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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D. C. 20549
FORM 10-Q

þ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 2004

OR

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

For the transition period from ______________ to _________________

COMMISSION FILE NUMBER 1-16477

COVENTRY HEALTH CARE, INC.

(Exact name of registrant as specified in its charter)

6705 Rockledge Drive, Suite 900, Bethesda, Maryland 20817
(Address of principal executive offices) (Zip Code)

(301) 581-0600
(Registrant’s telephone number, including area code)

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

     Indicate by check mark whether the registrant is an accelerated filer (as defined in the Securities Exchange Act of 1934 Rule 12b-2). Yes þ No¨

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

COVENTRY HEALTH CARE, INC.
FORM 10-Q
TABLE OF CONTENTS

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PART I. FINANCIAL INFORMATION
ITEM 1: Financial Statements

COVENTRY HEALTH CARE, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE
(in thousands)

        See accompanying notes to the condensed consolidated financial statements.

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COVENTRY HEALTH CARE, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF OPERATIONS
(in thousands, except per share data)
(unaudited)

        See accompanying notes to the condensed consolidated financial statements.

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COVENTRY HEALTH CARE, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(in thousands)
(unaudited)

        See accompanying notes to the condensed consolidated financial statements.

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COVENTRY HEALTH CARE, INC. AND SUBSIDIARIES
NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(UNAUDITED)

A.     BASIS OF PRESENTATION

         The condensed consolidated financial statements of Coventry Health Care, Inc. and subsidiaries (“Coventry” or the “Company”) contained in this report are unaudited but reflect all normal recurring adjustments which, in the opinion of management, are necessary for the fair presentation of the results of the interim periods reflected. Certain information and footnote disclosures normally included in the consolidated financial statements prepared in accordance with accounting principles generally accepted in the United States have been omitted pursuant to applicable rules and regulations of the Securities and Exchange Commission. The results of operations for the interim periods reported herein are not necessarily indicative of results to be expected for the full year. It is suggested that these condensed consolidated financial statements be read in conjunction with the consolidated financial statements and notes thereto included in the Company’s most recent Annual Report on Form 10–K for the year ended December 31, 2003.

         On December 23, 2003, the Company’s Board of Directors approved a three–for–two stock split of the Company’s common stock. The stock split, in the form of a stock dividend, was distributed January 30, 2004 to stockholders of record on January 9, 2004. The stock split is reflected retroactively in the Company’s condensed consolidated financial statements and notes thereto for all periods presented.

B.     SIGNIFICANT ACCOUNTING POLICIES

         Stock–based Compensation – The Company accounts for stock–based compensation to employees under Accounting Principles Board (“APB”) No. 25 – “Accounting for Stock Issued to Employees,” and complies with the disclosure requirements for Statement of Financial Accounting Standards (“SFAS”) No. 123 – “Accounting for Stock–Based Compensation” and SFAS No. 148 – “Accounting for Stock–Based Compensation – Transition and Disclosure.” Unless the accounting rules change, the Company does not expect to transition to the fair value method of accounting for stock–based compensation. Had stock–based compensation cost been determined consistent with SFAS No. 123, the Company’s net earnings and earnings per share (“EPS”) would have been reduced to the following pro–forma amounts (in thousands, except per share data):

C.    SENIOR NOTES

         The Company’s senior notes contain certain covenants and restrictions regarding incurring additional debt, limiting dividends or other restricted payments, and restricting transactions with affiliates, sales of assets and consolidations or mergers. The Company has complied with all covenants under the senior notes.

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D.     CONTINGENCIES

         In the normal course of business, the Company has been named as a defendant in various legal actions such as actions seeking payments for claims denied by the Company, medical malpractice actions, employment related claims and other various claims seeking monetary damages. The claims are in various stages of proceedings and some may ultimately be brought to trial. Incidents occurring through September 30, 2004 may result in the assertion of additional claims. The Company maintains general liability, professional liability and employment practices liability insurances in amounts that the Company believes are appropriate, with varying deductibles for which the Company maintains reserves. The professional liability and employment practices liability insurances are carried through the Company’s captive subsidiary.

         The Company’s captive subsidiary provides up to $5 million in professional liability coverage for each single claim and up to $10 million in coverage for each class action claim. The captive professional liability policy has an aggregate limit of $20 million per year. The captive is also co–insured with a commercial carrier for an additional $10 million for professional liability claims made and reported prior to May 1, 2004. For claims made and reported after May 1, 2004, the Company has chosen to have no co–insurance coverage with a commercial carrier. Additionally, the captive employment practices liability policy provides up to $250,000 per single claim, $10 million per class action claim, and an aggregate policy limit of $10 million. Each year the Company will re–evaluate the most cost effective method for insuring these types of claims.

         Coventry Health Care, Inc. is a defendant in the provider track in the Managed Care Litigation filed in the United States District Court for the Southern District of Florida, Miami Division, Multi-District Litigation (“MDL”) No. 1334, styled in re: Humana, Inc., Charles B. Shane, MD, et al. vs. Humana, Inc., et al. This action was filed by a group of physicians as a class action against Coventry and twelve other companies in the managed care industry. In its fourth amended complaint, the plaintiffs have alleged violations of the federal racketeering act, Racketeer Influenced and Corrupt Organizations (“RICO”), conspiracy to violate RICO and aiding and abetting a scheme to violate RICO. In addition to these RICO claims, the complaint includes counts for breach of contract, violations of various state prompt payment laws and equitable claims for unjust enrichment and quantum meruit. Coventry has filed a motion to dismiss each of these claims because they fail to state a cause of action or, in the alternative, to compel arbitration pursuant to the arbitration provisions which exist in the Company’s physician contracts. In response to the motion to dismiss, the trial court dismissed several of the claims and ordered that all physicians who have an arbitration provision in their provider contracts must submit all of their claims to arbitration. As a consequence of this ruling, all the plaintiffs who have arbitration provisions voluntarily dismissed all of their claims that are subject to arbitration. In response to the trial court’s order, the defendants filed demands to arbitrate the plaintiffs’ arbitrable claims. The trial court, however, in response to a motion filed by the plaintiffs, entered an order enjoining the defendants from arbitrating those claims. The 11th Circuit Court of Appeals overturned the trial court’s order and dissolved the injunction barring arbitration of the plaintiffs’ arbitrable claims. The trial court however has ordered that the plaintiffs’ claims of conspiracy, conspiracy to violate RICO and aiding and abetting violations of RICO are not subject to arbitration. The defendants, including Coventry, have appealed the trial court’s order to the 11th Circuit Court of Appeals. The appeal has been fully briefed and argued and the parties are awaiting the decision. The Court of Appeals has stayed the Shane lawsuit pending its decision. The trial court has certified various subclasses of physicians; however, Coventry is not subject to the class certification order because the motion to certify was filed before Coventry was joined as a defendant. The plaintiffs have now filed a motion to certify a class as to Coventry, and Coventry has filed their opposition to that motion. The trial court has not yet issued a ruling on the motion. The defendants who were subject to the certification order filed an appeal to the 11th Circuit Court of Appeals. The Court of Appeals has overturned the class certification order as to the plaintiffs’ state law claims but affirmed the certification with respect to the plaintiffs’ federal law claims. The Court of Appeals also suggested to the trial court that it reconsider the various subclasses it had certified. Two defendants have entered into settlement agreements with the plaintiffs. Both settlement agreements have been filed with the Court and have received final approval. The Shane lawsuit has triggered the filing of copycat class action complaints by other health care providers such as chiropractors, podiatrists, acupuncturists and other licensed health care professionals. Each of these actions has been transferred to the MDL and has been designated as “tag–along” actions to Shane. The court has entered an order which stays all proceedings in the tag–along actions until all pre–trial proceedings in Shane have been concluded. Although the Company can not predict the outcome, management believes that the Shane lawsuit and tag–along actions will not have a material adverse effect on its financial position or its results of operations. Management also believes that the claims asserted against the Company in these lawsuits are without merit, and the Company intends to defend its position.

E.     RESTRICTED STOCK AWARDS

         The Company awarded 27,000 shares of restricted stock in the third quarter of 2004 and 545,500 during the nine months ended September 30, 2004, of which 518,500 shares are subject to certain performance criteria. The weighted average fair value, at the measurement date, of the restricted stock awards was $53.15. The fair value of the restricted shares is amortized over various vesting periods through September 2008. The Company recorded compensation expense related to restricted stock grants, including restricted stock granted in prior periods of approximately $4.6 million and $2.8 million for the quarters ended September 30, 2004 and 2003, respectively, and $10.9 million and $6.8 million for the nine months ended September 30, 2004 and 2003, respectively. The deferred portion of the restricted stock as reported as a reduction to additional paid in capital is $41.3 million at September 30, 2004 and $23.4 million at December 31, 2003.

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F.     SHARE REPURCHASE PROGRAM

         Under a share repurchase program previously approved by the Board of Directors, the Company purchased 2.0 million shares of the Company’s common stock during the nine months ended September 30, 2004 at an aggregate cost of $84.6 million. There were no shares repurchased during the current quarter under this program. The program authorized the repurchase of 9.4 million shares, of which 1.8 million remain still to be repurchased. Excluded from these amounts are shares purchased in exchange for employee payroll taxes on vesting of restricted stock awards as these purchases are not considered part of the program.

G.     SEGMENT INFORMATION

         The Company evaluates the performance of its operating segments and allocates resources based on gross margin. Assets are not allocated to specific products and, accordingly, can not be reported by segment. The following tables summarize the Company’s reportable segments through gross margin and include a medical loss ratio (“MLR”) calculation:

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H.     COMPREHENSIVE INCOME

         Comprehensive income for the quarters and nine months ended September 30, 2004 and 2003 was as follows (in thousands):

I.     SUBSEQUENT EVENTS

         Effective October 1, 2004, the Company completed its purchase of certain assets of OmniCare Health Plan (“OmniCare”), in Detroit, Michigan. Assets purchased include rights to enroll approximately 63,000 Medicaid risk members. The purchase price will be allocated to identifiable assets based on estimated fair values. The purchase price is based on members that enroll with Coventry as of January 1, 2005. Projected payments are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.

         On October 14, 2004, the Company announced that it had signed a definitive agreement to acquire First Health Group Corporation (“First Health”). First Health is a full service national health benefits services company, headquartered in Downers Grove, Illinois, that serves the group health, workers’ compensation and state public program markets. Pursuant to the agreement, each outstanding share of First Health common stock will be converted into and represent the right to receive 0.1791 shares of the Company’s common stock and $9.375 in cash. Based on the closing price of Coventry’s shares on October 13, 2004, the indicated combined per share consideration for each outstanding share of First Health common stock amounts to a total indicated purchase price of approximately $1.8 billion. The agreement has been approved by the Boards of Directors of the Company and First Health. The transaction is expected to close in the first quarter of 2005 and is subject to the approval of a majority of First Health’s shareholders, regulatory approvals and other customary conditions.

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ITEM 2: Management’s Discussion and Analysis of Financial Condition and Results of Operations
Quarters and Nine Months Ended September 30, 2004 and 2003

         This Form 10–Q contains forward–looking statements which are subject to risks and uncertainties in accordance with the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Forward–looking statements, typically include assumptions, estimates or descriptions of our future plans, strategies and expectations, and are generally identifiable by the use of the words “anticipate,” “will,” “believe,” “estimate,” “expect,” “intend,” “seek,” or other similar expressions. Examples of these include discussions regarding our operating and growth strategy, projections of revenue, income or loss and future operations. Unless this Form 10–Q indicates otherwise or the context otherwise requires, the terms “we,” “our,” “our Company,” “the Company” or “us” as used in this Form 10–Q refer to Coventry Health Care, Inc. and its subsidiaries.

         These forward–looking statements may be affected by a number of factors, including, but not limited to, the “Risk Factors” contained in Part II, Item 7, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” of our Annual Report on Form 10–K for the year ended December 31, 2003. Actual operations and results may differ materially from those expressed in this Form 10–Q.

         The following discussion and analysis relates to our financial condition and results of operations for the quarters ended and nine months ended September 30, 2004 and 2003. This discussion should be read in conjunction with the condensed consolidated financial statements and other information presented herein as well as in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” contained in our Annual Report on Form 10–K for the year ended December 31, 2003, including the critical accounting policies discussed therein.

Highlights of Third Quarter 2004 Performance

wMembership increased 4.0% over the prior year quarter.
wRevenue increased 15.6% over the prior year quarter.
wMedical loss ratio of 80.1% improved 40 basis points over the prior year quarter.
wSelling, general and administrative expenses were 11.6% of operating revenue, a 30 basis point improvement over the prior year quarter.
wOperating margin of 9.6% improved 70 basis points over the prior year quarter.
wDiluted earnings per share increased 29.7% over the prior year quarter.

Stock split

         On December 23, 2003, our Board of Directors approved a three–for–two stock split of our common stock, effective January 30, 2004 for stockholders of record on January 9, 2004. The stock split is reflected retroactively in per share data for all periods presented.

Subsequent Acquisitions

         Effective October 1, 2004, we completed our purchase of certain assets of OmniCare Health Plan (“OmniCare”), in Detroit, Michigan. Assets purchased include rights to enroll approximately 63,000 Medicaid risk members. The purchase price will be allocated to identifiable assets based on estimated fair values. The purchase price is based on members that enroll with us through January 1, 2005. Projected payments are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.

         On October 14, 2004, we announced that we had signed a definitive agreement to acquire First Health Group Corporation (“First Health”). First Health is a full service national health benefits services company, headquartered in Downers Grove, Illinois, that serves the group health, workers’ compensation and state public program markets. Pursuant to the agreement, each outstanding share of First Health common stock will be converted into and represent the right to receive 0.1791 shares of the Company’s common stock and $9.375 in cash. Based on the closing price of the Company’s shares on October 13, 2004, the indicated combined per share consideration for each outstanding share of First Health common stock amounts to a total indicated purchase price of approximately $1.8 billion. The agreement has been approved by our Board of Directors and the Board of Directors of First Health. The transaction is expected to close in the first quarter of 2005 and is subject to the approval of a majority of First Health’s shareholders, regulatory approvals and other customary conditions.

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Membership

         The following tables present our membership as of September 30, 2004 and 2003 (amounts in thousands).