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| þ | QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
| o | TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
| Delaware | 13-4204626 | |
| (State or other jurisdiction of | (I.R.S. Employer | |
| incorporation or organization) | Identification No.) | |
| 200 Oceangate, Suite 100 | ||
| Long Beach, California | 90802 | |
| (Address of principal executive offices) | (Zip Code) |
| Large accelerated filer o | Accelerated filer þ | Non-accelerated filer o | Smaller reporting company o | |||
| (Do not check if a smaller reporting company) |
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| Exhibit 31.1 | ||||||||
| Exhibit 31.2 | ||||||||
| Exhibit 32.1 | ||||||||
| Exhibit 32.2 | ||||||||
2
| September 30, | December 31, | |||||||
| 2010 | 2009 | |||||||
| (Amounts in thousands, | ||||||||
| except per-share data) | ||||||||
| (Unaudited) | ||||||||
|
ASSETS
|
||||||||
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Current assets:
|
||||||||
|
Cash and cash equivalents
|
$ | 426,455 | $ | 469,501 | ||||
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Investments
|
195,358 | 174,844 | ||||||
|
Receivables
|
225,547 | 136,654 | ||||||
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Income and related taxes refundable
|
2,755 | 6,067 | ||||||
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Deferred income taxes
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7,580 | 8,757 | ||||||
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Prepaid expenses and other current assets
|
25,185 | 15,583 | ||||||
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||||||||
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Total current assets
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882,880 | 811,406 | ||||||
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Property and equipment, net
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91,826 | 78,171 | ||||||
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Deferred contract costs
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20,255 | | ||||||
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Intangible assets, net
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115,270 | 80,846 | ||||||
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Goodwill and indefinite-lived intangible assets
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213,261 | 133,408 | ||||||
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Investments
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20,294 | 59,687 | ||||||
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Restricted investments
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45,047 | 36,274 | ||||||
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Receivable for ceded life and annuity contracts
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25,134 | 25,455 | ||||||
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Other assets
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17,463 | 19,988 | ||||||
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||||||||
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$ | 1,431,430 | $ | 1,245,235 | ||||
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||||||||
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LIABILITIES AND STOCKHOLDERS EQUITY
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||||||||
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Current liabilities:
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||||||||
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Medical claims and benefits payable
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$ | 355,140 | $ | 316,516 | ||||
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Accounts payable and accrued liabilities
|
117,299 | 71,732 | ||||||
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Deferred revenue
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37,648 | 101,985 | ||||||
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Total current liabilities
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510,087 | 490,233 | ||||||
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Long-term debt
|
162,700 | 158,900 | ||||||
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Deferred income taxes
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16,773 | 12,506 | ||||||
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Liability for ceded life and annuity contracts
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25,134 | 25,455 | ||||||
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Other long-term liabilities
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19,004 | 15,403 | ||||||
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Total liabilities
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733,698 | 702,497 | ||||||
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Stockholders equity:
|
||||||||
|
Common stock, $0.001 par value; 80,000 shares
authorized; outstanding: 30,207 shares at
September 30, 2010 and 25,607 shares at
December 31, 2009
|
30 | 26 | ||||||
|
Preferred stock, $0.001 par value;
20,000 shares authorized, no shares issued and
outstanding
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| | ||||||
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Additional paid-in capital
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247,845 | 129,902 | ||||||
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Accumulated other comprehensive loss
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(2,107 | ) | (1,812 | ) | ||||
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Retained earnings
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451,964 | 414,622 | ||||||
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||||||||
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Total stockholders equity
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697,732 | 542,738 | ||||||
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$ | 1,431,430 | $ | 1,245,235 | ||||
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3
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (Amounts in thousands, except | ||||||||||||||||
| net income per share) | ||||||||||||||||
| (Unaudited) | ||||||||||||||||
|
Revenue:
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||||||||||||||||
|
Premium revenue
|
$ | 1,005,115 | $ | 914,805 | $ | 2,947,020 | $ | 2,697,796 | ||||||||
|
Service revenue
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32,271 | | 53,325 | | ||||||||||||
|
Investment income
|
1,760 | 1,707 | 4,880 | 7,336 | ||||||||||||
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||||||||||||||||
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Total revenue
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1,039,146 | 916,512 | 3,005,225 | 2,705,132 | ||||||||||||
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Expenses:
|
||||||||||||||||
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Medical care costs
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845,937 | 792,771 | 2,508,366 | 2,333,865 | ||||||||||||
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Cost of service revenue
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27,605 | | 41,859 | | ||||||||||||
|
General and administrative expenses
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88,660 | 68,563 | 245,619 | 198,981 | ||||||||||||
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Premium tax expenses
|
35,037 | 30,257 | 104,578 | 87,612 | ||||||||||||
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Depreciation and amortization
|
11,954 | 9,832 | 33,234 | 28,468 | ||||||||||||
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Total expenses
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1,009,193 | 901,423 | 2,933,656 | 2,648,926 | ||||||||||||
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||||||||||||||||
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Gain on retirement of convertible senior notes
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| | | 1,532 | ||||||||||||
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Operating income
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29,953 | 15,089 | 71,569 | 57,738 | ||||||||||||
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Interest expense
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(4,600 | ) | (3,279 | ) | (12,056 | ) | (9,917 | ) | ||||||||
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Income before income taxes
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25,353 | 11,810 | 59,513 | 47,821 | ||||||||||||
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Provision for income taxes
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9,180 | 3,246 | 22,171 | 12,481 | ||||||||||||
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Net income
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$ | 16,173 | $ | 8,564 | $ | 37,342 | $ | 35,340 | ||||||||
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Net income per share:
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Basic
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$ | 0.58 | $ | 0.34 | $ | 1.41 | $ | 1.36 | ||||||||
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Diluted
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$ | 0.57 | $ | 0.33 | $ | 1.39 | $ | 1.36 | ||||||||
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Weighted average shares outstanding:
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Basic
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28,118 | 25,539 | 26,511 | 25,944 | ||||||||||||
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Diluted
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28,363 | 25,630 | 26,802 | 26,058 | ||||||||||||
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4
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (Amounts in thousands) | ||||||||||||||||
| (Unaudited) | ||||||||||||||||
|
Net income
|
$ | 16,173 | $ | 8,564 | $ | 37,342 | $ | 35,340 | ||||||||
|
Other comprehensive income, net of tax:
|
||||||||||||||||
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Unrealized (loss) gain on investments
|
(68 | ) | 37 | (295 | ) | 645 | ||||||||||
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||||||||||||||||
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Other comprehensive (loss) income
|
(68 | ) | 37 | (295 | ) | 645 | ||||||||||
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Comprehensive income
|
$ | 16,105 | $ | 8,601 | $ | 37,047 | $ | 35,985 | ||||||||
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||||||||||||||||
5
| Nine Months Ended | ||||||||
| September 30, | ||||||||
| 2010 | 2009 | |||||||
| (Amounts in thousands) | ||||||||
| (Unaudited) | ||||||||
|
Operating activities:
|
||||||||
|
Net income
|
$ | 37,342 | $ | 35,340 | ||||
|
Adjustments to reconcile net income to net cash provided by operating activities:
|
||||||||
|
Depreciation and amortization
|
40,485 | 28,468 | ||||||
|
Unrealized gain on trading securities
|
(4,170 | ) | (3,509 | ) | ||||
|
Loss on rights agreement
|
3,807 | 3,204 | ||||||
|
Deferred income taxes
|
4,463 | 2,322 | ||||||
|
Stock-based compensation
|
7,268 | 5,730 | ||||||
|
Non-cash interest on convertible senior notes
|
3,800 | 3,563 | ||||||
|
Gain on repurchase and retirement of convertible senior notes
|
| (1,532 | ) | |||||
|
Amortization of deferred financing costs
|
1,278 | 1,040 | ||||||
|
Tax deficiency from employee stock compensation recorded as additional paid-in
capital
|
(676 | ) | (704 | ) | ||||
|
Changes in operating assets and liabilities:
|
||||||||
|
Receivables
|
(64,896 | ) | (15,567 | ) | ||||
|
Prepaid expenses and other current assets
|
(8,307 | ) | 454 | |||||
|
Medical claims and benefits payable
|
33,947 | 10,672 | ||||||
|
Accounts payable and accrued liabilities
|
15,131 | (6,140 | ) | |||||
|
Deferred revenue
|
(64,337 | ) | 61,381 | |||||
|
Income taxes
|
3,327 | 5,561 | ||||||
|
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||||||||
|
Net cash provided by operating activities
|
8,462 | 130,283 | ||||||
|
|
||||||||
|
Investing activities:
|
||||||||
|
Purchases of equipment
|
(31,918 | ) | (28,390 | ) | ||||
|
Purchases of investments
|
(162,620 | ) | (127,335 | ) | ||||
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Sales and maturities of investments
|
185,193 | 149,770 | ||||||
|
Net cash paid in business combinations
|
(127,231 | ) | (10,900 | ) | ||||
|
Increase in deferred contract costs
|
(20,616 | ) | | |||||
|
Increase in restricted investments
|
(8,513 | ) | (4,198 | ) | ||||
|
Increase in other assets
|
(389 | ) | (1,877 | ) | ||||
|
Increase (decrease) in other long-term liabilities
|
2,729 | (8,788 | ) | |||||
|
|
||||||||
|
Net cash used in investing activities
|
(163,365 | ) | (31,718 | ) | ||||
|
|
||||||||
|
Financing activities:
|
||||||||
|
Amount borrowed under credit facility
|
105,000 | | ||||||
|
Proceeds from common stock offering, net of underwriting discount
|
111,578 | | ||||||
|
Repayment of amount borrowed under credit facility
|
(105,000 | ) | | |||||
|
Treasury stock purchases
|
| (27,712 | ) | |||||
|
Purchase of convertible senior notes
|
| (9,653 | ) | |||||
|
Credit facility fees paid
|
(1,671 | ) | | |||||
|
Equity offering costs paid
|
(332 | ) | | |||||
|
Proceeds from employee stock plans
|
1,862 | 1,081 | ||||||
|
Excess tax benefits from employee stock compensation
|
420 | 26 | ||||||
|
|
||||||||
|
Net cash provided by (used in) financing activities
|
111,857 | (36,258 | ) | |||||
|
|
||||||||
|
Net (decrease) increase in cash and cash equivalents
|
(43,046 | ) | 62,307 | |||||
|
Cash and cash equivalents at beginning of period
|
469,501 | 387,162 | ||||||
|
|
||||||||
|
Cash and cash equivalents at end of period
|
$ | 426,455 | $ | 449,469 | ||||
|
|
||||||||
6
| Nine Months Ended | ||||||||
| September 30, | ||||||||
| 2010 | 2009 | |||||||
| (Amounts in thousands) | ||||||||
| (Unaudited) | ||||||||
|
Supplemental cash flow information:
|
||||||||
|
Cash paid during the period for:
|
||||||||
|
Income taxes
|
$ | 12,129 | $ | 16,305 | ||||
|
|
||||||||
|
Interest
|
$ | 7,175 | $ | 4,254 | ||||
|
|
||||||||
|
Schedule of non-cash investing and financing activities:
|
||||||||
|
Unrealized (loss) gain on investments
|
$ | (476 | ) | $ | 936 | |||
|
Deferred taxes
|
181 | (291 | ) | |||||
|
|
||||||||
|
Net unrealized (loss) gain on investments
|
$ | (295 | ) | $ | 645 | |||
|
|
||||||||
|
Accrued purchases of equipment
|
$ | 632 | $ | 366 | ||||
|
|
||||||||
|
Retirement of common stock used for stock-based compensation
|
$ | 2,173 | $ | 920 | ||||
|
|
||||||||
|
Retirement of treasury stock
|
$ | | $ | 48,102 | ||||
|
|
||||||||
|
Details of business combinations:
|
||||||||
|
Fair value of assets acquired
|
$ | (161,862 | ) | $ | (30,600 | ) | ||
|
Fair value of liabilities assumed
|
25,880 | | ||||||
|
Release of deposit
|
| 9,000 | ||||||
|
Payable to seller
|
8,751 | 10,700 | ||||||
|
|
||||||||
|
Net cash paid in business combinations
|
$ | (127,231 | ) | $ | (10,900 | ) | ||
|
|
||||||||
7
8
9
10
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Depreciation and amortization
|
$ | 11,954 | $ | 9,832 | $ | 33,234 | $ | 28,468 | ||||||||
|
Amortization recorded as contra-service revenue
|
2,655 | | 4,246 | | ||||||||||||
|
Depreciation recorded as cost of service revenue
|
1,964 | | 3,005 | | ||||||||||||
|
|
||||||||||||||||
|
Depreciation and amortization reported in our
consolidated statements of cash flows
|
$ | 16,573 | $ | 9,832 | $ | 40,485 | $ | 28,468 | ||||||||
|
|
||||||||||||||||
11
| |
ASU No. 2009-14, Software (ASC Topic 985)
Certain Revenue Arrangements That Include
Software Elements
, a consensus of the FASB Emerging Issues Task Force. This guidance
modifies the scope of ASC Subtopic 985-605
Software-Revenue Recognition
to exclude from
its requirements (a) non-software components of tangible products and (b) software
components of tangible products that are sold, licensed or leased with tangible products
when the software components and non-software components of the tangible product function
together to deliver the tangible products essential functionality. We do not expect the
update to impact our consolidated financial position, results of operations or cash flows.
|
| |
ASU No. 2009-13, Revenue Recognition (ASC
Topic 605) —
Multiple-Deliverable Revenue Arrangements
, a
consensus of the FASB Emerging Issues Task Force. This guidance modifies
previous requirements by allowing the use of the best estimate of
selling price in the absence of vendor-specific objective evidence
(“VSOE”) or verifiable objective evidence (VOE) (now
referred to as TPE or third-party evidence) for determining the
selling price of a deliverable. A vendor is now required to use its best
estimate of the selling price when more objective evidence of the selling price
cannot be determined. In addition, the residual method of allocating
arrangement consideration is no longer permitted. We do not expect the update
to impact our consolidated financial position, results of operations or cash
flows.
|
| |
ASU No. 2010-6, Fair Value Measurements and Disclosures (Topic 820)
Improving
Disclosures about Fair Value Measurements
. This guidance requires (a) separate disclosure of
the amounts of significant transfers in and out of Level 1 and Level 2 fair value
measurements along with the reasons for such transfers, (b) information about purchases,
sales, issuances and settlements to be presented separately in the reconciliation for Level 3
fair value measurements, (c) fair value measurement disclosures for each class of assets and
liabilities and (d) disclosures about the valuation techniques and inputs used to measure
fair value for both recurring and nonrecurring fair value measurements for fair value
measurements that fall in either Level 2 or Level 3. The adoption of this guidance did not
impact our consolidated financial position, results of operations or cash flows.
|
12
| May 1, 2010 | ||||
| (In thousands) | ||||
|
Assets
|
||||
|
Accounts receivable
|
$ | 17,128 | ||
|
Other current assets
|
3,884 | |||
|
Equipment and other long-term assets
|
783 | |||
|
Identifiable intangible assets
|
48,150 | |||
|
Goodwill
|
72,943 | |||
|
|
||||
|
|
142,888 | |||
|
Less: liabilities
|
||||
|
Accounts payable and accrued liabilities
|
11,153 | |||
|
Deferred tax liability
|
115 | |||
|
Other long-term liabilities
|
370 | |||
|
|
||||
|
Net assets acquired
|
$ | 131,250 | ||
|
|
||||
| Estimated Fair | Weighted Average | |||||||
| Value | Useful Life | |||||||
| (In thousands) | (years) | |||||||
|
Customer relationships
|
$ | 24,550 | 5.2 | |||||
|
Contract backlog
|
23,600 | 3.3 | ||||||
|
|
||||||||
|
|
$ | 48,150 | ||||||
|
|
||||||||
13
| |
Expected synergies and other benefits that we believe will result from combining the
operations of Molina Medicaid Solutions with the operations of Molina;
|
| |
Any intangible assets that do not qualify for separate recognition such as the assembled
workforce; and
|
| |
The value of the going-concern element of Molina Medicaid Solutions existing businesses
(the higher rate of return on the assembled collection of net assets versus acquiring all of
the net assets separately).
|
| Three Months | ||||||||||||
| Ended Sept. 30, | Nine Months Ended Sept. 30, | |||||||||||
| 2009 | 2010 | 2009 | ||||||||||
|
Revenue
|
$ | 942,846 | $ | 3,044,149 | $ | 2,781,356 | ||||||
|
Net income
|
$ | 8,557 | $ | 40,645 | $ | 34,369 | ||||||
|
Diluted earnings per share
|
$ | 0.33 | $ | 1.52 | $ | 1.32 | ||||||
14
| Molina | ||||||||||||
| Medicaid | ||||||||||||
| Health Plans | Solutions | Total | ||||||||||
| (In thousands) | ||||||||||||
|
Three months ended September 30, 2010
|
||||||||||||
|
Premium revenue
|
$ | 1,005,115 | $ | | $ | 1,005,115 | ||||||
|
Service revenue
|
| 32,271 | 32,271 | |||||||||
|
Investment income
|
1,760 | | 1,760 | |||||||||
|
|
||||||||||||
|
Total revenue
|
$ | 1,006,875 | $ | 32,271 | $ | 1,039,146 | ||||||
|
|
||||||||||||
|
Operating income
|
$ | 28,796 | $ | 1,157 | $ | 29,953 | ||||||
|
|
||||||||||||
|
|
||||||||||||
|
Nine months ended September 30, 2010
|
||||||||||||
|
Premium revenue
|
$ | 2,947,020 | $ | | $ | 2,947,020 | ||||||
|
Service revenue
|
| 53,325 | 53,325 | |||||||||
|
Investment income
|
4,880 | | 4,880 | |||||||||
|
|
||||||||||||
|
Total revenue
|
$ | 2,951,900 | $ | 53,325 | $ | 3,005,225 | ||||||
|
|
||||||||||||
|
Operating income
|
$ | 65,407 | $ | 6,162 | $ | 71,569 | ||||||
|
|
||||||||||||
|
|
||||||||||||
|
Three months ended September 30, 2009
|
||||||||||||
|
Premium revenue
|
$ | 914,805 | $ | | $ | 914,805 | ||||||
|
Service revenue
|
| | | |||||||||
|
Investment income
|
1,707 | | 1,707 | |||||||||
|
|
||||||||||||
|
Total revenue
|
$ | 916,512 | $ | | $ | 916,512 | ||||||
|
|
||||||||||||
|
Operating income
|
$ | 15,089 | $ | | $ | 15,089 | ||||||
|
|
||||||||||||
|
|
||||||||||||
|
Nine months ended September 30, 2009
|
||||||||||||
|
Premium revenue
|
$ | 2,697,796 | $ | | $ | 2,697,796 | ||||||
|
Service revenue
|
| | | |||||||||
|
Investment income
|
7,336 | | 7,336 | |||||||||
|
|
||||||||||||
|
Total revenue
|
$ | 2,705,132 | $ | | $ | 2,705,132 | ||||||
|
|
||||||||||||
|
Operating income
|
$ | 57,738 | $ | | $ | 57,738 | ||||||
|
|
||||||||||||
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Segment operating income
|
$ | 29,953 | $ | 15,089 | $ | 71,569 | $ | 57,738 | ||||||||
|
Interest expense
|
(4,600 | ) | (3,279 | ) | (12,056 | ) | (9,917 | ) | ||||||||
|
|
||||||||||||||||
|
Income before income taxes
|
$ | 25,353 | $ | 11,810 | $ | 59,513 | $ | 47,821 | ||||||||
|
|
||||||||||||||||
| Molina | ||||||||||||
| Medicaid | ||||||||||||
| Health Plans | Solutions | Total | ||||||||||
| (In thousands) | ||||||||||||
|
As of September 30, 2010
|
$ | 1,261,967 | $ | 169,463 | $ | 1,431,430 | ||||||
|
|
||||||||||||
|
As of December 31, 2009
|
$ | 1,245,235 | $ | | $ | 1,245,235 | ||||||
|
|
||||||||||||
15
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Shares outstanding at the beginning of the period
|
25,811 | 25,529 | 25,607 | 26,725 | ||||||||||||
|
Weighted-average number of shares issued
|
2,279 | | 768 | | ||||||||||||
|
Weighted-average number of shares purchased
|
| | | (865 | ) | |||||||||||
|
Weighted-average number of shares issued
|
28 | 10 | 136 | 84 | ||||||||||||
|
|
||||||||||||||||
|
Denominator for basic earnings per share
|
28,118 | 25,539 | 26,511 | 25,944 | ||||||||||||
|
Dilutive effect of employee stock options and
stock grants(1)
|
245 | 91 | 291 | 114 | ||||||||||||
|
|
||||||||||||||||
|
Denominator for diluted earnings per share(2)
|
28,363 | 25,630 | 26,802 | 26,058 | ||||||||||||
|
|
||||||||||||||||
| (1) |
Options to purchase common shares are included in the calculation of
diluted earnings per share when their exercise prices are below the
average fair value of the common shares for each of the periods
presented. For the three months ended September 30, 2010, and 2009,
there were approximately 472,000 and 618,000 antidilutive weighted
options, respectively. For the nine months ended September 30, 2010,
and 2009, there were approximately 492,000 and 622,000 antidilutive
weighted options, respectively. Restricted shares are included in the
calculation of diluted earnings per share when their grant date fair
values are below the average fair value of the common shares for each
of the periods presented. For the three months ended September 30,
2010, and 2009, there were approximately 6,000, and 232,000
antidilutive weighted restricted shares, respectively. For the nine
months ended September 30, 2010, and 2009, there were approximately
6,000, and 28,000 antidilutive weighted restricted shares,
respectively.
|
|
| (2) |
Potentially dilutive shares issuable pursuant to our convertible
senior notes were not included in the computation of diluted earnings
per share because to do so would have been anti-dilutive for the three
month and nine month periods ended September 30, 2010 and 2009.
|
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Restricted stock awards
|
$ | 2,367 | $ | 1,787 | $ | 6,113 | $ | 4,661 | ||||||||
|
Stock options (including shares
issued under our employee stock
purchase plan)
|
393 | 485 | 1,155 | 1,069 | ||||||||||||
|
|
||||||||||||||||
|
Total stock-based compensation expense
|
$ | 2,760 | $ | 2,272 | $ | 7,268 | $ | 5,730 | ||||||||
|
|
||||||||||||||||
16
| Weighted | ||||||||
| Average | ||||||||
| Grant Date | ||||||||
| Shares | Fair Value | |||||||
|
Unvested balance as of December 31, 2009
|
687,630 | $ | 24.64 | |||||
|
Granted
|
521,225 | 22.78 | ||||||
|
Vested
|
(257,781 | ) | 25.83 | |||||
|
Forfeited
|
(87,875 | ) | 23.32 | |||||
|
|
||||||||
|
Unvested balance as of September 30, 2010
|
863,199 | 23.30 | ||||||
|
|
||||||||
| Weighted | ||||||||||||||||
| Weighted | Average | |||||||||||||||
| Average | Aggregate | Remaining | ||||||||||||||
| Exercise | Intrinsic | Contractual | ||||||||||||||
| Shares | Price | Value | Term | |||||||||||||
| (In thousands) | (Years) | |||||||||||||||
|
Stock options outstanding as of December 31, 2009
|
650,739 | $ | 30.25 | |||||||||||||
|
Exercised
|
(29,702 | ) | 25.58 | |||||||||||||
|
Forfeited
|
(11,513 | ) | 32.39 | |||||||||||||
|
|
||||||||||||||||
|
Stock options outstanding as of September 30, 2010
|
609,524 | 30.44 | $ | 583 | 4.4 | |||||||||||
|
|
||||||||||||||||
|
Stock options exercisable and expected to vest as of
September 30, 2010
|
606,816 | 30.43 | $ | 582 | 4.4 | |||||||||||
|
|
||||||||||||||||
|
Exercisable as of September 30, 2010
|
559,974 | 30.29 | $ | 580 | 4.2 | |||||||||||
|
|
||||||||||||||||
| Balance Sheet Classification | Description | |
|
Current assets:
|
||
|
Investments (see Note 8)
|
Investment grade debt securities; designated as available-for-sale; reported at fair value based on market prices that are readily available (Level 1). | |
|
|
||
|
Non-current assets:
|
||
|
Investments (see Note 8)
|
Auction rate securities; designated as available-for-sale; reported at fair value based on discounted cash flow analysis or other type of valuation model (Level 3). |
17
| Fair Value Measurements at Reporting Date Using | ||||||||||||||||
| Total | Level 1 | Level 2 | Level 3 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Government -sponsored enterprise securities
|
$ | 70,787 | $ | 70,787 | $ | | $ | | ||||||||
|
Municipal securities
|
23,644 | 23,644 | | | ||||||||||||
|
Corporate debt securities
|
79,354 | 79,354 | | | ||||||||||||
|
U.S. treasury notes
|
18,296 | 18,296 | | | ||||||||||||
|
Certificates of deposit
|
3,277 | 3,277 | | | ||||||||||||
|
Auction rate securities (available-for-sale)
|
20,294 | | | 20,294 | ||||||||||||
|
|
||||||||||||||||
|
Total assets measured at fair value
|
$ | 215,652 | $ | 195,358 | $ | | $ | 20,294 | ||||||||
|
|
||||||||||||||||
| (Level 3) | ||||
| (In thousands) | ||||
|
Balance at December 31, 2009
|
$ | 63,494 | ||
|
Total gains (losses):
|
||||
|
Included in earnings:
|
||||
|
Auction rate securities designated as trading securities
|
4,170 | |||
|
Change in fair value of Rights
|
(3,807 | ) | ||
|
Included in other comprehensive income
|
(513 | ) | ||
|
Settlements
|
(43,050 | ) | ||
|
|
||||
|
Balance at September 30, 2010
|
$ | 20,294 | ||
|
|
||||
|
The amount of total losses for the period included in other
comprehensive loss attributable to the change in unrealized
losses relating to assets still held at September 30, 2010
|
$ | (513 | ) | |
|
|
||||
18
| September 30, 2010 | ||||||||||||||||
| Gross | Estimated | |||||||||||||||
| Unrealized | Fair | |||||||||||||||
| Cost | Gains | Losses | Value | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Government-sponsored enterprise securities
|
$ | 70,687 | $ | 426 | $ | 326 | $ | 70,787 | ||||||||
|
Municipal securities (including
non-current auction rate securities)
|
48,293 | 144 | 4,499 | 43,938 | ||||||||||||
|
Corporate debt securities
|
79,892 | 163 | 701 | 79,354 | ||||||||||||
|
U.S. treasury notes
|
18,169 | 137 | 10 | 18,296 | ||||||||||||
|
Certificates of deposit
|
3,277 | | | 3,277 | ||||||||||||
|
|
||||||||||||||||
|
|
$ | 220,318 | $ | 870 | $ | 5,536 | $ | 215,652 | ||||||||
|
|
||||||||||||||||
| December 31, 2009 | ||||||||||||||||
| Gross | Estimated | |||||||||||||||
| Unrealized | Fair | |||||||||||||||
| Cost | Gains | Losses | Value | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Government-sponsored enterprise securities
|
$ | 89,451 | $ | 504 | $ | 281 | $ | 89,674 | ||||||||
|
Municipal securities (including
non-current auction rate securities)
|
82,009 | 3,120 | 4,154 | 80,975 | ||||||||||||
|
Corporate debt securities
|
32,543 | 206 | 185 | 32,564 | ||||||||||||
|
U.S. treasury notes
|
28,052 | 92 | 84 | 28,060 | ||||||||||||
|
Certificates of deposit
|
3,258 | | | 3,258 | ||||||||||||
|
|
||||||||||||||||
|
|
$ | 235,313 | $ | 3,922 | $ | 4,704 | $ | 234,531 | ||||||||
|
|
||||||||||||||||
| Estimated | ||||||||
| Cost | Fair Value | |||||||
| (In thousands) | ||||||||
|
Due in one year or less
|
$ | 100,109 | $ | 99,474 | ||||
|
Due one year through five years
|
94,779 | 95,071 | ||||||
|
Due after five years through ten years
|
1,430 | 1,421 | ||||||
|
Due after ten years
|
24,000 | 19,686 | ||||||
|
|
||||||||
|
|
$ | 220,318 | $ | 215,652 | ||||
|
|
||||||||
19
| In a Continuous Loss | In a Continuous Loss | |||||||||||||||||||||||
| Position | Position | |||||||||||||||||||||||
| for Less than 12 Months | for 12 Months or More | Total | ||||||||||||||||||||||
| Estimated | Estimated | Estimated | ||||||||||||||||||||||
| Fair | Unrealized | Fair | Unrealized | Fair | Unrealized | |||||||||||||||||||
| Value | Losses | Value | Losses | Value | Losses | |||||||||||||||||||
| (In thousands) | ||||||||||||||||||||||||
|
Government-sponsored
enterprise securities
|
$ | 7,712 | $ | 17 | $ | 9,639 | $ | 309 | $ | 17,351 | $ | 326 | ||||||||||||
|
Municipal securities
|
9,110 | 55 | 23,963 | 4,444 | 33,073 | 4,499 | ||||||||||||||||||
|
Corporate debt securities
|
45,090 | 331 | 12,350 | 370 | 57,440 | 701 | ||||||||||||||||||
|
U.S. treasury notes
|
8,558 | 10 | | | 8,558 | 10 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
|
$ | 70,470 | $ | 413 | $ | 45,952 | $ | 5,123 | $ | 116,422 | $ | 5,536 | ||||||||||||
|
|
||||||||||||||||||||||||
| In a Continuous Loss | In a Continuous Loss | |||||||||||||||||||||||
| Position | Position | |||||||||||||||||||||||
| for Less than 12 Months | for 12 Months or More | Total | ||||||||||||||||||||||
| Estimated | Estimated | Estimated | ||||||||||||||||||||||
| Fair | Unrealized | Fair | Unrealized | Fair | Unrealized | |||||||||||||||||||
| Value | Losses | Value | Losses | Value | Losses | |||||||||||||||||||
| (In thousands) | ||||||||||||||||||||||||
|
Government-sponsored
enterprise securities
|
$ | 30,460 | $ | 187 | $ | 7,297 | $ | 94 | $ | 37,757 | $ | 281 | ||||||||||||
|
Municipal securities
|
12,460 | 78 | 24,031 | 3,902 | 36,491 | 3,980 | ||||||||||||||||||
|
Corporate debt securities
|
13,513 | 149 | 1,203 | 36 | 14,716 | 185 | ||||||||||||||||||
|
U.S. treasury notes
|
21,824 | 84 | | | 21,824 | 84 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
|
$ | 78,257 | $ | 498 | $ | 32,531 | $ | 4,032 | $ | 110,788 | $ | 4,530 | ||||||||||||
|
|
||||||||||||||||||||||||
20
| Sept. 30, | Dec. 31, | |||||||
| 2010 | 2009 | |||||||
| (In thousands) | ||||||||
|
Health Plans:
|
||||||||
|
California
|
$ | 96,797 | $ | 34,289 | ||||
|
Michigan
|
14,285 | 14,977 | ||||||
|
Missouri
|
21,576 | 19,670 | ||||||
|
New Mexico
|
17,757 | 11,919 | ||||||
|
Ohio
|
23,142 | 37,004 | ||||||
|
Utah
|
5,220 | 6,107 | ||||||
|
Washington
|
14,281 | 9,910 | ||||||
|
Wisconsin
|
6,651 | | ||||||
|
Others
|
3,424 | 2,778 | ||||||
|
|
||||||||
|
|
203,133 | 136,654 | ||||||
|
Molina Medicaid Solutions
|
22,414 | | ||||||
|
|
||||||||
|
Total receivables
|
$ | 225,547 | $ | 136,654 | ||||
|
|
||||||||
| Sept. 30, | Dec. 31, | |||||||
| 2010 | 2009 | |||||||
| (In thousands) | ||||||||
|
California
|
$ | 369 | $ | 368 | ||||
|
Florida
|
4,466 | 2,052 | ||||||
|
Michigan
|
1,000 | 1,000 | ||||||
|
Missouri
|
500 | 503 | ||||||
|
New Mexico
|
18,873 | 15,497 | ||||||
|
Ohio
|
9,061 | 9,036 | ||||||
|
Texas
|
3,501 | 1,515 | ||||||
|
Utah
|
1,280 | 578 | ||||||
|
Washington
|
151 | 151 | ||||||
|
Wisconsin
|
260 | | ||||||
|
Insurance company
|
4,689 | 4,686 | ||||||
|
Other
|
897 | 888 | ||||||
|
|
||||||||
|
Total
|
$ | 45,047 | $ | 36,274 | ||||
|
|
||||||||
| Amortized | Estimated | |||||||
| Cost | Fair Value | |||||||
| (In thousands) | ||||||||
|
Due in one year or less
|
$ | 36,148 | $ | 36,155 | ||||
|
Due one year through five years
|
8,774 | 8,815 | ||||||
|
Due after five years through ten years
|
125 | 164 | ||||||
|
|
||||||||
|
|
$ | 45,047 | $ | 45,134 | ||||
|
|
||||||||
21
| |
During any fiscal quarter after our fiscal quarter ended 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.
|
22
| |
An amount in cash (the principal return) equal to the sum of, for each of the 20
Volume-Weighted Average Price (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
|
| |
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.
|
| As of | As of | |||||||
| September 30, | December 31, | |||||||
| 2010 | 2009 | |||||||
| (In thousands) | ||||||||
|
Details of the liability component:
|
||||||||
|
Principal amount
|
$ | 187,000 | $ | 187,000 | ||||
|
Unamortized discount
|
(24,300 | ) | (28,100 | ) | ||||
|
|
||||||||
|
Net carrying amount
|
$ | 162,700 | $ | 158,900 | ||||
|
|
||||||||
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Interest cost recognized for the period relating to the:
|
||||||||||||||||
|
Contractual interest coupon rate of 3.75%
|
$ | 1,753 | $ | 1,753 | $ | 5,259 | $ | 5,323 | ||||||||
|
Amortization of the discount on the liability component
|
1,291 | 1,197 | 3,800 | 3,563 | ||||||||||||
|
|
||||||||||||||||
|
Total interest cost recognized
|
$ | 3,044 | $ | 2,950 | $ | 9,059 | $ | 8,886 | ||||||||
|
|
||||||||||||||||
23
24
25
| |
budgetary pressures on the federal and state governments and their resulting inability to
fully fund Medicaid, Medicare, or CHIP, or to maintain current payment rates, benefit
packages, or membership eligibility thresholds and criteria;
|
| |
uncertainties regarding the impact of the recently enacted Patient Protection and
Affordable Care Act, including the funding provisions related to health plans, and
uncertainties regarding the likely impact of other federal or state health care and insurance
reform measures;
|
| |
management of our medical costs, including normal seasonal flu patterns and rates of
utilization that are consistent with our expectations;
|
| |
the accurate estimation of incurred but not paid medical costs across our health
plans;
|
| |
retroactive adjustments to premium revenue or accounting estimates which require
adjustment based upon subsequent developments, including our ability to retain expected
Medicaid pharmaceutical rebates;
|
| |
the continuation and renewal of the government contracts of our health plans and if
renewed, the terms on which such contracts are renewed;
|
| |
our ability and the ability of our providers to maintain state accreditations to
participate in certain state Medicaid programs;
|
| |
changes with respect to our provider contracts and the loss of providers;
|
| |
changes in services offered, number of our members, membership mix and membership
demographics;
|
| |
performance of our principal vendors pursuant to our vendor contracts;
|
| |
the integration of Molina Medicaid Solutions, including its employees, systems, and
operations;
|
| |
the retention and renewal of the Molina Medicaid Solutions state government contracts on
terms consistent with our expectations;
|
| |
the accuracy of our operating cost and capital outlay projections for Molina Medicaid
Solutions;
|
| |
the timing of receipt and recognition of revenue and the amortization of expense under our
various state contracts held by Molina Medicaid Solutions, including the state of Idahos
acceptance of the MMIS;
|
| |
additional administrative
costs and the potential payment of damages amounts as a result of MMIS system issues in Idaho;
|
| |
the implementation of the expected 2% premium rate increase in California, retroactively
effective October 1, 2010;
|
| |
the expansion of service in 174 rural counties by our Texas health plan under Texas CHIP
Rural Service Area Program;
|
| |
government audits and reviews, including the audit of our Medicare plans by CMS at the end
of July 2010;
|
| |
the establishment of a federal or state medical cost expenditure floor as a percentage of
the premiums we receive;
|
| |
revenue recognition and the interpretation and implementation of medical cost expenditure floors, administrative
cost and profit ceilings, and profit sharing arrangements in state
contracts in New Mexico, Florida, and Texas;
|
| |
the interpretation and
implementation of at-risk premium rules in Ohio, New Mexico, and
Texas that require us to meet certain performance measures in order to earn all of our
contract revenue in those states;
|
26
| |
rate increases that do not
adequately compensate us for the loss of drug rebates as a result of
health reform;
|
| |
up-coding by providers or billing in a manner at material variance with historic patterns;
|
| |
approval by state regulators of dividends and distributions by our subsidiaries;
|
| |
changes in funding under our contracts as a result of regulatory changes, programmatic
adjustments, or other reforms;
|
| |
high dollar claims related to catastrophic illness;
|
| |
the favorable resolution of litigation or arbitration matters;
|
| |
restrictions and covenants in our credit facility;
|
| |
the success of our efforts to leverage our administrative costs to address the needs
associated with increased enrollment;
|
| |
the relatively small number of states in which we operate health plans and the impact on
the consolidated entity of adverse developments in any single health plan;
|
| |
the availability of financing to fund and capitalize our acquisitions and start-up
activities and to meet our liquidity needs;
|
| |
a states failure to renew its federal Medicaid waiver;
|
| |
an unauthorized disclosure of confidential member information;
|
| |
changes in laws regarding the transmission, security and privacy of protected health
information and costs associated to comply with such changes;
|
| |
changes generally affecting the managed care or Medicaid management information systems
industries;
|
| |
increases in government surcharges, taxes and assessments; and
|
| |
general economic conditions, including unemployment rates.
|
27
| |
Health Plans; and
|
| |
Molina Medicaid Solutions.
|
28
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (Amounts in thousands, except per share data) | ||||||||||||||||
|
Earnings per diluted share
|
$ | 0.57 | $ | 0.33 | $ | 1.39 | $ | 1.36 | ||||||||
|
Premium revenue
|
$ | 1,005,115 | $ | 914,805 | $ | 2,947,020 | $ | 2,697,796 | ||||||||
|
Service revenue
|
$ | 32,271 | $ | | $ | 53,325 | $ | | ||||||||
|
Operating income
|
$ | 29,953 | $ | 15,089 | $ | 71,569 | $ | 57,738 | ||||||||
|
Net income
|
$ | 16,173 | $ | 8,564 | $ | 37,342 | $ | 35,340 | ||||||||
|
Total ending membership
|
1,597 | 1,411 | 1,597 | 1,411 | ||||||||||||
|
Premium revenue
|
96.7 | % | 99.8 | % | 98.1 | % | 99.7 | % | ||||||||
|
Service revenue
|
3.1 | | 1.8 | | ||||||||||||
|
Investment income
|
0.2 | 0.2 | 0.1 | 0.3 | ||||||||||||
|
|
||||||||||||||||
|
Total revenue
|
100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | ||||||||
|
|
||||||||||||||||
|
Medical care ratio
|
84.2 | % | 86.7 | % | 85.1 | % | 86.5 | % | ||||||||
|
General and administrative expense ratio
|
8.5 | % | 7.5 | % | 8.2 | % | 7.4 | % | ||||||||
|
Premium tax ratio
|
3.5 | % | 3.3 | % | 3.5 | % | 3.2 | % | ||||||||
|
Operating income
|
2.9 | % | 1.6 | % | 2.4 | % | 2.1 | % | ||||||||
|
Net income
|
1.6 | % | 0.9 | % | 1.2 | % | 1.3 | % | ||||||||
|
Effective tax rate
|
36.2 | % | 27.5 | % | 37.3 | % | 26.1 | % | ||||||||
29
| Sept. 30, | Dec. 31, | Sept. 30, | ||||||||||
| 2010 | 2009 | 2009 | ||||||||||
|
Total Ending Membership by Health Plan:
|
||||||||||||
|
California
|
349,000 | 351,000 | 355,000 | |||||||||
|
Florida
|
57,000 | 50,000 | 43,000 | |||||||||
|
Michigan
|
225,000 | 223,000 | 210,000 | |||||||||
|
Missouri
|
79,000 | 78,000 | 78,000 | |||||||||
|
New Mexico
|
91,000 | 94,000 | 90,000 | |||||||||
|
Ohio
|
241,000 | 216,000 | 208,000 | |||||||||
|
Texas
|
96,000 | 40,000 | 31,000 | |||||||||
|
Utah
|
78,000 | 69,000 | 69,000 | |||||||||
|
Washington
|
353,000 | 334,000 | 327,000 | |||||||||
|
Wisconsin (1)
|
28,000 | | | |||||||||
|
|
||||||||||||
|
Total
|
1,597,000 | 1,455,000 | 1,411,000 | |||||||||
|
|
||||||||||||
|
Total Ending Membership by State for
our Medicare Advantage Plans (1):
|
||||||||||||
|
California
|
4,300 | 2,100 | 1,900 | |||||||||
|
Florida
|
500 | | | |||||||||
|
Michigan
|
5,700 | 3,300 | 2,700 | |||||||||
|
New Mexico
|
600 | 400 | 400 | |||||||||
|
Texas
|
600 | 500 | 500 | |||||||||
|
Utah
|
8,600 | 4,000 | 3,500 | |||||||||
|
Washington
|
2,300 | 1,300 | 1,100 | |||||||||
|
|
||||||||||||
|
Total
|
22,600 | 11,600 | 10,100 | |||||||||
|
|
||||||||||||
|
Total Ending Membership by State for
our Aged, Blind or Disabled
Population:
|
||||||||||||
|
California
|
13,500 | 13,900 | 13,700 | |||||||||
|
Florida
|
9,500 | 8,800 | 8,700 | |||||||||
|
Michigan
|
31,400 | 32,200 | 30,200 | |||||||||
|
New Mexico
|
5,700 | 5,700 | 5,700 | |||||||||
|
Ohio
|
27,900 | 22,600 | 19,600 | |||||||||
|
Texas
|
18,900 | 17,600 | 17,500 | |||||||||
|
Utah
|
7,900 | 7,500 | 7,700 | |||||||||
|
Washington
|
3,700 | 3,200 | 3,200 | |||||||||
|
Wisconsin (1)
|
1,700 | | | |||||||||
|
|
||||||||||||
|
Total
|
120,200 | 111,500 | 106,300 | |||||||||
|
|
||||||||||||
| (1) |
We acquired the Wisconsin health plan on September 1, 2010. As of September 30, 2010, the
Wisconsin health plan had approximately 3,000 Medicare Advantage members covered under a
reinsurance contract with a third party; these members are not included in the membership
tables herein.
|
30
| |
Fee-for-service expenses paid for specific encounters or episodes of care according to
a fee schedule or other basis established by the state or by contract with the provider.
|
| |
Capitation expenses for PMPM payments to the provider without regard to the frequency,
extent, or nature of the medical services actually furnished.
|
| |
Pharmacy expenses for
all drug, injectible, and immunization costs paid primarily through our
pharmacy benefit manager.
|
| |
Other expenses for medically related administrative costs ($61.9 million and
$54.9 million for the nine months ended September 30, 2010 and 2009, respectively), certain
provider incentive costs, reinsurance, costs to operate our medical clinics, and other
medical expenses.
|
31
| Three Months Ended September 30, | ||||||||||||||||||||||||
| 2010 | 2009 | |||||||||||||||||||||||
| % of | % of | |||||||||||||||||||||||
| Amount | PMPM | Total | Amount | PMPM | Total | |||||||||||||||||||
|
Fee for service
|
$ | 601,836 | $ | 130.60 | 71.1 | % | $ | 515,164 | $ | 122.86 | 65.0 | % | ||||||||||||
|
Capitation
|
136,425 | 29.61 | 16.1 | 140,551 | 33.52 | 17.7 | ||||||||||||||||||
|
Pharmacy
|
76,049 | 16.50 | 9.0 | 104,274 | 24.87 | 13.2 | ||||||||||||||||||
|
Other
|
31,627 | 6.87 | 3.8 | 32,782 | 7.82 | 4.1 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
Total
|
$ | 845,937 | $ | 183.58 | 100.0 | % | $ | 792,771 | $ | 189.07 | 100.0 | % | ||||||||||||
|
|
||||||||||||||||||||||||
32
| Three Months Ended September 30, 2010 | ||||||||||||||||||||||||||||
| Member | Premium Revenue | Medical Care Costs | Medical | Premium Tax | ||||||||||||||||||||||||
| Months(1) | Total | PMPM | Total | PMPM | Care Ratio | Expense | ||||||||||||||||||||||
|
California
|
1,046 | $ | 128,350 | $ | 122.75 | $ | 103,002 | $ | 98.51 | 80.3 | % | $ | 1,888 | |||||||||||||||
|
Florida
|
169 | 43,485 | 256.25 | 42,258 | 249.02 | 97.2 | (14 | ) | ||||||||||||||||||||
|
Michigan
|
675 | 156,609 | 232.05 | 134,238 | 198.90 | 85.7 | 9,655 | |||||||||||||||||||||
|
Missouri
|
236 | 52,952 | 224.63 | 45,930 | 194.84 | 86.7 | | |||||||||||||||||||||
|
New Mexico
|
274 | 93,602 | 341.38 | 78,121 | 284.92 | 83.5 | 2,170 | |||||||||||||||||||||
|
Ohio
|
715 | 210,651 | 294.55 | 171,051 | 239.18 | 81.2 | 16,734 | |||||||||||||||||||||
|
Texas
|
180 | 48,188 | 267.95 | 43,129 | 239.82 | 89.5 | 861 | |||||||||||||||||||||
|
Utah
|
234 | 67,566 | 289.28 | 57,381 | 245.67 | 84.9 | | |||||||||||||||||||||
|
Washington
|
1,051 | 195,578 | 186.03 | 155,307 | 147.73 | 79.4 | 3,622 | |||||||||||||||||||||
|
Wisconsin(2)
|
28 | 6,310 | 224.18 | 6,154 | 218.65 | 97.5 | | |||||||||||||||||||||
|
Other(3)
|
| 1,824 | | 9,366 | | | 121 | |||||||||||||||||||||
|
|
||||||||||||||||||||||||||||
|
Total
|
4,608 | $ | 1,005,115 | $ | 218.12 | $ | 845,937 | $ | 183.58 | 84.2 | % | $ | 35,037 | |||||||||||||||
|
|
||||||||||||||||||||||||||||
| Three Months Ended September 30, 2009 | ||||||||||||||||||||||||||||
| Member | Premium Revenue | Medical Care Costs | Medical | Premium Tax | ||||||||||||||||||||||||
| Months(1) | Total | PMPM | Total | PMPM | Care Ratio | Expense | ||||||||||||||||||||||
|
California
|
1,065 | $ | 122,048 | $ | 114.61 | $ | 112,663 | $ | 105.80 | 92.3 | % | $ | 3,700 | |||||||||||||||
|
Florida
|
109 | 27,292 | 250.27 | 25,931 | 237.80 | 95.0 | 10 | |||||||||||||||||||||
|
Michigan
|
629 | 136,262 | 216.74 | 110,577 | 175.89 | 81.2 | 8,663 | |||||||||||||||||||||
|
Missouri
|
232 | 60,867 | 261.76 | 50,075 | 215.35 | 82.3 | | |||||||||||||||||||||
|
New Mexico
|
264 | 105,721 | 400.04 | 86,678 | 327.99 | 82.0 | 2,953 | |||||||||||||||||||||
|
Ohio
|
618 | 204,565 | 331.22 | 175,187 | 283.65 | 85.6 | 11,167 | |||||||||||||||||||||
|
Texas
|
93 | 26,299 | 282.13 | 26,904 | 288.61 | 102.3 | 574 | |||||||||||||||||||||
|
Utah
|
203 | 46,849 | 231.14 | 43,346 | 213.86 | 92.5 | | |||||||||||||||||||||
|
Washington
|
979 | 182,096 | 185.99 | 151,099 | 154.33 | 83.0 | 3,131 | |||||||||||||||||||||
|
Wisconsin(2)
|
| | | | | | | |||||||||||||||||||||
|
Other(3)
|
| 2,806 | | 10,311 | | | 59 | |||||||||||||||||||||
|
|
||||||||||||||||||||||||||||
|
Total
|
4,192 | $ | 914,805 | $ | 218.17 | $ | 792,771 | $ | 189.07 | 86.7 | % | $ | 30,257 | |||||||||||||||
|
|
||||||||||||||||||||||||||||
| (1) |
A member month is defined as the aggregate of each months ending membership for the period presented.
|
|
| (2) |
We acquired the Wisconsin health plan on September 1, 2010.
|
|
| (3) |
Other medical care costs represent primarily medically related administrative costs at the parent company.
|
33
| Sept. 30, | June 30, | Dec. 31, | Sept. 30, | |||||||||||||
| 2010 | 2010 | 2009 | 2009 | |||||||||||||
|
Days in claims payable fee-for-service only
|
42 days | 44 days | 44 days | 44 days | ||||||||||||
|
Number of claims in inventory at end of period
|
110,200 | 106,700 | 93,100 | 107,700 | ||||||||||||
|
Billed charges of claims in inventory at end
of period (dollars in thousands)
|
$ | 158,900 | $ | 147,500 | $ | 131,400 | $ | 145,500 | ||||||||
| (In thousands) | ||||
|
Service revenue before amortization
|
$ | 34,926 | ||
|
Amortization of contract backlog recorded as contra-service revenue
|
(2,655 | ) | ||
|
|
||||
|
Service revenue
|
32,271 | |||
|
|
||||
|
Cost of service revenue
|
27,605 | |||
|
General and administrative costs
|
2,195 | |||
|
Amortization of customer relationship intangibles recorded as amortization
|
1,314 | |||
|
|
||||
|
Operating income
|
$ | 1,157 | ||
|
|
||||
34
| Three Months Ended September 30, | ||||||||||||||||
| 2010 | 2009 | |||||||||||||||
| % of Total | % of Total | |||||||||||||||
| Amount | Revenue | Amount | Revenue | |||||||||||||
| (Dollar amounts in thousands) | ||||||||||||||||
|
Medicare-related administrative costs
|
$ | 6,511 | 0.6 | % | $ | 4,288 | 0.5 | % | ||||||||
|
Non Medicare-related administrative costs:
|
||||||||||||||||
|
Molina Medicaid Solutions segment administrative costs
|
2,195 | 0.2 | | | ||||||||||||
|
Employee severance and settlement costs
|
4,654 | 0.4 | 132 | | ||||||||||||
|
Health Plans segment administrative payroll,
including employee incentive compensation
|
57,741 | 5.6 | 53,042 | 5.8 | ||||||||||||
|
All other Health Plans segment administrative expense
|
17,559 | 1.7 | 11,101 | 1.2 | ||||||||||||
|
|
||||||||||||||||
|
|
$ | 88,660 | 8.5 | % | $ | 68,563 | 7.5 | % | ||||||||
|
|
||||||||||||||||
| Three Months Ended September 30, | ||||||||||||||||
| 2010 | 2009 | |||||||||||||||
| % of Total | % of Total | |||||||||||||||
| Amount | Revenue | Amount | Revenue | |||||||||||||
| (Dollar amounts in thousands) | ||||||||||||||||
|
Depreciation and amortization
|
$ | 11,954 | 1.1 | % | $ | 9,832 | 1.1 | % | ||||||||
|
Amortization recorded as contra-service revenue
|
2,655 | 0.3 | | | ||||||||||||
|
Depreciation recorded as cost of service revenue
|
1,964 | 0.2 | | | ||||||||||||
|
|
||||||||||||||||
|
|
$ | 16,573 | 1.6 | % | $ | 9,832 | 1.1 | % | ||||||||
|
|
||||||||||||||||
35
| Nine Months Ended September 30, | ||||||||||||||||||||||||
| 2010 | 2009 | |||||||||||||||||||||||
| % of | % of | |||||||||||||||||||||||
| Amount | PMPM | Total | Amount | PMPM | Total | |||||||||||||||||||
|
Fee for service
|
$ | 1,763,675 | $ | 130.55 | 70.3 | % | $ | 1,521,371 | $ | 125.24 | 65.2 | % | ||||||||||||
|
Capitation
|
410,321 | 30.37 | 16.4 | 413,351 | 34.03 | 17.7 | ||||||||||||||||||
|
Pharmacy
|
241,290 | 17.86 | 9.6 | 306,168 | 25.20 | 13.1 | ||||||||||||||||||
|
Other
|
93,080 | 6.89 | 3.7 | 92,975 | 7.65 | 4.0 | ||||||||||||||||||
|
|
||||||||||||||||||||||||
|
Total
|
$ | 2,508,366 | $ | 185.67 | 100.0 | % | $ | 2,333,865 | $ | 192.12 | 100.0 | % | ||||||||||||
|
|
||||||||||||||||||||||||
36
| Nine Months Ended September 30, 2010 | ||||||||||||||||||||||||||||
| Member | Premium Revenue | Medical Care Costs | Medical | Premium Tax | ||||||||||||||||||||||||
| Months(1) | Total | PMPM | Total | PMPM | Care Ratio | Expense | ||||||||||||||||||||||
|
California
|
3,158 | $ | 376,811 | $ | 119.32 | $ | 316,569 | $ | 100.24 | 84.0 | % | $ | 5,153 | |||||||||||||||
|
Florida
|
483 | 124,035 | 256.70 | 116,079 | 240.23 | 93.6 | (2 | ) | ||||||||||||||||||||
|
Michigan
|
2,029 | 468,723 | 230.98 | 395,450 | 194.87 | 84.4 | 29,305 | |||||||||||||||||||||
|
Missouri
|
704 | 156,874 | 222.83 | 135,766 | 192.85 | 86.5 | | |||||||||||||||||||||
|
New Mexico
|
834 | 281,149 | 336.93 | 225,346 | 270.06 | 80.2 | 7,161 | |||||||||||||||||||||
|
Ohio
|
2,083 | 641,683 | 308.11 | 517,951 | 248.70 | 80.7 | 50,251 | |||||||||||||||||||||
|
Texas
|
426 | 130,881 | 307.51 | 114,593 | 269.24 | 87.6 | 2,247 | |||||||||||||||||||||
|
Utah
|
685 | 191,040 | 278.99 | 179,816 | 262.60 | 94.1 | | |||||||||||||||||||||
|
Washington
|
3,080 | 562,836 | 182.75 | 473,609 | 153.78 | 84.2 | 10,278 | |||||||||||||||||||||
|
Wisconsin(2)
|
28 | 6,310 | 224.18 | 6,154 | 218.65 | 97.5 | | |||||||||||||||||||||
|
Other(3)
|
| 6,678 | | 27,033 | | | 185 | |||||||||||||||||||||
|
|
||||||||||||||||||||||||||||
|
Total
|
13,510 | $ | 2,947,020 | $ | 218.14 | $ | 2,508,366 | $ | 185.67 | 85.1 | % | $ | 104,578 | |||||||||||||||
|
|
||||||||||||||||||||||||||||
| Nine Months Ended September 30, 2009 | ||||||||||||||||||||||||||||
| Member | Premium Revenue | Medical Care Costs | Medical | Premium Tax | ||||||||||||||||||||||||
| Months(1) | Total | PMPM | Total | PMPM | Care Ratio | Expense | ||||||||||||||||||||||
|
California
|
3,076 | $ | 354,001 | $ | 115.09 | $ | 328,386 | $ | 106.76 | 92.8 | % | $ | 10,411 | |||||||||||||||
|
Florida
|
245 | 66,322 | 270.67 | 61,054 | 249.17 | 92.1 | 10 | |||||||||||||||||||||
|
Michigan
|
1,872 | 405,576 | 216.72 | 332,974 | 177.93 | 82.1 | 26,039 | |||||||||||||||||||||
|
Missouri
|
695 | 177,715 | 255.62 | 145,631 | 209.47 | 82.0 | | |||||||||||||||||||||
|
New Mexico
|
763 | 301,947 | 395.79 | 258,954 | 339.43 | 85.8 | 8,035 | |||||||||||||||||||||
|
Ohio
|
1,774 | 586,672 | 330.73 | 501,606 | 282.77 | 85.5 | 32,090 | |||||||||||||||||||||
|
Texas
|
283 | 93,655 | 330.78 | 79,161 | 279.59 | 84.5 | 1,830 | |||||||||||||||||||||
|
Utah
|
587 | 155,385 | 264.67 | 140,791 | 239.81 | 90.6 | | |||||||||||||||||||||
|
Washington
|
2,850 | 546,520 | 191.76 | 457,625 | 160.57 | 83.7 | 9,142 | |||||||||||||||||||||
|
Wisconsin(2)
|
| | | | | | | |||||||||||||||||||||
|
Other(3)
|
| 10,003 | | 27,683 | | | 55 | |||||||||||||||||||||
|
|
||||||||||||||||||||||||||||
|
Total
|
12,145 | $ | 2,697,796 | $ | 222.08 | $ | 2,333,865 | $ | 192.12 | 86.5 | % | $ | 87,612 | |||||||||||||||
|
|
||||||||||||||||||||||||||||
| (1) |
A member month is defined as the aggregate of each months ending
membership for the period presented.
|
|
| (2) |
We acquired the Wisconsin health plan on September 1, 2010.
|
|
| (3) |
Other medical care costs represent primarily medically related
administrative costs at the parent company.
|
37
| (In thousands) | ||||
|
Service revenue before amortization
|
$ | 57,571 | ||
|
Amortization of contract backlog recorded as contra-service revenue
|
(4,246 | ) | ||
|
|
||||
|
Service revenue
|
53,325 | |||
|
Cost of service revenue
|
41,859 | |||
|
General and administrative costs
|
3,161 | |||
|
Amortization of customer relationship intangibles recorded as amortization
|
2,143 | |||
|
|
||||
|
Operating income
|
$ | 6,162 | ||
|
|
||||
| Nine Months Ended September 30, | ||||||||||||||||
| 2010 | 2009 | |||||||||||||||
| % of Total | % of Total | |||||||||||||||
| Amount | Revenue | Amount | Revenue | |||||||||||||
| (Dollar amounts in thousands) | ||||||||||||||||
|
Medicare-related administrative costs
|
$ | 21,010 | 0.7 | % | $ | 12,842 | 0.5 | % | ||||||||
|
Non Medicare-related administrative costs:
|
||||||||||||||||
|
Molina Medicaid Solutions segment administrative costs
|
3,161 | 0.1 | | | ||||||||||||
|
Employee severance and settlement costs
|
5,152 | 0.2 | 538 | | ||||||||||||
|
Molina Medicaid Solutions and Wisconsin health plan
acquisition costs
|
2,688 | 0.1 | | | ||||||||||||
|
Health Plans segment administrative payroll,
including employee incentive compensation
|
167,150 | 5.6 | 150,952 | 5.6 | ||||||||||||
|
All other Health Plans segment administrative expense
|
46,458 | 1.5 | 34,649 | 1.3 | ||||||||||||
|
|
||||||||||||||||
|
|
$ | 245,619 | 8.2 | % | $ | 198,981 | 7.4 | % | ||||||||
|
|
||||||||||||||||
38
| Nine Months Ended September 30, | ||||||||||||||||
| 2010 | 2009 | |||||||||||||||
| % of Total | % of Total | |||||||||||||||
| Amount | Revenue | Amount | Revenue | |||||||||||||
| (Dollar amounts in thousands) | ||||||||||||||||
|
Depreciation and amortization
|
$ | 33,234 | 1.1 | % | $ | 28,468 | 1.1 | % | ||||||||
|
Amortization recorded as contra- service revenue
|
4,246 | 0.1 | | | ||||||||||||
|
Depreciation recorded as cost of service revenue
|
3,005 | 0.1 | | | ||||||||||||
|
|
||||||||||||||||
|
Depreciation and amortization reported in the
consolidated statements of cash flows
|
$ | 40,485 | 1.3 | % | $ | 28,468 | 1.1 | % | ||||||||
|
|
||||||||||||||||
39
40
| Three Months Ended | Nine Months Ended | |||||||||||||||
| September 30, | September 30, | |||||||||||||||
| 2010 | 2009 | 2010 | 2009 | |||||||||||||
| (In thousands) | ||||||||||||||||
|
Operating income
|
$ | 29,953 | $ | 15,089 | $ | 71,569 | $ | 57,738 | ||||||||
|
Add back:
|
||||||||||||||||
|
Depreciation and amortization expense
|
11,954 | 9,832 | 33,234 | 28,468 | ||||||||||||
|
Amortization expense recorded as contra-service revenue
|
2,655 | | 4,246 | | ||||||||||||
|
Depreciation expense recorded as cost of service revenue
|
1,964 | | 3,005 | | ||||||||||||
|
|
||||||||||||||||
|
EBITDA
|
$ | 46,526 | $ | 24,921 | $ | 112,054 | $ | 86,206 | ||||||||
|
|
||||||||||||||||
| (1) |
GAAP stands for U.S. generally accepted accounting principles.
|
|
| (2) |
We calculate EBITDA consistently on a quarterly and annual basis by
adding back depreciation and amortization expense to operating income.
Operating income included interest income of $3.7 million and
$6.6 million for the nine months ended September 30, 2010, and 2009,
respectively. EBITDA is not prepared in conformity with GAAP because
it excludes depreciation and amortization expense, as well as interest
expense, and the provision for income taxes. This non-GAAP financial
measure should not be considered as an alternative to the GAAP
measures of net income, operating income, operating margin, or cash
provided by operating activities, nor should EBITDA be considered in
isolation from these GAAP measures of operating performance.
Management uses EBITDA as a supplemental metric in evaluating our
financial performance, in evaluating financing and business
development decisions, and in forecasting and analyzing future
periods. For these reasons, management believes that EBITDA is a
useful supplemental measure to investors in evaluating our performance
and the performance of other companies in our industry.
|
41
42
| |
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 $1,000 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.
|
| |
An amount in cash (the principal return) equal to the sum of, for each of the 20
Volume-Weighted Average Price, or VWAP, trading days during the conversion period, the
lesser of the daily conversion value for such VWAP trading day and $50 (representing
1/20th of $1,000); and
|
| |
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 $50.
|
43
| |
The recognition of revenue;
|
| |
The determination of deferred contract costs;
|
| |
The determination of medical claims and benefits payable;
|
| |
The determination of the amount of revenue to be recognized under certain contracts that
place revenue at risk dependent upon either the achievement of certain quality or
administrative measurements, or the expenditure of certain percentages of revenue on defined
expenses;
|
| |
The determination of allowances for uncollectible accounts;
|
| |
The valuation of certain investments;
|
| |
Settlements under risk or savings sharing programs;
|
| |
The impairment of long-lived and intangible assets;
|
| |
The determination of professional and general liability claims, and reserves for
potential absorption of claims unpaid by insolvent providers;
|
| |
The determination of reserves for the outcome of litigation;
|
| |
The determination of valuation allowances for deferred tax assets; and
|
| |
The determination of unrecognized tax benefits.
|
44
| |
Florida Health Plan Medical Cost Floor (Minimum) for Behavioral Health:
A portion of
premium revenue paid to our Florida health plan by the state of Florida may be refunded to
the state if certain minimum amounts are not spent on defined behavioral health care costs.
At September 30, 2010, we had not recorded any liability under the terms of this contract
provision. If the state of Florida disagrees with our interpretation of the existing
contract terms, an adjustment to the amounts owed may be required. Any changes to the terms
of this provision, including revisions to the definitions of premium revenue or behavioral
health care costs, the period of time over which performance is measured or the manner of
its measurement, or the percentages used in the calculations, may affect the profitability
of our Florida health plan.
|
| |
New Mexico Health Plan Medical Cost Floors (Minimums) and Administrative Cost and Profit
Ceilings (Maximums):
A portion of premium revenue paid to our New Mexico health plan by the
state of New Mexico may be refunded to the state if certain minimum amounts are not spent on
defined medical care costs, or if administrative costs or profit (as defined) exceed certain
amounts. 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 (the medical
cost floor). Our contract is for a three-year period, and the medical cost floor is based on
premiums and medical care costs over the entire contract period. Effective July 1, 2008, our
New Mexico health plan entered into a new three year contract that, in addition to retaining
the medical cost floor, added certain limits on the amount our New Mexico health plan can:
(a) expend on administrative costs; and (b) retain as profit. At September 30, 2010, there
was no liability recorded under the terms of these contract provisions. If the state of New
Mexico disagrees with our interpretation of the existing contract terms, an adjustment to
the amounts owed may be required. Any changes to the terms of these provisions, including
revisions to the definitions of premium revenue, medical care costs, administrative costs or
profit, the period of time over which performance is measured or the manner of its
measurement, or the percentages used in the calculations, may affect the profitability of
our New Mexico health plan.
|
| |
New Mexico Health Plan At-Risk Premium Revenue:
Under our contract with the state of New
Mexico, up to 1% of our New Mexico health plans revenue may be refundable to the state if
certain performance measures are not met. These performance measures are generally linked to
various quality of care and administrative measures dictated by the state. The state of New
Mexicos fiscal year ends June 30, and open contract years typically include up to the two
preceding years. For the open state fiscal years ending June 30, 2011, our New Mexico health
plan has received $4.6 million in at-risk revenue to date. To date, we have recognized
$2.2 million of that amount as revenue, and recorded a liability of approximately
$2.4 million as of September 30, 2010, for the remainder. If the state of New Mexico
disagrees with our estimation of our compliance with the at-risk premium requirements, an
adjustment to the amounts owed may be required.
|
| |
Ohio Health Plan At-Risk Premium Revenue:
Under our contract with the state of Ohio, up
to 1% of our Ohio health plans revenue may be refundable to the state if certain
performance measures are not met. Effective January 1, 2010 an additional 0.25% of the Ohio
health plans revenue became refundable if certain pharmacy specific performance measures
were not met. These performance measures are generally linked to various quality-of-care
measures dictated by the state. The state of Ohios fiscal year ends June 30, and open
contract years typically include up to the two preceding years. For the open state fiscal
years ending June 30, 2011, our Ohio health plan has received $11.2 million in at-risk
revenue to date. To date, we have recognized $3.7 million of that amount as revenue and
recorded a liability of approximately $7.5 million as of September 30, 2010, for the
remainder. If the state of Ohio disagrees with our estimation of our compliance with the
at-risk premium requirements, an adjustment to the amounts owed may be required. During the
third quarter of 2010, we reversed the recognition of approximately $3.3 million of at-risk
revenue previously recognized.
|
| |
Utah Health Plan Premium Revenue:
Our Utah health plan may be entitled to receive
additional premium revenue from the state of Utah as an incentive payment for saving the
state of Utah money in relation to fee-for-service Medicaid. 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 from prior years 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 assert its claim to the
amounts believed to be due under the savings share agreement. When additional information is
known, or resolution is reached with the state regarding the appropriate savings sharing
payment amount for prior years, we will adjust the amount of savings sharing revenue
recorded in our financial statements as appropriate in light of such new
information or agreement. No receivables for saving sharing revenue have been established at
September 30, 2010 or December 31, 2009.
|
45
| |
Texas Health Plan Profit Sharing:
Under our contract with
the state of Texas there is a profit-sharing agreement, where we pay a rebate to
the state of Texas if our Texas health plan generates pretax income, as defined in the
contract, above a certain specified percentage, as determined in accordance with a tiered
rebate schedule. We are limited in the amount of administrative costs that we may deduct in
calculating the rebate, if any. As of September 30, 2010, we had an aggregate liability of
approximately $0.6 million accrued pursuant to our profit-sharing agreement with the state
of Texas for the 2009 and 2010 contract years (ending August 31 of each year). We paid $1.4
million to the state under the terms of this profit sharing agreement during the nine months
ended September 30, 2010. 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 estimates.
|
| |
Texas Health Plan At-Risk Premium Revenue:
Under our contract with the state of Texas,
up to 1% of our Texas health plans revenue may be refundable to the state if certain
performance measures are not met. These performance measures are generally linked to various
quality-of-care measures dictated by the state. The state of Texass fiscal year ends August
31, and open contract years typically include up to the two preceding years. For the open
state fiscal years ending August 31, 2011, our Texas health plan received $1.2 million in
at-risk revenue, all of which has been recognized as revenue. If the state of Texas
disagrees with our estimation of our compliance with the at-risk premium requirements, an
adjustment to the amounts owed may be required.
|
| |
Medicare Premium Revenue:
Based on member encounter data that we submit to CMS, our
Medicare revenue is subject to retroactive adjustment for both member risk scores and member
pharmacy cost experience for up to two years after the original year of service. This
adjustment takes into account the acuity of each members medical needs relative to what was
anticipated when premiums were originally set for that member. In the event that a member
requires less acute medical care than was anticipated by the original premium amount, CMS
may recover premium from us. In the event that a member requires more acute medical care
than was anticipated by the original premium amount, CMS may pay us additional retroactive
premium. A similar retroactive reconciliation is undertaken by CMS for our Medicare members
pharmacy utilization. That analysis is similar to the process for the adjustment of member
risk scores, but is further complicated by member pharmacy cost sharing provisions attached
to the Medicare pharmacy benefit that do not apply to the services measured by the member
risk adjustment process. We estimate the amount of Medicare revenue that will ultimately be
realized for the periods presented based on our knowledge of our members heath care
utilization patterns and CMS practices. To the extent that the premium revenue ultimately
received from CMS differs from recorded amounts, we will adjust reported Medicare revenue.
Based on our knowledge of member health care utilization patterns we have recorded a
liability of approximately $1.3 million related to the potential recoupment of Medicare
premium revenue at September 30, 2010.
|
46
| Sept. 30, | Dec. 31, | Sept. 30, | ||||||||||
| 2010 | 2009 | 2009 | ||||||||||
| (In thousands) | ||||||||||||
|
Fee-for-service claims incurred but not paid (IBNP)
|
$ | 271,285 | $ | 246,508 | $ | 237,495 | ||||||
|
Capitation payable
|
53,410 | 39,995 | 39,361 | |||||||||
|
Pharmacy
|
14,663 | 20,609 | 21,100 | |||||||||
|
Other
|
15,782 | 9,404 | 5,158 | |||||||||
|
|
||||||||||||
|
|
$ | 355,140 | $ | 316,516 | $ | 303,114 | ||||||
|
|
||||||||||||
47
| Increase (Decrease) in | ||||
| Medical Claims and | ||||
| (Decrease) Increase in Estimated Completion Factors | Benefits Payable | |||
|
(6)%
|
$ | 80,718 | ||
|
(4)%
|
53,812 | |||
|
(2)%
|
26,906 | |||
|
2%
|
(26,906 | ) | ||
|
4%
|
(53,812 | ) | ||
|
6%
|
(80,718 | ) | ||
| (Decrease) Increase in | ||||
| Medical Claims and | ||||
| (Decrease) Increase in Trended Per member Per Month Cost Estimates | Benefits Payable | |||
|
(6)%
|
$ | (65,330 | ) | |
|
(4)%
|
(43,553 | ) | ||
|
(2)%
|
(21,777 | ) | ||
|
2%
|
21,777 | |||
|
4%
|
43,553 | |||
|
6%
|
65,330 | |||
48
49
| |
In New Mexico, we underestimated the degree to which cuts to the Medicaid fees schedule
would reduce our liability as of December 31, 2009.
|
| |
In California, we underestimated the extent to which various network restructuring,
provider contracting and medical management imitative had reduced our medical care costs
during the second half of 2009, thereby resulting in a lower liability at December 31, 2009.
|
| |
In New Mexico, we overestimated at December 31, 2008 the ultimate amounts we would need
to pay to resolve certain high dollar provider claims.
|
| |
In Ohio, we underestimated the degree to which certain operational initiatives had
reduced our medical costs in the last few months of 2008.
|
| |
In Washington, we overestimated the impact that certain adverse utilization trends would
have on our liability at December 31, 2008.
|
| |
In California, we underestimated utilization trends at the end of 2008, leading to an
underestimation of our liability at December 31, 2008. Additionally, we underestimated the
impact that certain delays in the receipt of paper claims would have on our liability,
leading to a further underestimation of our liability at December 31, 2008.
|
| |
The rapid growth of membership in our Medicare line of business between December 31, 2009
and September 30, 2010.
|
| |
An increase in claims inventory at our Ohio health plan between June 30, 2010 and
September 30, 2010.
|
| |
The transition of claims processing for our Missouri health plan from a third party
service provider to our internal claims processing platform effective April l, 2010.
|
| |
Changes to the Medicaid fee schedule in Utah effective July 1, 2010.
|
50
| As of and for the | ||||||||||||||||||||
| Six | Three | |||||||||||||||||||
| Months | Months | Year | ||||||||||||||||||
| Nine Months Ended | Ended | Ended | Ended | |||||||||||||||||
| September 30, | September 30, | June 30, | March 31, | Dec. 31, | ||||||||||||||||
| 2010 | 2009 | 2010 | 2010 | 2009 | ||||||||||||||||
|
Balances at beginning of period
|
$ | 316,516 | $ | 292,442 | $ | 316,516 | $ | 316,516 | $ | 292,442 | ||||||||||
|
|
||||||||||||||||||||
|
Components of medical care costs related
to:
|
||||||||||||||||||||
|
Current period
|
2,554,579 | 2,381,903 | 1,705,411 | 861,271 | 3,227,794 | |||||||||||||||
|
Prior periods
|
(46,213 | ) | (48,038 | ) | (42,982 | ) | (38,455 | ) | (51,558 | ) | ||||||||||
|
|
||||||||||||||||||||
|
Total medical care costs
|
2,508,366 | 2,333,865 | 1,662,429 | 822,816 | 3,176,236 | |||||||||||||||
|
|
||||||||||||||||||||
|
Payments for medical care costs related to:
|
||||||||||||||||||||
|
Current period
|
2,219,296 | 2,089,417 | 1,389,307 | 581,389 | 2,919,240 | |||||||||||||||
|
Prior periods
|
250,446 | 233,776 | 244,038 | 230,970 | 232,922 | |||||||||||||||
|
|
||||||||||||||||||||
|
Total paid
|
2,469,742 | 2,323,193 | 1,633,345 | 812,359 | 3,152,162 | |||||||||||||||
|
|
||||||||||||||||||||
|
Balances at end of period
|
$ | 355,140 | $ | 303,114 | $ | 345,600 | $ | 326,973 | $ | 316,516 | ||||||||||
|
|
||||||||||||||||||||
|
Benefit from prior period as a percentage
of:
|
||||||||||||||||||||
|
Balance at beginning of period
|
14.6 | % | 16.4 | % | 13.6 | % | 12.1 | % | 17.6 | % | ||||||||||
|
Premium revenue
|
1.5 | % | 1.8 | % | 2.2 | % | 4.0 | % | 1.4 | % | ||||||||||
|
Total medical care costs
|
1.8 | % | 2.1 | % | 2.6 | % | 4.7 | % | 1.6 | % | ||||||||||
|
Days in claims payable, fee for service only
|
42 | 44 | 44 | 44 | 44 | |||||||||||||||
|
Number of members at end of period
|
1,597,000 | 1,411,000 | 1,498,000 | 1,482,000 | 1,455,000 | |||||||||||||||
|
Number of claims in inventory at end of
period
|
110,200 | 107,700 | 106,700 | 153,700 | 93,100 | |||||||||||||||
|
Billed charges of claims in inventory at
end of period
|
$ | 158,900 | $ | 145,500 | $ | 147,500 | $ | 194,000 | $ | 131,400 | ||||||||||
|
Claims in inventory per member at end of
period
|
0.07 | 0.08 | 0.07 | 0.10 | 0.06 | |||||||||||||||
|
Billed charges of claims in inventory per
member at end of period
|
$ | 99.50 | $ | 103.12 | $ | 98.46 | $ | 130.90 | $ | 90.31 | ||||||||||
|
Number of claims received during the
period
|
10,701,900 | 9,427,400 | 7,066,100 | 3,493,300 | 12,930,100 | |||||||||||||||
|
Billed charges of claims received during
the period
|
$ | 8,615,500 | $ | 7,180,800 | $ | 5,605,400 | $ | 2,760,500 | $ | 9,769,000 | ||||||||||
51
52
53
54
| 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.
|
|||
55
|
|
MOLINA HEALTHCARE, INC. | |||
|
|
(Registrant) | |||
|
|
||||
|
Dated:
November 4, 2010
|
/s/ JOSEPH M. MOLINA, M.D.
|
|||
|
|
Chairman of the Board, | |||
|
|
Chief Executive Officer and President | |||
|
|
(Principal Executive Officer) | |||
|
|
||||
|
Dated:
November 4, 2010
|
/s/ JOHN C. MOLINA, J.D.
|
|||
|
|
Chief Financial Officer and Treasurer | |||
|
|
(Principal Financial Officer) |
56
No information found
* THE VALUE IS THE MARKET VALUE AS OF THE LAST DAY OF THE QUARTER FOR WHICH THE 13F WAS FILED.
| FUND | NUMBER OF SHARES | VALUE ($) | PUT OR CALL |
|---|
| DIRECTORS | AGE | BIO | OTHER DIRECTOR MEMBERSHIPS |
|---|
No information found
No Customers Found
No Suppliers Found
Price
Yield
| Owner | Position | Direct Shares | Indirect Shares |
|---|