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 |
Puerto Rico | 66-0555678 | |
(State or other jurisdiction of incorporation or | (I.R.S. Employer Identification No.) | |
organization) | ||
1441 F.D. Roosevelt Avenue | ||
San Juan, Puerto Rico | 00920 | |
(Address of principal executive offices) | (Zip code) |
Large accelerated filer o | Accelerated filer o | Non-accelerated filer þ |
Title of each class | Outstanding at March 31, 2006 | |
Common Stock, $40.00 par value | 8,911 |
2
(Unaudited) | ||||||||
March 31, | December 31, | |||||||
2006 | 2005 | |||||||
ASSETS |
||||||||
Investments and cash: |
||||||||
Securities held for trading, at fair value: |
||||||||
Equity securities |
$ | 81,550 | 78,215 | |||||
Securities available for sale, at fair value: |
||||||||
Fixed maturities |
715,337 | 515,174 | ||||||
Equity securities |
53,331 | 51,810 | ||||||
Securities held to maturity, at amortized cost: |
||||||||
Fixed maturities |
21,083 | 21,129 | ||||||
Policy loans |
4,888 | | ||||||
Cash and cash equivalents |
48,909 | 48,978 | ||||||
Total investments and cash |
925,098 | 715,306 | ||||||
Premiums and other receivables, net |
154,711 | 244,038 | ||||||
Deferred policy acquisition costs and value of business acquired |
104,239 | 81,568 | ||||||
Property and equipment, net |
38,544 | 34,709 | ||||||
Net deferred tax asset |
498 | 2,151 | ||||||
Other assets |
57,073 | 59,690 | ||||||
Total assets |
$ | 1,280,163 | 1,137,462 | |||||
LIABILITIES AND STOCKHOLDERS EQUITY |
||||||||
Claim liabilities: |
||||||||
Claims processed and incomplete |
$ | 147,069 | 139,694 | |||||
Unreported losses |
163,868 | 143,224 | ||||||
Unpaid loss-adjustment expenses |
15,402 | 14,645 | ||||||
Total claim liabilities |
326,339 | 297,563 | ||||||
Future policy benefits |
168,457 | | ||||||
Future policy benefits reserve related to funds withheld reinsurance |
| 118,635 | ||||||
Unearned premiums |
98,588 | 95,703 | ||||||
Policyholder deposits |
54,384 | 41,738 | ||||||
Liability to Federal Employees Health Benefits Program |
8,097 | 4,356 | ||||||
Accounts payable and accrued liabilities |
119,547 | 106,468 | ||||||
Short-term borrowings |
| 1,740 | ||||||
Long-term borrowings |
185,317 | 150,590 | ||||||
Additional minimum pension liability |
14,133 | 11,966 | ||||||
Total liabilities |
974,862 | 828,759 | ||||||
Stockholders equity: |
||||||||
Common stock, $40 par value. Authorized 12,500 shares;
issued and outstanding
8,911 at March 31, 2006
and
8,904 at December 31, 2005 |
356 | 356 | ||||||
Additional paid-in capital |
150,408 | 150,408 | ||||||
Retained earnings |
166,114 | 162,964 | ||||||
Accumulated other comprehensive loss |
(11,577 | ) | (5,025 | ) | ||||
Total stockholders equity |
305,301 | 308,703 | ||||||
Total liabilities and stockholders equity |
$ | 1,280,163 | 1,137,462 | |||||
3
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
REVENUE: |
||||||||
Premiums earned, net |
$ | 382,104 | 333,389 | |||||
Amounts attributable to self-funded
arrangements |
50,806 | 51,915 | ||||||
Less amounts attributable to claims under
self-funded arrangements |
(47,377 | ) | (48,540 | ) | ||||
385,533 | 336,764 | |||||||
Net investment income |
10,050 | 7,064 | ||||||
Net realized investment gains |
528 | 3,314 | ||||||
Net
unrealized investment gain (loss) on trading securities |
2,556 | (5,793 | ) | |||||
Other income, net |
1,199 | 632 | ||||||
Total revenue |
399,866 | 341,981 | ||||||
BENEFITS AND EXPENSES: |
||||||||
Claims incurred |
326,684 | 302,923 | ||||||
Operating expenses, net of reimbursement
for services |
57,730 | 43,766 | ||||||
Interest expense |
3,394 | 1,788 | ||||||
Total benefits and expenses |
387,808 | 348,477 | ||||||
Income (loss) before taxes |
12,058 | (6,496 | ) | |||||
INCOME TAX EXPENSE (BENEFIT): |
||||||||
Current |
2,636 | 1,221 | ||||||
Deferred |
41 | (2,510 | ) | |||||
Total income taxes |
2,677 | (1,289 | ) | |||||
Net income (loss) |
$ | 9,381 | (5,207 | ) | ||||
Basic net income (loss) per share |
$ | 1,053 | (585 | ) | ||||
4
2006 | 2005 | |||||||
BALANCE AT JANUARY 1 |
$ | 308,703 | 301,433 | |||||
Dividends |
(6,231 | ) | | |||||
Comprehensive income (loss): |
||||||||
Net income (loss) |
9,381 | (5,207 | ) | |||||
Net unrealized change in investment securities |
(6,644 | ) | (12,488 | ) | ||||
Net change in fair value of cash flow hedges |
92 | 337 | ||||||
Total comprehensive income (loss) |
2,829 | (17,358 | ) | |||||
BALANCE AT MARCH 31 |
$ | 305,301 | 284,075 | |||||
5
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
CASH FLOWS FROM OPERATING ACTIVITIES: |
||||||||
Premiums collected |
$ | 366,287 | 323,459 | |||||
Cash paid to suppliers and employees |
(65,552 | ) | (44,943 | ) | ||||
Claims, losses and benefits paid |
(305,380 | ) | (276,277 | ) | ||||
Interest received |
10,462 | 6,359 | ||||||
Proceeds from trading securities sold or matured: |
||||||||
Fixed maturities sold |
| 31,946 | ||||||
Equity securities |
5,866 | 5,027 | ||||||
Acquisitions of investments in trading portfolio: |
||||||||
Fixed maturities |
| (14,463 | ) | |||||
Equity securities |
(5,762 | ) | (5,116 | ) | ||||
Interest paid |
(3,161 | ) | (1,509 | ) | ||||
Expense reimbursement from Medicare |
1,155 | 3,003 | ||||||
Net cash provided by operating activities |
3,915 | 27,486 | ||||||
CASH FLOWS FROM INVESTING ACTIVITIES: |
||||||||
Proceeds from investments sold or matured: |
||||||||
Securities available for sale: |
||||||||
Fixed maturities sold |
4,838 | 5,038 | ||||||
Fixed maturities matured |
14,569 | 206 | ||||||
Equity securities |
360 | 2,677 | ||||||
Securities held to maturity: |
||||||||
Fixed maturities matured |
122 | 290 | ||||||
Acquisitions of investments: |
||||||||
Securities available for sale: |
||||||||
Fixed maturities |
(21,844 | ) | (17,919 | ) | ||||
Equity securities |
| (2,821 | ) | |||||
Securities held to maturity: |
||||||||
Fixed maturities |
| (993 | ) | |||||
Acquisition of business, net of $10,403 of cash acquired |
(27,793 | ) | | |||||
Net disbursements for policy loans |
(109 | ) | | |||||
Capital expenditures |
(3,780 | ) | (1,338 | ) | ||||
Proceeds from sale of property and equipment |
3 | 2 | ||||||
Net cash used in investing activities |
(33,634 | ) | (14,858 | ) | ||||
CASH FLOWS FROM FINANCING ACTIVITIES: |
||||||||
Change in outstanding checks in excess of bank balances |
2,569 | 8,700 | ||||||
Payments of short-term borrowings |
(8,652 | ) | (17,125 | ) | ||||
Proceeds from short-term borrowings |
6,912 | 17,125 | ||||||
Payments of long-term borrowings |
(273 | ) | (273 | ) | ||||
Proceeds from long-term borrowings |
35,000 | | ||||||
Dividends |
(6,231 | ) | | |||||
Proceeds from policyholder deposits |
2,255 | 3,164 | ||||||
Surrenders of policyholder deposits |
(1,930 | ) | (1,166 | ) | ||||
Net cash provided by financing activities |
29,650 | 10,425 | ||||||
Net (decrease) increase in cash and cash equivalents |
(69 | ) | 23,053 | |||||
Cash and cash equivalents at beginning of the period |
48,978 | 35,115 | ||||||
Cash and cash equivalents at end of the period |
$ | 48,909 | 58,168 | |||||
6
7
8
Operating Segments | ||||||||||||||||||||||||
Health | Health | |||||||||||||||||||||||
Insurance | Insurance | Property | Life and | |||||||||||||||||||||
Commercial | Reform | and Casualty | Disability | |||||||||||||||||||||
Program | Program | Insurance | Insurance | Other * | Total | |||||||||||||||||||
THREE MONTHS ENDED MARCH 31, 2006 |
||||||||||||||||||||||||
Premiums earned, net |
$ | 211,107 | 127,496 | 21,898 | 21,603 | | 382,104 | |||||||||||||||||
Amounts attributable to self-funded arrangements |
50,806 | | | | | 50,806 | ||||||||||||||||||
Less: Amounts attributable to claims under self-funded
arrangements |
(47,377 | ) | | | | | (47,377 | ) | ||||||||||||||||
Intersegment premiums earned/service revenues |
1,398 | | 129 | 78 | 13,268 | 14,873 | ||||||||||||||||||
215,934 | 127,496 | 22,027 | 21,681 | 13,268 | 400,406 | |||||||||||||||||||
Net investment income |
3,755 | 801 | 2,364 | 3,010 | | 9,930 | ||||||||||||||||||
Realized gain (loss) on sale of securities |
485 | 33 | (32 | ) | 42 | | 528 | |||||||||||||||||
Unrealized gain on trading securities |
1,914 | | 552 | 90 | | 2,556 | ||||||||||||||||||
Other |
1,063 | (4 | ) | 54 | 69 | | 1,182 | |||||||||||||||||
Total revenue |
$ | 223,151 | 128,326 | 24,965 | 24,892 | 13,268 | 414,602 | |||||||||||||||||
Net income |
$ | 2,116 | 3,667 | 2,659 | 507 | 7 | 8,956 | |||||||||||||||||
Claims incurred |
$ | 190,857 | 113,882 | 10,313 | 11,632 | | 326,684 | |||||||||||||||||
Operating expenses |
$ | 28,401 | 9,240 | 11,642 | 11,390 | 12,984 | 73,657 | |||||||||||||||||
Depreciation expense, included in operating expenses |
$ | 760 | 157 | 107 | 135 | | 1,159 | |||||||||||||||||
Interest expense |
$ | 1,240 | 324 | | 1,285 | | 2,849 | |||||||||||||||||
Income tax expense |
$ | 537 | 1,213 | 351 | 78 | 277 | 2,456 | |||||||||||||||||
* | Includes segments which are not required to be reported separately. These segments include the data processing services organization as well as the third-party administrator of health insurance services. |
9
Operating Segments | ||||||||||||||||||||||||
Health | Health | |||||||||||||||||||||||
Insurance | Insurance | Property | Life and | |||||||||||||||||||||
Commercial | Reform | and Casualty | Disability | |||||||||||||||||||||
Program | Program | Insurance | Insurance | Other * | Total | |||||||||||||||||||
THREE MONTHS ENDED MARCH 31, 2005 |
||||||||||||||||||||||||
Premiums earned, net |
$ | 184,300 | 123,140 | 22,096 | 3,853 | | 333,389 | |||||||||||||||||
Amounts attributable to self-funded arrangements |
51,915 | | | | | 51,915 | ||||||||||||||||||
Less: Amounts attributable to claims under self-funded
arrangements |
(48,540 | ) | | | | | (48,540 | ) | ||||||||||||||||
Intersegment premiums earned/service revenues |
1,076 | | | | 13,638 | 14,714 | ||||||||||||||||||
188,751 | 123,140 | 22,096 | 3,853 | 13,638 | 351,478 | |||||||||||||||||||
Net investment income |
3,413 | 741 | 2,105 | 711 | | 6,970 | ||||||||||||||||||
Realized gain (loss) on sale of securities |
2,103 | (25 | ) | 1,176 | 60 | | 3,314 | |||||||||||||||||
Unrealized loss on trading securities |
(4,806 | ) | | (793 | ) | (194 | ) | | (5,793 | ) | ||||||||||||||
Other |
188 | (5 | ) | 338 | 62 | | 583 | |||||||||||||||||
Total revenue |
$ | 189,649 | 123,851 | 24,922 | 4,492 | 13,638 | 356,552 | |||||||||||||||||
Net income (loss) |
$ | (6,803 | ) | (911 | ) | 2,658 | (414 | ) | 69 | (5,401 | ) | |||||||||||||
Claims incurred |
$ | 172,829 | 116,088 | 11,373 | 2,633 | | 302,923 | |||||||||||||||||
Operating expenses |
$ | 24,240 | 8,914 | 10,341 | 1,982 | 13,405 | 58,882 | |||||||||||||||||
Depreciation expense, included in operating expenses |
$ | 644 | 181 | 107 | 39 | | 971 | |||||||||||||||||
Interest expense |
$ | 1,058 | 204 | | 279 | | 1,541 | |||||||||||||||||
Income tax expense (benefit) |
$ | (1,675 | ) | (444 | ) | 550 | 12 | 164 | (1,393 | ) | ||||||||||||||
* | Includes segments which are not required to be reported separately. These segments include the data processing services organization as well as the third-party administrator of health of health insurance services. |
10
Operating Segments | ||||||||||||||||||||||||
Health | Health | |||||||||||||||||||||||
Insurance | Insurance | Property | Life and | |||||||||||||||||||||
Commercial | Reform | and Casualty | Disability | |||||||||||||||||||||
Program | Program | Insurance | Insurance | Other * | Total | |||||||||||||||||||
AS OF MARCH 31, 2006 |
||||||||||||||||||||||||
Segment assets |
$ | 481,275 | 92,073 | 305,514 | 396,893 | 4,201 | 1,279,956 | |||||||||||||||||
Significant noncash item: |
||||||||||||||||||||||||
Net change in unrealized gain on securities
available for sale |
$ | (1,832 | ) | (355 | ) | (877 | ) | (3,512 | ) | | (6,576 | ) | ||||||||||||
AS OF DECEMBER 31, 2005 |
||||||||||||||||||||||||
Segment assets |
$ | 459,288 | 82,685 | 307,228 | 271,615 | 4,310 | 1,125,126 | |||||||||||||||||
Significant noncash item: |
||||||||||||||||||||||||
Net change in unrealized gain on securities
available for sale |
$ | (12,432 | ) | (1,301 | ) | (3,090 | ) | (1,844 | ) | | (18,667 | ) | ||||||||||||
Net change in minimum pension liability |
(2,048 | ) | | (142 | ) | (76 | ) | (453 | ) | (2,719 | ) | |||||||||||||
* | Includes segments which are not required to be reported separately. These segments include the data processing services organization as well as the third-party administrator of health insurance services. |
11
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
TOTAL REVENUE |
||||||||
Total revenues for reportable segments |
$ | 401,334 | 342,914 | |||||
Total revenues for other segments |
13,268 | 13,638 | ||||||
414,602 | 356,552 | |||||||
Elimination of intersegment premiums earned |
(1,605 | ) | (1,076 | ) | ||||
Elimination of intersegment service revenues |
(13,268 | ) | (13,638 | ) | ||||
Unallocated amount revenues from external sources |
137 | 143 | ||||||
(14,736 | ) | (14,571 | ) | |||||
Consolidated total revenue |
$ | 399,866 | 341,981 | |||||
NET INCOME |
||||||||
Net income (loss) for reportable segments |
$ | 8,949 | (5,470 | ) | ||||
Net income for other segments |
7 | 69 | ||||||
8,956 | (5,401 | ) | ||||||
Elimination of TSM charges: |
||||||||
Rent expense |
1,690 | 1,624 | ||||||
Interest expense |
1,343 | 256 | ||||||
Management fees |
680 | | ||||||
3,713 | 1,880 | |||||||
Unallocated amounts related to TSM: |
||||||||
General and administrative expenses |
(1,316 | ) | (1,222 | ) | ||||
Income tax expense |
(221 | ) | (104 | ) | ||||
Interest expense |
(1,888 | ) | (503 | ) | ||||
Other revenues from external sources |
137 | 143 | ||||||
(3,288 | ) | (1,686 | ) | |||||
Consolidated net income (loss) |
$ | 9,381 | (5,207 | ) | ||||
12
Three months ended March 31, 2006 | ||||||||||||
Segment | Consolidated | |||||||||||
Totals | Adjustments * | Totals | ||||||||||
Claims incurred |
$ | 326,684 | | 326,684 | ||||||||
Operating expenses |
73,657 | (15,927 | ) | 57,730 | ||||||||
Depreciation expense |
1,159 | 283 | 1,442 | |||||||||
Interest expense |
2,849 | 545 | 3,394 | |||||||||
Income tax expense |
2,456 | 221 | 2,677 |
Three months ended March 31, 2005 | ||||||||||||
Segment | Consolidated | |||||||||||
Totals | Adjustments * | Totals | ||||||||||
Claims incurred |
$ | 302,923 | | 302,923 | ||||||||
Operating expenses |
58,882 | (15,116 | ) | 43,766 | ||||||||
Depreciation expense |
971 | 277 | 1,248 | |||||||||
Interest expense |
1,541 | 247 | 1,788 | |||||||||
Income tax expense (benefit) |
(1,393 | ) | 104 | (1,289 | ) |
* | Adjustments represent TSM operations and the elimination of intersegment charges. |
13
March 31, | December 31, | |||||||
2006 | 2005 | |||||||
ASSETS |
||||||||
Total assets for reportable segments |
$ | 1,275,755 | 1,120,816 | |||||
Total assets for other segments |
4,201 | 4,310 | ||||||
1,279,956 | 1,125,126 | |||||||
Elimination entries intersegment receivables and others |
(38,456 | ) | (28,705 | ) | ||||
Unallocated amounts related to TSM: |
||||||||
Parent cash, cash equivalents and investments |
11,376 | 11,054 | ||||||
Parent net property and equipment |
24,479 | 24,760 | ||||||
Parent other assets |
2,808 | 5,227 | ||||||
38,663 | 41,041 | |||||||
Consolidated assets |
$ | 1,280,163 | 1,137,462 | |||||
As of March 31, 2006 | ||||||||||||
Segment | Consolidated | |||||||||||
Totals | Adjustments * | Totals | ||||||||||
Significant noncash item net change in unrealized
gain on securities available for sale |
$ | (6,576 | ) | (68 | ) | (6,644 | ) |
As of December 31, 2005 | ||||||||||||
Segment | Consolidated | |||||||||||
Totals | Adjustments * | Totals | ||||||||||
Significant noncash items: |
||||||||||||
Net change in unrealized gain on securities
available for sale |
$ | (18,667 | ) | (165 | ) | (18,832 | ) | |||||
Net change in minimum pension liability |
(2,719 | ) | (69 | ) | (2,788 | ) |
* | Adjustments represent principally TSM operations and the elimination of intersegment charges. |
14
March 31, 2006 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Trading securities: |
||||||||||||||||
Equity securities |
$ | 70,176 | 13,323 | (1,949 | ) | 81,550 | ||||||||||
March 31, 2006 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Securities available for sale: |
||||||||||||||||
Fixed maturities |
$ | 732,732 | 536 | (17,931 | ) | 715,337 | ||||||||||
Equity securities |
40,658 | 14,575 | (1,902 | ) | 53,331 | |||||||||||
$ | 773,390 | 15,111 | (19,833 | ) | 768,668 | |||||||||||
March 31, 2006 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Securities held to maturity: |
||||||||||||||||
Fixed maturities |
$ | 21,083 | 297 | (971 | ) | 20,409 | ||||||||||
December 31, 2005 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Trading securities: |
||||||||||||||||
Equity securities |
$ | 69,397 | 11,378 | (2,560 | ) | 78,215 | ||||||||||
December 31, 2005 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Securities available for sale: |
||||||||||||||||
Fixed maturities |
$ | 524,287 | 694 | (9,807 | ) | 515,174 | ||||||||||
Equity securities |
38,675 | 14,550 | (1,415 | ) | 51,810 | |||||||||||
$ | 562,962 | 15,244 | (11,222 | ) | 566,984 | |||||||||||
15
December 31, 2005 | ||||||||||||||||
Gross | Gross | |||||||||||||||
Amortized | unrealized | unrealized | Estimated fair | |||||||||||||
cost | gains | losses | value | |||||||||||||
Securities held to maturity: |
||||||||||||||||
Fixed maturities |
$ | 21,129 | 254 | (623 | ) | 20,760 | ||||||||||
16
March 31, | December 31, | |||||||
2006 | 2005 | |||||||
Premiums |
$ | 75,834 | 53,391 | |||||
Self-funded group receivables |
22,108 | 21,620 | ||||||
FEHBP |
11,747 | 9,491 | ||||||
Accrued interest |
8,051 | 5,074 | ||||||
Agents balances |
3,049 | | ||||||
Funds withheld reinsurance receivable |
| 118,635 | ||||||
Reinsurance recoverable |
35,086 | 33,915 | ||||||
Other |
12,392 | 14,152 | ||||||
168,267 | 256,278 | |||||||
Less allowance for doubtful receivables: |
||||||||
Premiums |
8,365 | 7,792 | ||||||
Other |
5,191 | 4,448 | ||||||
13,556 | 12,240 | |||||||
Total premiums and other receivables |
$ | 154,711 | 244,038 | |||||
Three months ended March 31, | ||||||||
2006 | 2005 | |||||||
Claim liabilities at beginning of period |
$ | 297,563 | 279,325 | |||||
Reinsurance recoverable on claim liabilities |
(28,720 | ) | (26,555 | ) | ||||
Net claim
liabilities at
beginning of period |
268,843 | 252,770 | ||||||
Claim liabilities acquired from GA Life |
8,771 | | ||||||
Incurred claims and loss-adjustment expenses: |
||||||||
Current period insured events |
316,804 | 297,517 | ||||||
Prior period insured events |
4,460 | 5,406 | ||||||
Total |
321,264 | 302,923 | ||||||
Payments of losses and loss-adjustment expenses: |
||||||||
Current period insured events |
167,711 | 137,351 | ||||||
Prior period insured events |
133,859 | 138,995 | ||||||
Total |
301,570 | 276,346 | ||||||
Net claim liabilities at end of period |
297,308 | 279,347 | ||||||
Reinsurance recoverable on claim liabilities |
29,031 | 25,285 | ||||||
Claim liabilities at end of period |
$ | 326,339 | 304,632 | |||||
17
March 31, | December 31, | |||||||
2006 | 2005 | |||||||
Secured loan payable of $20,000, payable in various different
installments up to August 31, 2007, with interest payable on a
monthly basis at a rate reset periodically of 130 basis points
over LIBOR selected (which was 5.87% and 5.71% at
March 31, 2006 and December 31, 2005, respectively) |
$ | 11,500 | 11,500 | |||||
Senior unsecured notes payable of $50,000 due September 2019.
Interest is payable semiannually at a fixed rate of 6.30%. |
50,000 | 50,000 | ||||||
Senior unsecured notes payable of $60,000 due December 2020.
Interest is payable monthly at a fixed rate of 6.60%. |
60,000 | 60,000 | ||||||
Senior unsecured notes payable of $35,000 due January 2021.
Interest is payable monthly at a fixed rate of 6.70%. |
35,000 | | ||||||
Secured loan payable of $41,000, payable in monthly installments of
$137 up to July 1, 2024, plus interest at a rate reset periodically
of 100 basis points over LIBOR selected (which was 5.63% and
5.29% at March 31, 2006 and December 31, 2005, respectively) |
28,817 | 29,090 | ||||||
Total long-term borrowings |
$ | 185,317 | 150,590 | |||||
Accumulated | ||||||||||||||||
Unrealized | Minimum | other | ||||||||||||||
gains on | pension | Cash flow | comprehensive | |||||||||||||
securities | liability | hedges | income | |||||||||||||
BALANCE AT JANUARY 1 |
$ | 3,217 | (8,613 | ) | 371 | (5,025 | ) | |||||||||
Net current period change |
(6,644 | ) | | 92 | (6,552 | ) | ||||||||||
BALANCE AT MARCH 31 |
$ | (3,427 | ) | (8,613 | ) | 463 | (11,577 | ) | ||||||||
18
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
Components of net periodic benefit cost: |
||||||||
Service cost |
$ | 1,370 | 1,143 | |||||
Interest cost |
1,175 | 1,030 | ||||||
Expected return on assets |
(991 | ) | (843 | ) | ||||
Amortization of prior service cost |
12 | 12 | ||||||
Amortization of actuarial loss |
602 | 490 | ||||||
Net periodic benefit cost |
$ | 2,168 | 1,832 | |||||
19
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
Numerator for basic earnings per share: |
||||||||
Net income (loss) available to stockholders |
$ | 9,381 | (5,207 | ) | ||||
Denominator for basic earnings per share: |
||||||||
Weighted average of outstanding common
shares |
8,906 | 8,904 | ||||||
Basic net income (loss) per share |
$ | 1,053 | (585 | ) | ||||
(a) | As of March 31, 2006, the Corporation is a defendant in various lawsuits arising in the ordinary course of business. Management believes, based on the opinion of its legal counsel, that the aggregate liabilities, if any, arising from such actions would not have a material adverse effect on the consolidated financial position and results of operations of the Corporation. | ||
(b) | Drs. Carlyle Benavent and Ibrahim Pérez (the plaintiffs) caused the initiation of an administrative proceeding before the Puerto Rico Insurance Commissioner against TSI and TSM alleging the illegality of the repurchase and subsequent sale of 1,582 shares of TSIs common stock due to the fact that the ultimate purchasers of said shares were selected on an improper and selective basis by the Corporation in violation of the Puerto Rico Insurance Code. The plaintiffs alleged that they were illegally excluded from participation in the sale of shares by TSI due to the illegally selective nature of the sale of shares and that, consequently, the sale of shares should be eliminated. | ||
In December 1996, the Commissioner of Insurance issued an order to annul the sale of the 1,582 shares that TSI had repurchased from the estate of deceased stockholders. TSI contested such order through an administrative and judicial review process. Consequently, the sale of 1,582 shares was cancelled and the purchase price was returned to each former stockholder. In the year 2000, the Commissioner of Insurance issued a pronouncement providing further clarification of the content and effect of the order. This order also required that all corporate decisions undertaken by TSI through the vote of its stockholders of record, be ratified in a stockholders meeting or in a subsequent referendum. In November 2000, TSM, as the sole stockholder of TSI, ratified all such decisions. Furthermore, on November 19, 2000, TSM held a special stockholders meeting, where a ratification of these decisions was undertaken except for the resolution related to the approval of the reorganization of TSI and its subsidiaries. This resolution did not reach the two thirds majority required by the order because the number of shares that were present and represented at the meeting was below such amount (total shares present and represented in the stockholders meeting was 64%). As stipulated in the order, TSM began the process to conduct a referendum among its stockholders in order to ratify such resolution. The process was later suspended because upon further review of the scope of the order, the Commissioner of Insurance issued an opinion in a letter dated January 8, 2002 which indicated that the ratification of the corporate reorganization was not required. | |||
In another letter dated March 14, 2002, the Commissioner of Insurance stated that the ratification of the corporate reorganization was not required and that TSI had complied with the Commissioners order of December 6, 1996 related to the corporate reorganization. Thereafter, the plaintiffs filed a petition for review of the Commissioners determination before the Puerto Rico Circuit Court of Appeals. Such petition was opposed by TSI and by the Commissioner of Insurance. |
20
Pursuant to that review, on September 24, 2002, the Puerto Rico Circuit Court of Appeals issued an order requiring the Commissioner of Insurance to order that a meeting of shareholders be held to ratify TSIs corporate reorganization and the change of name of TSI from Seguros de Servicios de Salud de Puerto Rico, Inc. to Triple-S, Inc. The Puerto Rico Circuit Court of Appeals based its decision on administrative and procedural issues directed at the Commissioner of Insurance. The Commissioner of Insurance filed a motion of reconsideration with the Puerto Rico Circuit Court of Appeals on October 11, 2002. TSM and TSI also filed a motion of reconsideration. | |||
On October 25, 2002, the Puerto Rico Circuit Court of Appeals dismissed the Commissioner of Insurances Motion for Reconsideration and ordered the plaintiffs to reply to TSIs Motion of Reconsideration. | |||
On May 18, 2003, the Puerto Rico Circuit Court of Appeals granted TSIs and TSMs Motion of Reconsideration. The Puerto Rico Circuit Court of Appeals held that the Commissioner of Insurance had the authority to waive the celebration of a referendum to ratify TSIs reorganization and that therefore the reorganization of TSI, inasmuch as the 1,582 shares annulled were not decisive, was approved by the stockholders. | |||
On June 26, 2003, the plaintiffs presented a writ of certiorari before the Supreme Court of Puerto Rico. TSI and TSM filed a motion opposing the issuance of the writ. The writ was issued by the Supreme Court on August 22, 2003 when it ordered the Puerto Rico Circuit Court of Appeals to transmit the record of the case. On December 1, 2003, the plaintiffs filed a motion submitting their case on the basis of their original petition. TSI and TSM filed its brief on December 30, 2003, while the Commissioner of Insurance, in turn, filed a separate brief on December 31, 2003. On June 24, 2004 the Supreme Court of Puerto Rico ordered the plaintiffs to file a brief in support of their allegations. The case is still pending before the Supreme Court of Puerto Rico. It is the opinion of the management and its legal counsels that the corporate reorganization as approved is in full force and effect. | |||
(c) | On September 4, 2003, José Sánchez and others filed a putative class action complaint against the Corporation, present and former directors of TSM and TSI, and others, in the United States District Court for the District of Puerto Rico, alleging violations under the Racketeer Influenced and Corrupt Organizations Act, better known as the RICO Act. The suit, among other allegations, alleges a scheme to defraud the plaintiffs by acquiring control of TSI through illegally capitalizing TSI and later converting it to a for-profit corporation and depriving the stockholders of their ownership rights. The plaintiffs base their later allegations on the supposed decisions of TSIs board of directors and stockholders, allegedly made in 1979, to operate with certain restrictions in order to turn TSI into a charitable corporation, basically forever. On March 4, 2005 the Court issued an Opinion and Order. In this Opinion and Order, of the twelve counts included in the complaint, eight counts were dismissed for failing to assert an actionable injury; six of them for lack of standing and two for failing to plead with sufficient particularity in compliance with the Rules. All shareholder allegations, including those described above, were dismissed in the Opinion and Order. The remaining four counts were found standing, in a limited way, in the Opinion and Order. The parties finished class certification discovery and fully briefed the issue of class certification. In addition, the defendants are evaluating the dismissal of the surviving claims. While waiting for the Courts decision on the issue of class certification, the Court sua sponte, issued an Order to Show Cause (OTC) to plaintiffs as to why the complaint should not be dismissed with prejudice. The Courts OTC is predicated on the parties submissions about class certification. The Court then granted plaintiffs leave to file a sur-reply, which they did on April |
21
21, 2006. In its OTC the Court indicated that it will decide first the sustainability of the complaint before deciding plaintiffs request for class certification. The parties are in anticipation of the Courts ruling on the OTC. On May 4, 2006, the Court issued an Opinion and Order which entered a summary judgment in favor of the Corporation and the case was dismissed by the Court. The plaintiffs have ten (10) business days to file for reconsideration with the Court, they may also request additional findings from the Court, and/or they have thirty (30) days to appeal the judgment to the United States Court of Appeals for the First Circuit. |
(d) | On April 24, 2002, Octavio Jordán, Agripino Lugo, Ramón Vidal, and others filed a suit against TSM, TSI and others in the Court of First Instance for San Juan, Superior Section, alleging, among other things, violations by the defendants of provisions of the Puerto Rico Insurance Code, anti-monopolistic practices, unfair business practices and damages in the amount of $12.0 million. They also requested that TSM sell shares to them. After a preliminary review of the complaint, it appears that many of the allegations brought by the plaintiffs have been resolved in favor of TSM and TSI in previous cases brought by the same plaintiffs in the United States District Court for the District of Puerto Rico and by most of the plaintiffs in the local courts. The defendants, including TSM and TSI answered the complaint, filed a counterclaim and filed several motions to dismiss this claim. On February 18, 2005 the plaintiffs informed their intention to amend the complaint and the Court granted them 45 days to do so and 90 days to the defendants to file the corresponding motion to dismiss. On May 9, 2005 the plaintiffs amended the complaint and the defendants are preparing the corresponding motions to dismiss this amended complaint. The plaintiffs amended the complaint to allege causes of action similar to those dismissed by the United States District Court for the District of Puerto Rico in the Sánchez case. Defendants moved to dismiss the amended complaint. Plaintiffs have notified their opposition to some of the defendants motion to dismiss, and the defendants filed the corresponding replies. On January 25, 2006, the court held a hearing to argue the dispositive motions. On March 16, 2006 the Court held another hearing to hear additional argument on the same motions. The Court set a final hearing for July 6, 2006. | ||
(e) | On May 22, 2003 a putative class action suit was filed by Kenneth A. Thomas, M.D. and Michael Kutell, M.D., on behalf of themselves and all others similarly situated and the Connecticut State Medical Society against the Blue Cross and Blue Shield Association (BCBSA) and multiple other insurance companies including TSI. The case is pending before the U.S. District Court for the Southern District of Florida, Miami District. | ||
The individual plaintiffs bring this action on behalf of themselves and a class of similarly situated physicians seeking redress for alleged illegal acts of the defendants, which they allege have resulted in a loss of their property and a detriment to their business, and for declaratory and injunctive relief to end those practices and prevent further losses. Plaintiffs alleged that the defendants, on their own and as part of a common scheme, systematically deny, delay and diminish the payments due to doctors so that they are not paid in a timely manner for the covered, medically necessary services they render. | |||
The class action complaint alleges that the health care plans are the agents of BCBSA licensed entities, and as such have committed the acts alleged above and acted within the scope of their agency, with the consent, permission, authorization and knowledge of the others, and in furtherance of both their interest and the interests of other defendants. | |||
Management believes that TSI was brought to this litigation for the sole reason of being associated with the BCBSA. However, on June 18, 2004 the plaintiffs moved to amend the complaint to |
22
include the Colegio de Médicos y Cirujanos de Puerto Rico (a compulsory association grouping all physicians in Puerto Rico), Marissel Velázquez, MD, President of the Colegio de Médicos y Cirujanos de Puerto Rico, and Andrés Meléndez, MD, as plaintiffs against TSI. Later Marissel Velázquez, MD voluntarily dismissed her complaint against TSI. | |||
TSI, along with the other defendants, moved to dismiss the complaint on multiple grounds, including but not limited to arbitration and applicability of the McCarran Ferguson Act. | |||
The Court issued a 90-day stay to allow the parties to discuss their differences and come to amicable agreement. The stay expired on March 7, 2006. Upon the expiration of the stay, both plaintiffs and defendants agreed to request the Court to extend the stay until April 21, 2006. The stay expired and the parties informed the Court that they need additional time to iron out the details of an amicable solution. The Court has not reacted to the parties joint request. If the Court denies another stay, the parties will have to continue the proceedings where they were left before the issuance of the first stay. In the meantime, the Court issued an Agreed Order on the Preservation of Records. This order supersedes the parties existing record-keeping policies in regards to the documents and materials specified in the order. The purpose of the order is to avoid the disposition of documents that might be relevant for the case. | |||
(f) | On December 8, 2003 a putative class action was filed by Jeffrey Solomon, MD and Orlando Armstrong, MD, on behalf of themselves and all other similarly situated and the American Podiatric Medical Association, Florida Chiropractic Association, California Podiatric Medical Association, Florida Podiatric Medical Association, Texas Podiatric Medical Association, and Independent Chiropractic Physicians, against the BCBSA and multiple other insurance companies, including TSI and all members of the BCBSA. The case is still pending before the United States District Court for the Southern District of Florida, Miami District. | ||
The lawsuit challenges many of the same practices as the litigation described in the immediately preceding item. | |||
Management believes that TSI was made a party to this litigation for the sole reason that TSI is associated with the BCBSA. | |||
On June 25, 2004, plaintiffs amended the complaint but the allegations against TSI did not vary. TSI along with the other defendants, moved to dismiss the complaint on multiple grounds, including but not limited to arbitration and applicability of the McCarran Ferguson Act. | |||
The Court issued a 90-day stay to allow the parties to discuss their differences and come to an amicable agreement. The stay expired on March 7, 2006. Upon the expiration of the stay, both plaintiffs and defendants agreed to request the Court to extend the stay until April 21, 2006. The stay expired and the parties informed the Court that they need additional time to iron out the details of an amicable solution. The Court has not reacted to the parties joint request. If the Court denies another stay, the parties will have to continue the proceedings where they were left before the issuance of the first stay. In the meantime, the Court issued an Agreed Order on the Preservation of Records. This order supersedes the parties existing record-keeping policies in regards to the documents and materials specified in the order. The purpose of the order is to avoid the disposition of documents that might be relevant for the case. |
23
Current assets |
$ | 219,747 | ||
Property and equipment |
1,500 | |||
Value of business acquired |
21,973 | |||
Total assets acquired |
243,220 | |||
Total liabilities assumed |
205,024 | |||
Net assets acquired |
$ | 38,196 | ||
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
Total revenue |
$ | 407,149 | 363,240 | |||||
Net income |
$ | 9,698 | (3,667 | ) | ||||
Basic net income (loss) per share |
$ | 1,089 | (412 | ) | ||||
24
Three months ended | ||||||||
March 31, | ||||||||
2006 | 2005 | |||||||
Net income (loss) |
$ | 9,381 | (5,207 | ) | ||||
Adjustments to reconcile net income to net cash
provided by operating expenses: |
||||||||
Depreciation and amortization |
1,442 | 1,248 | ||||||
Amortization of investment discounts |
245 | 194 | ||||||
Accretion in value of securities |
(182 | ) | (106 | ) | ||||
Increase (decrease) in provision for doubtful
receivables |
451 | (100 | ) | |||||
Increase (decrease) in net deferred taxes |
41 | (2,506 | ) | |||||
Gain on sale of securities |
(528 | ) | (3,314 | ) | ||||
Unrealized gain (loss) of trading securities |
(2,556 | ) | 5,793 | |||||
Proceeds from trading securities sold: |
||||||||
Fixed maturities |
| 31,946 | ||||||
Equity securities |
5,866 | 5,027 | ||||||
Acquisition of securities in trading portfolio: |
||||||||
Fixed maturities |
| (14,463 | ) | |||||
Equity securities |
(5,762 | ) | (5,116 | ) | ||||
Loss on sale of property and equipment |
| (2 | ) | |||||
(Increase) decrease in assets: |
||||||||
Premiums receivable |
(23,969 | ) | (11,081 | ) | ||||
Accrued interest receivable |
349 | (793 | ) | |||||
Agents balances |
(94 | ) | | |||||
Reinsurance receivable |
(348 | ) | 1,339 | |||||
Other receivables |
1,782 | 2,717 | ||||||
Deferred policy acquisition costs |
(698 | ) | 460 | |||||
Prepaid income tax |
2,555 | | ||||||
Other assets |
762 | (769 | ) | |||||
Increase (decrease) in liabilities: |
||||||||
Claims processed and incomplete |
2,661 | 3,705 | ||||||
Unreported losses |
16,475 | 21,271 | ||||||
Unpaid loss-adjustment expenses |
457 | 331 | ||||||
Future policy benefits |
2,059 | | ||||||
Unearned premiums |
585 | (3,393 | ) | |||||
Policyholder deposits |
416 | 279 | ||||||
Liability to FEHBP |
3,741 | 988 | ||||||
Accounts payable and accrued liabilities |
(11,216 | ) | (2,179 | ) | ||||
Income tax payable |
| 1,217 | ||||||
Net cash provided
by operating
activities |
$ | 3,915 | 27,486 | |||||
25
| Triple-S, Inc. (TSI), a health insurance company serving two major segments: the Commercial Program and the Commonwealth of Puerto Rico Healthcare Reform Program (the Healthcare Reform); | ||
| Seguros Triple-S, Inc. (STS), a property and casualty insurance company; | ||
| Great American Life Assurance Company of Puerto Rico (GA Life) a life insurance company; and | ||
| Seguros de Vida Triple-S, Inc. (SVTS), a life and disability insurance and annuity products company. |
26
27
Three months ended March 31, 2005 | ||||||||||||
Comparable | ||||||||||||
(Dollar amounts in thousands) | TSM | GA Life | Basis | |||||||||
REVENUE: |
||||||||||||
Premiums earned, net |
$ | 333,389 | 12,294 | 345,683 | ||||||||
Amounts attributable to self-funded arrangements |
51,915 | | 51,915 | |||||||||
Less amounts attributable to claims under
self-funded arrangements |
(48,540 | ) | | (48,540 | ) | |||||||
336,764 | 12,294 | 349,058 | ||||||||||
Net investment income |
7,064 | 1,958 | 9,022 | |||||||||
Net realized investment gains (losses) |
3,314 | (375 | ) | 2,939 | ||||||||
Net unrealized investment loss on trading securities |
(5,793 | ) | | (5,793 | ) | |||||||
Other income, net |
632 | | 632 | |||||||||
Total revenue |
341,981 | 13,877 | 355,858 | |||||||||
BENEFITS AND EXPENSES: |
||||||||||||
Claims incurred |
302,923 | 6,718 | 309,641 | |||||||||
Operating expenses, net of reimbursement for services |
43,766 | 5,455 | 49,221 | |||||||||
Interest expense |
1,788 | | 1,788 | |||||||||
Total benefits and expenses |
348,477 | 12,173 | 360,650 | |||||||||
Income (loss) before taxes |
(6,496 | ) | 1,704 | (4,792 | ) | |||||||
INCOME TAX EXPENSE (BENEFIT): |
||||||||||||
Current |
1,221 | 123 | 1,344 | |||||||||
Deferred |
(2,510 | ) | (396 | ) | (2,906 | ) | ||||||
Total income taxes |
(1,289 | ) | (273 | ) | (1,562 | ) | ||||||
Net income (loss) |
$ | (5,207 | ) | 1,977 | (3,230 | ) | ||||||
Basic net loss per share |
$ | (585 | ) | (363 | ) | |||||||
Three months ended March 31, 2005 | ||||||||||||
Comparable | ||||||||||||
(Dollar amounts in thousands) | SVTS | GA Life | Basis | |||||||||
Net earned premiums and commission income: |
||||||||||||
Earned premiums |
||||||||||||
Life |
$ | 2,202 | 9,806 | 12,008 | ||||||||
Disability |
3,354 | 26 | 3,380 | |||||||||
Cancer and other dreaded diseases |
213 | 2,781 | 2,994 | |||||||||
Total earned premiums |
5,769 | 12,613 | 18,382 | |||||||||
Earned premiums ceded |
(2,023 | ) | (319 | ) | (2,342 | ) | ||||||
Net earned premiums |
3,746 | 12,294 | 16,040 | |||||||||
Commission income on reinsurance |
107 | | 107 | |||||||||
Net premiums earned |
$ | 3,853 | 12,294 | 16,147 | ||||||||
Claims incurred |
$ | 2,633 | 6,718 | 9,351 | ||||||||
Operating expenses |
1,982 | 5,455 | 7,437 | |||||||||
Total underwriting costs |
$ | 4,615 | 12,173 | 16,788 | ||||||||
Underwriting income (loss) |
$ | (762 | ) | 121 | (641 | ) | ||||||
28
Three months ended March 31, | ||||||||||||
Comparable | ||||||||||||
(dollar amounts in thousands) | 2006 | 2005 | Basis 2005 | |||||||||
Consolidated earned premiums, net
and fee revenue |
$ | 385,533 | 336,764 | 349,058 | ||||||||
Consolidated claims incurred |
$ | 326,684 | 302,923 | 309,641 | ||||||||
Consolidated operating expenses |
57,730 | 43,766 | 49,221 | |||||||||
Consolidated operating costs |
$ | 384,414 | 346,689 | 358,862 | ||||||||
Consolidated loss ratio |
84.7 | % | 90.0 | % | 88.7 | % | ||||||
Consolidated expense ratio |
15.0 | % | 13.0 | % | 14.1 | % | ||||||
Consolidated combined ratio |
99.7 | % | 103.0 | % | 102.8 | % | ||||||
Consolidated net investment income |
$ | 10,050 | 7,064 | 9,022 | ||||||||
Consolidated realized gain on sale of securities |
528 | 3,314 | 2,939 | |||||||||
Consolidated unrealized gain (loss) on
trading securities |
2,556 | (5,793 | ) | (5,793 | ) | |||||||
Total consolidated net investment income |
$ | 13,134 | 4,585 | 6,168 | ||||||||
Consolidated interest expense |
$ | 3,394 | 1,788 | 1,788 | ||||||||
Consolidated income tax expense (benefit) |
$ | 2,677 | (1,289 | ) | (1,562 | ) | ||||||
Consolidated net income (loss) |
$ | 9,381 | (5,207 | ) | (3,230 | ) | ||||||
29
| The earned premiums, net and fee revenue corresponding to the Health Insurance Commercial segment increased by $27.2 million, or 14.4%, during the period. The increase in premiums earned, net of this segment is primarily due to an increase in the average enrollment of the Medicare Advantage business in the 2006 period. The average enrollment of the segments rated contracts decreased during the same period, the effect of which was mitigated by an average increase in premium rates of 4.0%. | ||
| The earned premiums, net of the Health Insurance Healthcare Reform segment presented an increase of $4.4 million, or 3.5% during this period. This increase is the result of a 5.8% increase in premium rates effective August 1, 2005, net of decrease in average enrollment. | ||
| On a comparable basis, in the 2006 period the earned premiums, net of the Life and Disability Insurance segment increased by $5.5 million, or 34.3%. The increase in the earned premiums net of this segment is due to the following: |
° | The assumed earned premiums of the segment on both the actual and comparable basis increased by $4.4 million in the 2006 period. This increase is due to the business assumed by SVTS during January 2006 as a result of the coinsurance funds withheld agreement with GA Life, in which SVTS assumes 69% of GA Lifes business effective December 22, 2005. However, since TSM acquired GA Life, now both entities form the Corporations Life and Disability Insurance segment. Thus, this reinsurance agreement is eliminated upon the combination of both entities for segment presentation. The effects of the reinsurance transactions corresponding to this agreement were eliminated for consolidated financial statement purposes for the period following January 31, 2006. | ||
° | On a comparable basis, the earned premiums of the segments individual life and cancer and other dreaded diseases lines of business increased by $714 thousand, or 7.3%, and $639 thousand, or 21.3%, respectively. |
30
Three months ended | ||||||||
March 31, | ||||||||
(dollar amounts in thousands) | 2006 | 2005 | ||||||
Average enrollment: |
||||||||
Corporate accounts |
298,626 | 306,308 | ||||||
Self-funded employers |
151,970 | 151,315 | ||||||
Individual accounts |
77,478 | 83,290 | ||||||
Federal employees |
47,966 | 50,154 | ||||||
Local government employees |
31,630 | 36,562 | ||||||
Medicare Advantage |
18,876 | 986 | ||||||
Total enrollment |
626,546 | 628,615 | ||||||
Earned premiums |
$ | 211,845 | 185,057 | |||||
Amounts attributable to self-funded arrangements |
51,466 | 52,234 | ||||||
Less: Amounts attributable to claims under
self-funded arrangements |
(47,377 | ) | (48,540 | ) | ||||
Earned premiums and fee revenue |
$ | 215,934 | 188,751 | |||||
Claims incurred |
$ | 190,857 | 172,829 | |||||
Operating expenses |
28,401 | 24,240 | ||||||
Total underwriting costs |
$ | 219,258 | 197,069 | |||||
Underwriting loss |
$ | (3,324 | ) | (8,318 | ) | |||
Loss ratio |
88.4 | % | 91.6 | % | ||||
Expense ratio |
13.2 | % | 12.8 | % | ||||
Combined ratio |
101.5 | % | 104.4 | % | ||||
| Premiums generated by the segments Medicare Advantage program presented an increase of $28.3 million, from $3.1 million in the 2005 period to $31.4 million in the 2006 period. This increase is primarily due to the increase in enrollment experienced in this business. The average enrollment of the Medicare Advantage program presented an increase of 17,890 members upon |
31
comparison of the 2006 and 2005 periods. In January 2006, the segment expanded its Medicare Advantage program with the introduction of Medicare Platino (for medically indigent Medicare-qualified beneficiaries in Puerto Rico) and FarmaMed (prescription drugs program for beneficiaries of Medicare Parts A and B). The enrollment for these programs contributed to the increase in average membership of the Medicare Advantage business. | |||
| The segment experienced a decrease in the earned premiums corresponding to its other rated contracts lines of business of approximately $900 thousand. This decrease is the combined effect of a decrease in the average enrollment of 20,614 members, or 4.3% and an average increase in premium rates of 4.0%. The segment maintained its contract renewal ratio of over 90% during the first quarter of 2006. The decrease in average enrollment is primarily noted in the individual and local government employees as a result of qualifying enrollees selecting Medicare Advantage policies. The average enrollment of the individual and local government employees business decreased by 5,812, or 7.0%, and 4,932, or 13.5%, respectively, during the 2006 period. |
Three months ended | ||||||||
March 31, | ||||||||
(dollar amounts in thousands) | 2006 | 2005 | ||||||
Average enrollment: |
||||||||
North area |
227,386 | 232,977 | ||||||
Metro-north area |
210,887 | 215,707 | ||||||
Southwest area |
158,281 | 162,573 | ||||||
596,554 | 611,257 | |||||||
Earned premiums |
$ | 127,496 | 123,140 | |||||
Claims incurred |
$ | 113,882 | 116,088 | |||||
Operating expenses |
9,240 | 8,914 | ||||||
Total underwriting costs |
$ | 123,122 | 125,002 | |||||
Underwriting income (loss) |
$ | 4,374 | (1,862 | ) | ||||
Loss ratio |
89.3 | % | 94.3 | % | ||||
Expense ratio |
7.2 | % | 7.2 | % | ||||
Combined ratio |
96.6 | % | 101.5 | % | ||||
32
| Premium rates for this segment were increased, effective August 1st, 2005, by approximately 5.8% during the Healthcare Reform contract renegotiation process for the eleven-month period ending June 30, 2006. | ||
| The segments average enrollment during the 2006 quarter decreased by 14,703 members, or 2.4%, when compared to the average enrollment during the 2005 quarter. This decrease is mainly due to the shift of membership into a government-sponsored Medicare Advantage policy (Medicare Platino). |
Three months ended | ||||||||
March 31, | ||||||||
(dollar amounts in thousands) | 2006 | 2005 | ||||||
Premiums written: |
||||||||
Commercial multiperil |
$ | 13,170 | 12,984 | |||||
Dwelling |
6,190 | 6,221 | ||||||
Auto physical damage |
6,010 | 4,995 | ||||||
Commercial auto liability |
4,050 | 3,679 | ||||||
Other liability |
1,893 | 2,325 | ||||||
Medical malpractice |
951 | 1,101 | ||||||
All other |
2,469 | 2,462 | ||||||
Total premiums written |
34,733 | 33,767 | ||||||
Premiums ceded |
(13,729 | ) | (14,475 | ) | ||||
Change in unearned premiums |
1,023 | 2,804 | ||||||
Net premiums earned |
$ | 22,027 | 22,096 | |||||
Claims incurred |
$ | 10,313 | 11,373 | |||||
Operating expenses |
11,642 | 10,341 | ||||||
Total underwriting costs |
$ | 21,955 | 21,714 | |||||
Underwriting income |
$ | 72 | 382 | |||||
Loss ratio |
46.8 | % | 51.5 | % | ||||
Expense ratio |
52.9 | % | 46.8 | % | ||||
Combined ratio |
99.7 | % | 98.3 | % | ||||
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Three months ended March 31, | ||||||||||||
Comparable | ||||||||||||
(dollar amounts in thousands) | 2006 | 2005 | Basis 2005 | |||||||||
Net earned premiums and commission income: |
||||||||||||
Earned premiums: |
||||||||||||
Life |
$ | 12,543 | 2,202 | 12,008 | ||||||||
Disability |
3,182 | 3,354 | 3,380 | |||||||||
Cancer and other dreaded diseases |
3,633 | 213 | 2,994 | |||||||||
Total earned premiums |
19,358 | 5,769 | 18,382 | |||||||||
Earned premiums ceded |
(2,243 | ) | (2,023 | ) | (2,342 | ) | ||||||
Assumed earned premiums |
4,413 | | | |||||||||
Net earned premiums |
21,528 | 3,746 | 16,040 | |||||||||
Commission income on reinsuarance |
153 | 107 | 107 | |||||||||
Net premiums earned |
$ | 21,681 | 3,853 | 16,147 | ||||||||
Claims incurred |
$ | 11,632 | 2,633 | 9,351 | ||||||||
Operating expenses |
11,390 | 1,982 | 7,437 | |||||||||
Total underwriting costs |
$ | 23,022 | 4,615 | 16,788 | ||||||||
Underwriting loss |
$ | (1,341 | ) | (762 | ) | (641 | ) | |||||
Loss ratio |
53.7 | % | 68.3 | % | 57.9 | % | ||||||
Expense ratio |
52.5 | % | 51.4 | % | 46.1 | % | ||||||
Combined ratio |
106.2 | % | 119.8 | % | 104.0 | % | ||||||
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| The premiums earned of the individual life line of business on a comparable basis increased by $714 thousand, or 7.3%, in the 2006 period. This fluctuation is mainly the result of increases in the ordinary life and the monthly debit ordinary (MDO) premiums of 12.0% and 5.0%, respectively. The increase in premiums earned of the ordinary life and MDO business is principally due to new sales made during the 2006 period. | ||
| The premiums earned of the cancer and other dreaded diseases on a comparable basis increased by $639 thousand, or 21.3%, in the 2006 period. This increase is primarily attributed to the growth in the sales of the new cancer products that the segment began selling during the last quarter of the year 2004. | ||
| The premiums earned on a comparable basis for the group life and group disability lines of business had a combined decrease of $377 thousand, or 6.7%, when compared to the three months ended March 31, 2005. This fluctuation is primarily due to a disciplined underwriting of groups where premiums have been significantly adjusted to reflect expected losses and those groups have decided not to renew. |
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| The amount of claims, losses and benefits paid for the three months ended March 31, 2006 reflect an increase of $29.1 million when compared with the three months ended March 31, 2005. The increase in the amount of claims, losses and benefits paid is mostly the result of the segments increased volume of business. | ||
| The payments to suppliers and employees increased by $20.6 million when comparing the amount paid during the 2006 and 2005 periods. This increase is basically attributed to additional commission expense generated from the acquisition of new business and general operating expenses. | ||
| The net proceeds of investments in the trading portfolio decreased by $17.3 million for the three months ended March 31, 2006, when compared to the three months ended March 31, 2005. The fluctuation when compared to the 2005 period is due to the sale of the corporate bonds portfolio in mid year 2005. The corporate bonds portfolio was considered as a trading portfolio. | ||
| Premiums collected increased by $42.8 million when comparing collections during the three months ended March 31, 2006 with collections for the three months ended March 31, 2004. This increase is mostly related to the increased volume of business and increases in premium rates of the operating segments. | ||
| Interest received increased by $4.1 million during the 2006 period. This increase is mostly the related to the increase experienced in the Corporations investments in fixed income securities during the 2006 period. |
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| During the 2006 period the Corporation completed the acquisition of 100% of the common stock of GA Life. This transaction had an acquisition cost of $38.2 million, net of $10.4 million of acquired cash. | ||
| The amount of capital expenditures increased by $2.4 million when comparing the 2006 and 2005 periods. This increase is principally due to incurred cost related to the renovation of one of Corporations facilities in one building adjacent to its main offices and to expenses related to STSs acquisition of a new computer system to manage its insurance operations. | ||
| The Corporation had net decrease of $11.6 million in the net acquisition of investments during the 2006 period. During the three months ended March 31, 2006 and 2005 total acquisition of investments exceeded the proceeds from investments sold or matured by $1.9 million and $13.5 million, respectively. |
| During the three months ended March 31, 2006 the Corporation received the proceeds from the issuance of its 6.7% Senior Unsecured Notes amounting to $35.0 million. No long-term debt was issued in the 2005 period. | ||
| On January 13, 2006 the Corporation declared and paid dividends amounting to $6.2 million. There was no dividend payment during the 2005 period. | ||
| The change in outstanding checks in excess of bank balances reflects a decrease of $6.1 million during the three months ended March 31, 2006 compared to the 2005 period. The amount of checks in excess of bank balances represents a timing difference between the issuance of checks and the cash balance in the bank account at one point in time. | ||
| In the 2006 period the payments of short-term borrowings exceeded proceeds from short-term borrowings by $1.7 million. In the 2005 period the short-term borrowings activity did not result in net borrowings or payments. Short-term borrowings are used to address timing differences between cash receipts and disbursements. |
| On September 30, 2004 TSI issued and sold $50.0 million of its 6.3% senior unsecured notes due September 2019 (the 6.3% notes). The 6.3% notes are unconditionally guaranteed as to payment of principal, premium, if any and interest by the Corporation. The notes were privately placed to various institutional accredited investors. The notes pay interest semiannually beginning on March 2005, until such principal becomes due and payable. These notes can be prepaid after five years at par, in total or partially, as determined by the Corporation. Most of the proceeds obtained from this issuance were used to repay $37.0 million of short-term borrowings made by TSI. The remaining proceeds were used for general business purposes. | ||
| On December 21, 2005 TSM issued and sold $60.0 million of its 6.6% senior unsecured notes due December 2020 (the 6.6% notes). The 6.6% notes were privately placed to various institutional accredited investors. The notes pay interest each month beginning on January 2006, until such principal becomes due and payable. These notes can be prepaid after five years at par, in full or in |
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part, as determined by the Corporation. The proceeds obtained from this issuance were used to pay the initial ceding commission to GA Life on the effective date of the coinsurance funds withheld reinsurance agreement. |
(a) | As of March 31, 2006, the Corporation is a defendant in various lawsuits arising out of the ordinary course of business. Management believes, based on the opinion of legal counsel, that the aggregate liabilities, if any, arising from such actions would not have a material adverse effect on the Corporations consolidated financial position or results of operations. |
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(b) | Drs. Carlyle Benavent and Ibrahim Pérez (the plaintiffs) caused the initiation of an administrative proceeding before the Puerto Rico Insurance Commissioner against TSI and TSM alleging the illegality of the repurchase and subsequent sale of 1,582 shares of TSIs common stock due to the fact that the ultimate purchasers of said shares were selected on an improper and selective basis by the Corporation in violation of the Puerto Rico Insurance Code. The plaintiffs alleged that they were illegally excluded from participation in the sale of shares by TSI due to the illegally selective nature of the sale of shares and that, consequently, the sale of shares should be eliminated. | |
In December 1996, the Commissioner of Insurance issued an order to annul the sale of the 1,582 shares that TSI had repurchased from the estate of deceased stockholders. TSI contested such order through an administrative and judicial review process. Consequently, the sale of 1,582 shares was cancelled and the purchase price was returned to each former stockholder. In the year 2000, the Commissioner of Insurance issued a pronouncement providing further clarification of the content and effect of the order. This order also required that all corporate decisions undertaken by TSI through the vote of its stockholders of record, be ratified in a stockholders meeting or in a subsequent referendum. In November 2000, TSM, as the sole stockholder of TSI, ratified all such decisions. Furthermore, on November 19, 2000, TSM held a special stockholders meeting, where a ratification of these decisions was undertaken except for the resolution related to the approval of the reorganization of TSI and its subsidiaries. This resolution did not reach the two thirds majority required by the order because the number of shares that were present and represented at the meeting was below such amount (total shares present and represented in the stockholders meeting was 64%). As stipulated in the order, TSM began the process to conduct a referendum among its stockholders in order to ratify such resolution. The process was later suspended because upon further review of the scope of the order, the Commissioner of Insurance issued an opinion in a letter dated January 8, 2002 which indicated that the ratification of the corporate reorganization was not required. | ||
In another letter dated March 14, 2002, the Commissioner of Insurance stated that the ratification of the corporate reorganization was not required and that TSI had complied with the Commissioners order of December 6, 1996 related to the corporate reorganization. Thereafter, the plaintiffs filed a petition for review of the Commissioners determination before the Puerto Rico Circuit Court of Appeals. Such petition was opposed by TSI and by the Commissioner of Insurance. | ||
Pursuant to that review, on September 24, 2002, the Puerto Rico Circuit Court of Appeals issued an order requiring the Commissioner of Insurance to order that a meeting of shareholders be held to ratify TSIs corporate reorganization and the change of name of TSI from Seguros de Servicios de Salud de Puerto Rico, Inc. to Triple-S, Inc. The Puerto Rico Circuit Court of Appeals based its decision on administrative and procedural issues directed at the Commissioner of Insurance. The Commissioner of Insurance filed a motion of reconsideration with the Puerto Rico Circuit Court of Appeals on October 11, 2002. TSM and TSI also filed a motion of reconsideration. | ||
On October 25, 2002, the Puerto Rico Circuit Court of Appeals dismissed the Commissioner of Insurances Motion for Reconsideration and ordered the plaintiffs to reply to TSIs Motion of Reconsideration. | ||
On May 18, 2003, the Puerto Rico Circuit Court of Appeals granted TSIs and TSMs Motion of Reconsideration. The Puerto Rico Circuit Court of Appeals held that the Commissioner of Insurance had the authority to waive the celebration of a referendum to ratify TSIs reorganization and that therefore the reorganization of TSI, inasmuch as the 1,582 shares annulled were not decisive, was approved by the stockholders. | ||
On June 26, 2003, the plaintiffs presented a writ of certiorari before the Supreme Court of Puerto Rico. TSI and TSM filed a motion opposing the issuance of the writ. The writ was issued by the Supreme Court on August 22, 2003 when it ordered the Puerto Rico Circuit Court of Appeals to transmit the record of the case. On December 1, 2003, the plaintiffs filed a motion submitting their case on the basis of their original petition. TSI and TSM filed its brief on December 30, 2003, while the Commissioner of Insurance, in turn, filed a separate brief on December 31, 2003. On June 24, 2004 |
39
the Supreme Court of Puerto Rico ordered the plaintiffs to file a brief in support of their allegations. The case is still pending before the Supreme Court of Puerto Rico. It is the opinion of the management and its legal counsels that the corporate reorganization as approved is in full force and effect. |
(c) | On September 4, 2003, José Sánchez and others filed a putative class action complaint against the Corporation, present and former directors of TSM and TSI, and others, in the United States District Court for the District of Puerto Rico, alleging violations under the Racketeer Influenced and Corrupt Organizations Act, better known as the RICO Act. The suit, among other allegations, alleges a scheme to defraud the plaintiffs by acquiring control of TSI through illegally capitalizing TSI and later converting it to a for-profit corporation and depriving the stockholders of their ownership rights. The plaintiffs base their later allegations on the supposed decisions of TSIs board of directors and stockholders, allegedly made in 1979, to operate with certain restrictions in order to turn TSI into a charitable corporation, basically forever. On March 4, 2005 the Court issued an Opinion and Order. In this Opinion and Order, of the twelve counts included in the complaint, eight counts were dismissed for failing to assert an actionable injury; six of them for lack of standing and two for failing to plead with sufficient particularity in compliance with the Rules. All shareholder allegations, including those described above, were dismissed in the Opinion and Order. The remaining four counts were found standing, in a limited way, in the Opinion and Order. The parties finished class certification discovery and fully briefed the issue of class certification. While waiting for the Courts decision on the issue of class certification, the Court, sua sponte, issued an Order to Show Cause (OTC) to plaintiffs as to why the complaint should not be dismissed with prejudice. The Courts OTC is predicated on the parties submissions about class certification. The Court then granted plaintiffs leave to file a sur-reply, which they did on April 21, 2006. In its OTC the Court indicated that it will decide first the sustainability of the complaint before deciding plaintiffs request for class certification. The parties are in anticipation of the Courts ruling on the OTC. On May 4, 2006, the Court issued an Opinion and Order which entered a summary judgment in favor of the Corporation and the case was dismissed by the Court. The plaintiffs have ten (10) business days to file for reconsideration with the Court, they may also request additional findings from the Court, and/or they have thirty (30) days to appeal the judgment to the United States Court of Appeals for the First Circuit. |
(d) | On April 24, 2002, Octavio Jordán, Agripino Lugo, Ramón Vidal, and others filed a suit against TSM, TSI and others in the Court of First Instance for San Juan, Superior Section, alleging, among other things, violations by the defendants of provisions of the Puerto Rico Insurance Code, anti-monopolistic practices, unfair business practices and damages in the amount of $12.0 million. They also requested that TSM sell shares to them. After a preliminary review of the complaint, it appears that many of the allegations brought by the plaintiffs have been resolved in favor of TSM and TSI in previous cases brought by the same plaintiffs in the United States District Court for the District of Puerto Rico and by most of the plaintiffs in the local courts. The defendants, including TSM and TSI answered the complaint, filed a counterclaim and filed several motions to dismiss this claim. On February 18, 2005 the plaintiffs informed their intention to amend the complaint and the Court granted them 45 days to do so and 90 days to the defendants to file the corresponding motion to dismiss. On May 9, 2005 the plaintiffs amended the complaint and the defendants are preparing the corresponding motions to dismiss this amended complaint. The plaintiffs amended the complaint to allege causes of action similar to those dismissed by the United States District Court for the District of Puerto Rico in the Sánchez case. Defendants moved to dismiss the amended complaint. Plaintiffs have notified their opposition to some of the defendants motion to dismiss, and the defendants filed the corresponding replies. On January 25, 2006, the court held a hearing to argue the dispositive motions. On March 16, 2006 the Court held another hearing to hear additional argument on the same motions. The Court set a final hearing for July 6, 2006. |
(e) | On May 22, 2003 a putative class action suit was filed by Kenneth A. Thomas, M.D. and Michael Kutell, M.D., on behalf of themselves and all others similarly situated and the Connecticut State Medical Society against the Blue Cross and Blue Shield Association (BCBSA) and multiple other insurance companies including TSI. The case is pending before the U.S. District Court for the Southern District of Florida, Miami District. |
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The individual plaintiffs bring this action on behalf of themselves and a class of similarly situated physicians seeking redress for alleged illegal acts of the defendants, which they allege have resulted in a loss of their property and a detriment to their business, and for declaratory and injunctive relief to end those practices and prevent further losses. Plaintiffs alleged that the defendants, on their own and as part of a common scheme, systematically deny, delay and diminish the payments due to doctors so that they are not paid in a timely manner for the covered, medically necessary services they render. | ||
The class action complaint alleges that the health care plans are the agents of BCBSA licensed entities, and as such have committed the acts alleged above and acted within the scope of their agency, with the consent, permission, authorization and knowledge of the others, and in furtherance of both their interest and the interests of other defendants. | ||
Management believes that TSI was brought to this litigation for the sole reason of being associated with the BCBSA. However, on June 18, 2004 the plaintiffs moved to amend the complaint to include the Colegio de Médicos y Cirujanos de Puerto Rico (a compulsory association grouping all physicians in Puerto Rico), Marissel Velázquez, MD, President of the Colegio de Médicos y Cirujanos de Puerto Rico, and Andrés Meléndez, MD, as plaintiffs against TSI. Later Marissel Velázquez, MD voluntarily dismissed her complaint against TSI. | ||
TSI, along with the other defendants, moved to dismiss the complaint on multiple grounds, including but not limited to arbitration and applicability of the McCarran Ferguson Act. | ||
The Court issued a 90-day stay to allow the parties to discuss their differences and come to amicable agreement. The stay expired on March 7, 2006. Upon the expiration of the stay, both plaintiffs and defendants agreed to request the Court to extend the stay until April 21, 2006. The stay expired and the parties informed the Court that they need additional time to iron out the details of an amicable solution. The Court has not reacted to the parties joint request. If the Court denies another stay, the parties will have to continue the proceedings where they were left before the issuance of the first stay. In the meantime, the Court issued an Agreed Order on the Preservation of Records. This order supersedes the parties existing record-keeping policies in regards to the documents and materials specified in the order. The purpose of the order is to avoid the disposition of documents that might be relevant for the case. |
(f) | On December 8, 2003 a putative class action was filed by Jeffrey Solomon, MD and Orlando Armstrong, MD, on behalf of themselves and all other similarly situated and the American Podiatric Medical Association, Florida Chiropractic Association, California Podiatric Medical Association, Florida Podiatric Medical Association, Texas Podiatric Medical Association, and Independent Chiropractic Physicians, against the BCBSA and multiple other insurance companies, including TSI and all members of the BCBSA. The case is still pending before the United States District Court for the Southern District of Florida, Miami District. | |
The lawsuit challenges many of the same practices as the litigation described in the immediately preceding item. | ||
Management believes that TSI was made a party to this litigation for the sole reason that TSI is associated with the BCBSA. | ||
On June 25, 2004, plaintiffs amended the complaint but the allegations against TSI did not vary. TSI along with the other defendants, moved to dismiss the complaint on multiple grounds, including but not limited to arbitration and applicability of the McCarran Ferguson Act. | ||
The Court issued a 90-day stay to allow the parties to discuss their differences and come to an amicable agreement. The stay expired on March 7, 2006. Upon the expiration of the stay, both plaintiffs and defendants agreed to request the Court to extend the stay until April 21, 2006. The stay expired and the parties informed the Court that they need additional time to iron out the details of an amicable solution. The Court has not reacted to the parties joint request. If the Court denies another |
41
stay, the parties will have to continue the proceedings where they were left before the issuance of the first stay. In the meantime, the Court issued an Agreed Order on the Preservation of Records. This order supersedes the parties existing record-keeping policies in regards to the documents and materials specified in the order. The purpose of the order is to avoid the disposition of documents that might be relevant for the case. |
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Triple-S Management Corporation | ||||||||
Registrant | ||||||||
Date: May 12, 2006
|
By: | /s/ Ramón M. Ruiz-Comas | ||||||
Ramón M. Ruiz-Comas, CPA | ||||||||
President and | ||||||||
Chief Executive Officer | ||||||||
Date: May 12, 2006
|
By: | /s/ Juan J. Román | ||||||
Juan J. Román, CPA | ||||||||
Vice President of Finance | ||||||||
and Chief Financial Office |
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