SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 Form 10-Q [X] Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the quarterly period ended June 30, 1996 or [ ] Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Commission file number: 0-12024 ------- MAXICARE HEALTH PLANS, INC. ------------------------------------------------------ (Exact name of registrant as specified in its charter) Delaware 95-3615709 ------------------------------- ------------------- (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) 1149 South Broadway Street, Los Angeles, California 90015 --------------------------------------------------- ---------- (Address of principal executive offices) (Zip Code) Registrant's telephone number, including area code (213) 765-2000 -------------- 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 [ X ] No [ ] Indicate by check mark whether the registrant has filed all documents and reports required to be filed by Sections 12, 13, or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes [ X ] No [ ] Exhibit Index Page 15 of 119 Page 1 of 119 Common Stock, $.01 par value - 17,539,318 shares outstanding as of August 9, 1996, of which 622,358 shares were held by the Registrant as disbursing agent for the benefit of holders of allowed claims and interests under the Registrant's Joint Plan of Reorganization. 2 PART I: FINANCIAL INFORMATION --------------------- Item 1: Financial Statements -------------------- MAXICARE HEALTH PLANS, INC. AND SUBSIDIARIES CONSOLIDATED BALANCE SHEETS (Amounts in thousands except par value) June 30, December 31, 1996 1995 ----------- --------- CURRENT ASSETS (Unaudited) Cash and cash equivalents................................. $ 27,932 $ 49,170 Marketable securities..................................... 63,298 49,659 Accounts receivable, net.................................. 32,655 32,946 Deferred tax asset........................................ 14,252 14,000 Prepaid expenses.......................................... 2,759 1,195 Other current assets...................................... 319 294 --------- --------- TOTAL CURRENT ASSETS.................................... 141,215 147,264 --------- --------- PROPERTY AND EQUIPMENT Leasehold improvements.................................... 5,441 5,441 Furniture and equipment................................... 18,855 18,849 --------- --------- 24,296 24,290 Less accumulated depreciation and amortization.......... 22,346 21,755 --------- --------- NET PROPERTY AND EQUIPMENT.............................. 1,950 2,535 --------- --------- LONG-TERM ASSETS Long-term receivables..................................... 156 200 Statutory deposits........................................ 13,481 12,593 Intangible assets, net.................................... 315 244 --------- --------- TOTAL LONG-TERM ASSETS.................................. 13,952 13,037 --------- --------- TOTAL ASSETS............................................ $ 157,117 $ 162,836 ========= ========= CURRENT LIABILITIES Estimated claims and incentives payable................... 37,212 $ 46,232 Accounts payable.......................................... 456 689 Deferred income........................................... 1,717 5,272 Accrued salary expense.................................... 3,336 3,296 Payable to disbursing agent............................... 6,248 6,248 Other current liabilities................................. 4,829 5,239 --------- --------- TOTAL CURRENT LIABILITIES............................... 53,798 66,976 LONG-TERM LIABILITIES....................................... 807 1,155 --------- --------- TOTAL LIABILITIES....................................... 54,605 68,131 --------- --------- SHAREHOLDERS' EQUITY Common stock, $.01 par value - 40,000 shares authorized, 1996 - 17,539 shares and 1995 - 17,420 shares issued and outstanding......................................... 175 174 Additional paid-in capital................................ 249,237 247,690 Accumulated deficit....................................... (146,900) (153,159) --------- --------- TOTAL SHAREHOLDERS' EQUITY.............................. 102,512 94,705 --------- --------- TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY.............. $ 157,117 $ 162,836 ========= ========= See notes to consolidated financial statements. 3 MAXICARE HEALTH PLANS, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF OPERATIONS (Amounts in thousands except per share data) (Unaudited) For the three For the six months ended months ended June 30, June 30, ------------------ ------------------ 1996 1995 1996 1995 -------- -------- -------- -------- OPERATING REVENUES................................................... $134,573 $113,692 $266,339 $226,047 -------- -------- -------- -------- OPERATING EXPENSES Physician services................................................ 53,576 44,904 106,157 89,126 Hospital services................................................. 46,487 34,594 88,456 68,195 Outpatient services............................................... 20,348 16,197 38,534 32,122 Other health care services........................................ 3,009 2,875 6,063 6,326 -------- -------- -------- -------- TOTAL HEALTH CARE EXPENSES...................................... 123,420 98,570 239,210 195,769 Marketing, general and administrative expenses.................... 11,817 10,591 23,263 21,165 Depreciation and amortization..................................... 329 301 675 595 -------- -------- -------- -------- TOTAL OPERATING EXPENSES........................................ 135,566 109,462 263,148 217,529 -------- -------- -------- -------- INCOME (LOSS) FROM OPERATIONS........................................ (993) 4,230 3,191 8,518 Investment income, net of interest expense........................ 1,516 1,679 3,068 3,020 -------- -------- -------- -------- INCOME BEFORE INCOME TAXES........................................... 523 5,909 6,259 11,538 INCOME TAX PROVISION................................................. 1,012 1,953 -------- -------- -------- -------- NET INCOME........................................................... $ 523 $ 4,897 $ 6,259 $ 9,585 ======== ======== ======== ======== NET INCOME PER COMMON AND COMMON EQUIVALENT SHARE: Primary Primary Earnings per Common Share................................. $ .03 $ .27 $ .34 $ .61 ======== ======== ======== ======== Weighted average number of common and common equivalent shares outstanding................................... 18,406 18,092 18,446 15,758 ======== ======== ======== ======== Fully Diluted Fully Diluted Earnings per Common Share........................... $ .03 $ .27 $ .34 $ .53 ======== ======== ======== ======== Weighted average number of common and common equivalent shares outstanding................................... 18,406 18,092 18,446 18,076 ======== ======== ======== ======== See notes to consolidated financial statements. 4 MAXICARE HEALTH PLANS, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF CASH FLOWS (Amounts in thousands) (Unaudited) For the six months ended June 30, 1996 1995 --------- -------- CASH FLOWS FROM OPERATING ACTIVITIES: Net income....................................................... $ 6,259 $ 9,585 Adjustments to reconcile net income to net cash used for operating activities: Depreciation and amortization.................................. 675 595 Benefit from deferred taxes.................................... (252) Amortization of restricted stock............................... 349 233 Changes in assets and liabilities: (Increase) decrease in accounts receivable................... 291 (3,223) Decrease in estimated claims and incentives payable.......... (9,020) (10,531) Increase (decrease) in deferred income....................... (3,555) 2,148 Changes in other miscellaneous assets and liabilities........ (2,388) 845 -------- -------- Net cash used for operating activities........................... (7,641) (348) -------- -------- CASH FLOWS FROM INVESTING ACTIVITIES: Dispositions of property and equipment......................... 4 Purchases of property and equipment............................ (41) (173) Increase in statutory deposits................................. (888) (726) Proceeds from sales and maturities of marketable securities.... 21,131 34,578 Purchases of marketable securities............................. (34,770) (34,250) Decrease in long-term receivables.............................. 44 39 -------- -------- Net cash used for investing activities........................... (14,524) (528) -------- -------- CASH FLOWS FROM FINANCING ACTIVITIES: Payments on capital lease obligations.......................... (272) (80) Stock options exercised........................................ 1,199 845 Redemption of preferred stock.................................. (525) -------- -------- Net cash provided by financing activities........................ 927 240 -------- -------- Net decrease in cash and cash equivalents........................ (21,238) (636) Cash and cash equivalents at beginning of period................. 49,170 37,858 -------- -------- Cash and cash equivalents at end of period....................... $ 27,932 $ 37,222 ======== ======== Supplemental disclosures of cash flow information: Cash paid during the period for - Interest..................................................... $ 65 $ 21 Income taxes................................................. $ 263 $ 1,670 Supplemental schedule of non-cash financing activities: Reclassification of preferred capital accounts to common stock capital accounts pursuant to the conversion of preferred stock to common stock.............. $ 53,195 Issuance of restricted common stock.......................... $ 2,096 See notes to consolidated financial statements. 5 MAXICARE HEALTH PLANS, INC. AND SUBSIDIARIES NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 1 - SIGNIFICANT ACCOUNTING POLICIES: Basis of Presentation --------------------- Maxicare Health Plans, Inc., a Delaware corporation ("MHP"), is a holding company which owns various subsidiaries, primarily health maintenance organizations ("HMOs"). The accompanying unaudited consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information. In the opinion of management, all adjustments considered necessary for a fair presentation, which consist solely of normal recurring adjustments, have been included. All significant inter-company balances and transactions have been eliminated. For further information on MHP and subsidiaries (collectively the "Company") refer to the consolidated financial statements and accompanying footnotes included in the Company's annual report on Form 10-K as filed with the Securities and Exchange Commission for the year ended December 31, 1995. Capital Stock and Net Income Per Common and Common Equivalent ------------------------------------------------------------- Share ----- The Company concluded the redemption of its Series A Cumulative Convertible Preferred Stock ("Series A Stock") on March 14, 1995 (the "Redemption Date"). Holders of approximately 2.27 million shares of Series A Stock converted their shares into approximately 6.25 million shares of the Company's Common Stock. As a result of the redemption of the Series A Stock the Company paid no preferred stock dividends in 1995, and, accordingly, no consideration is given to preferred stock dividends in the calculation of earnings per share for the three and six month periods ended June 30, 1995. Primary earnings per share are computed by dividing net income by the weighted average number of common shares outstanding, after giving effect to stock options with an exercise price less than the average market price for the period. Common shares issued upon the conversion of preferred stock have been included in the weighted average number of common shares outstanding subsequent to the conversion date. Fully diluted earnings per share are computed by dividing net income by the weighted average number of common shares outstanding, after giving effect to stock options with an 6 exercise price less than the market price at the end of the period (or average market price if use of that price results in greater dilution) and shares assumed to be issued upon conversion of the Company's preferred stock. Common shares issued upon the conversion of preferred stock have been included in the weighted average number of common shares outstanding and the preferred shares have been excluded from the weighted average number of common equivalent shares outstanding subsequent to the conversion date. 7 Item 2: Management's Discussion and Analysis of Financial ------------------------------------------------- Condition and Results of Operations ----------------------------------- Results of Operations Maxicare Health Plans, Inc. and subsidiaries (the "Company") reported net income of $.5 million for the three months ended June 30, 1996, compared to $4.9 million for the same three month period in 1995. Net income per common share on a fully diluted basis was $.03 for the second quarter of 1996, compared to $.27 for 1995. For the three months ended June 30, 1996, the Company reported operating revenues of $134.6 million, an increase of 18% or $20.9 million when compared to the same period in 1995. Operating revenues increased as a result of a 25% increase in the Company's membership over the prior year period. A majority of the increase resulted from a doubling of membership in the Company's Medicaid and Medicare lines of business primarily in Indiana and California. The remaining increase resulted from a 15% increase in commercial membership primarily in California and Indiana, offset in part by a decrease in the average per member per month ("PMPM") commercial premium. The increase in operating revenues for the second quarter of 1996 was more than offset by a $24.8 million increase in health care expenses. This increase in health care expenses was in part a result of a $5.0 million charge for unanticipated health care claims costs primarily related to the Illinois and Carolinas health plans, where the Company assumes greater risk for claims costs as compared to its other health plans. The remaining increase principally results from growth in the Company's Medicaid and Medicare lines of business, both of which have a higher medical loss ratio (health care expenses as a percentage of operating revenues) than the Company's commercial line of business. Marketing, general and administrative ("MG&A") expenses for the second quarter of 1996 increased $1.2 million to $11.8 million as compared to the second quarter of 1995. However, MG&A expenses as a percentage of operating revenues decreased to 8.8% for the three months ended June 30, 1996 as compared to 9.3% for the second quarter of 1995 primarily as a result of revenue growth in the Company's Medicaid line of business. Net investment income for the second quarter of 1996 decreased by $200,000 to $1.5 million, as compared to 1995, due to lower interest rates partially offset by greater cash and investment balances. The Company reported a $32,000 provision for income taxes for the three months ended June 30, 1996 and an offsetting income tax benefit of $32,000 due to the Company increasing its deferred tax asset. The Company reported a $1.0 million provision for income taxes for the three months ended June 30, 1995. 8 Operating revenues for the first six months of 1996 increased 17.8% to $266.3 million from $226.0 million for the same period in 1995 primarily due to a 24% membership increase in the Company's Medicaid, Medicare and commercial lines of business; offset in part by a 5.2% decline in the average premium PMPM primarily as a result of the growth in the lower premium PMPM Medicaid line of business. Total health care expenses increased $43.4 million for the first six months of 1996 as compared to the same period in 1995 as a result of the increase in membership and the $5.0 million charge recorded in the second quarter of 1996. MG&A expenses increased $2.1 million for the six months ended June 30, 1996, but decreased as a percentage of operating revenues to 8.7% from 9.4%. The Company reported net income of $6.3 million for the six months ended June 30, 1996 as compared to $9.6 million for the same period in 1995. 9 Liquidity and Capital Resources Certain of MHP's operating subsidiaries are subject to state regulations which require compliance with certain statutory deposit, reserve, dividend distribution and net worth requirements. To the extent the operating subsidiaries must comply with these regulations, they may not have the financial flexibility to transfer funds to MHP. MHP's proportionate share of net assets (after inter-company eliminations) which, at June 30, 1996, may not be transferred to MHP by subsidiaries in the form of loans, advances or cash dividends without the consent of a third party is referred to as "Restricted Net Assets". Total Restricted Net Assets of these operating subsidiaries were $38.8 million at June 30, 1996, with deposit requirements and limitations imposed by state regulations on the distribution of dividends representing $12.9 million and $18.6 million of the Restricted Net Assets, respectively, and net worth requirements in excess of deposit requirements and dividend limitations representing the remaining $7.3 million. The Company's total Restricted Net Assets at June 30, 1996 were $39.1 million. In addition to the $23.9 million in cash, cash equivalents and marketable securities held by MHP, approximately $13.3 million could be considered available to transfer to MHP from operating subsidiaries. All of MHP's operational subsidiaries are direct subsidiaries of MHP. All of the Company's HMOs are federally qualified and licensed in the states where they operate. Subsequent to the close of the Company's fiscal 1996 second quarter, in July 1996 the North Carolina Department of Insurance and the South Carolina Department of Insurance approved the expansion of the Company's North Carolina HMO into the state of South Carolina through its acquisition of the existing membership, contracts and net assets of the Company's South Carolina HMO. As a result of this approval, the Company's North Carolina HMO is licensed to conduct business in both the states of North Carolina and South Carolina. Prior to such approval, the operations of the Company's South Carolina HMO were under Bankruptcy Court jurisdiction. The operating HMOs currently pay monthly fees to MHP pursuant to administrative services agreements for various management, financial, legal, computer and telecommunications services. The Company believes that for the foreseeable future it will have sufficient resources to fund ongoing operations and remain in compliance with statutory financial requirements. With a current ratio (i.e., current assets divided by current liabilities) of 2.6 and less than $.9 million of long-term liabilities at June 30, 1996, the Company does not believe that it needs additional working capital at this time. Although the Company believes that it would be able to raise additional working capital through either an equity infusion or borrowings if it so desired, the Company can not state with any degree of certainty at this time whether additional equity capital or working capital would be available to the Company, and if available, would be at terms and conditions acceptable to the Company. 10 PART II: OTHER INFORMATION ----------------- Item 1: Legal Proceedings ----------------- The information contained in "Part I, Item 3. Legal Proceedings" of the Company's 1995 Annual Report on Form 10-K is hereby incorporated by reference and the following information updates the information contained in the relevant subparts thereof. a. PENN HEALTH During the period March 1, 1986 through June 30, 1989, Penn Health Corporation ("Penn Health"), a subsidiary of the Company, contracted with the Commonwealth of Pennsylvania Department of Public Welfare (the "DPW") to provide a full range of managed health care services to Medicaid enrollees under the Pennsylvania Medical Assistance Program known as the HealthPass Program. On February 27, 1991, the Company filed a petition against the DPW with the Pennsylvania Board of Claims (the "Claims Board") seeking in excess of $24 million in damages for monies due from the DPW in connection with the HealthPass Program plus accrued interest (the "Board Action"). The Claims Board consolidated the Board Action for purposes of trial with two separate actions filed by Penn Health hospital providers (the "Hospital Providers") and by a class consisting of Penn Health primary care physician providers (the "PCP Class") against DPW to secure payment directly from the DPW for pre-petition services rendered to HealthPass members. Pursuant to an order of the Claims Board, the actions were set for trial in two phases; a liability phase and a damages phase. Following trial before the Claims Board in July 1994 of contractual issues pertaining to DPW's liability the Claims Board issued an order on December 2, 1994 on the liability phase which found that: (i) a contract exists between Penn Health and the DPW; (ii) the DPW breached the contract; and (iii) Penn Health is an independent general contractor and not an agent of the DPW. Trial on the parties' respective damages claims concluded on November 30, 1995. All post trial briefing has been completed and the parties are waiting for the Claims Board to issue its ruling on the damages phase and to enter a judgment in the Board Action. The Company believes that its damage claims are meritorious and that it will prevail in the Board Action. On June 7 and 19, 1996 the Company and Penn Health filed complaints with the United States Bankruptcy Court for the Central District of California (the "Bankruptcy Court") against the Hospital Providers, and the PCP Class and its counsel, respectively (the "Provider Bankruptcy Actions"), for violating the terms of the Company's and Penn Health's Joint Plan of Reorganization (the "Plan") and the Bankruptcy Court's order confirming the Plan. In the Provider Bankruptcy Actions the Company and Penn Health seek, among other things, turnover and the 11 recovery of payments (plus accrued interest) made by the DPW, to the Hospital Providers in the amount of $13 million and the PCP Class in the amount of $2.1 million (collectively, the "DPW Payments"), after confirmation of the Plan, as unlawful Plan distributions and post-petition transfers. (Maxicare Health Plans, Inc. and Penn Health Corporation v. Albert Einstein et al. (Case No. AD96-01611)); (Maxicare Health Plans, Inc. and Penn Health Corporation v. Faezeh Behjat et al. (Case No. AD96-01668)). The Company believes that its claims against the defendants in the Provider Bankruptcy Actions are meritorious and that it will prevail in these actions. Notwithstanding the foregoing, the Company believes that its aggregate recovery from the Board Action and the Provider Bankruptcy Actions will not exceed the aggregate amount of damages plus accrued interest sought by Penn Health in the Board Action. b. OTHER LITIGATION The Company is a defendant in a number of other lawsuits arising in the ordinary course from the operations of its HMOs, including cases in which the plaintiffs assert claims against the Company or third parties that might assert indemnity or contribution claims against the Company for malpractice, negligence, bad faith in the failure to pay claims on a timely basis or denial of coverage. The Company does not believe that an adverse determination in any one or more of these cases would have a material, adverse effect on the Company's business and operations. Item 2: Change in Securities -------------------- None. Item 3: Defaults Upon Senior Securities ------------------------------- None. Item 4: Submission of Matters to a Vote of Security Holders --------------------------------------------------- None. Item 5: Other Information ----------------- None. 12 Item 6: Exhibits and Reports on Form 8-K -------------------------------- (a) Exhibits -------- Exhibit 10.3d. Amended and Restated Employment and Indemnification Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of April 1, 1996 Exhibit 10.4d. Amended and Restated Employment and Indemnification Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of April 1, 1996 Exhibit 10.14a Amendment No. 1 to the Stock Option Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of December 5, 1990. Exhibit 10.15a Amendment No. 1 to the Stock Option Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of December 5, 1990. Exhibit 10.42a Amendment No. 1 to the Stock Option Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of February 25, 1992. Exhibit 10.43a Amendment No. 1 to the Stock Option Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of February 25, 1992. Exhibit 10.82a. Stock Option Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of April 1, 1996 Exhibit 10.82b. Stock Option Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of April 1, 1996 Exhibit 27. Financial Data Schedule (b) Reports on Form 8-K ------------------- None. 13 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. MAXICARE HEALTH PLANS, INC. --------------------------- (Registrant) August 12, 1996 /s/ Eugene L. Froelich --------------------------- Eugene L. Froelich Chief Financial Officer and Executive Vice President - Finance and Administration 14 INDEX TO EXHIBITS Exhibit Sequential Number Description Page Number ------ ----------------------------------------- ----------- 10.3d Amended and Restated Employment and 16 of 119 Indemnification Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of April 1, 1996 10.4d Amended and Restated Employment and 51 of 119 Indemnification Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of April 1, 1996 10.14a Amendment No. 1 to the Stock Option 86 of 119 Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of December 5, 1990 10.15a Amendment No. 1 to the Stock Option 90 of 119 Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of December 5, 1990 10.42a Amendment No. 1 to the Stock Option 94 of 119 Agreement by and between Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of February 25, 1992 10.43a Amendment No. 1 to the Stock Option 97 of 119 Agreement by and between Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of February 25, 1992 10.82a Stock Option Agreement by and between 100 of 119 Maxicare Health Plans, Inc. and Peter J. Ratican, dated as of April 1, 1996 10.82b Stock Option Agreement by and between 109 of 119 Maxicare Health Plans, Inc. and Eugene L. Froelich, dated as of April 1, 1996 27 Financial Data Schedule 118 of 119 15