
Earnings Per Share
The denominators for the computation of basic and diluted earnings per share are calculated as
follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
|
|
2008 |
|
2007 |
|
2008 |
|
2007 |
Shares outstanding at the beginning of
the period |
|
|
28,479,000 |
|
|
|
28,199,000 |
|
|
|
28,444,000 |
|
|
|
28,119,000 |
|
Weighted average number of treasury
shares purchased |
|
|
(489,000 |
) |
|
|
|
|
|
|
(244,000 |
) |
|
|
|
|
Weighted average number of shares issued
under employee stock plans |
|
|
7,000 |
|
|
|
34,000 |
|
|
|
29,000 |
|
|
|
74,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for basic earnings per share |
|
|
27,997,000 |
|
|
|
28,233,000 |
|
|
|
28,229,000 |
|
|
|
28,193,000 |
|
Dilutive effect of employee stock options
and restricted stock |
|
|
47,000 |
|
|
|
110,000 |
|
|
|
95,000 |
|
|
|
116,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Denominator for diluted earnings per share |
|
|
28,044,000 |
|
|
|
28,343,000 |
|
|
|
28,324,000 |
|
|
|
28,309,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7
Stock-Based Compensation
At June 30, 2008, we had employee equity incentives outstanding under two plans: (1) the 2002
Equity Incentive Plan; and (2) the 2000 Omnibus Stock and Incentive Plan (from which equity
incentives are no longer awarded). Charged to general and administrative expenses, total
stock-based compensation expense (net of tax) for the three and six months ended June 30, 2008 and
2007 was as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Six Months |
|
|
|
June 30, |
|
|
Ended June 30, |
|
|
|
2008 |
|
|
2007 |
|
|
2008 |
|
|
2007 |
|
|
|
(in thousands) |
|
Stock options (including shares issued under our
employee stock purchase plan) |
|
$ |
452 |
|
|
$ |
567 |
|
|
$ |
817 |
|
|
$ |
1,086 |
|
Restricted stock awards |
|
|
775 |
|
|
|
534 |
|
|
|
1,306 |
|
|
|
1,173 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total stock-based compensation expense, net of tax |
|
$ |
1,227 |
|
|
$ |
1,101 |
|
|
$ |
2,123 |
|
|
$ |
2,259 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of June 30, 2008, unrecognized compensation expense related to stock options totaled $2.6
million, which we expect to recognize over a weighted-average period of 2.2 years. Also as of June
30, 2008, unrecognized compensation expense related to restricted stock awards totaled $16.9
million, which we expect to recognize over a weighted-average period of 3.2 years.
We account for stock-based compensation in accordance with Statement of Financial Accounting
Standards (SFAS) No. 123(R), Share-Based Payment. Restricted stock awards are valued based on the
closing market price of our common stock on the grant date. The Black-Scholes valuation model is
used to estimate the fair value of stock options at grant date. The risk-free interest rate is
based on the implied yield available at June 30, 2008 on U.S. treasury zero coupon issues for the
expected option term. The expected volatility is based on historical volatility levels of our
common stock. Beginning in the first quarter of 2008, we used an expected term for each option
award based on historical experience of employee post-vesting exercise and termination behavior.
Prior to 2008, the expected option term of each award granted was calculated using the simplified
method in accordance with Staff Accounting Bulletin No. 107. This change did not produce
materially different valuation results for the stock options awarded in the first half of 2008. For
both restricted stock and stock option awards, the expense is recognized over the vesting period,
generally straight-line over four years. The assumptions used in the Black-Scholes valuation model
for options awarded in the three and six months ended June 30, 2008 and 2007 were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
|
|
2008 |
|
2007 |
|
2008 |
|
2007 |
Risk-free interest rate |
|
|
2.9 |
% |
|
|
4.7 |
% |
|
|
2.5 |
% |
|
|
4.5 |
% |
Expected volatility |
|
|
45.7 |
% |
|
|
48.7 |
% |
|
|
45.3 |
% |
|
|
48.8 |
% |
Expected option term (in years) |
|
|
4 |
|
|
|
6 |
|
|
|
4 |
|
|
|
6 |
|
Expected dividend yield |
|
None |
|
None |
|
None |
|
None |
Grant date weighted-average fair value per share |
|
$ |
9.68 |
|
|
$ |
16.96 |
|
|
$ |
12.80 |
|
|
$ |
16.54 |
|
Stock option activity for the six months ended June 30, 2008 was as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted- |
|
|
|
|
|
|
|
Weighted- |
|
|
|
|
|
|
Average |
|
|
|
|
|
|
|
Average |
|
|
Aggregate |
|
|
Remaining |
|
|
|
|
|
|
|
Exercise |
|
|
Intrinsic |
|
|
Contractual |
|
|
|
Options |
|
|
Price |
|
|
Value |
|
|
Term |
|
|
|
|
|
|
|
|
|
|
|
(in thousands) |
|
|
(in years) |
|
Outstanding as of December 31, 2007 |
|
|
733,713 |
|
|
$ |
30.45 |
|
|
|
|
|
|
|
|
|
Granted |
|
|
12,000 |
|
|
|
33.57 |
|
|
|
|
|
|
|
|
|
Exercised |
|
|
(6,081 |
) |
|
|
28.33 |
|
|
$ |
31 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(32,475 |
) |
|
|
35.43 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Outstanding as of June 30, 2008 |
|
|
707,157 |
|
|
$ |
30.30 |
|
|
$ |
344 |
|
|
|
7.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable and expected to vest as of June 30, 2008 |
|
|
652,701 |
|
|
$ |
30.17 |
|
|
$ |
344 |
|
|
|
7.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Exercisable as of June 30, 2008 |
|
|
423,110 |
|
|
$ |
29.07 |
|
|
$ |
344 |
|
|
|
6.5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8
Restricted stock activity for the six months ended June 30, 2008 was as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted- |
|
|
|
|
|
|
|
|
|
|
Average |
|
|
Aggregate |
|
|
|
|
|
|
|
Grant Date |
|
|
Market |
|
|
|
Shares |
|
|
Fair Value |
|
|
Value |
|
|
|
|
|
|
|
|
|
|
|
(in thousands) |
|
Unvested balance as of December 31, 2007 |
|
|
235,413 |
|
|
$ |
34.14 |
|
|
|
|
|
Granted |
|
|
374,000 |
|
|
|
31.02 |
|
|
$ |
11,601 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Vested |
|
|
(52,061 |
) |
|
|
30.92 |
|
|
$ |
1,524 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Forfeited |
|
|
(29,235 |
) |
|
|
34.62 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Unvested balance as of June 30, 2008 |
|
|
528,117 |
|
|
$ |
32.22 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Impairment Charge
During the six months ended June 30, 2007, an impairment charge of $782,000 was recorded
related to commercial software no longer used for operations. No such charge occurred during the
six months ended June 30, 2008.
New Accounting Pronouncements
In May 2008, the Financial Accounting Standards Board (FASB) issued FASB Staff Position APB
14-1, Accounting for Convertible Debt Instruments That May Be Settled in Cash upon Conversion
(Including Partial Cash Settlement)(the FSP). The FSP requires the proceeds from the issuance of
such convertible debt instruments to be allocated between a liability component and an equity
component. The resulting debt discount is amortized over the period the convertible debt is
expected to be outstanding, as additional non-cash interest expense. The change in accounting
treatment is effective for fiscal years beginning after December 15, 2008, and shall be applied
retrospectively to prior periods. The FSP changes the accounting treatment for our $200.0 million
3.75% Convertible Senior Notes due 2014, which were issued in October 2007 (see Note 6 to the
condensed consolidated financial statements included in this quarterly report, Long-Term Debt).
The impact of this new accounting treatment will result in an increase to non-cash interest expense
beginning in fiscal year 2009 for financial statements covering past and future periods. Assuming a
7.9% interest rate, we have estimated the incremental impact of the FSP to our results of
operations in 2009 to be $3.4 million, or $0.13 per diluted share, net of tax. This estimate
assumes a 38% effective tax rate and 27 million diluted shares outstanding. We estimate the
retroactive adjustment for prior periods will be approximately $0.8 million, or $0.02 per diluted
share, net of tax, for 2007, and $2.9 million, or $0.10 per diluted share, net of tax, for 2008.
In December 2007, the FASB issued SFAS 141(R), Business Combinations and SFAS 160,
Noncontrolling Interests in Consolidated Financial Statements. The standards are intended to
improve, simplify, and converge internationally the accounting for business combinations and the
reporting of noncontrolling (minority) interests in consolidated financial statements. SFAS 141(R)
requires the acquiring entity in a business combination to recognize all (and only) the assets
acquired and liabilities assumed in the transaction; establishes the acquisition-date fair value as
the measurement objective for all assets acquired and liabilities assumed; and requires the
acquirer to disclose to investors and other users all of the information they need to evaluate and
understand the nature and financial effect of the business combination. SFAS 141(R) is effective
for fiscal years, and interim periods within those fiscal years, beginning on or after December 15,
2008. SFAS 141(R) applies prospectively to business combinations for which the acquisition date is
on or after the beginning of the first annual reporting period beginning on or after December 15,
2008. Earlier adoption is prohibited.
SFAS 160 is designed to improve the relevance, comparability, and transparency of financial
information provided to investors by requiring all entities to report minority interests in
subsidiaries in the same wayas equity in the consolidated financial statements. Moreover, SFAS
160 eliminates the diversity that currently exists in accounting for transactions between an entity
and minority interests by requiring they be treated as equity transactions. SFAS 160 is effective
for fiscal years, and interim periods within those fiscal years, beginning on or after December 15,
2008. Earlier adoption is prohibited. In addition, SFAS 160 shall be applied prospectively as of
the beginning of the fiscal year in which it is initially applied, except for the presentation and
disclosure
9
requirements. The presentation and disclosure requirements shall be applied retrospectively
for all periods presented. We do not have any material outstanding minority interests and,
therefore, SFAS 160 is not applicable to us at this time.
Other recent accounting pronouncements issued by the FASB (including its Emerging Issues Task
Force), the AICPA, and the SEC did not, or are not believed by management to, have a material
impact on our present or future consolidated financial statements.
3. Fair Value Measurements
As of June 30, 2008, we had cash and cash equivalents of $425.4 million, investments totaling
$263.1 million, and restricted investments of $29.9 million. The cash equivalents consist of highly
liquid securities with original or purchase date remaining maturities of up to three months that
are readily convertible into known amounts of cash. Our investments consisted of investment grade
debt securities and are designated as available-for-sale. Of the $263.1 million total, $196.3
million are classified as current assets, and $66.8 million are classified as non-current assets
(see further discussion below). Our investment policies require that all of our investments have
final maturities of ten years or less (excluding auction rate and variable rate securities where
interest rates are periodically reset) and that the average maturity be four years or less. The
restricted investments, classified as non-current assets and designated as held-to-maturity,
consist of interest-bearing deposits and U.S. treasury securities required by the respective states
in which we operate. Investments and restricted investments are subject to interest rate risk and
will decrease in value if market rates increase. All non-restricted investments are reported at
fair market value on the balance sheet. All restricted investments are carried at amortized cost,
which approximates market value. We have the ability to hold these restricted investments until
maturity and, as a result, we would not expect the value of these investments to decline
significantly due to a sudden change in market interest rates. Declines in interest rates over time
will reduce our investment income.
In September 2006, the FASB issued SFAS 157, Fair Value Measurements. SFAS 157 defines fair
value, establishes a framework for measuring fair value in accordance with accounting principles
generally accepted in the United States, and expands disclosures about fair value measurements. We
adopted the provisions of SFAS 157 as of January 1, 2008 for our financial instruments. Although
the adoption of SFAS 157 did not materially impact our financial position, results of operations,
or cash flow, we are now required to provide additional disclosures as part of our financial
statements.
SFAS 157 establishes a three-tier fair value hierarchy, which prioritizes the inputs used in
measuring fair value. These tiers are: Level 1, defined as observable inputs such as quoted prices
in active markets; Level 2, defined as inputs other than quoted prices in active markets that are
either directly or indirectly observable; and Level 3, defined as unobservable inputs in which
little or no market data exists, therefore requiring an entity to develop its own assumptions.
As of June 30, 2008, we held investments in auction rate securities, totaling $71.8 million,
with a fair value of $66.8 million, which are required to be measured at fair value on a recurring
basis. Our auction rate securities are designated as available-for-sale securities and are
reflected at fair value. Prior to January 1, 2008, these securities were recorded at fair value
based on quoted prices in active markets (i.e., SFAS 157 Level 1 data). Liquidity for these auction
rate securities is typically provided by an auction process which allows holders to sell their
notes, and which resets the applicable interest rate at pre-determined intervals, usually every 7,
28, or 35 days. However, due to recent events in the credit markets, the auction events for some of
these instruments failed during the first half of 2008. An auction failure means that the parties
wishing to sell their securities could not be matched with an adequate volume of buyers. Therefore,
the fair values of these securities were estimated using a discounted cash flow analysis or other
type of valuation model as of June 30, 2008. These analyses considered, among other things, the
collateral underlying the securities, the creditworthiness of the counterparty, the timing of
expected future cash flows, and the expectation of the next time the security would be expected to
have a successful auction. The estimated values of these securities were also compared, when
possible, to valuation data with respect to similar securities held by other parties.
As a result of the declines in fair value for our investments in auction rate securities,
which we deem to be temporary and attribute to liquidity issues rather than to credit issues, we
recorded net unrealized losses of $1.7
10
million and $5.0 million for the three and six months ended June 30, 2008, respectively, to
accumulated other comprehensive income. Substantially all of the $66.8 million in auction rate
security instruments held by us at June 30, 2008 were in securities collateralized by student loans, which loans are guaranteed
by the U.S. government. Due to our belief that the market for these student loan collateralized
instruments may take in excess of twelve months to fully recover, we have classified these
investments as non-current, and have included them in investments on the unaudited condensed
consolidated balance sheet at June 30, 2008. As of June 30, 2008, we continue to earn interest on
our auction rate security instruments. Any future fluctuation in fair value related to these
instruments that we deem to be temporary, including any recoveries of previous write-downs, would
be recorded to accumulated other comprehensive (loss) income. If we determine that any future
valuation adjustment was other than temporary, we would record a charge to earnings as appropriate.
Our assets measured at fair value on a recurring basis subject to the disclosure requirements
of SFAS 157 at June 30, 2008, were as follows:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value Measurements at Reporting Date Using |
|
|
|
|
|
|
|
Quoted |
|
|
|
|
|
|
|
|
|
|
|
|
|
Prices in |
|
|
|
|
|
|
|
|
|
|
|
|
|
Active |
|
|
Significant |
|
|
|
|
|
|
|
|
|
|
Markets for |
|
|
Other |
|
|
|
|
|
|
|
|
|
|
Identical |
|
|
Observable |
|
|
Significant |
|
|
|
June 30, |
|
|
Assets |
|
|
Inputs |
|
|
Unobservable Inputs |
|
|
|
2008 |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
|
|
(in thousands) |
|
Auction rate securities |
|
$ |
66,786 |
|
|
$ |
|
|
|
$ |
|
|
|
$ |
66,786 |
|
Other available-for-sale securities |
|
|
196,268 |
|
|
|
196,268 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total assets measured at fair value |
|
$ |
263,054 |
|
|
$ |
196,268 |
|
|
$ |
|
|
|
$ |
66,786 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Based on market conditions which resulted in the absence of quoted prices in active markets
for our auction rate securities, we changed our valuation methodology for auction rate securities
to a discounted cash flow analysis during the first quarter of 2008. Accordingly, since our initial
adoption of SFAS 157 on January 1, 2008, these securities changed from Level 1 to Level 3 within
SFAS 157s hierarchy. The following table presents our assets measured at fair value on a recurring
basis using significant unobservable inputs (Level 3) as defined in SFAS 157 at June 30, 2008:
|
|
|
|
|
|
|
Fair Value |
|
|
|
Measurements |
|
|
|
Using Significant |
|
|
|
Unobservable Inputs |
|
|
|
(Level 3) |
|
Auction Rate Securities |
|
(in thousands) |
|
Balance at December 31, 2007 |
|
$ |
|
|
Transfers to Level 3 |
|
|
82,150 |
|
Total losses (realized or unrealized): |
|
|
|
|
Included in earnings |
|
|
|
|
Included in other comprehensive income |
|
|
(4,964 |
) |
Purchases (settlements), net |
|
|
(10,400 |
) |
|
|
|
|
Balance at June 30, 2008 |
|
$ |
66,786 |
|
|
|
|
|
The amount of total losses for the period included in
other comprehensive income attributable to the change
in unrealized losses relating to assets still held at
June 30, 2008 |
|
$ |
(4,964 |
) |
|
|
|
|
11
4. Receivables
Receivables consist primarily of amounts due from the various states in which we operate. All
receivables are subject to potential retroactive adjustment. As the amounts of all receivables are
readily determinable and our creditors are in almost all instances state governments, our allowance
for doubtful accounts is immaterial. Any amounts determined to be uncollectible are charged to
expense when such determination is made. Accounts receivable by health plan operating subsidiary
were as follows:
|
|
|
|
|
|
|
|
|
|
|
June 30, |
|
|
December 31, |
|
|
|
2008 |
|
|
2007 |
|
|
|
(in thousands) |
|
California |
|
$ |
18,773 |
|
|
$ |
23,046 |
|
Michigan |
|
|
7,892 |
|
|
|
6,419 |
|
Missouri |
|
|
18,228 |
|
|
|
15,986 |
|
Ohio |
|
|
30,752 |
|
|
|
28,522 |
|
Utah |
|
|
23,997 |
|
|
|
23,987 |
|
Washington |
|
|
8,535 |
|
|
|
8,308 |
|
Others |
|
|
5,420 |
|
|
|
5,269 |
|
|
|
|
|
|
|
|
Total receivables |
|
$ |
113,597 |
|
|
$ |
111,537 |
|
|
|
|
|
|
|
|
Substantially all receivables due our California and Missouri health plans at June 30, 2008 were
collected in July 2008.
Our Utah health plans agreement with the state of Utah calls for the reimbursement of medical
costs incurred in serving our members plus an administrative fee of 9% of that medical cost amount,
plus a portion of any cost savings realized as defined in the agreement. Our Utah health plan bills
the state of Utah monthly for actual paid health care claims plus administrative fees. Our
receivable balance from the state of Utah includes: (1) amounts billed to the state for actual paid
health care claims plus administrative fees; and (2) amounts estimated for incurred but not
reported claims, which, along with the related administrative fees, are not billable to the state
of Utah until such claims are actually paid.
As of June 30, 2008, the receivable due our Ohio health plan included approximately $8.5
million of accrued delivery payments due from the state of Ohio and approximately $21.7 million due
from a capitated provider group. Our agreement with that group calls for us to pay for certain
medical services incurred by the groups members, and then to deduct the amount of such payments
from the monthly capitation paid to the group. This receivable also includes an estimate of our
liability for claims incurred by members of this group for which we have not made payment. The
offsetting liability for the amount of this receivable established for claims incurred but not paid
is included in Medical claims and benefits payable in our condensed consolidated balance sheets.
At June 30, 2008, this receivable comprised approximately $14.3 million paid on behalf of the
provider group, which will be deducted from capitation payments in the months of July and August
2008. An additional $7.5 million receivable has been recorded to reflect amounts included in
Medical claims and benefits payable in our condensed consolidated balance sheets that are the
responsibility of the capitated provider group. Our Ohio health plan has withheld approximately
$9.0 million from capitation payments due this provider group and placed the funds in an escrow
account. The Ohio health plan is entitled to the escrow amount if the provider is unable to repay
amounts owed to us. The escrow amount is included in Restricted investments in our condensed
consolidated balance sheets. Monthly gross capitation paid to the provider group is approximately
$10.5 million.
5. Other Assets
Other assets include an investment in a vision services provider (see Note 9, Related Party
Transactions), deferred financing costs associated with our secured credit agreement, and certain
investments held in connection with our deferred employee compensation program. A liability
approximately equal to the assets held in connection with our deferred employee compensation
program is included in other long-term liabilities.
12
6. Long-Term Debt
Convertible Senior Notes
In October 2007, we completed our offering of $200.0 million aggregate principal amount of
3.75% Convertible Senior Notes due 2014 (the Notes). The sale of the Notes resulted in net
proceeds of $193.4 million. The Notes rank equally in right of payment with our existing and future
senior indebtedness, and are convertible into cash and, under certain circumstances, shares of our
common stock. The initial conversion rate is 21.3067 shares of our common stock per one thousand
dollar principal amount of the Notes. This represents an initial conversion price of approximately
$46.93 per share of our common stock. In addition, if certain corporate transactions that
constitute a change of control occur prior to maturity, we will increase the conversion rate in
certain circumstances. Prior to July 2014, holders may convert their Notes only under the following
circumstances:
|
|
During any fiscal quarter after our fiscal quarter ending December 31, 2007, if the closing
sale price per share of our common stock, for each of at least 20 trading days during the
period of 30 consecutive trading days ending on the last trading day of the previous fiscal
quarter, is greater than or equal to 120% of the conversion price per share of our common
stock; |
|
|
|
During the five business day period immediately following any five consecutive trading day
period in which the trading price per one thousand dollar principal amount of the Notes for
each trading day of such period was less than 98% of the product of the closing price per
share of our common stock on such day and the conversion rate in effect on such day; or |
|
|
|
Upon the occurrence of specified corporate transactions or other specified events. |
On or after July 1, 2014, holders may convert their Notes at any time prior to the close of
business on the scheduled trading day immediately preceding the stated maturity date regardless of
whether any of the conditions noted above is satisfied.
We will deliver cash and shares of our common stock, if any, upon conversion of each $1,000
principal amount of Notes, as follows:
|
|
An amount in cash equal to the sum of, for each of the 20 Volume-Weighted Average Price (the
VWAP) trading days during the conversion period, the lesser of the daily conversion value
for such VWAP trading day and fifty dollars (representing 1/20th of one thousand dollars); and |
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A number of shares based upon, for each of the 20 VWAP trading days during the conversion
period, any excess of the daily conversion value above fifty dollars. |
Credit Facility
In 2005, we entered into the Amended and Restated Credit Agreement, dated as of March 9, 2005,
among Molina Healthcare Inc., certain lenders, and Bank of America N.A., as Administrative Agent
(the Credit Facility). Effective May 2007, we entered into a third amendment of the Credit
Facility that increased the size of the revolving line of credit to $200.0 million, maturing in May
2012. The Credit Facility is intended to be used for working capital and general corporate
purposes, and subject to obtaining commitments from existing or new lenders and satisfaction of
other specified conditions, we may increase the Credit Facility to up to $250.0 million.
Borrowings under the Credit Facility are based, at our election, on the London Interbank
Offered Rate, or LIBOR, or the base rate plus an applicable margin. The base rate equals the higher
of Bank of Americas prime rate or 0.500% above the federal funds rate. We also pay a commitment
fee on the total unused commitments of the lenders under the Credit Facility. The applicable
margins and commitment fee are based on our ratio of consolidated funded debt to consolidated
earnings before interest, taxes, depreciation and amortization, or EBITDA. The applicable margins
range between 0.750% and 1.750% for LIBOR loans and between 0.000% and 0.750% for base rate loans.
The commitment fee ranges between 0.150% and 0.275%. In addition, we are required to pay a fee for
13
each letter of credit issued under the Credit Facility equal to the applicable margin for
LIBOR loans and a customary fronting fee. As of June 30, 2008 and December 31, 2007, there were no
amounts outstanding under the Credit Facility.
Our obligations under the Credit Facility are secured by a lien on substantially all of our
assets and by a pledge of the capital stock of our Michigan, New Mexico, Utah, and Washington
health plan subsidiaries. The Credit Facility includes usual and customary covenants for credit
facilities of this type, including covenants limiting liens, mergers, asset sales, other
fundamental changes, debt, acquisitions, dividends and other distributions, capital expenditures,
investments, and a fixed charge coverage ratio. The amended Credit Facility also requires us to
maintain a ratio of total consolidated debt to total consolidated EBITDA of not more than 2.75 to
1.00 at any time. At June 30, 2008, we were in compliance with all financial covenants in the
Credit Facility.
7. Stockholders Equity
In April 2008, our board of directors authorized the repurchase of up to $30 million of our
common stock on the open market or through privately negotiated transactions. We used working
capital to fund the repurchases under this program. The timing and amount of repurchases were
primarily made pursuant to a trading plan dated as of May 2, 2008. The trading plan became effective
May 5, 2008, and terminated when the aggregate
cost of the repurchases totaled $30 million on June 12, 2008. During the quarter ended June 30,
2008, we repurchased approximately 1.1 million shares. We did not repurchase any shares during the
quarter ended March 31, 2008. See Note 10, Subsequent
Events, regarding the authorization to repurchase additional
shares.
On
June 30, 2008, we issued a total of 48,186 shares of our
common stock in connection with our acquisition of the assets of The
Game of Work, LLC.
8. Commitments and Contingencies
Legal
The health care industry is subject to numerous laws and regulations of federal, state, and
local governments. Compliance with these laws and regulations can be subject to government review
and interpretation, as well as regulatory actions unknown and unasserted at this time. Penalties
associated with violations of these laws and regulations include significant fines and penalties,
exclusion from participating in publicly-funded programs, and the repayment of previously billed
and collected revenues.
Malpractice Action. On February 1, 2007, a complaint was filed in the Superior Court of the
State of California for the County of Riverside by plaintiff Staci Robyn Ward through her guardian
ad litem, Case No. 465374. The complaint purports to allege claims for medical malpractice against
several unaffiliated physicians, medical groups, and hospitals, including Molina Medical Centers
and one of its physician employees. The plaintiff alleges that the defendants failed to properly
diagnose her medical condition which has resulted in her severe and permanent disability. On July
22, 2007, the plaintiff passed away. The proceeding is in the discovery stage, and no prediction
can be made as to the outcome.
Starko. Our New Mexico HMO is named as a defendant in a class action lawsuit brought by New
Mexico pharmacies and pharmacists, Starko, Inc., et al. v. NMHSD, et al., No. CV-97-06599, Second
Judicial District Court, State of New Mexico. The lawsuit was originally filed in August 1997
against the New Mexico Human Services Department (NMHSD). In February 2001, the plaintiffs named
health maintenance organizations participating in the New Mexico Medicaid program as defendants
(the HMOs), including Cimarron Health Plan, the predecessor of our New Mexico HMO. The plaintiffs
assert that NMHSD and the HMOs failed to pay pharmacy dispensing fees under an alleged New Mexico
statutory mandate. On July 10, 2007, the court dismissed all damages claims against Molina
Healthcare of New Mexico, leaving at that time only a pending action for injunctive and declaratory
relief. On August 15, 2007, the court dismissed all remaining claims against Molina Healthcare of
New Mexico, including the action for injunctive and declaratory relief. The plaintiffs have filed
an appeal with respect to the courts dismissal orders and the parties have submitted their
respective appellate briefs and are awaiting oral argument. Under the terms of the stock purchase agreement pursuant to which we
acquired Health Care Horizons, Inc., the parent company to Molina Healthcare of New Mexico, an
indemnification escrow account was established and funded with $6.0 million to indemnify Molina
Healthcare of New Mexico against the costs of such litigation and any eventual liability or
settlement costs. As of June 30, 2008, approximately $4.2 million remained in the indemnification
escrow fund.
14
We are involved in other legal actions in the normal course of business, some of which seek
monetary damages, including claims for punitive damages, which are not covered by insurance. These
actions, individually or in the aggregate, when finally concluded and determined, are not likely,
in our opinion, to have a material adverse effect on our consolidated financial position, results
of operations, or cash flows.
Provider Claims
Many of our medical contracts are complex in nature and may be subject to differing
interpretations regarding amounts due for the provision of various services. Such differing
interpretations have led certain medical providers to pursue us for additional compensation. The
claims made by providers in such circumstances often involve issues of contract compliance,
interpretation, payment methodology, and intent. These claims often extend to services provided by
the providers over a number of years.
Various providers have contacted us seeking additional compensation for claims that we believe
to have been settled. These matters, when finally concluded and determined, will not, in our
opinion, have a material adverse effect on our consolidated financial position, results of
operations, or cash flows.
Regulatory Capital and Dividend Restrictions
Our principal operations are conducted through our HMO subsidiaries operating in California,
Michigan, Missouri, Nevada, New Mexico, Ohio, Texas, Washington, and Utah. Our HMOs 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 as the sole stockholder. To the extent the subsidiaries
must comply with these regulations, they may not have the financial flexibility to transfer funds
to us. The net assets in these subsidiaries (after intercompany eliminations), which may not be
transferable to us in the form of cash dividends, loans, or advances, were $337.0 million at June
30, 2008 and $332.2 million at December 31, 2007. The National Association of Insurance
Commissioners, or NAIC, adopted model rules effective December 31, 1998, which, if implemented by a
state, set new minimum capitalization requirements for insurance companies, HMOs, and other
entities bearing risk for health care coverage. The requirements take the form of risk-based
capital, or RBC, rules. Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and Washington have
adopted these rules, although the rules as adopted may vary somewhat from state to state.
California and Missouri have established their own minimum capitalization requirements for
insurance companies.
As of June 30, 2008, our HMOs had aggregate statutory capital and surplus of approximately
$349.7 million, compared with the required minimum aggregate statutory capital and surplus of
approximately $207.6 million. All of our HMOs were in compliance with the minimum capital
requirements at June 30, 2008. We have the ability and commitment to provide additional capital to
each of our HMOs when necessary to ensure that they continue to meet statutory and regulatory
capital requirements.
9. Related Party Transactions
We have an equity investment in a medical service provider that provides certain vision
services to our members. We account for this investment under the equity method of accounting
because we have an ownership interest in the investee in excess of 20%. As of June 30, 2008 and
2007, our carrying amount for this investment totaled $3.6 million and $1.4 million, respectively.
Effective July 1, 2007, we paid this provider a $0.9 million network access fee, which was fully
amortized as of June 30, 2008. Advances outstanding to this provider totaling $315,000 were offset
in full to capitation payments during the quarter ended June 30, 2008. For the three months ended
June 30, 2008 and 2007, we paid $3.6 million and $3.1 million, respectively, for medical service
fees to this provider. For the six months ended June 30, 2008 and 2007, we paid $7.1 million and
$5.9 million, respectively, for medical service fees to this provider.
We are a party to a fee for service agreement with Pacific Hospital of Long Beach (Pacific
Hospital). Pacific Hospital is owned by Abrazos Healthcare, Inc., the shares of which are held as
community property by the husband of Dr. Martha Bernadett, our Executive Vice President, Research
and Development. Amounts paid under the terms of this fee for service agreement were $54,000 and
$23,000 for the three months ended June 30, 2008 and 2007,
15
respectively, and $110,000 and $43,000 for the six months ended June 30, 2008 and 2007,
respectively. We believe that the claims submitted to us by Pacific Hospital were reimbursed at
prevailing market rates. In 2006, we entered into an additional agreement with Pacific Hospital as
part of a capitation arrangement. Under this arrangement, we pay Pacific Hospital a fixed monthly
fee based on member type. We paid Pacific Hospital for capitation services totaling approximately
$818,000 and $1.0 million for the three months ended June 30, 2008 and 2007, respectively, and $1.7
million and $2.1 million for the six months ended June 30, 2008 and 2007, respectively. We believe
that this agreement with Pacific Hospital is based on prevailing market rates for similar services.
Also as of June 30, 2008, we had an advance outstanding to this provider totaling $0.2 million
which is offsetting capitation payments in 2008.
In 2006, we assumed an office lease from Millworks Capital Ventures which at that time had a
remaining term of 52 months. Millworks Capital Ventures is owned by John C. Molina, our Chief
Financial Officer, and his wife. The monthly base lease payment is approximately $18,000 and is
subject to an annual increase. Based on a market report prepared by an independent realtor, we
believe the terms and conditions of the assumed lease were at that time at fair market value. We
are currently using the office space under the lease for an office expansion. Payments made under
this lease totaled $75,000 and $56,000 for the three months ended June 30, 2008 and 2007,
respectively, and $132,000 and $131,000 for the six months ended June 30, 2008 and 2007,
respectively.
We lease two medical clinics that are owned by the Mary R. Molina Living Trust and the Molina
Marital Trust. These leases have 5 five-year renewal options. Rental expense for these leases
totaled $24,000 for each of the three-month periods ended June 30, 2008 and 2007, respectively, and
$49,000 for each of the six-month periods ended June 30, 2008 and 2007, respectively.
10.
Subsequent Event
On
July 22, 2008, our board of directors authorized the repurchase
of up to one million shares of our common stock. The repurchase
program will be funded using our working capital, and the timing and
amount of any shares repurchased will be made pursuant to a trading
plan. The repurchase program extends through December 31, 2008,
but we reserve the right to suspend or discontinue the program at any
time.
16
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Item 2. |
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Managements Discussion and Analysis of Financial Condition and Results of Operations. |
Forward Looking Statements
This quarterly report on Form 10-Q contains forward-looking statements within the meaning of
Section 27A of the Securities Act of 1933, or Securities Act, and Section 21E of the Securities
Exchange Act of 1934, or Securities Exchange Act. All statements, other than statements of
historical facts, that we include in this quarterly report may be deemed to be forward-looking
statements for purposes of the Securities Act and the Securities Exchange Act. We use the words
anticipate(s), believe(s), estimate(s), expect(s), intend(s), may, plan(s),
project(s), will, would and similar expressions to identify forward-looking statements,
although not all forward-looking statements contain these identifying words. We cannot guarantee
that we will actually achieve the plans, intentions, or expectations disclosed in our
forward-looking statements and, accordingly, you should not place undue reliance on our
forward-looking statements. There are a number of important factors that could cause actual results
or events to differ materially from the forward-looking statements that we make. You should read
these factors and the other cautionary statements as being applicable to all related
forward-looking statements wherever they appear in this quarterly report. We caution you that we do
not undertake any obligation to update forward-looking statements made by us. Forward-looking
statements involve known and unknown risks and uncertainties that may cause our actual results in
future periods to differ materially from those projected or contemplated as a result of, but not
limited to, the following factors:
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the achievement of savings from the successful management of the medical care ratio of
our health plans; |
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an increase in enrollment in both our Medicaid and Medicare populations consistent with
our expectations; |
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our ability to reduce administrative costs in the event enrollment or revenue is lower
than expected; |
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increased administrative costs in support of the Companys efforts to expand Medicare
membership; |
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our ability to accurately estimate incurred but not reported medical costs; |
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the securing of projected premium rate increases under the government contracts of our
health plans, in particular in the states of Michigan and Texas and in connection with our
Medicare plans; |
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|
the January 1, 2008 increase in Michigan state taxes and the success of our efforts to
mitigate the impact of that tax increase; |
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|
the budget crisis in California and the pressure to reduce HMO rates in that
state, including current PMPM rates under our existing contracts; |
|
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the final terms as implemented of the Rogers Amendment to the Deficit Reduction Act of
2005 regarding the rates to be paid to non-contracting hospitals by our California health
plan; |
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changes in market interest rates and actions by the Federal Reserve Bank Board; |
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|
the potential termination or expiration without renewal of the government contracts of
our health plans; |
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the imposition of fines or assessments by state or federal regulators for perceived
operating deficiencies; |
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our dependence upon a relatively small number of government contracts and subcontracts
for our revenue; |
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limitations in our ability to control our medical costs and other operating expenses; |
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risks related to our new Medicare Advantage plans with prescription drug coverage, or
MAPD plans, including our lack of operating experience with such plans, compliance issues,
and confusion regarding the new plans among Medicare beneficiaries, providers, pharmacists,
and regulators; |
17
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the successful and cost-effective integration of Mercy CarePlus, including risks
related to our lack of prior operating experience in Missouri; |
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risks related to our lack of experience with members in Ohio, Texas, and Missouri; |
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the availability of adequate financing to fund and/or capitalize our acquisitions and
start-up activities; |
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membership eligibility processes and methodologies; |
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unexpected changes in demographics, member utilization patterns, healthcare practices,
or healthcare technologies; |
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high dollar claims related to catastrophic illness or conditions, increases in
respiratory illnesses, or increases in the number of premature infants among our plans
members; |
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risks related to the continued solvency of our major providers and provider groups; |
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failure to maintain effective, efficient, and secure information systems and claims
processing technology; |
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the unfavorable resolution of pending litigation or arbitration; |
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risks associated with the potential negative perception among regulators, governmental
representatives, and the public of abuses occurring within the Medicaid or Medicare managed
care sectors and the association or general attribution of such negative perceptions to us; |
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funding decreases in the Medicaid, SCHIP, or Medicare programs or the failure to timely
renew the SCHIP program; |
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risks associated with our $200 million 3.75% Convertible
Senior Notes due 2014; |
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epidemics such as the avian flu; and |
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changes to government laws and regulations or in the interpretation and enforcement of
those laws and regulations, including the recently enacted citizenship certification
requirements. |
Investors should refer to Part II, Item 1A of this Quarterly Report, and to Part I, Item 1A of
our Annual Report on Form 10-K for the year ended December 31, 2007, for a discussion of certain
risk factors which could materially affect our business, financial condition, or future results.
Given these risks and uncertainties, we can give no assurances that any results or events projected
or contemplated by our forward-looking statements will in fact occur and we caution investors not
to place undue reliance on these statements.
This document and the following discussion of our financial condition and results of
operations should be read in conjunction with the accompanying consolidated financial statements
and the notes to those statements appearing elsewhere in this report and the audited financial
statements and Managements Discussion and Analysis appearing in our Annual Report on Form 10-K for
the year ended December 31, 2007.
18
Overview
Our financial performance for the three and six months ended June 30, 2008 compared with the
same prior year periods is briefly summarized as follows:
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Three Months Ended June 30, |
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Six Months Ended June 30, |
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2008 |
|
|
2007 |
|
|
2008 |
|
|
2007 |
|
|
|
(Dollar amounts in thousands, except per-share data) |
|
Earnings per diluted share |
|
$ |
0.59 |
|
|
$ |
0.47 |
|
|
$ |
1.05 |
|
|
$ |
0.81 |
|
Premium revenue |
|
$ |
761,153 |
|
|
$ |
607,127 |
|
|
$ |
1,490,791 |
|
|
$ |
1,163,362 |
|
Operating income |
|
$ |
30,258 |
|
|
$ |
22,284 |
|
|
$ |
54,709 |
|
|
$ |
38,879 |
|
Net income |
|
$ |
16,516 |
|
|
$ |
13,314 |
|
|
$ |
29,671 |
|
|
$ |
22,906 |
|
Medical care ratio |
|
|
84.2 |
% |
|
|
85.1 |
% |
|
|
85.0 |
% |
|
|
85.4 |
% |
G&A expenses as a
percentage of total
revenue |
|
|
11.4 |
% |
|
|
10.9 |
% |
|
|
11.0 |
% |
|
|
11.1 |
% |
Total ending membership |
|
|
|
|
|
|
|
|
|
|
1,234,000 |
|
|
|
1,076,000 |
|
Revenue
Premium revenue is fixed in advance of the periods covered and, except as described below, is
not generally subject to significant accounting estimates. For the six months ended June 30, 2008,
we received approximately 92% of our premium revenue as a fixed amount per member per month, or
PMPM, pursuant to our contracts with state Medicaid agencies and other managed care organizations
for which we operate as a subcontractor. These premium revenues are recognized in the month that
members are entitled to receive health care services. The state Medicaid programs periodically
adjust premium rates.
The amount of these premiums may vary substantially between states and among various
government programs. PMPM premiums for members of the State Childrens Health Insurance Program, or
SCHIP, are generally among our lowest, with rates as low as approximately $80 PMPM in California
and Utah. Premium revenues for Medicaid members are generally higher. Among the Temporary Aid for
Needy Families (TANF) Medicaid population the Medicaid group that includes most mothers and
children PMPM premiums range between approximately $100 in California to $300 in New Mexico and
Utah. Among our Medicaid Aged, Blind or Disabled (ABD) membership, PMPM premiums range from
approximately $450 in California to over $1,000 in New Mexico and Ohio. Medicare revenue is
approximately $1,200 PMPM. Approximately 3% of our premium revenue for the six months ended June
30, 2008 was realized under a Medicaid cost-plus reimbursement agreement that our Utah plan has
with that state. For the six months ended June 30, 2008, we also received approximately 4% of our
premium revenue in the form of birth income a one-time payment for the delivery of a child
from the Medicaid programs in Michigan, Ohio, Texas, and Washington. Such payments are recognized
as revenue in the month the birth occurs. Our premium revenue also included premiums generated from
Medicare, totaling approximately $44.4 million and $19.5 million for the six months ended June 30,
2008 and 2007, respectively. All of our Medicare revenue is paid to us as a fixed PMPM amount.
Certain components of premium revenue are subject to accounting estimates. Chief among these
are (1) that portion of premium revenue paid to our New Mexico health plan by the state of New
Mexico that may be refunded to the state if certain minimum amounts are not expended on defined
medical care costs, (2) the additional premium revenue our Utah health plan is entitled to receive
from the state of Utah as an incentive payment for saving the state of Utah money in relation to
fee-for-service Medicaid, and (3) the profit-sharing agreement between our Texas health plan and
the state of Texas, where we pay a rebate to the state of Texas if our Texas health plan generates
pretax income above a certain specified percentage, according to a tiered rebate schedule.
Our contract with the state of New Mexico requires that we spend a minimum percentage of
premium revenue on certain explicitly defined medical care costs. Our contract is for a three-year
period, and the minimum percentage is based on premiums and medical care costs over the entire
contract period. Year to date, we have recorded adjustments totaling $12.9 million to increase
premium revenue associated with this requirement. The revenue resulted from a reversal of
previously recorded amounts due the state of New Mexico because we exceeded the minimum percentage
in the first half of 2008. At June 30, 2008, there is no remaining liability recorded under our
interpretation of the existing terms of this contract provision. Any change to the
terms of this provision, including revisions to the definitions of premium
revenue or medical care costs, the period of time over which the minimum
19
percentage is measured or
the manner of its measurement, or the percentage of revenue required to be spent on the defined
medical care costs, may trigger a change in this amount. If the state of New Mexico disagrees with
our interpretation of the existing contract terms, an adjustment to this amount may occur.
In prior years, we estimated amounts we believed were recoverable under our savings sharing
agreement with the state of Utah based on available information and our interpretation of our
contract with the state. The state may not agree with our interpretation or our application of the
contract language, and it may also not agree with the manner in which we have processed and
analyzed our member claims and encounter records. Thus, the ultimate amount of savings sharing
revenue that we realize may be subject to negotiation with the state. During 2007, as a result of
an ongoing disagreement with the state of Utah, we wrote off the entire receivable, totaling $4.7
million. Our Utah health plan continues to work with the state to assure an appropriate
determination of amounts due under the savings share agreement. When additional information is
known, or agreement is reached with the state regarding the appropriate savings sharing payment
amount, we will adjust the amount of savings sharing revenue recorded in our financial statements
as appropriate in light of such new information or agreement.
As of June 30, 2008, we had a liability of approximately $9.0 million accrued pursuant to our
profit-sharing agreement with the state of Texas, for the 2007 and 2008 contract years ending
August 31. Because the final settlement calculations include a claims run-out period of nearly one
year, the amounts recorded, based on our estimates, may be adjusted. We believe that the ultimate
settlement will not differ materially from our estimate.
Historically, membership growth has been the primary reason for our increasing revenues,
although more recently our revenues have also grown due to the more care intensive benefits
associated with our ABD and Medicare members. We have increased our membership through both
internal growth and acquisitions. The following table sets forth the approximate total number of
members by state as of the dates indicated:
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|
|
|
|
|
|
|
|
|
As of |
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|
As of |
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|
As of |
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|
|
June 30, |
|
|
December 31, |
|
|
June 30, |
|
Total Ending Membership by Health Plan: |
|
2008 |
|
|
2007 |
|
|
2007 |
|
California |
|
|
310,000 |
|
|
|
296,000 |
|
|
|
291,000 |
|
Michigan |
|
|
212,000 |
|
|
|
209,000 |
|
|
|
217,000 |
|
Missouri (1) |
|
|
76,000 |
|
|
|
68,000 |
|
|
|
|
|
Nevada (2) |
|
|
|
|
|
|
|
|
|
|
|
|
New Mexico |
|
|
81,000 |
|
|
|
73,000 |
|
|
|
66,000 |
|
Ohio |
|
|
173,000 |
|
|
|
136,000 |
|
|
|
138,000 |
|
Texas |
|
|
29,000 |
|
|
|
29,000 |
|
|
|
30,000 |
|
Utah |
|
|
57,000 |
|
|
|
55,000 |
|
|
|
47,000 |
|
Washington |
|
|
296,000 |
|
|
|
283,000 |
|
|
|
287,000 |
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
1,234,000 |
|
|
|
1,149,000 |
|
|
|
1,076,000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Ending Membership by State for the Medicare Advantage
Plans: |
|
|
|
|
|
|
|
|
|
|
|
|
California |
|
|
1,452 |
|
|
|
1,115 |
|
|
|
724 |
|
Michigan |
|
|
1,469 |
|
|
|
1,090 |
|
|
|
459 |
|
Nevada |
|
|
680 |
|
|
|
520 |
|
|
|
9 |
|
New Mexico |
|
|
149 |
|
|
|
|
|
|
|
|
|
Texas |
|
|
430 |
|
|
|
|
|
|
|
|
|
Utah |
|
|
2,056 |
|
|
|
1,860 |
|
|
|
1,646 |
|
Washington |
|
|
911 |
|
|
|
507 |
|
|
|
413 |
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
7,147 |
|
|
|
5,092 |
|
|
|
3,251 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Ending Membership by State for the Aged, Blind or
Disabled Population: |
|
|
|
|
|
|
|
|
|
|
|
|
California |
|
|
12,092 |
|
|
|
11,837 |
|
|
|
10,728 |
|
Michigan |
|
|
30,896 |
|
|
|
31,399 |
|
|
|
31,940 |
|
New Mexico |
|
|
6,716 |
|
|
|
6,792 |
|
|
|
6,822 |
|
Ohio |
|
|
15,355 |
|
|
|
14,887 |
|
|
|
15,117 |
|
Texas |
|
|
15,999 |
|
|
|
16,018 |
|
|
|
16,603 |
|
Utah |
|
|
6,993 |
|
|
|
6,795 |
|
|
|
6,876 |
|
Washington |
|
|
3,049 |
|
|
|
2,814 |
|
|
|
2,693 |
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
91,100 |
|
|
|
90,542 |
|
|
|
90,779 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
We acquired our Missouri health plan effective as of November 1, 2007. |
|
(2) |
|
Less than 1,000 members. |
20
The following table provides details of total member months (defined as the aggregation of each
months ending membership for the period) by state for the periods indicated:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
|
|
|
|
June 30, |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
% of Increase |
|
|
|
2008 |
|
|
2007 |
|
|
(Decrease) |
|
California |
|
|
921,000 |
|
|
|
874,000 |
|
|
|
5.4 |
% |
Michigan |
|
|
639,000 |
|
|
|
658,000 |
|
|
|
(2.9 |
) |
Missouri (1) |
|
|
227,000 |
|
|
|
|
|
|
|
|
|
Nevada |
|
|
2,000 |
|
|
|
|
|
|
|
|
|
New Mexico |
|
|
239,000 |
|
|
|
197,000 |
|
|
|
21.3 |
|
Ohio |
|
|
522,000 |
|
|
|
399,000 |
|
|
|
30.8 |
|
Texas |
|
|
85,000 |
|
|
|
91,000 |
|
|
|
(6.6 |
) |
Utah |
|
|
164,000 |
|
|
|
145,000 |
|
|
|
13.1 |
|
Washington |
|
|
879,000 |
|
|
|
860,000 |
|
|
|
2.2 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
3,678,000 |
|
|
|
3,224,000 |
|
|
|
14.1 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended |
|
|
|
|
|
|
June 30, |
|
|
% of Increase |
|
|
|
2008 |
|
|
2007 |
|
|
(Decrease) |
|
California |
|
|
1,829,000 |
|
|
|
1,760,000 |
|
|
|
3.9 |
% |
Michigan |
|
|
1,277,000 |
|
|
|
1,327,000 |
|
|
|
(3.8 |
) |
Missouri |
|
|
450,000 |
|
|
|
|
|
|
|
|
|
Nevada (2) |
|
|
4,000 |
|
|
|
|
|
|
|
|
|
New Mexico |
|
|
467,000 |
|
|
|
389,000 |
|
|
|
20.1 |
|
Ohio |
|
|
935,000 |
|
|
|
739,000 |
|
|
|
26.5 |
|
Texas |
|
|
170,000 |
|
|
|
157,000 |
|
|
|
8.3 |
|
Utah |
|
|
321,000 |
|
|
|
296,000 |
|
|
|
8.4 |
|
Washington |
|
|
1,738,000 |
|
|
|
1,716,000 |
|
|
|
1.3 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
|
7,191,000 |
|
|
|
6,384,000 |
|
|
|
12.6 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
We acquired our Missouri health plan effective November 1, 2007. |
|
(2) |
|
Our Nevada health plan became operational on June 1, 2007, serving only Medicare
members. |
Expenses
Our operating expenses include expenses related to the provision of medical care services and
general and administrative, or G&A, expenses. Our results of operations are impacted by our ability
to effectively manage expenses related to health care services and to accurately estimate costs
incurred. Expenses related to medical care services are captured in the following four categories:
|
|
|
Fee-for-service: Physician providers paid on a fee-for-service basis are paid according
to a fee schedule set by the state or by our contracts with these providers. We pay
hospitals in a variety of ways, including per diem amounts, diagnostic-related groups, or
DRGs, percent of billed charges, case rates, and capitation. We also have stop-loss
agreements with the hospitals with which we contract. Under all fee-for-service
arrangements, we retain the financial responsibility for medical care provided. Expenses
related to fee-for-service contracts are recorded in the period in which the related
services are dispensed. The costs of drugs administered in a physician or hospital setting
that are not billed through our pharmacy benefit managers are included in fee-for-service
costs. |
|
|
|
|
Capitation: Many of our primary care physicians and a small portion of our specialists
and hospitals are paid on a capitation basis. Under capitation contracts, we typically pay
a fixed PMPM payment to the provider without regard to the frequency, extent, or nature of
the medical services actually furnished. Under capitated
|
21
|
|
|
contracts, we remain liable for
the provision of certain health care services. Certain of our capitated contracts also
contain incentive programs based on service delivery, quality of care, utilization
management, and other criteria. Capitation payments are fixed in advance of the periods
covered and are not subject to significant accounting estimates. These payments are
expensed in the period the providers are obligated to provide services. The financial risk
for pharmacy services for a small portion of our membership is delegated to capitated
providers. |
|
|
|
|
Pharmacy: Pharmacy costs include all drug, injectibles, and immunization costs paid
through our pharmacy benefit managers. As noted above, drugs and injectibles not paid
through our pharmacy benefit managers are included in fee-for-service costs, except in
those limited instances where we capitate drug and injectible costs. |
|
|
|
|
Other: Other medical care costs include medically related administrative costs, certain
provider incentive costs, reinsurance cost, and other health care expense. Medically
related administrative costs include, for example, expenses relating to health education,
quality assurance, case management, disease management, 24-hour on-call nurses, and a
portion of our information technology costs. Salary and benefit costs are a substantial
portion of these expenses. For the six months ended June 30, 2008 and 2007, medically
related administrative costs were approximately $36.9 million and $30.8 million,
respectively. |
The following table provides the details of our consolidated medical care costs for the
periods indicated (dollars in thousands except PMPM amounts):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, |
|
|
|
2008 |
|
|
2007 |
|
|
|
|
|
|
|
|
|
|
|
% of |
|
|
|
|
|
|
|
|
|
|
% of |
|
|
|
Amount |
|
|
PMPM |
|
|
Total |
|
|
Amount |
|
|
PMPM |
|
|
Total |
|
Fee for service |
|
$ |
410,619 |
|
|
$ |
111.65 |
|
|
|
64.1 |
% |
|
$ |
336,654 |
|
|
$ |
104.41 |
|
|
|
65.1 |
% |
Capitation |
|
|
117,707 |
|
|
|
32.00 |
|
|
|
18.4 |
|
|
|
92,931 |
|
|
|
28.82 |
|
|
|
18.0 |
|
Pharmacy |
|
|
88,676 |
|
|
|
24.11 |
|
|
|
13.8 |
|
|
|
65,930 |
|
|
|
20.45 |
|
|
|
12.8 |
|
Other |
|
|
23,827 |
|
|
|
6.48 |
|
|
|
3.7 |
|
|
|
21,350 |
|
|
|
6.62 |
|
|
|
4.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
640,829 |
|
|
$ |
174.24 |
|
|
|
100.0 |
% |
|
$ |
516,865 |
|
|
$ |
160.30 |
|
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, |
|
|
|
2008 |
|
|
2007 |
|
|
|
|
|
|
|
|
|
|
|
% of |
|
|
|
|
|
|
|
|
|
|
% of |
|
|
|
Amount |
|
|
PMPM |
|
|
Total |
|
|
Amount |
|
|
PMPM |
|
|
Total |
|
Fee for service |
|
$ |
822,628 |
|
|
$ |
114.40 |
|
|
|
64.9 |
% |
|
$ |
644,534 |
|
|
$ |
100.96 |
|
|
|
64.9 |
% |
Capitation |
|
|
221,498 |
|
|
|
30.80 |
|
|
|
17.5 |
|
|
|
180,864 |
|
|
|
28.33 |
|
|
|
18.2 |
|
Pharmacy |
|
|
174,958 |
|
|
|
24.33 |
|
|
|
13.8 |
|
|
|
126,509 |
|
|
|
19.82 |
|
|
|
12.7 |
|
Other |
|
|
48,092 |
|
|
|
6.70 |
|
|
|
3.8 |
|
|
|
41,435 |
|
|
|
6.49 |
|
|
|
4.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
1,267,176 |
|
|
$ |
176.23 |
|
|
|
100.0 |
% |
|
$ |
993,342 |
|
|
$ |
155.60 |
|
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
22
Our medical care costs include amounts that have been paid by us through the reporting date as
well as estimated liabilities for medical care costs incurred but not paid by us as of the
reporting date. See Critical Accounting Policies below for a comprehensive discussion of how we
estimate such liabilities.
G&A expenses largely consist of wage and benefit costs for our employees, premium taxes, and
other administrative expenses. Some G&A services are provided locally, while others are delivered
to our health plans from a centralized location. The primary centralized functions are claims
processing, information systems, finance and accounting services, and legal and regulatory
services. Locally provided functions include member services, plan administration, and provider
relations. G&A expenses include premium taxes for each of our health plans in California, Michigan,
New Mexico, Ohio, Texas, and Washington.
Results of Operations
The following table sets forth selected operating ratios. All ratios with the exception of the
medical care ratio are shown as a percentage of total revenue. The medical care ratio is shown as a
percentage of premium revenue because there is a direct relationship between the premium revenue
earned and the cost of health care.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Six Months Ended |
|
|
June 30, |
|
June 30, |
|
|
2008 |
|
2007 |
|
2008 |
|
2007 |
Premium revenue |
|
|
99.3 |
% |
|
|
98.9 |
% |
|
|
99.2 |
% |
|
|
98.9 |
% |
Investment income |
|
|
0.7 |
|
|
|
1.1 |
|
|
|
0.8 |
|
|
|
1.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total revenue |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Ratio of
direct medical care costs to premium revenue |
|
|
81.9 |
% |
|
|
82.5 |
% |
|
|
82.5 |
% |
|
|
82.7 |
% |
Ratio of
administrative costs included in medical
care costs to premium revenue |
|
|
2.3 |
|
|
|
2.6 |
|
|
|
2.5 |
|
|
|
2.7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medical care ratio |
|
|
84.2 |
% |
|
|
85.1 |
% |
|
|
85.0 |
% |
|
|
85.4 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
General and
administrative
expense ratio,
excluding premium
taxes |
|
|
8.2 |
% |
|
|
7.7 |
% |
|
|
8.0 |
% |
|
|
7.8 |
% |
Premium taxes
included in general
and administrative
expenses |
|
|
3.2 |
|
|
|
3.2 |
|
|
|
3.0 |
|
|
|
3.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total general and
administrative
expense ratio |
|
|
11.4 |
% |
|
|
10.9 |
% |
|
|
11.0 |
% |
|
|
11.1 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and
amortization
expense ratio |
|
|
1.1 |
% |
|
|
1.1 |
% |
|
|
1.1 |
% |
|
|
1.1 |
% |
Effective tax rate |
|
|
40.9 |
% |
|
|
38.2 |
% |
|
|
40.8 |
% |
|
|
38.1 |
% |
Operating income |
|
|
3.9 |
% |
|
|
3.6 |
% |
|
|
3.6 |
% |
|
|
3.3 |
% |
Income
before income taxes |
|
|
3.6 |
% |
|
|
3.5 |
% |
|
|
3.3 |
% |
|
|
3.1 |
% |
Net income |
|
|
2.2 |
% |
|
|
2.2 |
% |
|
|
2.0 |
% |
|
|
1.9 |
% |
23
Three Months Ended June 30, 2008 Compared with Three Months Ended June 30, 2007
The following summarizes premium revenue, medical care costs, medical care ratio, and premium
taxes by health plan for the three months ended June 30, 2008 and June 30, 2007 (dollars in
thousands except PMPM amounts):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2008 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
104,136 |
|
|
$ |
113.00 |
|
|
$ |
88,449 |
|
|
$ |
95.98 |
|
|
|
84.9 |
% |
|
$ |
3,242 |
|
Michigan |
|
|
125,382 |
|
|
|
196.37 |
|
|
|
100,273 |
|
|
|
157.05 |
|
|
|
80.0 |
|
|
|
6,625 |
|
Missouri |
|
|
54,250 |
|
|
|
238.84 |
|
|
|
45,050 |
|
|
|
198.34 |
|
|
|
83.0 |
|
|
|
|
|
Nevada |
|
|
2,243 |
|
|
|
1,303.04 |
|
|
|
2,506 |
|
|
|
1,456.25 |
|
|
|
111.8 |
|
|
|
|
|
New Mexico |
|
|
89,279 |
|
|
|
374.58 |
|
|
|
69,593 |
|
|
|
291.99 |
|
|
|
78.0 |
|
|
|
4,184 |
|
Ohio |
|
|
147,114 |
|
|
|
281.73 |
|
|
|
133,816 |
|
|
|
256.26 |
|
|
|
91.0 |
|
|
|
6,672 |
|
Texas |
|
|
25,742 |
|
|
|
303.09 |
|
|
|
19,669 |
|
|
|
231.58 |
|
|
|
76.4 |
|
|
|
460 |
|
Utah |
|
|
35,385 |
|
|
|
214.89 |
|
|
|
31,932 |
|
|
|
193.92 |
|
|
|
90.2 |
|
|
|
|
|
Washington |
|
|
177,619 |
|
|
|
202.11 |
|
|
|
145,840 |
|
|
|
165.95 |
|
|
|
82.1 |
|
|
|
2,993 |
|
Other (1) |
|
|
3 |
|
|
|
|
|
|
|
3,701 |
|
|
|
|
|
|
|
|
|
|
|
(5 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
761,153 |
|
|
$ |
206.96 |
|
|
$ |
640,829 |
|
|
$ |
174.24 |
|
|
|
84.2 |
% |
|
$ |
24,171 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
94,710 |
|
|
$ |
108.43 |
|
|
$ |
76,185 |
|
|
$ |
87.22 |
|
|
|
80.4 |
% |
|
$ |
3,202 |
|
Michigan |
|
|
121,427 |
|
|
|
184.43 |
|
|
|
101,184 |
|
|
|
153.68 |
|
|
|
83.3 |
|
|
|
7,364 |
|
New Mexico |
|
|
61,337 |
|
|
|
312.44 |
|
|
|
52,949 |
|
|
|
269.71 |
|
|
|
86.3 |
|
|
|
1,394 |
|
Ohio |
|
|
111,457 |
|
|
|
279.18 |
|
|
|
101,515 |
|
|
|
254.28 |
|
|
|
91.1 |
|
|
|
5,016 |
|
Texas |
|
|
24,953 |
|
|
|
273.48 |
|
|
|
22,774 |
|
|
|
249.59 |
|
|
|
91.3 |
|
|
|
433 |
|
Utah |
|
|
30,033 |
|
|
|
206.15 |
|
|
|
26,535 |
|
|
|
182.14 |
|
|
|
88.4 |
|
|
|
|
|
Washington |
|
|
162,905 |
|
|
|
189.45 |
|
|
|
130,726 |
|
|
|
152.02 |
|
|
|
80.2 |
|
|
|
2,685 |
|
Other (1) |
|
|
305 |
|
|
|
|
|
|
|
4,997 |
|
|
|
|
|
|
|
|
|
|
|
(19 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
607,127 |
|
|
$ |
188.30 |
|
|
$ |
516,865 |
|
|
$ |
160.30 |
|
|
|
85.1 |
% |
|
$ |
20,075 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
Other medical care costs represent medically related administrative costs at
the parent company. |
Net Income
Net income for the quarter ended June 30, 2008, increased to $16.5 million, or $0.59 per
diluted share, compared with net income of $13.3 million, or $0.47 per diluted share, for the
quarter ended June 30, 2007.
Premium Revenue
Premium revenue for the second quarter of 2008 was $761.1 million, an increase of $154.0
million, or 25.4%, over the $607.1 million of premium revenue for the second quarter of 2007.
Medicare premium revenue for the second quarter of 2008 was $23.1 million compared with $10.5
million in the second quarter of 2007. Excluding the impact of the November 1, 2007 acquisition of
our Missouri health plan, consolidated membership increased 7.6% between June 30, 2008 and June 30,
2007. Significant contributors to the $154.0 million increase in quarterly premium revenues
included the following:
|
|
|
A $54.3 million increase as a result of the acquisition of Mercy CarePlus in Missouri on
November 1, 2007. |
|
|
|
|
A $35.7 million increase at the Ohio health plan due to higher enrollment, particularly
in the Covered Families and Children (CFC) population. |
|
|
|
|
A $27.9 million increase at the New Mexico health plan due to higher enrollment, higher
premium rates, and the recognition of $6.2 million in revenues associated with a minimum
medical care ratio contract provision. |
24
|
|
|
A $14.7 million increase at the Washington health plan due to higher premium rates and
slightly higher membership. |
Investment Income
Investment
income during the second quarter of 2008 totaled $5.3 million compared with $6.7
million in the second quarter of 2007, a decrease of $1.4 million, primarily due to declining
interest rates and slightly lower invested balances as a result of cash used in the treasury share
repurchase program.
Medical Care Costs
Medical care costs as a percentage of premium revenue (the medical care ratio) decreased to
84.2% in the second quarter of 2008 from 85.1% in the second quarter of 2007. Sequentially, the
medical care ratio decreased from 85.8% for the quarter ended March 31, 2008, a change of 160 basis
points. Excluding Medicare, our medical care ratio was 84.2% in the second quarter of 2008, 85.4%
in the second quarter of 2007, and 85.8% in the first quarter of 2008.
|
|
|
The medical care ratio of the Michigan health plan decreased 330 basis points to 80.0%
in the second quarter of 2008, from 83.3% in the second quarter of 2007. This decrease was
due primarily to lower hospital fee-for-service costs. |
|
|
|
|
The medical care ratio of the Missouri health plan was 83.0% for the quarter, down from
89.7% in the first quarter of 2008. The sequential decrease was due primarily to lower
hospital fee-for-service costs. |
|
|
|
|
The medical care ratio of the California health plan increased as a result of an
increase in PMPM medical costs of approximately 10%, chiefly in pharmacy costs and
specialist fee-for-service costs. The California medical care ratio rose to 84.9% in the
second quarter of 2008 from 80.4% in the second quarter of 2007. |
|
|
|
|
The medical care ratio of the New Mexico health plan decreased 830 basis points to 78.0%
in the second quarter of 2008, from 86.3% in the second quarter of 2007. This decrease was
due to higher premium rates, particularly under the State Coverage Initiative (SCI)
contract, which offset higher medical costs. The medical care ratio decrease also included
the impact of the recognition of $6.2 million in revenue associated with a minimum medical
care ratio contract provision. Absent the adjustments made to premium revenue in the second
quarter of 2008 and 2007 under this provision, the medical care ratio in New Mexico would
have been 83.8% in the second quarter of 2008 and 82.1% in the second quarter of 2007. |
|
|
|
|
The medical care ratios of the Ohio health plan, by line of business, were as follows: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
June 30, |
|
March 31, |
|
June 30, |
|
|
2008 |
|
2008 |
|
2007 |
Covered Families and Children (CFC) |
|
|
90.7 |
% |
|
|
88.9 |
% |
|
|
90.6 |
% |
Aged, Blind or Disabled (ABD) |
|
|
91.5 |
|
|
|
92.7 |
|
|
|
92.3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Aggregate |
|
|
91.0 |
% |
|
|
90.3 |
% |
|
|
91.1 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
In total, the medical care ratio decreased 10 basis points year over year and increased 70
basis points sequentially. The sequential increase was due primarily to increased expense
due a sub-capitated behavioral health provider under a risk-sharing arrangement with that
provider. These amounts added approximately 70 basis points to the aggregate medical care
ratio in Ohio when compared with the first quarter of 2008. We are in the process of
terminating our contract with this provider and will bring behavioral health care in-house
beginning September 1, 2008. |
|
|
|
|
The medical care ratio of the Texas health plan decreased from 91.5% in the second
quarter of 2007 to 76.4% in the second quarter of 2008 primarily due to low medical costs
for the Star Plus membership. During the second quarter of 2008, the Texas health plan
reduced revenue $2.3 million to record amounts due back to the state under a profit-sharing
agreement. |
25
|
|
|
The medical care ratio of the Utah health plan increased 180 basis points to 90.2% in
the second quarter of 2008, from 88.4% in the second quarter of 2007. This increase was
primarily the result of higher medical care ratios in the Utah
plans SCHIP and Medicare lines of business. The Utah health plan
serves the majority of its Medicaid membership under a cost-plus contract with the state of
Utah. The Utah health plans SCHIP and Medicare lines of business are conducted under at
risk prepaid capitation contracts. |
|
|
|
|
The medical care ratio reported at the Washington health plan increased to 82.1% in the
second quarter of 2008 from 80.2% in the second quarter of 2007, primarily due to higher
fee-for-service hospital and specialist costs. The higher fee-for-service costs were
driven by increases to the Medicaid in-patient fee schedule that took effect on each of
August 1, 2007 and January 1, 2008. |
Days in medical claims and benefits payable were 47 days at June 30, 2008, 50 days at March
31, 2008, and 54 days at June 30, 2007. Our reserving methodology is applied consistently across
all periods presented. As of June 30, 2008, medical claims inventory (measured as the total billed
charges of all claims received but not paid as of the reporting date) has decreased approximately
20% since June 30, 2007, and 4% since March 31, 2008. Additionally, increased capitation and
pharmacy expenses (measured as a percentage of total medical costs) reduced days in medical claims
payable by approximately one day between June 30, 2008 and March 31, 2008.
General and Administrative Expenses
General and administrative expenses were $87.1 million, or 11.4% of total revenue, for the
second quarter of 2008 compared with $67.2 million, or 10.9% of total revenue, for the second
quarter of 2007.
Core G&A expenses (defined as G&A expenses less premium taxes) were 8.2% of revenue in the
second quarter of 2008 compared with 7.7% in the second quarter of 2007 and 7.8% in the first
quarter of 2008. The increase in core G&A compared with the second quarter of 2007 was primarily
due to our continued investment in the administrative infrastructure necessary to support our
Medicare product line, and also due to an increase in the accrual for employee incentive
compensation, as indicated in the table below.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended June 30, |
|
|
|
2008 |
|
|
2007 |
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
% of Total |
|
|
|
Amount |
|
|
Revenue |
|
|
Amount |
|
|
Revenue |
|
|
|
(in thousands) |
|
|
|
|
|
|
(in thousands) |
|
|
|
|
|
Medicare-related administrative costs |
|
$ |
4,118 |
|
|
|
0.5 |
% |
|
$ |
2,043 |
|
|
|
0.3 |
% |
Non Medicare-related administrative costs: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Administrative payroll, including
employee incentive compensation |
|
|
48,656 |
|
|
|
6.3 |
|
|
|
38,120 |
|
|
|
6.2 |
|
All other administrative expense |
|
|
10,129 |
|
|
|
1.4 |
|
|
|
6,970 |
|
|
|
1.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Core G&A expenses |
|
$ |
62,903 |
|
|
|
8.2 |
% |
|
$ |
47,133 |
|
|
|
7.7 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and Amortization
Depreciation and amortization expense increased $1.6 million in the second quarter of 2008
compared with the second quarter of 2007, including a $0.9 million increase in depreciation expense
due to investments in infrastructure, and a $0.7 million increase in amortization expense
primarily due to intangible assets associated with the 2007 Mercy CarePlus acquisition in Missouri.
Impairment Charge on Purchased Software
During the second quarter of 2007, an impairment charge of $782,000 was recorded related to
commercial software no longer used for operations. No such charge occurred in the second quarter of
2008.
26
Interest Expense
Interest expense in the second quarter of 2008 increased $1.6 million compared with the second
quarter of 2007, principally due to the issuance of our $200 million 3.75% Convertible Senior Notes
in October 2007.
Income Taxes
Income taxes were recorded at an effective rate of 40.9% in the second quarter of 2008
compared with 38.2% in the second quarter of 2007. The increase in our effective tax rate was
primarily the result of a change in Michigan state taxes effective January 1, 2008. Prior to
January 1, 2008, Michigan state taxes were calculated as a percentage of net income at a rate of
1.9%. As of January 1, 2008, the state income tax was changed to comprise three components on a
combined filing basis: a gross receipts tax calculated at 0.8% of modified gross receipts; an
income tax calculated at 4.95% of income before taxes; and a surtax of 21.99% of the total of the
previous two items.
27
Six Months Ended June 30, 2008 Compared to Six Months Ended June 30, 2007
The following summarizes premium revenue, medical care costs, medical care ratio, and premium
taxes by health plan for the six months ended June 30, 2008 and June 30, 2007 (dollars in thousands
except PMPM amounts):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2008 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
205,756 |
|
|
$ |
112.49 |
|
|
$ |
178,103 |
|
|
$ |
97.37 |
|
|
|
86.6 |
% |
|
$ |
6,201 |
|
Michigan |
|
|
250,134 |
|
|
|
195.89 |
|
|
|
203,173 |
|
|
|
159.12 |
|
|
|
81.2 |
|
|
|
13,565 |
|
Missouri |
|
|
106,286 |
|
|
|
236.29 |
|
|
|
91,732 |
|
|
|
203.93 |
|
|
|
86.3 |
|
|
|
|
|
Nevada |
|
|
4,187 |
|
|
|
1,267.13 |
|
|
|
4,133 |
|
|
|
1,250.76 |
|
|
|
98.7 |
|
|
|
|
|
New Mexico |
|
|
177,928 |
|
|
|
381.45 |
|
|
|
141,518 |
|
|
|
303.40 |
|
|
|
79.5 |
|
|
|
5,686 |
|
Ohio |
|
|
271,720 |
|
|
|
290.54 |
|
|
|
246,354 |
|
|
|
263.42 |
|
|
|
90.7 |
|
|
|
12,277 |
|
Texas |
|
|
49,174 |
|
|
|
288.81 |
|
|
|
37,499 |
|
|
|
220.24 |
|
|
|
76.3 |
|
|
|
936 |
|
Utah |
|
|
72,731 |
|
|
|
226.40 |
|
|
|
64,923 |
|
|
|
202.10 |
|
|
|
89.3 |
|
|
|
|
|
Washington |
|
|
352,817 |
|
|
|
202.97 |
|
|
|
290,353 |
|
|
|
167.03 |
|
|
|
82.3 |
|
|
|
5,838 |
|
Other (1) |
|
|
58 |
|
|
|
|
|
|
|
9,388 |
|
|
|
|
|
|
|
|
|
|
|
20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
1,490,791 |
|
|
$ |
207.33 |
|
|
$ |
1,267,176 |
|
|
$ |
176.23 |
|
|
|
85.0 |
% |
|
$ |
44,523 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, 2007 |
|
|
|
Premium Revenue |
|
|
Medical Care Costs |
|
|
Medical |
|
|
Premium Tax |
|
|
|
Total |
|
|
PMPM |
|
|
Total |
|
|
PMPM |
|
|
Care Ratio |
|
|
Expense |
|
California |
|
$ |
187,642 |
|
|
$ |
106.64 |
|
|
$ |
152,509 |
|
|
$ |
86.68 |
|
|
|
81.3 |
% |
|
$ |
6,232 |
|
Michigan |
|
|
245,193 |
|
|
|
184.75 |
|
|
|
205,785 |
|
|
|
155.05 |
|
|
|
83.9 |
% |
|
|
14,873 |
|
New Mexico |
|
|
118,530 |
|
|
|
305.11 |
|
|
|
102,168 |
|
|
|
262.99 |
|
|
|
86.2 |
% |
|
|
3,610 |
|
Ohio |
|
|
186,401 |
|
|
|
252.13 |
|
|
|
170,777 |
|
|
|
231.00 |
|
|
|
91.6 |
% |
|
|
8,388 |
|
Texas |
|
|
39,409 |
|
|
|
250.35 |
|
|
|
36,122 |
|
|
|
229.47 |
|
|
|
91.7 |
% |
|
|
690 |
|
Utah |
|
|
60,960 |
|
|
|
205.88 |
|
|
|
55,001 |
|
|
|
185.76 |
|
|
|
90.2 |
% |
|
|
|
|
Washington |
|
|
324,887 |
|
|
|
189.33 |
|
|
|
261,985 |
|
|
|
152.67 |
|
|
|
80.6 |
% |
|
|
5,369 |
|
Other (1) |
|
|
340 |
|
|
|
|
|
|
|
8,995 |
|
|
|
|
|
|
|
|
|
|
|
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
1,163,362 |
|
|
$ |
182.23 |
|
|
$ |
993,342 |
|
|
$ |
155.60 |
|
|
|
85.4 |
% |
|
$ |
39,176 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(1) |
|
Other medical care costs represent medically related administrative costs at
the parent company. |
Net Income
Net income for the six months ended June 30, 2008, increased to $29.7 million, or $1.05 per
diluted share, compared with net income of $22.9 million, or $0.81 per diluted share, for the six
months ended June 30, 2007.
Premium Revenue
Premium revenue for the six months ended June 30, 2008, was $1,490.8 million, an increase of
$327.4 million, or 28.1%, over $1,163.4 million of premium revenue for the six months ended June
30, 2007. Medicare premium revenue for the first half of 2008 was $44.4 million compared with
$19.5 million in the same period of 2007. Significant contributors to this $327.4 million increase
in premium revenues included the following:
|
|
|
A $106.3 million increase as a result of the acquisition of Mercy CarePlus in Missouri
on November 1, 2007. |
|
|
|
|
An $85.3 million increase at the Ohio health plan due to
higher enrollment. |
|
|
|
|
A $59.4 million increase at the New Mexico health plan due to higher enrollment, higher
premium rates, and the recognition of $12.9 million in revenues associated with a minimum
medical care ratio contract provision. |
|
|
|
|
A $27.9 million increase at the Washington health plan due to higher premium rates and
slightly higher membership. |
28
Investment Income
Investment income for the six months ended June 30, 2008 totaled $12.7 million compared with
$13.4 million earned in the same period of 2007. The $0.7 million decrease was primarily due to
declining interest rates.
Medical Care Costs
The medical care ratio decreased to 85.0% in the first half of 2008, compared with 85.4% for
the first half of 2007. Excluding Medicare, the Companys medical care ratio was 85.0% in the
first half 2008 compared with 85.7% in the first half of 2007.
|
|
|
The medical care ratio of the Michigan health plan decreased 270 basis points to 81.2%
in the first half of 2008, from 83.9% in the first half of 2007. This decrease was due
primarily to lower hospital fee-for-service costs. |
|
|
|
|
The medical care ratio of the Missouri health plan was 86.3% for the first half of 2008. |
|
|
|
|
The medical care ratio of the California health plan increased as a result of an
increase in PMPM medical costs of approximately 12%, chiefly in pharmacy costs and hospital
and specialist fee-for-service costs. The California medical care ratio rose to 86.6% in
the first half of 2008 from 81.3% in the first half of 2007. |
|
|
|
|
The medical care ratio of the New Mexico health plan decreased 670 basis points to 79.5%
in the first half of 2008, from 86.2% in the first half of 2007. This decrease was due to
higher premium rates, particularly under the State Coverage Initiative (SCI) contract,
which more than offset higher medical costs. The MCR decrease also included the impact of
the recognition of $12.9 million in revenue associated with a minimum medical care ratio
contract provision. Absent the adjustments made to premium revenue in
the first half of 2008 and 2007, the medical care ratio in New Mexico would have been 85.8% in the first
half of 2008 and 81.0% in the first half of 2007. |
|
|
|
|
The medical care ratios of the Ohio health plan, by line of business, were as follows: |
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended |
|
|
June 30, 2008 |
|
June 30, 2007 |
Covered Families and Children (CFC) |
|
|
89.9 |
% |
|
|
91.4 |
% |
Aged, Blind or Disabled (ABD) |
|
|
92.1 |
|
|
|
92.4 |
|
|
|
|
|
|
|
|
|
|
Aggregate |
|
|
90.7 |
% |
|
|
91.6 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
In total, the medical care ratio decreased 90 basis points year over year. This decrease was
due primarily to lower fee-for-service hospital costs, offset slightly by higher capitation
rates. |
|
|
|
|
The medical care ratio of the Texas health plan decreased from 91.7% in the first half
of 2007 to 76.3% in the first half of 2008 primarily due to low medical costs for the Star
Plus membership. During the first half of 2008, the Texas health plan reduced revenue by
$6.8 million to record amounts due the state under a profit-sharing agreement. |
|
|
|
|
The medical care ratio of the Utah health plan decreased 90 basis points to 89.3% in the
first half of 2008, from 90.2% in the first half of 2007. This decrease was primarily the
result of lower medical care ratios in the Utah health plans SCHIP and Medicare lines
of business. The Utah health plan serves the majority of its Medicaid membership under a
cost-plus contract with the state of Utah. The Utah health plans SCHIP and Medicare lines
of business are conducted under at risk prepaid capitation contracts. |
|
|
|
|
The medical care ratio of the Washington health plan increased to 82.3% in the first
half of 2008 from 80.6% in the first half of 2007. Fee-for-service hospital and specialist
costs as a percentage of premium revenue were higher in the first half of 2008 than in the
first half of 2007. The higher fee-for-service costs
were driven by increases to the Medicaid fee schedule that took effect on each of August
1, 2007 and January 1, 2008. |
29
General and Administrative Expenses
General and administrative expenses were $165.2 million, or 11.0% of total revenue, for the
first half of 2008 compared with $130.6 million, or 11.1% of total revenue, for the first half of
2007. This decrease was due primarily to a reduction in premium taxes in Michigan from 6.0% of
premium revenue to 5.5% of premium revenue effective January 1, 2008, and increased credits taken
against premium taxes in New Mexico during the first half of 2008.
Core G&A expenses increased to 8.0% of revenue in the first half of 2008 compared with 7.8% in
the first half of 2007. The increase in core G&A compared with the first half of 2007 was primarily
due to our continued investment in the administrative infrastructure necessary to support our
Medicare product line as indicated in the table below.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Six Months Ended June 30, |
|
|
|
2008 |
|
|
2007 |
|
|
|
|
|
|
|
% of Total |
|
|
|
|
|
|
% of Total |
|
|
|
Amount |
|
|
Revenue |
|
|
Amount |
|
|
Revenue |
|
|
|
(in thousands) |
|
|
|
|
|
|
(in thousands) |
|
|
|
|
|
Medicare-related administrative costs |
|
$ |
9,410 |
|
|
|
0.6 |
% |
|
$ |
3,679 |
|
|
|
0.3 |
% |
Non Medicare-related administrative costs: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Administrative payroll, including
employee incentive compensation |
|
|
92,603 |
|
|
|
6.2 |
|
|
|
74,901 |
|
|
|
6.4 |
|
All other administrative expense |
|
|
18,630 |
|
|
|
1.2 |
|
|
|
12,840 |
|
|
|
1.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Core G&A expenses |
|
$ |
120,643 |
|
|
|
8.0 |
% |
|
$ |
91,420 |
|
|
|
7.8 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
Depreciation and Amortization
Depreciation and amortization expense increased $3.3 million in the first half of 2008
compared with the first half of 2007, including a $1.9 million increase in depreciation expense due
to investments in infrastructure, and a $1.4 million increase in amortization expense, primarily
due to intangible assets associated with the 2007 Mercy CarePlus acquisition in Missouri.
Interest Expense
Interest expense in the first half of 2008
increased $2.7 million compared with the first half of 2007, principally due to the issuance of our $200 million 3.75% Convertible Senior Notes
in October 2007.
Income Taxes
Income taxes were recorded at
an effective rate of 40.8% in the first half of 2008 compared
with 38.1% in the first half of 2007. The increase in our effective tax rate was primarily the
result of a change in Michigan state taxes effective January 1, 2008. Prior to January 1, 2008
Michigan state taxes were calculated as a percentage of net income at a rate of 1.9%. As of January
1, 2008, the state income tax was changed to comprise three components on a combined filing basis:
a gross receipts tax calculated at 0.8% of modified gross receipts; an income tax calculated at
4.95% of income before taxes; and a surtax of 21.99% of the total of the previous two items.
30
Liquidity and Capital Resources
We generate cash from premium revenue and investment income. Our primary uses of cash include
the payment of expenses related to medical care services and G&A expenses. We generally receive
premium revenue in advance of payment of claims for related health care services.
Our investment policies are designed to provide liquidity, preserve capital, and maximize
total return on invested assets. As of June 30, 2008, we had cash and cash equivalents of $425.4
million, investments totaling $263.1 million, and restricted investments of $29.9 million. The cash
equivalents consist of highly liquid securities with original or purchase date remaining maturities
of up to three months that are readily convertible into known amounts of cash. Our investments
consisted of investment grade debt securities and are designated as available-for-sale. Of the
$263.1 million total, $196.3 million are classified as current assets, and $66.8 million are
classified as non-current assets (see further discussion below). Our investment policies require
that all of our investments have final maturities of ten years or less (excluding auction rate and
variable rate securities where interest rates are periodically reset) and that the average maturity
be four years or less. The restricted investments, classified as non-current assets and designated
as held-to-maturity, consist of interest-bearing deposits and U.S. treasury securities required by
the respective states in which we operate. These states also prescribe the types of instruments in
which our subsidiaries may invest their funds. Professional portfolio managers operating
under documented investment guidelines manage our investments. The average annualized portfolio
yield for the six months ended June 30, 2008 and 2007 was approximately 3.5% and 5.1%,
respectively.
Cash
provided by operating activities for the six months ended
June 30, 2008, was $39.5
million compared with $87.9 million for the same period in 2007,
a decrease of $48.4 million. The
decline was due primarily to the following: timing of the receipt of premiums recorded as deferred
revenue in Ohio and Washington netting to a $16.1 million decline year over year; the reversal of
$12.9 accrued costs relating to the minimum medical care ratio contract provision in New Mexico in
the first half of 2008; and the maturation of our operations in Texas
and Ohio during the first half of 2008. As enrollment grew at these
health plans during 2007, medical expense outpaced claims payments,
leading to increased claims liabilities. In the first half of 2008
enrollment has stabilized and medical expenses are no longer
outpacing claims payments.
We have a $200 million credit facility. Borrowings under this credit facility are based, at
our election, on the London Interbank Offered Rate, or LIBOR, or the base rate plus an applicable
margin. As of June 30, 2008, there were no amounts outstanding under this credit facility. See Note
6 to the condensed consolidated financial statements included in this quarterly report for more
information regarding our credit facility.
In April 2008, our board of directors authorized the repurchase of up to $30 million of our
common stock on the open market or through privately negotiated transactions. We used working
capital to fund the repurchases under this program. The timing and amount of repurchases (up to an
aggregate repurchase amount of $30 million) were primarily made pursuant to a trading plan dated as
of May 2, 2008. The trading plan became effective May 5, 2008, and terminated when the aggregate
cost of the repurchases totaled $30 million on June 12, 2008. During the quarter ended June 30,
2008, we repurchased 1.1 million shares. We did not repurchase any shares during the quarter ended
March 31, 2008.
On
July 22, 2008, our board of directors authorized the repurchase
of up to one million shares of our common stock. The repurchase
program will be funded using our working capital, and the timing and
amount of any shares repurchased will be made pursuant to a trading
plan. The repurchase program extends through December 31, 2008,
but we reserve the right to suspend or discontinue the program at any
time.
At June 30, 2008, we had working capital of $332.6 million compared with $404.7 million at
December 31, 2007. At June 30, 2008, the parent company (Molina Healthcare, Inc.) had cash and
investments of approximately $76.1 million, including $19.6 million in auction rate securities. We
believe that our cash resources and internally generated funds will be sufficient to support our
operations, regulatory requirements, and capital expenditures for at least the next 12 months.
31
Regulatory Capital and Dividend Restrictions
Our principal operations are conducted through our nine HMO subsidiaries operating in
California, Michigan, Missouri, Nevada, New Mexico, Ohio, Texas, Utah, and Washington. The HMOs are
subject to state laws that, among other things, require the maintenance of minimum levels of
statutory capital, as defined by each state, and may restrict the timing, payment, and amount of
dividends and other distributions that may be paid to Molina Healthcare, Inc. as the sole
stockholder of each of our HMOs.
The National Association of Insurance Commissioners, or NAIC, has established model rules
which, if adopted by a particular state, set minimum capitalization requirements for HMOs and other
insurance entities bearing risk for health care coverage. The requirements take the form of
risk-based capital, or RBC, rules. These rules, which vary slightly from state to state, have been
adopted in Michigan, Nevada, New Mexico, Ohio, Texas, Utah, and Washington. California and Missouri
have not adopted RBC rules, but have established their own minimum capitalization requirements.
At June 30, 2008, our HMOs had aggregate statutory capital and surplus of approximately $349.7
million, compared with the required minimum aggregate statutory capital and surplus of
approximately $207.6 million. All of our HMOs were in compliance with the minimum capital
requirements at June 30, 2008. We have the ability and commitment to provide additional capital to
each of our HMOs when necessary to ensure that they continue to meet statutory and regulatory
capital requirements.
Contractual Obligations
In our Annual Report on Form 10-K for the year ended December 31, 2007, we reported on our
contractual obligations as of that date. There have been no material changes to our contractual
obligations since that report.
Critical Accounting Policies
When we prepare our consolidated financial statements, we use estimates and assumptions that
may affect reported amounts and disclosures. The determination of our liability for claims and
medical benefits payable is particularly important to the determination of our financial position
and results of operations in any given period. This determination of our liability requires the
application of a significant degree of judgment by our management. As a result, the determination
of our liability for claims and medical benefits is subject to an inherent degree of uncertainty.
Our medical care costs include amounts that have been paid by us through the reporting date,
as well as estimated liabilities for medical care costs incurred but not paid by us as of the
reporting date. Such medical care liabilities include, among other items, capitation payments owed
providers, unpaid pharmacy invoices, and various medically related administrative costs that have
been incurred but not paid. We use judgment to determine the appropriate assumptions for
determining the required estimates.
The most important element in estimating our medical care costs is our estimate for
fee-for-service claims which have been incurred but not paid by us. These fee-for-service costs
that have been incurred but have not been paid at the reporting date are collectively referred to
as medical costs that are Incurred But Not Reported, or
IBNR. Our IBNR liability, as
reported in our balance sheet, represents our best estimate of the total amount of claims we will
ultimately pay with respect to claims that we have incurred as of the balance sheet date. We
estimate our IBNR monthly using actuarial methods based on a number of factors. Our estimated IBNR
liability represented $248.7 million of our total medical claims and benefits payable of $305.5
million as of June 30, 2008. Excluding IBNR related to our Utah health plan, where we are primarily
reimbursed on a cost-plus basis, our IBNR liability at June 30, 2008 was $231.9 million.
The factors we consider when estimating our IBNR include, without limitation, claims receipt
and payment experience (and variations in that experience), changes in membership, provider billing
practices, health care service utilization trends, cost trends, product mix, seasonality, prior
authorization of medical services, benefit changes, known outbreaks of disease or increased
incidence of illness such as influenza, provider contract changes, changes to Medicaid fee
schedules, the incidence of high dollar or catastrophic claims, entry into new geographic markets,
and modifications and upgrades to our claims processing systems and practices. Our assessment of
these factors is then translated into an estimate of our IBNR liability at the relevant measuring
point through the calculation of a base estimate IBNR, a further reserve for adverse claims development, and an estimate of the
administrative costs of
32
settling all claims incurred through the reporting date. The base estimate of IBNR is derived through application of claims payment completion factors and trended per member
per month (PMPM) cost estimates.
For the fifth month of service prior to the reporting date and earlier, we estimate our
outstanding claims liability based on actual claims paid, adjusted for estimated completion
factors. Completion factors seek to measure the cumulative percentage of claims expense that will
have been paid for a given month of service as of the reporting date, based on historical payment
patterns.
The following table reflects the change in our estimate of claims liability as of June 30,
2008 that would have resulted had we changed our completion factors for the fifth through the
twelfth months preceding June 30, 2008 by the percentages indicated. A reduction in the completion
factor results in an increase in medical claims liabilities. Our Utah health plan is excluded from
these calculations, because the majority of the Utah business is conducted under a cost-plus
reimbursement contract.
|
|
|
|
|
|
|
Increase (Decrease) in |
(Decrease) Increase in Estimated |
|
Medical Claims and |
Completion Factors |
|
Benefits Payable |
|
|
(in thousands) |
(6)% |
|
$ |
50,315 |
|
(4)% |
|
|
33,543 |
|
(2)% |
|
|
16,772 |
|
2% |
|
|
(16,772 |
) |
4% |
|
|
(33,543 |
) |
6% |
|
|
(50,315 |
) |
For the four months of service immediately prior to the reporting date, actual claims paid are
not a reliable measure of our ultimate liability, given the inherent delay between the
patient/physician encounter and the actual submission of a claim for payment. For these months of
service, we estimate our claims liability based on trended PMPM cost estimates. These estimates are
designed to reflect recent trends in payments and expense, utilization patterns, authorized
services, and other relevant factors. The following table reflects the change in our estimate of
claims liability as of June 30, 2008 that would have resulted
had we altered our trended PMPM factors by
the percentages indicated. An increase in the PMPM costs results in an increase in medical claims
liabilities. Our Utah HMO is excluded from these calculations, because the majority of the Utah
business is conducted under a cost-plus reimbursement contract.
|
|
|
|
|
(Decrease) Increase in |
|
(Decrease) Increase in |
Trended Per Member Per Month |
|
Medical Claims and |
Cost Estimates |
|
Benefits Payable |
|
|
(in thousands) |
(6)% |
|
$ |
(26,877 |
) |
(4)% |
|
|
(17,918 |
) |
(2)% |
|
|
(8,959 |
) |
2% |
|
|
8,959 |
|
4% |
|
|
17,918 |
|
6% |
|
|
26,877 |
|
Assuming a hypothetical 1% change in completion factors from those used in our calculation of
IBNR at June 30, 2008, net income for the six months ended June 30, 2008 would increase or decrease by
approximately $8.4 million pretax, or $0.18 per diluted share, net of tax. Assuming a hypothetical
1% change in PMPM cost estimates from those used in our calculation of IBNR at June 30, 2008, net
income for the six months ended June 30, 2008 would increase or
decrease by approximately $4.5 million pretax, or $0.09 per
diluted share, net of tax. The corresponding figures for a 5% change in completion factors and PMPM
cost estimates would be $41.9 million pretax, or $0.88 per
diluted share, net of tax, and $22.4
million pretax, or $0.47 per diluted share, net of tax, respectively.
It is important to note that any error in the estimate of either completion factors or trended
PMPM costs would usually be accompanied by an error in the estimate of the other component, and
that an error in one component would almost always compound rather than offset the resulting
distortion to net income. When completion factors are overestimated, trended PMPM costs tend to be underestimated. Both circumstances will
create an overstatement
33
of net income. Likewise, when completion factors are underestimated, trended PMPM costs tend to be overestimated, creating an understatement of net income. In other
words, errors in estimates involving both completion factors and trended PMPM costs will act to
drive estimates of claims liabilities and medical care costs in the same direction. For example, if
completion factors were overestimated by 1%, resulting in an overstatement of net income by $5.0
million, it is likely that trended PMPM costs would be underestimated, resulting in an additional
overstatement of net income.
After we have established our base IBNR reserve through the application of completion factors
and trended PMPM cost estimates, we then compute an additional liability, which also uses actuarial
techniques, to account for adverse developments in our claims payments which the base actuarial
model is not intended to and does not account for. We refer to this additional liability as the
provision for adverse claims development. The provision for adverse claims development is a
component of our overall determination of the adequacy of our IBNR. It is intended to capture the
adverse development of factors such as known outbreaks of disease such as influenza, our entry into
new geographic markets, our provision of services to new populations such as the aged, blind or
disabled (ABD), claims receipt and payment experience, changes in membership, cost trends, changes
to Medicaid fee schedules, incidence of high dollar or catastrophic claims, changes in provider
billing practices, health care service utilization trends, and modifications and upgrades to our
claims processing systems and practices. Because of the complexity of our business, the number of
states in which we operate, and the need to account for different health care benefit packages
among those states, we make an overall assessment of IBNR after considering the base actuarial
model reserves and the provision for adverse claims development. We also include in our IBNR
liability an estimate of the administrative costs of settling all claims incurred through the
reporting date. The development of IBNR is a continuous process that we monitor and refine on a
monthly basis as additional claims payment information becomes available. As additional information
becomes known to us, we adjust our actuarial model accordingly to establish IBNR.
On a monthly basis, we review and update our estimated IBNR liability and the methods used to
determine that liability. Any adjustments, if appropriate, are reflected in the period known. While
we believe our current estimates are adequate, we have in the past been required to increase
significantly our claims reserves for periods previously reported and may be required to do so
again in the future. Any significant increases to prior period claims reserves would materially
decrease reported earnings for the period in which the adjustment is made.
In our judgment, the estimates for completion factors will likely prove to be more accurate
than trended PMPM cost estimates because estimated completion factors are subject to fewer
variables in their determination. Specifically, completion factors are developed over long periods
of time, and are most likely to be affected by changes in claims receipt and payment experience and
by provider billing practices. Trended PMPM cost estimates, while affected by the same factors,
will also be influenced by health care service utilization trends, cost trends, product mix,
seasonality, prior authorization of medical services, benefit changes, outbreaks of disease or
increased incidence of illness, provider contract changes, changes to Medicaid fee schedules, the
incidence of high dollar or catastrophic claims, changes in membership, entry into new geographic
markets, and modifications and upgrades to our claims processing systems and practices. As
discussed above, however, errors in estimates involving trended PMPM costs will almost always be
accompanied by errors in estimates involving completion factors, and vice versa. In such
circumstances, errors in estimation involving both completion factors and trended PMPM costs will
act to drive estimates of claims liabilities (and therefore medical care costs) in the same
direction.
Assuming that base reserves have been adequately set, we believe that amounts ultimately paid
out should generally be between 8% and 10% less than the liability recorded at the end of the
period as a result of the inclusion in that liability of the allowance for adverse claims
development and the accrued cost of settling those claims. However, there can be no assurance that
amounts ultimately paid out will not be higher or lower than this 8% to 10% range, as shown by our
results in 2007 when the amounts ultimately paid out were less than the amount of our established
reserves by approximately 19%. As of June 30, 2008, we estimate that the total payout in
satisfaction of the liability established for claims and medical benefits payable at December 31,
2007 will be approximately 15% less than the amount originally recorded. This estimate may change
during the course of the year as more information becomes available.
The apparent overestimation of our liability for claims and medical benefits payable at
December 31, 2007 led to the recognition of a benefit from prior period claims development in the first half of
2008. The overestimation of
34
the claims liability at our Michigan and Washington health plans was principally the
cause of the recognition of a benefit from prior period claims development. This
was partially offset by the underestimation of our claims liability at December 31, 2007 at our
Missouri health plan:
|
|
|
In Michigan, we overestimated the upward trend in medical costs in the second half of
2007, principally due to claims processing difficulties during the third quarter of 2007
that exaggerated the upward trend in medical costs. |
|
|
|
|
In Washington, we did not fully account for reduced utilization of medical services in
the fourth quarter of 2007, thus overestimating our liability at December 31, 2007. |
|
|
|
|
In Missouri, we underestimated the upward trend in medical costs during the latter half
of 2007 that was driven by an increase in the Medicaid fee schedule effective July 1, 2007.
Additionally, we underestimated the impact of the underpayment of certain hospital claims
in the second half of 2007. Additional payments were made on many of those claims in the
first quarter of 2008. |
The recognition of a benefit from prior period claims development did not have a material
impact on our consolidated results of operations in the first half of 2008.
In estimating our claims liability at June 30, 2008, we adjusted our base calculation to take
account of the impact of the following factors which we believe are reasonably likely to change our
final claims liability amount (some of the factors listed below were also factors impacting our
final claims liability amount at December 31, 2007):
|
|
|
Our assessment regarding the impact of some overpayments made to certain Ohio providers
in 2007 and 2006 and the impact of those overpayments on estimated medical cost trends. |
|
|
|
|
The impact of the increased incidence of respiratory illness in the first quarter of
2008 as compared to previous years. |
|
|
|
|
Costs associated with our newly acquired membership in Missouri, as well as the impact
of any difference between our claims payment policies and those used by the prior
management of our Missouri health plan. |
|
|
|
|
Increases in claims inventory at our California and Michigan
health plans during the second quarter of
2008. |
|
|
|
|
Decreases in claims inventory at our New Mexico, Ohio, and
Washington health plans during the second
quarter of 2008. |
|
|
|
|
The addition, effective April 1, 2008, of approximately 35,000 members to our Ohio
health plan. |
Any absence of adverse claims development (as well as the expensing of the costs, through
general and administrative expense, to settle claims held at the start of the period) will lead to
the recognition of a benefit from prior period claims development in the period subsequent to the
date of the original estimate. However, that benefit will affect current period earnings only to
the extent that the replenishment of the reserve for adverse claims development (and the re-accrual
of administrative costs for the settlement of those claims) is less than the benefit recognized
from the prior period liability.
We seek to maintain a consistent claims reserving methodology across all periods. Accordingly,
any prior period benefit from an un-utilized reserve for adverse claims development would likely be
offset by the establishment of a new reserve in an approximately equal amount (relative to premium
revenue, medical care costs, and medical claims and benefits payable) in the current period, and
thus the impact on earnings for the current period would likely be minimal.
The following table presents the components of the change in our medical claims and benefits
payable for the periods indicated. The negative amounts displayed for components of medical care
costs related to prior years represent the amount by which our original estimate of claims and
benefits payable at the beginning of the period exceeded the actual amount of the liability based
on information (principally the payment of claims) developed since
that liability was first reported. The benefit of this prior period development may be offset
by the addition of a
35
reserve for adverse claims development when estimating the liability at the end of the period (captured as a component of medical care costs related to current year).
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
As of and for |
|
|
|
As of and for the |
|
|
the Year Ended |
|
|
|
Six Months Ended June 30, |
|
|
December 31, |
|
|
|
2008 |
|
|
2007 |
|
|
2007 |
|
|
|
(dollar amounts in thousands) |
|
Balances at beginning of period |
|
$ |
311,606 |
|
|
$ |
290,048 |
|
|
$ |
290,048 |
|
Medical claims and benefits payable from business acquired |
|
|
|
|
|
|
|
|
|
|
14,876 |
|
Components of medical care costs related to: |
|
|
|
|
|
|
|
|
|
|
|
|
Current year |
|
|
1,315,469 |
|
|
|
1,036,378 |
|
|
|
2,136,381 |
|
Prior years |
|
|
(48,293 |
) |
|
|
(43,036 |
) |
|
|
(56,298 |
) |
|
|
|
|
|
|
|
|
|
|
Total medical care costs |
|
|
1,267,176 |
|
|
|
993,342 |
|
|
|
2,080,083 |
|
Payments for medical care costs related to: |
|
|
|
|
|
|
|
|
|
|
|
|
Current year |
|
|
1,043,522 |
|
|
|
764,638 |
|
|
|
1,851,035 |
|
Prior years |
|
|
229,719 |
|
|
|
215,513 |
|
|
|
222,366 |
|
|
|
|
|
|
|
|
|
|
|
Total paid |
|
|
1,273,241 |
|
|
|
980,151 |
|
|
|
2,073,401 |
|
|
|
|
|
|
|
|
|
|
|
Balances at end of period |
|
$ |
305,541 |
|
|
$ |
303,239 |
|
|
$ |
311,606 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Benefit from prior period as a percentage of balance at
beginning of period |
|
|
15.5 |
% |
|
|
14.8 |
% |
|
|
19.4 |
% |
Benefit from prior period as a percentage of premium
revenue |
|
|
3.2 |
% |
|
|
3.7 |
% |
|
|
2.3 |
% |
Benefit from prior period as a percentage of total
medical care costs |
|
|
3.8 |
% |
|
|
4.3 |
% |
|
|
2.7 |
% |
Days in claims payable |
|
|
47 |
|
|
|
54 |
|
|
|
52 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of members at end of period |
|
|
1,234,000 |
|
|
|
1,076,000 |
|
|
|
1,149,000 |
|
Number of claims in inventory at end of period |
|
|
151,500 |
|
|
|
254,800 |
|
|
|
161,400 |
|
Billed charges of claims in inventory at end of period |
|
$ |
209,100 |
|
|
$ |
260,100 |
|
|
$ |
212,000 |
|
Claims in inventory per member at end of period |
|
|
0.12 |
|
|
|
0.24 |
|
|
|
0.14 |
|
Inflation
We use various strategies to mitigate the negative effects of health care cost inflation.
Specifically, our health plans try to control medical and hospital costs through contracts with
independent providers of health care services. Through these contracted providers, our health plans
emphasize preventive health care and appropriate use of specialty and hospital services. There can
be no assurance, however, that our strategies to mitigate health care cost inflation will be
successful. Competitive pressures, new health care and pharmaceutical product introductions,
demands from health care providers and customers, applicable regulations, or other factors may
affect our ability to control health care costs.
Compliance Costs
Our health plans are regulated by both state and federal government agencies. Regulation of
managed care products and health care services is an evolving 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 occur frequently.
Compliance with such laws and rules may lead to additional costs related to the implementation of
additional systems, procedures and programs that we have not yet identified.
Item 3. Quantitative and Qualitative Disclosures About Market Risk.
Concentrations of Credit Risk
Financial instruments that potentially subject us to concentrations of credit risk consist
primarily of cash and cash equivalents, investments, receivables, and restricted investments. We
invest a substantial portion of our cash in the CADRE Liquid Asset Fund and CADRE Reserve Fund
(CADRE Funds), a portfolio of highly liquid money market securities. Professional portfolio
managers operating under documented investment guidelines manage our investments. Restricted investments are invested principally in certificates of deposit
and U.S. treasury
36
securities. Concentration of credit risk with respect to accounts receivable is
limited due to payors consisting principally of the governments of each state in which our HMO
subsidiaries operate.
As of June 30, 2008, we held investments in auction rate securities, totaling $71.8 million,
with a fair value of $66.8 million, which are required to be measured at fair value on a recurring
basis. Our auction rate securities are designated as available-for-sale securities and are
reflected at fair value. Prior to January 1, 2008, these securities were recorded at fair value
based on quoted prices in active markets (i.e., SFAS 157 Level 1 data). Liquidity for these auction
rate securities is typically provided by an auction process which allows holders to sell their
notes, and which resets the applicable interest rate at pre-determined intervals, usually every 7,
28, or 35 days. However, due to recent events in the credit markets, the auction events for some of
these instruments failed during the first half of 2008. An auction failure means that the parties
wishing to sell their securities could not be matched with an adequate volume of buyers. Therefore,
the fair values of these securities were estimated using a discounted cash flow analysis or other
type of valuation model as of June 30, 2008. These analyses considered, among other things, the
collateralization underlying the securities, the creditworthiness of the counterparty, the timing
of expected future cash flows, and the expectation of the next time the security would be expected
to have a successful auction. The estimated values of these securities were also compared, when
possible, to valuation data with respect to similar securities held by other parties.
As a result of the declines in fair value for our investments in auction rate securities,
which we deem to be temporary and attribute to liquidity issues rather than to credit issues, we
have recorded an unrealized loss of $5.0 million to accumulated other comprehensive income for the
six months ended June 30, 2008. Substantially all of the $66.8 million in auction rate security
instruments held by us at June 30, 2008 were in securities collateralized by student loans, which
loans are guaranteed by the U.S. government. Due to our belief that the market for these student
loan collateralized instruments may take in excess of twelve months to fully recover, we have
classified these investments as non-current, and have included them in investments on the unaudited
condensed consolidated balance sheet at June 30, 2008. As of June 30, 2008, we continue to earn
interest on our auction rate security instruments. Any future fluctuation in fair
value related to these instruments that we deem to be temporary, including any recoveries of
previous write-downs, would be recorded to accumulated other comprehensive (loss) income. If we
determine that any future valuation adjustment was other than temporary, we would record a charge
to earnings as appropriate.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures: Our management, with the participation of
our Chief Executive Officer and our Chief Financial Officer, has concluded, based upon its
evaluation as of the end of the period covered by this report, that the Companys disclosure
controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange
Act of 1934 (the Exchange Act)) are effective to ensure that information required to be disclosed
in the reports that we file or submit under the Exchange Act is recorded, processed, summarized,
and reported within the time periods specified in the Securities and Exchange Commissions rules
and forms.
Changes in Internal Control Over Financial Reporting: There has been no change in our internal
control over financial reporting during the three months ended June 30, 2008 that has materially
affected, or is reasonably likely to materially affect, our internal controls over financial
reporting.
37
PART II OTHER INFORMATION
Item 1. Legal Proceedings
The health care industry is subject to numerous laws and regulations of federal, state, and
local governments. Compliance with these laws and regulations can be subject to government review
and interpretation, as well as regulatory actions unknown and unasserted at this time. Penalties
associated with violations of these laws and regulations include significant fines and penalties,
exclusion from participating in publicly-funded programs, and the repayment of previously billed
and collected revenues.
Malpractice Action. On February 1, 2007, a complaint was filed in the Superior Court of the
State of California for the County of Riverside by plaintiff Staci Robyn Ward through her guardian
ad litem, Case No. 465374. The complaint purports to allege claims for medical malpractice against
several unaffiliated physicians, medical groups, and hospitals, including Molina Medical Centers
and one of its physician employees. The plaintiff alleges that the defendants failed to properly
diagnose her medical condition which has resulted in her severe and permanent disability. On July
22, 2007, the plaintiff passed away. The proceeding is in the discovery stage, and no prediction
can be made as to the outcome.
Starko. Our New Mexico HMO is named as a defendant in a class action lawsuit brought by New
Mexico pharmacies and pharmacists, Starko, Inc., et al. v. NMHSD, et al., No. CV-97-06599, Second
Judicial District Court, State of New Mexico. The lawsuit was originally filed in August 1997
against the New Mexico Human Services Department (NMHSD). In February 2001, the plaintiffs named
health maintenance organizations participating in the New Mexico Medicaid program as defendants
(the HMOs), including Cimarron Health Plan, the predecessor of our New Mexico HMO. The plaintiffs
assert that NMHSD and the HMOs failed to pay pharmacy dispensing fees under an alleged New Mexico
statutory mandate. On July 10, 2007, the court dismissed all damages claims against Molina
Healthcare of New Mexico, leaving at that time only a pending action for injunctive and declaratory
relief. On August 15, 2007, the court dismissed all remaining claims against Molina Healthcare of
New Mexico, including the action for injunctive and declaratory relief. The plaintiffs have filed
an appeal with respect to the courts dismissal orders, and the parties have submitted their
respective appellate briefs and are awaiting oral argument. Under the terms of the stock purchase agreement pursuant to which we
acquired Health Care Horizons, Inc., the parent company to the Molina Healthcare of New Mexico, an
indemnification escrow account was established and funded with $6.0 million to indemnify Molina
Healthcare of New Mexico against the costs of such litigation and any eventual liability or
settlement costs. As of June 30, 2008, approximately $4.2 million remained in the indemnification
escrow fund.
We are involved in other legal actions in the normal course of business, some of which seek
monetary damages, including claims for punitive damages, which are not covered by insurance. These
actions, individually or in the aggregate, when finally concluded and determined, are not likely,
in our opinion, to have a material adverse effect on our consolidated financial position, results
of operations, or cash flows.
Item 1A. Risk Factors
Our investment portfolio may suffer losses from reductions in market interest rates and
fluctuations in fixed income securities which could materially and adversely affect our results of
operations or liquidity.
As of June 30, 2008, our portfolio of fixed income securities totaled $263.1 million, our cash
and cash equivalents totaled $425.4 million, and restricted investments held as collateral totaled
$29.9 million. This portfolio of holdings generated investment income totaling approximately 25%
and 36% of our pretax income for the six months ended June 30, 2008 and 2007, respectively. The
performance of our portfolio is interest rate driven. Therefore, volatility in interest rates, such
as the recent actions by the Federal Reserve Bank Board, affects our returns on and the market
value of our portfolio. This and any future reductions in the federal funds interest rate or other
disruptions in the credit markets could materially and adversely affect our results of operations
and liquidity.
38
A mandated retroactive change to the inpatient per diem rates paid by our California health plan to
non-contracted hospitals could have a materially adverse effect on our results of operations.
Under the so-called Rogers Amendment to the Medicaid provisions of the Deficit Reduction Act
of 2005,
42 U.S.C. § 1396u-2(b)(2)(D), a Medicaid provider which does not have a contract with a
Medicaid managed care entity must accept as payment the amount otherwise applicable outside of
managed care minus any payments for indirect costs of medical education and direct costs of
graduate medical education. For purposes of a state where rates paid to hospitals are negotiated by
contract and not publicly released, such as in California, the amount applicable under this
requirement is the average contract rate that would apply under the State plan for general acute
care hospitals or the average contract rate that would apply under such plan for tertiary
hospitals.
There is a disagreement among health plans and hospitals over how this payment language
regarding average contract rates should be applied to the Medicaid program in California, known as
Medi-Cal. The California Department of Health Care Services, known as DHCS, has convened a
collaborative workgroup of health plans, hospitals, industry associations, and government
representatives to discuss the appropriate application of the Rogers Amendment to non-contracted
providers of emergency services in California. A recent DHCS proposal to the workgroup provides for
the creation of weighted average per diem rates for both tertiary and non-tertiary hospitals, and
for the retroactive application of these per diem rates to January 1, 2007, the effective date of
the Rogers Amendment. Because the proposed per diem rates are materially greater than the existing
average contract rates paid by our California health plan to non-contracting hospitals, if this
proposal were to become effective, the resulting additional cost to the Companys California health
plan could have a materially adverse effect on our results of operations.
In addition to the other information and risk factors set forth in this report, you should
carefully consider the risk factors discussed in Part I, Item 1A Risk Factors, in our Annual
Report on Form 10-K for the year ended December 31, 2007. The risks described herein and in our
Annual Report on Form 10-K are not the only risks facing our Company. Additional risks and
uncertainties not currently known to us or that we currently deem to be immaterial may also
materially adversely affect our business, financial condition, and/or operating results.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
On
June 30, 2008, we issued a total of 48,186 shares of our common stock in reliance upon the
exemption from securities registration provided by Section 4(2) of the Securities Act of 1933.
The shares were issued to a single accredited investor for investment purposes in connection
with our acquisition of all of the assets of The Game of Work, LLC, a Utah limited liability
company. The total agreed-upon consideration for the assets, including both the unregistered
shares issued and cash, was approximately $2.3 million.
Issuer Purchases of Equity Securities
As publicly announced on April 29, 2008, our board of directors authorized the repurchase of
up to $30 million of our common stock on the open market or through privately negotiated
transactions. We used working capital to fund the repurchases under this program. The timing and
amount of repurchases (up to an aggregate repurchase amount of $30 million) were primarily made
pursuant to a Rule 10b5-1 trading plan dated as of May 2, 2008. The Rule 10b5-1 plan became
effective May 5, 2008, and terminated when the aggregate cost of the repurchases totaled $30
million on June 12, 2008. Purchases of common stock made by or on behalf of the Company during the
quarter ended June 30, 2008 are set forth below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total Number of |
|
Maximum Number (or |
|
|
|
|
|
|
|
|
|
|
|
Shares Purchased as |
|
Approximate Dollar Value) |
|
|
Total Number |
|
|
|
|
|
Part of Publicly |
|
of Shares That May Yet Be |
|
|
of Shares |
|
Average Price |
|
Announced Plans or |
|
Purchased Under the Plans |
|
|
Purchased |
|
Paid per Share |
|
Programs |
|
or Programs |
April 1 April 30, 2008 |
|
|
|
|
|
|
|
|
|
|
|
|
|
$ |
30,000,000 |
|
May 1 May 31, 2008 |
|
|
731,000 |
|
|
$ |
25.3953 |
|
|
|
731,000 |
|
|
$ |
11,414,000 |
|
June 1 June 30, 2008 |
|
|
399,789 |
|
|
$ |
28.5203 |
|
|
|
399,789 |
|
|
|
|
|
Total |
|
|
1,130,789 |
|
|
$ |
26.5001 |
|
|
|
1,130,789 |
|
|
|
|
|
39
Item 4. Submission of Matters to a Vote of Security Holders
At our 2008 Annual Meeting of Stockholders held on May 15, 2008, our stockholders elected
three Class III directors as follows:
|
|
|
|
|
|
|
|
|
Director |
|
Votes For |
|
Votes Withheld |
J. Mario Molina |
|
|
26,166,849 |
|
|
|
66,103 |
|
Steven J. Orlando |
|
|
26,067,885 |
|
|
|
165,067 |
|
Ronna E. Romney |
|
|
26,067,470 |
|
|
|
165,482 |
|
The three directors terms as Class III directors shall continue until the 2011 Annual Meeting
of Stockholders. There were no additional matters voted upon at the Annual Meeting.
Item 5. Other Information.
None.
Item 6. Exhibits
A list of exhibits required to be filed as part of this Quarterly Report on Form 10-Q is set
forth in the Index to Exhibits, which immediately precedes such exhibits, and is incorporated
herein by this reference.
40
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly
caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
|
|
|
|
|
|
MOLINA HEALTHCARE, INC.
(Registrant)
|
|
|
/s/ JOSEPH M. MOLINA, M.D.
|
|
|
Joseph M. Molina, M.D. |
|
|
Chairman of the Board,
Chief Executive Officer and President
(Principal Executive Officer) |
|
|
Dated:
July 30, 2008
|
|
|
|
|
|
/s/ JOHN C. MOLINA, J.D.
|
|
|
John C. Molina, J.D. |
|
|
Chief Financial Officer and Treasurer
(Principal Financial Officer) |
|
|
Dated:
July 30, 2008
41
EXHIBIT INDEX
|
|
|
Exhibit No. |
|
Title |
31.1
|
|
Certification of Chief Executive Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as
amended. |
|
|
|
31.2
|
|
Certification of Chief Financial Officer pursuant to Rules 13a-14(a)/15d-14(a) under the Securities Exchange Act of 1934, as
amended. |
|
|
|
32.1
|
|
Certification of Chief Executive Officer pursuant to 18 U.S.C.
Section 1350, as adopted pursuant to Section 906 of the
Sarbanes-Oxley Act of 2002. |
|
|
|
32.2
|
|
Certification of Chief Financial Officer pursuant to 18 U.S.C.
Section 1350, as adopted pursuant to Section 906 of the
Sarbanes-Oxley Act of 2002. |
42