Back to GetFilings.com



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 logo

COVENTRY HEALTH CARE, INC.

(Exact name of registrant as specified in its charter)

Delaware 52-2073000
(State or other jurisdiction of (I.R.S. Employer
incorporation or organization) Identification Number)

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.

Class Outstanding at October 31, 2004
Common Stock $.01 Par Value 89,760,111

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

PART I. FINANCIAL INFORMATION
  ITEM 1: Financial Statements
    Consolidated Balance Sheets
at September 30, 2004 and December 31, 2003
3
    Consolidated Statements of Operations
for the quarters and nine months ended September 30, 2004 and 2003
4
    Condensed Consolidated Statements of Cash Flows
for the nine months ended September 30, 2004 and 2003
5
    Notes to the Condensed Consolidated Financial Statements 6
  ITEM 2: Management’s Discussion and Analysis of Financial Condition and Results of Operations 10
  ITEM 3: Quantitative and Qualitative Disclosures of Market Risk 17
  ITEM 4: Controls and Procedures 17
PART II. OTHER INFORMATION
  ITEM 1: Legal Proceedings 18
  ITEM 2: Unregistered Sales of Equity Securities and Use of Proceeds 19
  ITEM 3, 4 and 5: Not Applicable 19
  ITEM 6: Exhibits 20
  SIGNATURES 21
  INDEX TO EXHIBITS 22

2


PART I. FINANCIAL INFORMATION
ITEM 1: Financial Statements

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

September 30,
2004
December 31,
2003


ASSETS   (unaudited)    
Current assets:      
     Cash and cash equivalents  $    398,853    $    253,331   
     Short-term investments  287,141    101,191   
     Accounts receivable, net  91,523    89,766   
     Other receivables, net  52,240    45,335   
     Deferred income taxes  35,698    36,255   
     Other current assets  8,670    8,089   


          Total current assets  874,125    533,967   
     Long-term investments  949,099    1,051,400   
     Property and equipment, net  29,917    33,085   
     Goodwill  281,328    281,183   
     Other intangible assets, net  26,154    27,447   
     Other long-term assets  57,171    54,654   


          Total assets  $ 2,217,794    $ 1,981,736   


LIABILITIES AND STOCKHOLDERS' EQUITY 
Current liabilities: 
     Medical claims liabilities  $    597,510    $    537,340   
     Other medical liabilities  48,767    59,850   
     Accounts payable and other accrued liabilities  198,139    183,781   
     Deferred revenue  72,720    73,909   


          Total current liabilities  917,136    854,880   
     Senior notes  170,500    170,500   
     Other long-term liabilities  26,065    27,358   


          Total liabilities  1,113,701    1,052,738   


Stockholders' equity: 
     Common stock, $.01 par value; 200,000 authorized 
       105,700 issued and 89,768 outstanding in 2004 
       104,797 issued and 90,571 outstanding in 2003  1,057    1,048   
     Treasury stock, at cost; 15,932 in 2004; 14,226 in 2003  (291,043)   (204,274)  
     Additional paid-in capital  588,923    565,734   
     Accumulated other comprehensive income  11,153    17,838   
     Retained earnings  794,003    548,652   


          Total stockholders' equity  1,104,093    928,998   


          Total liabilities and stockholders' equity  $ 2,217,794    $ 1,981,736   


        See accompanying notes to the condensed consolidated financial statements.

3


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

Quarters Ended September 30, Nine Months Ended September 30,
2004 2003 2004 2003




Operating revenues:          
         Managed care premiums  $1,302,053   $1,126,594   $3,843,529   $3,244,884  
         Management services  27,763   23,395   84,260   66,953  




             Total operating revenues  1,329,816   1,149,989   3,927,789   3,311,837  




Operating expenses: 
         Medical costs  1,043,317   906,756   3,096,860   2,638,031  
         Selling, general and administrative  154,034   136,859   455,705   397,579  
         Depreciation and amortization  4,259   4,280   12,921   13,424  




             Total operating expenses  1,201,610   1,047,895   3,565,486   3,049,034  




Operating earnings  128,206   102,094   362,303   262,803  
Senior notes interest and amortization expense  3,572   4,126   10,719   11,470  
Other income, net  10,809   9,211   32,581   31,115  




Earnings before income taxes  135,443   107,179   384,165   282,448  
Provision for income taxes  48,421   39,656   138,814   101,991  




Net earnings  $     87,022   $     67,523   $   245,351   $   180,457  




Net earnings per share: 
      Basic earnings per share  $         0.99   $         0.76   $         2.79   $         2.05  




      Diluted earnings per share  $         0.96   $         0.74   $         2.71   $         1.99  




Weighted average common shares outstanding: 
      Basic  88,344   88,595   87,954   87,824  
      Effect of dilutive options, warrants and restricted stock  2,309   2,635   2,573   2,617  




        Diluted  90,653   91,230   90,527   90,441  




        See accompanying notes to the condensed consolidated financial statements.

4


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

Nine Months Ended September 30,
2004 2003


Net cash from operating activities   $ 347,318    $ 238,006   


Cash flows from investing activities: 
    Capital expenditures, net  (7,812)   (6,921)  
    Proceeds from sales of investments  248,296    364,493   
    Proceeds from maturities of investments  161,033    15,138   
    Purchases of investments  (514,489)   (449,069)  
    Payments for acquisitions, net of cash acquired  (975)   (60,473)  


Net cash from investing activities  (113,947)   (136,832)  


Cash flows from financing activities: 
    Proceeds from issuance of stock  8,886    11,851   
    Payments for repurchase of stock  (96,602)   (6,049)  
    Payments for repurchase of senior notes  --   (4,916)  
    Payments for fractional shares from stock split  (133)   --  


Net cash from financing activities  (87,849)   886   


Net change in cash and cash equivalents  145,522    102,060   
Cash and cash equivalents at beginning of period  253,331    186,768   


Cash and cash equivalents at end of period  $ 398,853    $ 288,828   


        See accompanying notes to the condensed consolidated financial statements.

5


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):

Quarters Ended September 30, Nine Months Ended September 30,
2004 2003 2004 2003




Net earnings, as reported   $   87,022    $   67,523    $   245,351    $   180,457  
       
Add: Stock-based employee 
compensation expense included in reported 
net earnings, net of tax  2,828    1,776    6,786    4,351   
       
Deduct: Total stock-based employee 
compensation expense determined 
under fair-value-based method for all 
awards, net of tax  (5,780) (3,335) (12,549) (7,825)




Net earnings, pro-forma  $   84,070    $   65,964    $   239,588    $   176,983   




EPS, basic - as reported  $       0.99    $       0.76    $         2.79    $         2.05   




EPS, basic - pro-forma  $       0.95    $       0.74    $         2.72    $         2.01   




EPS, diluted - as reported  $       0.96    $       0.74    $         2.71    $         1.99   




EPS, diluted - pro-forma  $       0.93    $       0.72    $         2.65    $         1.96   




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.

6


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.

7


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:

Quarters Ended September 30,
(in thousands)




Commercial Medicare Medicaid Total




2004        
   Revenues $1,015,184  $142,761  $144,108  $1,302,053 
   Medical costs 809,630  110,631  123,056  1,043,317 




   Gross margin $   205,554  $  32,130  $  21,052  $   258,736 
   MLR 79.8% 77.5% 85.4% 80.1%
       
2003  
   Revenues $   872,056  $120,794  $133,744  $1,126,594 
   Medical costs 696,467  97,238  113,051  906,756 




   Gross margin $   175,589  $  23,556  $  20,693  $   219,838 
   MLR 79.9% 80.5% 84.5% 80.5%

Nine Months Ended September 30,
(in thousands)




Commercial Medicare Medicaid Total




2004        
   Revenues $2,997,397  $419,189  $426,943  $3,843,529 
   Medical costs 2,378,663  348,726  369,471  3,096,860 




   Gross margin $   618,734  $  70,463  $  57,472  $   746,669 
   MLR 79.4% 83.2% 86.5% 80.6%
       
2003  
   Revenues $2,496,041  $358,315  $390,528  $3,244,884 
   Medical costs 2,003,630  295,258  339,143  2,638,031 




   Gross margin $   492,411  $  63,057  $  51,385  $   606,853 
   MLR 80.3% 82.4% 86.8% 81.3%

8


H.     COMPREHENSIVE INCOME

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

Quarters Ended September 30, Nine Months Ended September 30,
2004 2003 2004 2003




Net earnings $ 87,022  $ 67,523  $ 245,351  $ 180,457 




Other comprehensive gain:
   Holding gain (loss): 12,047  (9,479) (10,768) (195)
   Reclassification adjustment 26  102  (191) (493)




        Sub-total 12,073  (9,377) (10,959) (688)
   Tax (provision) benefit (4,708) 3,329  4,274  244 




Comprehensive income $ 94,387  $ 61,475  $ 238,666  $ 180,013 




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.

9


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.

10


Membership

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

September 30, 2004            
           
Market
Commercial
Medicare
Medicaid
Total
Risk

Non–Risk
Total
Delaware 50  --  52  51  103 
Georgia 40  --  --  40  36  76 
Illinois 74  --  --  74  13  87 
Iowa 49  --  54  12  66 
Kansas 148  14  --  162  48  210 
Louisiana 73  --  --  73  76 
Missouri 196  18  185  399  96  495 
Nebraska 45  --  --  45  50 
North Carolina 68  --  12  80  40  120 
Pennsylvania 467  33  94  594  142  736 
Utah 119  --  --  119  65  184 
Virginia 108  --  15  123  43  166 
West Virginia 50  20  73  77 






     Total 1,487  68  333  1,888  558  2,446 







September 30, 2003
           
Market
Commercial
Medicare
Medicaid
Total
Risk

Non–Risk
Total
Delaware 50  --  --  50  51  101 
Georgia 46  --  --  46  31  77 
Illinois 75  --  --  75  --  75 
Iowa 76  --  79  15  94 
Kansas 163  15  --  178  52  230 
Louisiana 73  --  --  73  --  73 
Missouri 173  16  187  376  85  461 
Nebraska 41  --  --  41  47 
North Carolina 66  --  12  78  40  118 
Pennsylvania 455  30  83  568  112  680 
Utah 117  --  --  117  51  168 
Virginia 100  --  14  114  40  154 
West Virginia 51  16  70  75 






     Total 1,486  64  315  1,865  488  2,353 






11


Coventry Map

         Total membership, excluding network rental membership of 574,000, increased by 4% from the prior year third quarter. Non–risk membership increased 15% from the prior year third quarter. The large increase in non–risk membership was influenced by three large groups changing from a risk product to a non–risk product effective January 1, 2004. We expect organic membership growth to be 3-5% for the full year.

         Network rental membership has declined from the prior year quarter of 719,000 due primarily to one group. The revenue associated with this group was insignificant.

         In January 2005, we expect to lose a large insured account of approximately 25,000 members to an administrative services only (“ASO”) bid and a large existing ASO account of approximately 20,000 members to another third party administrator. Because of the loss of this membership, we expect that organic growth is likely to be negative in January but net positive for all of 2005.

12


Results of Operations

         The following table is provided to facilitate a more meaningful discussion regarding the comparison of our operations for the quarters and nine months ended September 30, 2004 and 2003.

Quarters Ended
September 30,
Increase Nine Months Ended
September 30,
Increase
2004
2003
(Decrease)
2004
2003
(Decrease)
Summary Results (in thousands, except EPS)            
     Total operating revenues $1,329,816  $1,149,989  15.6%  $3,927,789 $3,311,837  18.6% 
     Operating earnings $   128,206  $   102,094  25.6%  $  362,303  $   262,803  37.9% 
     Net earnings $     87,022  $     67,523  28.9%  $  245,351  $   180,457  36.0% 
     Diluted earnings per share $         0.96  $         0.74  29.7%  $        2.71  $         1.99  36.2% 
Managed Care Premium Yields (per member per month):
     Commercial $     228.36  $     208.30  9.6%  $    225.00  $     204.73  9.9% 
     Medicare $     698.82  $     630.56  10.8%  $    691.96  $     628.61  10.1% 
     Medicaid $     143.87  $     141.33  1.8%  $    141.99  $     140.24  1.2% 
Medical Costs (per member per month):
     Commercial $     182.12  $     166.36  9.5%  $    178.56  $     164.34  8.7% 
     Medicare $     541.55  $     507.59  6.7%  $    575.65  $     517.98  11.1% 
     Medicaid $     122.86  $     119.46  2.8%  $    122.88  $     121.78  0.9% 
Medical Loss Ratios:
     Commercial 79.8%  79.9%  (0.1%) 79.4%  80.3%  (0.9%)
     Medicare 77.5%  80.5%  (3.0%) 83.2%  82.4%  0.8% 
     Medicaid 85.4%  84.5%  0.9%  86.5%  86.8%  (0.3%)






     Total 80.1%  80.5%  (0.4%) 80.6%  81.3%  (0.7%)






Administrative Statistics:
     Selling, general and administrative as a percentage of revenue 11.6%  11.9%  (0.3%) 11.6%  12.0%  (0.4%)
     Days in medical claims liabilities 52.7  55.8  (3.1)
     Days in other medical liabilities 4.3  6.1  (1.8)

Quarters Ended September 30, 2004 and 2003

         Managed care premium revenue increased as a result of rate increases that occurred throughout all markets, acquisitions and organic growth. We achieved commercial rate increases in excess of 11.5% on third quarter renewals representing approximately 18% of commercial risk membership. As noted above, the commercial yield PMPM increased 9.6%, but excluding the Altius acquisition the increase was 11.1%. Medicare yields increased as a result of the rate increases from the annual Adjusted Community Rating filings and as a result of the Medicare Modernization Act. The rate increases from the Medicare Modernization Act were for enhanced member benefits and/or network access and thus will not affect profitability. The acquisition of Altius effective September 1, 2003 resulted in an increase in managed care premium revenue of $43.6 million over the prior year quarter.

         Management services revenue increased due to the increase in non–risk membership discussed earlier.

         Medical costs expense has increased due to medical trend, organic growth and acquisitions. However, total medical expense as a percentage of premium revenue has improved by 0.4% over the prior year quarter. This favorable change was attributable to both our Medicare and commercial business. The unusually strong Medicare results were due to lower in-patient days in some of our markets and improved revenue beginning in July due to favorable changes to our risk adjusters. This business is relatively small and normal fluctuations can occur routinely. The favorable commercial results are a result of premium rate increases mentioned above outpacing commercial medical trend. Reported commercial medical trend, excluding Altius and net of benefit buy downs, was 11.0%. The Medicaid medical loss ratio deteriorated over the prior year quarter as a result of increased utilization in Missouri, our largest Medicaid market. Days in total medical claims liabilities decreased from the prior year quarter due primarily to faster claim receipts and continually improved processing cycle times.

13


         Selling, general and administrative expense increased primarily due to normal operating costs of recent acquisitions, an increase in broker commissions and an increase in salary expenses. Broker commissions, excluding acquisitions, have increased due to the growth in both organic membership and in premium rates. Salary expenses, excluding acquisitions, have increased due to annual salary increases, additional amortization expense related to restricted shares of common stock granted in 2003 and 2004, and incremental salary expense related to our organic membership growth. Selling, general and administrative expense as a percentage of revenue has improved as a result of continuing revenue growth and success in controlling customer service costs.

         Our provision for income taxes increased primarily due to an increase in earnings. The effective tax rate decreased to 35.8% in the third quarter of 2004 from 37.0% in 2003. We expect a full year 2004 tax rate between 35.8% and 36.2%.

Nine Months Ended September 30, 2004 and 2003

         Managed care premium revenue increased as a result of rate increases that occurred throughout all markets, acquisitions and organic growth. Medicare yields increased 10.1% on a PMPM basis as a result of the rate increases from the annual Adjusted Community Rating filings and as a result of the Medicare Modernization Act. The rate increases from the Medicare Modernization Act were for enhanced member benefits and/or network access and thus will not affect profitability. The acquisition of Altius effective September 1, 2003 resulted in an increase in managed care premium revenue of $165.0 million over the prior year nine months.

         Management services revenue increased due to the increase in non–risk membership discussed earlier.

         Medical costs expense has increased due to medical trend, acquisitions and organic growth. However, total medical expense as a percentage of premium revenue has improved by 0.7% over the prior year nine months. This favorable change was attributable mostly to our commercial business and is a result of the commercial premium rate increases mentioned above outpacing commercial medical trend. Reported commercial medical trend, excluding Altius and net of benefit buy downs, was 10.2%. Our Medicare business medical loss ratio deteriorated compared to the prior year nine months as a result of unusually high medical utilization in the first quarter of 2004. The deterioration was partially offset by the increase in premium yields discussed above. Our Medicaid medical loss ratio improved as a result of rate increases across our markets and as a result of much improved performance in our Virginia market. The Virginia market benefited from lower utilization, lower drug costs and favorable provider contract renegotiations.

         Selling, general and administrative expense increased primarily due to normal operating costs of recent acquisitions, an increase in broker commissions and an increase in salary expenses. Broker commissions, excluding acquisitions, have increased due to the growth in both organic membership and in premium rates. Salary expenses, excluding acquisitions, have increased due to annual salary increases, additional amortization expense related to restricted shares of common stock granted in 2003 and 2004, and incremental salary expense related to our organic membership growth. Selling, general and administrative expenses as a percentage of revenue have improved as a result of continuing revenue growth and success in controlling customer service costs.

         Our provision for income taxes increased due to an increase in earnings. The effective tax rate remained flat at 36.1%.

Liquidity and Capital Resources

      Consolidated

         Our total cash and investments, consisting of cash and cash equivalents and short–term and long–term investments, but excluding deposits of $23.2 million restricted under state regulations, increased $229.2 million to $1.6 billion at September 30, 2004 from December 31, 2003.

14


         We have classified all of our investments as available–for–sale. Our investments at September 30, 2004 mature according to their contractual terms, as follows, in thousands (actual maturities may differ because of call or prepayment rights):

Amortized
Cost

Fair
Value

As of September 30, 2004    
Maturities:
    Within 1 year $   347,005  $   347,167 
    1 to 5 years 473,007  480,815 
    5 to 10 years 248,960  255,691 
    Over 10 years 148,984  152,567 


Total short–term and long–term securities $1,217,956  $1,236,240 


         Net cash from operating activities is primarily driven by net earnings and an increase in certain liabilities. The medical claims liabilities increased during the nine months ended September 30, 2004 due to claim inventories being unusually low at December 31, 2003. Additionally, accounts payable and other accrued liabilities for the nine months increased primarily as a result of tax payments being less than the tax provision. Cash flow from operating activities has improved over the prior year quarter primarily as a result of higher earnings and a larger increase in medical claims liabilities during the nine months ended September 30, 2004 than over the same period of 2003.

         Net cash from financing activities decreased from the prior year nine months due primarily to cash paid for the repurchase of stock during the first quarter of 2004. The stock was repurchased under a share repurchase program previously approved by our Board of Directors. The program authorized 9.4 million shares to be repurchased and the total remaining common shares we are authorized to repurchase under this program is 1.8 million.

         Projected cash payments for the OmniCare purchase are $6.2 million in the fourth quarter of 2004 and $6.2 million in the first quarter of 2005.

         Projected capital investments in 2004 of approximately $10 million consist primarily of computer hardware, software and related equipment costs associated with the development and implementation of improved operational and communication systems.

         Our 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. We have complied with all covenants under the senior notes.

         Our investment guidelines emphasize investment grade fixed income instruments in order to provide liquidity to meet future payment obligations and minimize the risk to the principal. The fixed income portfolio includes government and corporate securities with an average quality rating of “AAA” and an average contractual duration of 2.6 years, as of September 30, 2004. We will continue to fund our working capital requirements from our cash flow from operations. We believe that because our long–term investments are available–for–sale, the amount of such investments should be considered when assessing our liquidity. On such basis, current assets plus long–term investments available–for–sale less current liabilities increased to $906.1 million at September 30, 2004 from $730.5 million at December 31, 2003.

      Health Plans

         Our regulated HMO and insurance company subsidiaries are required by state regulatory agencies to maintain minimum surplus balances, thereby limiting the dividends the parent may receive from its regulated entities. During the nine months ended September 30, 2004, we collected $158.6 million in dividends and $12.6 million for note repayments from our regulated subsidiaries.

15


         The majority of states in which we operate health plans have adopted a risk–based capital (“RBC”) policy that recommends the health plans maintain statutory reserves at or above the ‘Company Action Level’ which is currently equal to 200% of their RBC. We have adopted an internal policy to maintain all of our regulated subsidiaries’ statutory capital and surplus at or above 250% of their RBC and a level of 300% in aggregate (referred to below as “300% of RBC”). Some states in which our regulated subsidiaries operate, require deposits to be maintained with the respective states’ departments of insurance. The table below summarizes our statutory reserve information, as of September 30, 2004 and December 31, 2003 (in millions, except percentage data). The RBC threshold for September 30, 2004 has been estimated as we are not required to update this calculation except on an annual basis. This calculation was based on December 31, 2003 data and when it is recalculated at December 31, 2004 it is likely to increase.

September 30,
2004

December 31
2003

Regulated Capital and surplus $617.6(a) $588.6 
300% of RBC 449.4     449.4 
Excess capital and surplus above 300% of RBC 168.2     139.2 
Capital and surplus as a percentage of RBC 412%    393%
Statutory deposits 23.2     23.2 
     
(a) estimated    

         The increase in capital and surplus for our regulated subsidiaries is a result of income from 2004 offset by dividends paid to the parent company.

         Excluding funds held by entities subject to regulation, we had cash and investments of approximately $339.7 million and $209.5 million at September 30, 2004 and December 31, 2003, respectively. The increase in non–regulated cash and investments is primarily a result of dividends received from our regulated subsidiaries, as mentioned above, and ordinary operating activities offset by stock repurchases made during the first quarter. During the nine months ended September 30, 2004, we made a capital contribution of $15 million to our newly formed Michigan subsidiary to meet statutory capital requirements.

      Other

         The United States Department of Health and Human Services has issued rules, as mandated by the Health Insurance Portability and Accountability Act of 1996, which, among other things, impose security and privacy requirements with respect to individually identifiable patient data, including a member’s transactions with health care providers and payors, as well as requirements for the standardization of certain electronic transaction code sets and provider identifiers. We anticipate spending approximately $2.0 million in 2004, of which approximately $1.0 million will be capitalized, related to improved functionality of our electronic transaction code sets, improved provider identifier standards, and improved security and patient information privacy standards.

         Management believes that the combination of our ability to generate cash flows from operations, cash and investments on hand and the excess funds held in certain of our regulated subsidiaries will be sufficient to fund continuing operations, capital expenditures, debt interest costs and any other reasonably likely future cash requirements.

      Share Repurchase Program

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

      Legal Proceedings

         Refer to Part II, Item 1, “Legal Proceedings.”

16


ITEM 3: Quantitative and Qualitative Disclosures of Market Risk

         These disclosures should be read in conjunction with the condensed consolidated financial statements, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and other information presented herein as well as in “Quantitative and Qualitative Disclosures of Market Risk ” contained in our Annual Report on Form 10–K for the year ended December 31, 2003.

         No material changes have occurred in our exposures to market risk since the date of our Annual Report on Form 10–K for the fiscal year ended December 31, 2003.

         Our projections of hypothetical net losses in fair value of our market rate sensitive instruments, should potential changes in market rates occur, are presented below. The projection is based on a model, which incorporates effective duration, convexity and price to forecast hypothetical instantaneous changes in interest rates of positive and negative 100, 200 and 300 basis points. The model only takes into account the fixed income securities in the portfolio and excludes all cash. While we believe that the potential market rate change is reasonably possible, actual results may differ.

Increase (decrease) in fair value of portfolio
given an interest rate (decrease) increase of X basis points
As of September 30, 2004
(in thousands)

(300) (200) (100) 100  200  300 






$ 97,308  $ 63,515  $ 31,417  $ (31,325) $ (62,108) $ (91,874)

ITEM 4: Controls and Procedures

         We have performed an evaluation as of the end of the period covered by this report of the effectiveness of our “disclosure controls and procedures” (as defined in Rule 13a–15(e) promulgated under the Securities Exchange Act of 1934), under the supervision and with the participation of our Chief Executive Officer and Chief Financial Officer. Based upon our evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures are effective.

         There have been no significant changes in our internal control over financial reporting during the quarter ended September 30, 2004 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

17


PART II. OTHER INFORMATION

ITEM 1: Legal Proceedings

         In the normal course of business, we have 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. We maintain general liability, professional liability and employment practices liability insurances in amounts that we believe are appropriate, with varying deductibles for which we maintain reserves. The professional liability and employment practices liability insurances are carried through our captive subsidiary.

         Our 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 we will re–evaluate the most cost effective method for insuring these types of claims.

         We are 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. We have 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 our 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, we are not subject to the class certification order because the motion to certify was filed before we were joined as a defendant. The plaintiffs have now filed a motion to certify a class as to Coventry, and we have 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 we 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 us in these lawsuits are without merit, and we intend to defend our position.

18


ITEM 2: Unregistered Sales of Equity Securities and Use of Proceeds

         The following table shows our purchases of our common stock during the quarter ended September 30, 2004 (in thousands, except per share information).

Total Number
of Shares
Purchased(1)

Average Price
Paid per Share

Total Number of
Shares Purchased as
Part of Publicly
Announced Plans

Maximum Number of
Shares That May Yet be
Purchased Under the
Plan or Program(2)

July 1–31, 2004 100  $     47.72  --  1,756 
August 1–31, 2004 $     50.81  --  1,756 
September 1–30, 2004 --  $     51.76  --  1,756 
         
Totals 105  $     50.10  --  1,756 


(1)  

These shares were purchased in exchange for employee payroll taxes on vesting of restricted stock awards and are not part of the publicly announced program.

(2)  

These shares are under a program previously announced on December 20, 1999, as amended. The program authorized 9.4 million shares to be repurchased and does not have an expiration date.

ITEM 3, 4 and 5: Not Applicable

19


ITEM 6: Exhibits

Exhibit
No.

  Description of Exhibit
     
31.1  

Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the Sarbanes–Oxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director.

     
31.2  

Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the Sarbanes–Oxley Act of 2002 made by Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer.

     
32.1  

Certification pursuant to 18 U.S.C. section 1350 as adopted pursuant to section 906 of the Sarbanes–Oxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director and Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer.

20


SIGNATURES

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

   
COVENTRY HEALTH CARE, INC.

(Registrant)
   
Date: November 8, 2004 By: /s/ Allen F. Wise

Allen F. Wise
President, Chief Executive Officer and Director
   
Date: November 8, 2004 By: /s/ Dale B. Wolf

Dale B. Wolf
Executive Vice President, Chief Financial Officer and Treasurer
   
Date: November 8, 2004 By: /s/ John J. Ruhlmann

John J. Ruhlmann
Vice President and Controller

21


INDEX TO EXHIBITS

Reg. S-K: Item 601

Exhibit
No.

  Description of Exhibit
     
31.1  

Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the Sarbanes–Oxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director.

     
31.2  

Certification pursuant to 18 U.S.C. Section 1350 as adopted pursuant to section 302 of the Sarbanes–Oxley Act of 2002 made by Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer.

     
32.1  

Certification pursuant to 18 U.S.C. section 1350 as adopted pursuant to section 906 of the Sarbanes–Oxley Act of 2002 made by Allen F. Wise, President, Chief Executive Officer and Director and Dale B. Wolf, Executive Vice President, Chief Financial Officer and Treasurer.

22