0001193125-15-040432.txt : 20150210 0001193125-15-040432.hdr.sgml : 20150210 20150210083537 ACCESSION NUMBER: 0001193125-15-040432 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20150210 ITEM INFORMATION: Results of Operations and Financial Condition ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20150210 DATE AS OF CHANGE: 20150210 FILER: COMPANY DATA: COMPANY CONFORMED NAME: HEALTH NET INC CENTRAL INDEX KEY: 0000916085 STANDARD INDUSTRIAL CLASSIFICATION: HOSPITAL & MEDICAL SERVICE PLANS [6324] IRS NUMBER: 954288333 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 001-12718 FILM NUMBER: 15590532 BUSINESS ADDRESS: STREET 1: 21650 OXNARD ST CITY: WOODLAND HILLS STATE: CA ZIP: 91367 BUSINESS PHONE: 8186766000 MAIL ADDRESS: STREET 1: 225 N MAIN ST CITY: PUEBLO STATE: CO ZIP: 81003 FORMER COMPANY: FORMER CONFORMED NAME: FOUNDATION HEALTH SYSTEMS INC DATE OF NAME CHANGE: 19970513 FORMER COMPANY: FORMER CONFORMED NAME: HEALTH SYSTEMS INTERNATIONAL INC DATE OF NAME CHANGE: 19940207 FORMER COMPANY: FORMER CONFORMED NAME: HN MANAGEMENT HOLDINGS INC/DE/ DATE OF NAME CHANGE: 19931213 8-K 1 d867210d8k.htm 8-K 8-K

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

 

 

FORM 8-K

 

 

CURRENT REPORT

Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

Date of Report (Date of Earliest Event Reported):

February 10, 2015

 

 

Health Net, Inc.

(Exact Name of Registrant as Specified in Charter)

 

 

 

Delaware   1-12718   95-4288333

(State or Other Jurisdiction of

Incorporation)

 

(Commission

File Number)

 

(IRS Employer

Identification No.)

21650 Oxnard Street, Woodland

Hills, California

  91367
(Address of Principal Executive Offices)   (Zip Code)

Registrant’s telephone number, including area code: (818) 676-6000

Not Applicable

Former Name or Former Address, if Changed Since Last Report

 

 

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

 

¨ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

 

¨ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

 

¨ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

 

¨ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

 

 

 


Item 2.02 Results of Operations and Financial Condition.

On February 10, 2015, Health Net, Inc. (“we”, “us” or “our”) issued a press release announcing our financial results for the quarter and year ended December 31, 2014. The press release contains the non-GAAP financial measure “adjusted days claims payable (DCP).” Adjusted DCP for the fourth quarter of 2014 was 70.1 days, adjusted DCP for the third quarter of 2014 was 65.3 days, and adjusted DCP for the fourth quarter of 2013 was 57.9 days. In addition, adjusted DCP for full year 2014 was 77.2 days and adjusted DCP for full year 2013 was 58.7 days. Adjusted DCP excludes claims reserve and health plan costs related to our capitation, provider and other claims settlements and Medicare Advantage-Prescription Drug payables and costs. The most directly comparable GAAP financial measure to this non-GAAP financial measure is fourth quarter of 2014 DCP of 57.4 days, third quarter of 2014 DCP of 51.4 days, fourth quarter of 2013 DCP of 40.6 days, full year 2014 DCP of 61.2 days and full year 2013 DCP of 40.4 days.

Management believes that adjusted DCP provides useful information to investors because the adjusted DCP calculation excludes from both claims reserve and health plan costs amounts related to health care costs for which no or minimal reserves are maintained. Therefore, management believes that adjusted DCP may present a more accurate reflection of DCP than does GAAP DCP, which includes such amounts. This non-GAAP financial information should be considered in addition to, not as a substitute for, financial information prepared in accordance with GAAP. A reconciliation of the non-GAAP financial measure to the most directly comparable GAAP financial measure is included in the attached press release. As used herein, “GAAP” refers to accounting principles generally accepted in the United States.

The press release is attached hereto as Exhibit 99.1 and hereby incorporated in this Item 2.02 by reference. The information in this Item 2.02 shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934 (the “Exchange Act”) or otherwise subject to the liabilities of that section, nor shall it be deemed incorporated by reference in any filing by Health Net, Inc. under the Securities Act of 1933 or the Exchange Act, except as shall be expressly set forth by specific reference in such filing.

 

Item 9.01 Financial Statements and Exhibits.

 

(d) Exhibits

 

99.1

Press Release dated February 10, 2015


Exhibit Index

 

Exhibit No.

  

Document Description

99.1    Press Release dated February 10, 2015


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 hereunto duly authorized.

 

Health Net, Inc.
February 10, 2015 By:

/s/ James E. Woys

Name: James E. Woys
Title: Executive Vice President, Chief Financial and Operating Officer and Interim Treasurer
EX-99.1 2 d867210dex991.htm EX-99.1 EX-99.1

Exhibit 99.1

 

LOGO

 

Investor Contact:

David Olson

The Abernathy MacGregor Group

(818) 917-1469

dwo@abmac.com

Media Contact:

Brad Kieffer

(818) 676-6833

brad.kieffer@healthnet.com

HEALTH NET REPORTS FOURTH QUARTER 2014 GAAP NET INCOME

OF $4.9 MILLION, OR $0.06 PER DILUTED SHARE

WESTERN REGION OPERATIONS AND GOVERNMENT CONTRACTS SEGMENTS PRODUCE

COMBINED NET INCOME OF $0.60 PER DILUTED SHARE IN FOURTH QUARTER 2014

COMPANY UPDATES 2015 GAAP GUIDANCE

LOS ANGELES, February 10, 2015 – Health Net, Inc. (NYSE: HNT) today announced 2014 fourth quarter GAAP net income of $4.9 million, or $0.06 per diluted share, compared with GAAP net income of $19.8 million, or $0.25 per diluted share, for the fourth quarter of 2013.

For the full year 2014, the company reported GAAP net income of $145.6 million, or $1.80 per diluted share, compared with $170.1 million, or $2.12 per diluted share, for the full year 2013.

In the fourth quarter of 2014, the company incurred $72.1 million of pretax expenses primarily related to its master services agreement with a wholly owned subsidiary of Cognizant Technology Solutions Corporation (Cognizant).

The company’s Western Region Operations (Western Region) and Government Contracts segments produced combined net income of $47.4 million, or $0.60 per diluted share, in the fourth quarter of 2014 compared with $19.1 million, or $0.24 per diluted share, in the fourth quarter of 2013.

The company’s Western Region and Government Contracts segments produced combined net income of $187.5 million, or $2.32 per diluted share, for the full year 2014, compared with $177.4 million, or $2.21 per diluted share, for the full year 2013.

Highlights from the fourth quarter of 2014 include:

 

  1. Health Net’s total revenues climbed 37.0 percent and health plan services premiums revenues rose 40.1 percent in the fourth quarter of 2014 compared with the fourth quarter of 2013. These revenue increases were driven by ongoing Medicaid and commercial enrollment gains;


  2. Medicaid enrollment increased by approximately 559,000 members, or 50.0 percent, as of December 31, 2014 compared with December 31, 2013. This increase was primarily the result of new enrollment in Arizona and California as a result of the expansion of Medicaid eligibility under the Affordable Care Act (ACA);

 

  3. Individual health plan enrollment increased by approximately 217,000 members, or 188.7 percent, as of December 31, 2014 compared with December 31, 2013. The year-over-year growth was driven by the enrollment of new individual members through the ACA exchanges in Arizona and California; and

 

  4. The company’s Western Region commercial Medical Care Ratio (MCR) improved 280 basis points in the fourth quarter of 2014 compared with the fourth quarter of 2013.

“We are pleased that 2014’s strong momentum continued in the fourth quarter of 2014. This profitable revenue growth in 2014, we believe, sets the stage for further gains in 2015,” said Jay Gellert, Health Net’s chief executive officer.

“We look forward to 2015 and the expected implementation of our agreement with Cognizant following receipt of required regulatory approval. We believe this agreement will position Health Net for expanded product development and service capabilities that will support and provide scale for incremental growth in the years ahead,” Gellert explained.

CONSOLIDATED RESULTS

Health Net’s total revenues increased 37.0 percent in the fourth quarter of 2014 to $3.8 billion from $2.7 billion in the fourth quarter of 2013.

Health plan services premium revenues of $3.6 billion in the fourth quarter of 2014 increased by 40.1 percent compared with $2.6 billion in the fourth quarter of 2013.

Health plan services expenses increased by 36.3 percent in the fourth quarter of 2014 to $3.0 billion compared with $2.2 billion in the fourth quarter of 2013.

WESTERN REGION OPERATIONS SEGMENT

Health Plan Membership

Total enrollment in the Western Region at December 31, 2014 was approximately 3.2 million members, an increase of 29.1 percent from enrollment at December 31, 2013.

Total enrollment in the company’s California health plans increased 26.0 percent to approximately 2.7 million members at December 31, 2014 compared with enrollment at December 31, 2013.

Western Region commercial enrollment at December 31, 2014 was approximately 1.2 million members, a 9.9 percent increase compared with enrollment at December 31, 2013.

“Our fourth quarter 2014 Medicaid and commercial enrollment was lower than expected. This is because California has been aggressive in redetermining enrollee eligibility for both Medicaid and the commercial exchanges,” explained Gellert. “As a result of this effort, member attrition was higher than expected.”

Membership in tailored network products represented 49.8 percent of the company’s Western Region commercial membership at December 31, 2014 compared with 37.5 percent at December 31, 2013.

 

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“We believe these efficient commercial networks played an important role in our exchange enrollment growth in 2014. We expect they will support our future growth as we believe customers on public and private exchanges will continue to seek affordable networks that provide both quality and access,” said James Woys, Health Net’s chief financial and operating officer and interim treasurer.

“Given these dynamics, we expect the percentage of our commercial enrollment in such tailored network products to rise again in 2015,” Woys noted.

Enrollment in the company’s Medicare Advantage (MA) plans in the Western Region at December 31, 2014 was approximately 275,000 members, an increase of 12.7 percent compared with December 31, 2013.

Medicaid enrollment at December 31, 2014 was approximately 1.7 million members, an increase of 50.0 percent, from December 31, 2013.

“We are seeing growth from both Medicaid expansion and from those eligible for traditional Medicaid,” Woys added.

Dual eligibles enrollment at December 31, 2014 was approximately 16,000 members, an increase of 77.8 percent compared with enrollment of approximately 9,000 at September 30, 2014.

Revenues

Total revenues for the Western Region in the fourth quarter of 2014 were $3.6 billion compared with $2.6 billion in the fourth quarter of 2013.

Net investment income for the Western Region was $11.1 million in the fourth quarter of 2014 compared with $11.6 million in the fourth quarter of 2013 and $11.0 million in the third quarter of 2014.

Health Plan Services Expenses

Health plan services expenses in the Western Region were $3.0 billion in the fourth quarter of 2014 compared with $2.2 billion in the fourth quarter of 2013.

Commercial Premium Yield and Health Care Cost Trends

In the Western Region, commercial premiums per member per month (PMPM) decreased by 2.5 percent to approximately $379 in the fourth quarter of 2014 compared with approximately $388 in the fourth quarter of 2013.

Commercial health care costs PMPM in the Western Region decreased by 5.6 percent to approximately $321 in the fourth quarter of 2014 compared with approximately $340 in the fourth quarter of 2013.

These premium and health care cost declines were primarily due to the mix shift in the makeup of the commercial membership with significantly higher individual membership in 2014 compared with 2013.

“The underlying commercial health care cost trends remained moderate in the fourth quarter of 2014 with no evidence of flu-related pressure,” noted Woys. “Our guidance assumes some slight upward pressure on commercial health care cost trends in 2015.”

 

3


Medical Care Ratios (MCR)

The health plan services MCR in the Western Region was 84.7 percent in the fourth quarter of 2014 compared with 87.1 percent in the fourth quarter of 2013. The full year 2014 Western Region health plan services MCR was 84.6 percent compared with 85.6 percent for the full year 2013.

The Western Region commercial MCR was 84.6 percent in the fourth quarter of 2014 compared with 87.4 percent in the fourth quarter of 2013 and 83.9 percent in the third quarter of 2014. The full year 2014 Western Region commercial MCR was 83.0 percent compared with 85.6 percent for the full year 2013.

“We are very pleased that we were able to produce both significant year-over-year enrollment gains and MCR improvement. We believe the MCR improvement is due to better performance in our group accounts that allowed us to cover the expense of the health insurer fee, and a higher percentage of our commercial enrollment coming from the individual segment due to the substantial growth from the individual exchanges,” Woys commented.

The Medicaid MCR was 80.0 percent in the fourth quarter of 2014 compared with 82.7 percent in the fourth quarter of 2013. The full year 2014 Medicaid MCR in the Western Region was 82.1 percent compared with 80.4 percent for the full year 2013.

“The fourth quarter 2014 Medicaid MCR was impacted by a number of year-end adjustments related to the significant enrollment increases from new populations and other factors. Accordingly, we believe the full year Medicaid MCR of 82.7 percent is a better reflection of our actual experience,” Woys noted.

The MA MCR was 92.8 percent in the fourth quarter of 2014 compared with 90.5 percent in the fourth quarter of 2013. The full year 2014 MA MCR in the Western Region was 91.5 percent compared with 90.6 percent for the full year 2013.

“The Medicare MCR was adversely affected by higher fourth quarter 2014 utilization from MA members who changed health plans at year-end and from the impact of an earlier than expected flu season,” explained Woys.

General and Administrative (G&A) Expenses

G&A expense in the Western Region was $404.7 million in the fourth quarter of 2014 compared with $280.4 million in the fourth quarter of 2013. The $124.5 million increase in the Western Region G&A expense year-over-year was driven by a $92.1 million increase in premium taxes, health insurer fee and other ACA-related fees. The G&A expense ratio in the Western Region was 11.3 percent in the fourth quarter of 2014 compared with 10.9 percent in the fourth quarter of 2013. The 40 basis point increase in the Western Region G&A expense ratio year-over-year was driven by a 220 basis point increase in premium taxes, health insurer fee and other ACA-related fees, partially offset by a 180 basis point decline in the Western Region administrative expense ratio, which does not include premium taxes, health insurer fee and other ACA-related fees.

“We are pleased that our ongoing efficiency efforts and our rapid growth helped drive the administrative expense ratio lower,” Woys commented.

The Western Region G&A expense ratio for the full year 2014 was 10.9 percent compared with 10.3 percent for the full year 2013.

GOVERNMENT CONTRACTS SEGMENT

Government Contracts revenues in the fourth quarter of 2014 were $159.6 million compared with $148.5 million in the fourth quarter of 2013.

Government Contracts expenses in the fourth quarter of 2014 were $147.2 million compared with $124.6 million in the fourth quarter of 2013.

 

4


“Our Government Contracts performance for the fourth quarter of 2014 was affected by lower TRICARE earnings and startup costs related to the expansion of our work for the VA,” Woys explained.

BALANCE SHEET

Cash and investments as of December 31, 2014 were $2.7 billion compared with $2.1 billion as of December 31, 2013.

The company noted that the net receivable balance for commercial reinsurance, risk corridors and risk adjusters related to the ACA was approximately $248 million at December 31, 2014. Approximately 94 percent of this net receivable is related to reinsurance.

Reserves for claims and other settlements as of December 31, 2014 were $1.9 billion compared with $984.1 million as of December 31, 2013 and $1.7 billion as of September 30, 2014.

Days claims payable (DCP) for the fourth quarter of 2014 was 57.4 days compared with 40.6 days in the fourth quarter of 2013 and 51.4 days in the third quarter of 2014.

On an adjusted1 basis, DCP in the fourth quarter of 2014 was 70.1 days compared with 57.9 days in the fourth quarter of 2013 and 65.3 days in the third quarter of 2014.

“The 4.8 day increase in adjusted DCP sequentially in the fourth quarter of 2014 reflects the continued impact of reinsurance on health care costs and higher reserves as a consequence of our rapid enrollment growth,” Woys noted.

The company’s debt-to-total capital ratio was 22.6 percent as of December 31, 2014 compared with 23.5 percent as of December 31, 2013 and 22.1 percent as of September 30, 2014.

CASH FLOW FROM OPERATIONS

Operating cash flow was negative $109.7 million in the fourth quarter of 2014. For the full year 2014, operating cash flow was positive $776.0 million.

“The full year operating cash flow improvement was driven primarily by our strong operating results and our business growth,” explained Woys. “Operating cash flow in the fourth quarter of 2014, however, was negatively impacted by the timing of payments related to state health programs.”

The company noted that a late Medicaid payment from the state of California of approximately $311 million was received in January 2015.

Cash at the parent was approximately $61 million at December 31, 2014.

SHARE REPURCHASE UPDATE

For the full year 2014, Health Net repurchased approximately 3 million shares of its common stock for $137.8 million at an average price of $45.92 per share. On December 16, 2014, Health Net’s board of directors approved a $258 million increase to the company’s existing share repurchase program. Including this increase, Health Net had $400 million in repurchase authority under the company’s existing share repurchase program as of December 31, 2014.

Health Net continued its share repurchases in the first quarter of 2015. The company repurchased 1.1 million shares from January 1, 2015 through January 31, 2015, at a total cost of $57.7 million.

The company noted it funded its January share repurchases from its revolving credit facility.

 

1  See “Disclosures Regarding Non-GAAP Financial Information” attached to this press release for a reconciliation of this information to the comparable GAAP financial measure.

 

5


2015 GUIDANCE

The company expects GAAP earnings per diluted share of at least $2.70 for the full year 2015. The table included in this release provides specific metrics.

“Our 2015 GAAP earnings per diluted share guidance of at least $2.70 is based primarily on our expectation of an approximately 9 percent increase in membership and an approximately 23 percent increase in total revenues; stable MCRs in the commercial, Medicare and Medicaid lines of business; and an approximately 50 basis point decline in the company’s administrative expense ratio in 2015 compared with 2014 results,” said Gellert.

CONFERENCE CALL

As previously announced, Health Net will discuss the company’s fourth quarter and year-end 2014 earnings results during a conference call on Tuesday, February 10, 2015, beginning at approximately 11:00 a.m. Eastern time. The conference call should be accessed at least 15 minutes prior to its start with the following numbers:

 

(877) 407-4019 (Live – Domestic toll-free)

(201) 689-8337 (Live – International)

(877) 660-6853 (Replay – Domestic toll-free)

(201) 612-7415 (Replay – International)

An access code is not required for the live conference call on February 10, 2015. The access code for the replay is 13599556. The replay of the conference call will be available through February 15, 2015. A live webcast and replay of the conference call also will be available at www.healthnet.com under “Investor Relations.” The conference call webcast is open to all interested parties. Anyone listening to the company’s conference call or webcast will be presumed to have read Health Net’s Annual Report on Form 10-K for the year ended December 31, 2013, Quarterly Reports on Form 10-Q for the quarterly periods ended March 31, 2014, June 30, 2014, and September 30, 2014, and other reports filed by the company from time to time with the Securities and Exchange Commission.

ABOUT HEALTH NET

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net provides and administers health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “Part D”), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net also offers behavioral health, substance abuse and employee assistance programs, managed health care products related to prescription drugs, managed health care product coordination for multi-region employers, and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit Health Net’s website at www.healthnet.com.

CAUTIONARY STATEMENTS

The company and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. All statements in this press release, other than statements of historical information provided herein, including

 

6


the guidance for future periods and the assumptions underlying such projections, may be deemed to be forward-looking statements and as such are intended to be covered by the safe harbor for “forward-looking statements” provided by PSLRA. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to changes in circumstances and a number of risks and uncertainties. Without limiting the foregoing, the guidance as to expected future period results and statements including the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend,” “feels,” “will,” “projects” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially from those expressed in, or implied or projected by the forward-looking information and statements due to, among other things, health care reform and other increased government participation in and taxation or regulation of health benefits and managed care operations, including but not limited to the implementation of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, the “ACA”) and related fees, assessments and taxes; the company’s ability to successfully participate in California’s Coordinated Care Initiative, which is subject to a number of risks inherent in untested health care initiatives and requires the company to adequately predict the costs of providing benefits to individuals that are generally among the most chronically ill within each of Medicare and Medi-Cal and implement delivery systems for benefits with which the company has limited operating experience; the company’s ability to successfully participate in the federal and state health insurance exchanges under the ACA, which involve uncertainties related to the mix and volume of business that could negatively impact the adequacy of the company’s premium rates and may not be sufficiently offset by the risk apportionment provisions of the ACA; increasing health care costs, including but not limited to costs associated with the introduction of new treatments or therapies; the company’s ability to reduce administrative expenses while maintaining targeted levels of service and operating performance, including through the company’s master services agreement with a subsidiary of Cognizant Technology Solutions Corporation (Cognizant); whether the company receives required regulatory approvals for Cognizant’s provision of services to the company and any conditions imposed in order to obtain such regulatory approvals; the company’s ability to recognize the intended cost savings and other intended benefits of the Cognizant transaction; the risk that Cognizant may not perform contracted functions and services in a timely, satisfactory and compliant manner; negative prior period claims reserve developments; rate cuts and other risks and uncertainties affecting the company’s Medicare or Medicaid businesses; trends in medical care ratios; membership declines or negative changes in the company’s health care product mix; unexpected utilization patterns or unexpectedly severe or widespread illnesses; the timing of collections on amounts receivable from state and federal governments and agencies, including collections of amounts owed under the T-3 contract; litigation costs; regulatory issues with federal and state agencies including, but not limited to, the California Department of Managed Health Care and Department of Health Care Services, the Centers for Medicare & Medicaid Services, the Office of Civil Rights of the U.S. Department of Health and Human Services and state departments of insurance; operational issues; changes in economic or market conditions; failure to effectively oversee the company’s third-party vendors; noncompliance by the company or the company’s business associates with any privacy laws or any security breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information; impairment of the company’s goodwill or other intangible assets; investment portfolio impairment charges; volatility in the financial markets; and general business and market conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within the company’s most recent Annual Report on Form 10-K and subsequent Quarterly Reports on Form 10-Q filed with the SEC and the other risks discussed in the company’s filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. Except as may be required by law, the company undertakes no obligation to address or publicly update any of its guidance, the assessment of the underlying assumptions or forward-looking statements to reflect events or circumstances that arise after the date of this release.

 

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The financial information presented in this press release is unaudited and is subject to change, including as a result of subsequent events or adjustments, if any, arising prior to the filing of the company’s Annual Report on Form 10-K for the year ended December 31, 2014.

Ten pages of tables follow.

# # #

 

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Health Net, Inc.

2015 GAAP Guidance (1)

 

     
MEMBERSHIP (2)    Current
(updated 2/10/15)
    Previous (as of 12/17/14)  
   
      Enrollment
at 12/31/2015
    Enrollment
at 12/31/2015
 

Commercial

      

Large Group

     511,000        n/a   

Small Group

     301,000        n/a   

Individual

     388,000        n/a   
   

Total Commercial

     1,200,000        n/a   
   

Medicare Advantage

     270,000        n/a   
   

Medicaid

     1,938,000        n/a   
   

Dual Eligibles

     50,000        n/a   
   

Total Health Plan Membership

     3,457,000        3,500,000   
   

    

                

    

    
     

Premium Revenues

   FY2015     FY2015  

Commercial

   $ 5.7 billion        n/a   

Medicare Advantage

   $ 3.1 billion        n/a   

State Health Plans

   $ 6.7 billion        n/a   

Dual Eligibles

   $ 922 million        n/a   

Total Health Plans (2)

   $ 16.5 billion        n/a   
   

Total Consolidated Revenues

   $ 17.2 billion      $ 17.4 billion   
   

Medical Care Ratios (MCR) (2)

   FY2015     FY2015  

Commercial

     83.1%        n/a   

Medicare Advantage

     91.1%        n/a   

Medicaid

     82.1%        n/a   

Dual Eligibles

     88.3%        n/a   

Health Plan

     84.5%        84.6%   
   

G&A Expense Ratio (2)

     10.8%        10.9%   
   

Admin Expense Ratio (2)

     7.2%        7.2%   
   

GAAP Tax Rate

     56.7%        57.4%   
   

Western Region and Government Contracts Tax Rate

     54.8%        55.0%   
   

Weighted-average fully diluted shares outstanding

     77.8 million        ~78 million   
   

GAAP Earnings per Diluted Share (EPS)

     At least $2.70        At least $2.55   
   

Western Region and Government Contracts EPS

     $3.15 - $3.25        At least $3.15   
   
                  

 

(1) All guidance metrics are approximations
(2) For the company’s Western Region operations segment

 

9


Health Net, Inc.

Enrollment Data - By State

(In thousands)

 

                          Change from  
                          September 30, 2014     December 31, 2013  
     December 31,      September 30,      December 31,      Increase/     %     Increase/     %  
     2014      2014      2013      (Decrease)     Change     (Decrease)     Change  

California

                 

Large Group

     474         477         565         (3     (0.6 )%      (91     (16.1 )% 

Small Group

     246         243         244         3        1.2     2        0.8

Individual

     237         269         100         (32     (11.9 )%      137        137.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     957         989         909         (32     (3.2 )%      48        5.3

Medicare Advantage

     173         169         153         4        2.4     20        13.1

Medi-Cal

     1,595         1,485         1,113         110        7.4     482        43.3

Dual Eligibles

     16         9         0         7        77.8     16        0.0

Total California

     2,741         2,652         2,175         89        3.4     566        26.0

Arizona

                 

Large Group

     44         45         57         (1     (2.2 )%      (13     (22.8 )% 

Small Group

     43         44         39         (1     (2.3 )%      4        10.3

Individual

     92         97         12         (5     (5.2 )%      80        666.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     179         186         108         (7     (3.8 )%      71        65.7

Medicare Advantage

     46         46         43         0        0.0     3        7.0

Medicaid

     81         80         4         1        1.3     77        1925.0

Total Arizona

     306         312         155         (6     (1.9 )%      151        97.4

Northwest

                 

Large Group

     29         28         29         1        3.6     0        0.0

Small Group

     24         23         36         1        4.3     (12     (33.3 )% 

Individual

     3         4         3         (1     (25.0 )%      0        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     56         55         68         1        1.8     (12     (17.6 )% 

Medicare Advantage

     56         56         48         0        0.0     8        16.7

Total Northwest

     112         111         116         1        0.9     (4     (3.4 )% 

Total Health Plan Enrollment

                 

Large Group

     547         550         651         (3     (0.5 )%      (104     (16.0 )% 

Small Group

     313         310         319         3        1.0     (6     (1.9 )% 

Individual

     332         370         115         (38     (10.3 )%      217        188.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     1,192         1,230         1,085         (38     (3.1 )%      107        9.9

Medicare Advantage

     275         271         244         4        1.5     31        12.7

Medi-Cal/Medicaid

     1,676         1,565         1,117         111        7.1     559        50.0

Dual Eligibles

     16         9         0         7        77.8     16        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Western Region Operations

     3,159         3,075         2,446         84        2.7     713        29.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

TRICARE - North Contract Eligibles

     2,837         2,849         2,851         (12     (0.4 )%      (14     (0.5 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

10


Health Net, Inc.

Enrollment Data - Line of Business

(In thousands)

 

                          Change from  
                          September 30, 2014     December 31, 2013  
     December 31,      September 30,      December 31,      Increase/     %     Increase/     %  
     2014      2014      2013      (Decrease)     Change     (Decrease)     Change  

Large Group

                 

California

     474         477         565         (3     (0.6 )%      (91     (16.1 )% 

Arizona

     44         45         57         (1     (2.2 )%      (13     (22.8 )% 

Northwest

     29         28         29         1        3.6     0        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     547         550         651         (3     (0.5 )%      (104     (16.0 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Small Group

                 

California

     246         243         244         3        1.2     2        0.8

Arizona

     43         44         39         (1     (2.3 )%      4        10.3

Northwest

     24         23         36         1        4.3     (12     (33.3 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     313         310         319         3        1.0     (6     (1.9 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Individual

                 

California

     237         269         100         (32     (11.9 )%      137        137.0

Arizona

     92         97         12         (5     (5.2 )%      80        666.7

Northwest

     3         4         3         (1     (25.0 )%      0        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     332         370         115         (38     (10.3 )%      217        188.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

                 

California

     957         989         909         (32     (3.2 )%      48        5.3

Arizona

     179         186         108         (7     (3.8 )%      71        65.7

Northwest

     56         55         68         1        1.8     (12     (17.6 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     1,192         1,230         1,085         (38     (3.1 )%      107        9.9
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Medicare Advantage

                 

California

     173         169         153         4        2.4     20        13.1

Arizona

     46         46         43         0        0.0     3        7.0

Northwest

     56         56         48         0        0.0     8        16.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     275         271         244         4        1.5     31        12.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Medi-Cal/Medicaid

                 

California

     1,595         1,485         1,113         110        7.4     482        43.3

Arizona

     81         80         4         1        1.3     77        1925.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 
     1,676         1,565         1,117         111        7.1     559        50.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Dual Eligibles

                 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

California

     16         9         0         7        77.8     16        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Total Health Plan Enrollment

                 

Large Group

     547         550         651         (3     (0.5 )%      (104     (16.0 )% 

Small Group

     313         310         319         3        1.0     (6     (1.9 )% 

Individual

     332         370         115         (38     (10.3 )%      217        188.7
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Commercial Risk

     1,192         1,230         1,085         (38     (3.1 )%      107        9.9

Medicare Advantage

     275         271         244         4        1.5     31        12.7

Medi-Cal/Medicaid

     1,676         1,565         1,117         111        7.1     559        50.0

Dual Eligibles

     16         9         0         7        77.8     16        0.0
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

Western Region Operations

     3,159         3,075         2,446         84        2.7     713        29.1
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

TRICARE - North Contract Eligibles

     2,837         2,849         2,851         (12     (0.4 )%      (14     (0.5 )% 
  

 

 

    

 

 

    

 

 

    

 

 

   

 

 

   

 

 

   

 

 

 

 

11


Health Net, Inc.

Consolidated Statements of Operations

($ in thousands, except per share data)

 

     Quarter Ended
December 31,
2014
     Quarter Ended
September 30,
2014
    Quarter Ended
December 31,
2013
     Year Ended
December 31,
2014
    Year Ended
December 31,
2013
 

REVENUES:

            

Health plan services premiums

   $ 3,586,330       $ 3,631,617      $ 2,559,376       $ 13,361,170      $ 10,377,073   

Government contracts

     159,619         146,183        148,470         603,975        572,266   

Net investment income

     11,057         10,964        11,643         45,166        69,613   

Administrative services fees and other income

     1,383         1,106        23,755         (1,725     34,791   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues

     3,758,389         3,789,870        2,743,244         14,008,586        11,053,743   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

EXPENSES:

            

Health plan services

     3,038,220         3,104,010        2,229,332         11,307,751        8,886,547   

Government contracts

     147,058         124,403        124,709         536,643        502,918   

General and administrative

     472,984         373,623        279,339         1,552,364        1,083,694   

Selling

     68,073         66,111        63,600         262,338        239,428   

Depreciation and amortization

     3,982         6,500        10,234         29,786        38,589   

Interest

     7,919         7,810        7,988         31,376        32,614   

Asset impairment

     3,846         84,690        —           88,536        —     
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Total expenses

     3,742,082         3,767,147        2,715,202         13,808,794        10,783,790   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Income from operations before income taxes

     16,307         22,723        28,042         199,792        269,953   

Income tax provision

     11,393         31,662        8,289         54,163        99,827   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Net income (loss)

   $ 4,914       $ (8,939   $ 19,753       $ 145,629      $ 170,126   
  

 

 

    

 

 

   

 

 

    

 

 

   

 

 

 

Net income (loss) per share:

            

Basic

   $ 0.06       $ (0.11   $ 0.25       $ 1.83      $ 2.14   

Diluted

   $ 0.06       $ (0.11   $ 0.25       $ 1.80      $ 2.12   

Weighted average shares outstanding:

            

Basic

     78,145         80,235        79,511         79,602        79,455   

Diluted

     79,479         80,235        80,600         80,777        80,404   

 

12


Health Net, Inc.

Condensed Consolidated Balance Sheets

(Amounts in thousands, except ratio data)

 

     December 31,     September 30,     December 31,  
     2014     2014     2013  

ASSETS

      

Current Assets

      

Cash and cash equivalents

   $ 869,133      $ 1,114,558      $ 433,155   

Investments - available for sale

     1,791,060        1,664,830        1,567,020   

Premiums receivable, net

     951,935        579,515        430,012   

Amounts receivable under government contracts

     150,546        143,662        194,041   

Other receivables

     424,910        307,369        68,919   

Deferred taxes

     57,911        71,434        94,060   

Assets held for sale

     50,000        50,000        —     

Other assets

     220,122        157,066        132,683   
  

 

 

   

 

 

   

 

 

 

Total current assets

     4,515,617        4,088,434        2,919,890   

Property and equipment, net

     84,328        92,193        201,395   

Goodwill

     558,886        558,886        565,886   

Other intangible assets, net

     11,822        12,526        13,842   

Deferred taxes

     33,081        34,580        5,793   

Investments - available for sale - noncurrent

     4,570        3,055        59,768   

Other noncurrent assets

     187,630        173,230        162,551   
  

 

 

   

 

 

   

 

 

 

Total Assets

   $ 5,395,934      $ 4,962,904      $ 3,929,125   
  

 

 

   

 

 

   

 

 

 

LIABILITIES AND STOCKHOLDERS’ EQUITY

      

Current Liabilities

      

Reserves for claims and other settlements

   $ 1,896,035      $ 1,733,307      $ 984,075   

Health care and other costs payable under government contracts

     71,988        62,796        72,098   

Unearned premiums

     96,106        125,363        123,969   

Accounts payable and other liabilities

     880,374        540,968        397,036   
  

 

 

   

 

 

   

 

 

 

Total current liabilities

     2,944,503        2,462,434        1,577,178   

Senior notes payable

     399,504        399,453        399,300   

Deferred taxes

     —          —          10,409   

Borrowings under revolving credit facility

     100,000        100,000        100,000   

Other noncurrent liabilities

     242,705        235,393        213,427   
  

 

 

   

 

 

   

 

 

 

Total Liabilities

     3,686,712        3,197,280        2,300,314   
  

 

 

   

 

 

   

 

 

 

Stockholders’ Equity

      

Common stock

     153        152        150   

Additional paid-in capital

     1,444,705        1,432,513        1,377,624   

Treasury common stock, at cost

     (2,341,652     (2,272,180     (2,179,744

Retained earnings

     2,609,277        2,604,363        2,463,648   

Accumulated other comprehensive (loss) income

     (3,261     776        (32,867
  

 

 

   

 

 

   

 

 

 

Total Stockholders’ Equity

     1,709,222        1,765,624        1,628,811   
  

 

 

   

 

 

   

 

 

 

Total Liabilities and Stockholders’ Equity

   $ 5,395,934      $ 4,962,904      $ 3,929,125   
  

 

 

   

 

 

   

 

 

 

Debt-to-Total Capital Ratio

     22.6     22.1     23.5

 

13


Health Net, Inc.

Condensed Consolidated Statement of Cash Flows

(Amounts in thousands)

 

     Quarter Ended
December 31,
2014
    Quarter Ended
September 30,
2014
    Quarter Ended
December 31,
2013
    Year Ended
December 31,
2014
    Year Ended
December 31,
2013
 

CASH FLOWS FROM OPERATING ACTIVITIES:

          

Net income (loss)

   $ 4,914      $ (8,939   $ 19,753      $ 145,629      $ 170,126   

Adjustments to reconcile net income (loss) to net cash (used in) provided by operating activities:

          

Amortization and depreciation

     3,982        6,500        10,234        29,786        38,589   

Share-based compensation expense

     6,525        6,109        6,542        28,334        29,930   

Deferred income taxes

     18,191        (38,231     (9,676     (16,564     8,645   

Excess tax benefits from share-based compensation

     (635     (241     (169     (2,230     (620

Asset impairment

     3,846        84,690        —          88,536        —     

Net realized gain on sale on investments

     (128     (346     (755     (2,710     (24,061

Other changes

     6,648        7,264        7,975        29,838        31,539   

Changes in assets and liabilities:

          

Premiums receivable and unearned premiums

     (401,677     264,032        (91,622     (549,786     (83,822

Other current assets, receivables and noncurrent assets

     (192,809     (34,671     (24,528     (444,288     1,425   

Amounts receivable/payable under government contracts

     (6,212     12,369        (10,168     39,754        20,896   

Reserves for claims and other settlements

     162,728        244,985        (6,120     911,960        (53,898

Accounts payable and other liabilities

     284,965        44,434        26,648        517,742        (42,910
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by operating activities

     (109,662     587,955        (71,886     776,001        95,839   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES:

          

Sales of investments

     144,552        104,628        42,748        441,430        696,534   

Maturities of investments

     34,158        21,064        20,415        98,901        93,225   

Purchases of investments

     (303,749     (133,014     (70,179     (665,200     (722,223

Purchases of property and equipment

     (13,615     (18,439     (16,929     (62,010     (59,525

Sales and purchases of restricted investments and other

     (735     2,002        (2,735     2,027        (7,432
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash (used in) provided by investing activities

     (139,389     (23,759     (26,680     (184,852     579   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES:

          

Proceeds from exercise of stock options and employee stock purchases

     6,310        14,945        120        27,727        10,762   

Repurchases of common stock

     (82,863     (57,168     (241     (152,549     (77,810

Excess tax benefits from share-based compensation

     635        241        169        2,230        620   

Borrowings under financing arrangements

     —          —          22,000        —          345,000   

Repayment of borrowings under financing arrangements

     —          —          (22,000     —          (345,000

Net increase (decrease) in checks outstanding, net of deposits

     —          —          —          —          (23,842

Customer funds administered

     79,544        (10,753     (154,466     (32,579     86,897   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net cash provided by (used in) financing activities

     3,626        (52,735     (154,418     (155,171     (3,373
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Net (decrease) increase in cash and cash equivalents

     (245,425     511,461        (252,984     435,978        93,045   

Cash and cash equivalents, beginning of period

     1,114,558        603,097        686,139        433,155        340,110   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Cash and cash equivalents, end of period

   $ 869,133      $ 1,114,558      $ 433,155      $ 869,133      $ 433,155   
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

 

14


Health Net, Inc.

SEGMENT INFORMATION

($ in thousands, except per share and PMPM data)

The following table presents Health Net’s operating segment information.

 

    Quarter Ended December 31, 2014     Quarter Ended September 30, 2014     Quarter Ended December 31, 2013  
    Western
Region
Operations1
    Government
Contracts2
    Corporate/
Other4
    Consolidated     Western
Region
Operations1
    Government
Contracts2
    Corporate/
Other4
    Consolidated     Western
Region
Operations1
    Government
Contracts2
    Corporate/
Other3
    Consolidated  

Commercial premiums

  $ 1,370,656          $ 1,370,656      $ 1,430,769          $ 1,430,769      $ 1,271,553          $ 1,271,553   

Medicare premiums

    768,595            768,595        763,327            763,327        691,114            691,114   

Medicaid premiums

    1,374,243            1,374,243        1,397,732            1,397,732        596,709            596,709   

Dual Eligibles premiums

    72,836            72,836        39,789            39,789        0            0   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Health plan services premiums

    3,586,330            3,586,330        3,631,617            3,631,617        2,559,376            2,559,376   

Government contracts

      159,619          159,619          146,183          146,183          148,470          148,470   

Net investment income

    11,057            11,057        10,964            10,964        11,643            11,643   

Administrative services fees and other income

    1,383            1,383        1,106            1,106        23,755            23,755   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total revenues

    3,598,770        159,619          3,758,389        3,643,687        146,183          3,789,870        2,594,774        148,470          2,743,244   

Health plan services

    3,038,220            3,038,220        3,104,010            3,104,010        2,229,332            2,229,332   

Government contracts

      147,167        (109     147,058          123,571        832        124,403          124,638        71        124,709   

Premium tax

    63,345            63,345        53,417            53,417        31,601            31,601   

Health insurer fee

    35,361            35,361        31,947            31,947        —              —     

Other ACA fees

    25,841            25,841        26,643            26,643        836            836   

Administrative expenses

    280,107          68,330        348,437        241,352          20,264        261,616        247,946          (1,044     246,902   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total general and administrative

    404,654          68,330        472,984        353,359          20,264        373,623        280,383          (1,044     279,339   

Selling

    68,073            68,073        66,111            66,111        63,600            63,600   

Depreciation and amortization

    3,900          82        3,982        6,500            6,500        10,234            10,234   

Interest

    7,919            7,919        7,810            7,810        7,988            7,988   

Asset impairment

        3,846        3,846            84,690        84,690              0   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Total expenses

    3,522,766        147,167        72,149        3,742,082        3,537,790        123,571        105,786        3,767,147        2,591,537        124,638        (973     2,715,202   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations before income taxes

    76,004        12,452        (72,149     16,307        105,897        22,612        (105,786     22,723        3,237        23,832        973        28,042   

Income tax provision (benefit)

    36,010        5,010        (29,627     11,393        61,085        8,918        (38,341     31,662        (2,215     10,148        356        8,289   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Income (loss) from operations

  $ 39,994      $ 7,442      $ (42,522   $ 4,914      $ 44,812      $ 13,694      $ (67,445   $ (8,939   $ 5,452      $ 13,684      $ 617      $ 19,753   
 

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

Basic earnings (loss) per share

  $ 0.51      $ 0.10      $ (0.54   $ 0.06      $ 0.56      $ 0.17      $ (0.84   $ (0.11   $ 0.07      $ 0.17      $ 0.01      $ 0.25   

Diluted earnings (loss) per share

  $ 0.50      $ 0.10      $ (0.54   $ 0.06      $ 0.55      $ 0.17      $ (0.84   $ (0.11   $ 0.07      $ 0.17      $ 0.01      $ 0.25   

Basic weighted average shares outstanding

    78,145        78,145        78,145        78,145        80,235        80,235        80,235        80,235        79,511        79,511        79,511        79,511   

Diluted weighted average shares outstanding

    79,479        79,479        78,145        79,479        81,513        81,513        80,235        80,235        80,600        80,600        80,600        80,600   

Pretax margin

    2.1           2.9           0.1      

Commercial premium yield

    -2.5           -0.3           3.4      

Commercial premium PMPM

  $ 378.69            $ 385.67            $ 388.41         

Commercial health care cost trend

    -5.6           -0.7           2.0      

Commercial health care cost PMPM

  $ 320.56            $ 323.43            $ 339.53         

Commercial MCR

    84.6           83.9           87.4      

Medicare Advantage MCR

    92.8           90.8           90.5      

Medicaid MCR

    80.0           84.2           82.7      

Dual Eligibles MCR

    89.2           87.4           —           

Health plan services MCR

    84.7           85.5           87.1      

Administrative expense ratio

    7.8           6.6           9.6      

Total G&A expense ratio

    11.3           9.7           10.9      

Selling costs ratio

    1.9           1.8           2.5      

 

1 Includes the operations of the company’s commercial, Medicare, Medicaid and, in 2014, Dual Eligibles health plans in California, Arizona, Oregon and Washington, as well as the operations of the company’s health and life insurance companies, primarily in Arizona, California, Oregon and Washington, and the operations of the company’s behavioral health and pharmaceutical services subsidiaries in several states including California, Arizona and Oregon.

 

2 Includes administrative services provided under the T-3 Managed Care Support Contract for the TRICARE North Region and other health care-related Department of Defense and Veterans Affairs government contracts.

 

3 Primarily includes litigation reserve true-up related to previous accrual for litigation and related legal expenses. Also includes severance expenses.

 

4 Primarily includes costs related to the company’s comprehensive outsourcing arrangement with a third party and related asset impairment.

 

15


Health Net, Inc.

SEGMENT INFORMATION

($ in thousands, except per share and PMPM data)

The following table presents Health Net’s operating segment information.

 

     Year Ended December 31, 2014     Year Ended December 31, 2013  
     Western
Region
Operations1
    Government
Contracts2
     Corporate/
Other4
    Consolidated     Western
Region
Operations1
    Government
Contracts2
     Corporate/
Other3
    Consolidated  

Commercial premiums

   $ 5,443,062           $ 5,443,062      $ 5,175,370           $ 5,175,370   

Medicare premiums

     3,044,274             3,044,274        2,771,431             2,771,431   

Medicaid premiums

     4,755,897             4,755,897        2,430,272             2,430,272   

Dual Eligibles premiums

     117,937             117,937        0             0   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Health plan services premiums

     13,361,170             13,361,170        10,377,073             10,377,073   

Government contracts

       603,975           603,975          572,266           572,266   

Net investment income

     45,166             45,166        69,613             69,613   

Administrative services fees and other income

     (1,725          (1,725     34,791             34,791   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total revenues

     13,404,611        603,975           14,008,586        10,481,477        572,266           11,053,743   

Health plan services

     11,307,751             11,307,751        8,886,547             8,886,547   

Government contracts

       534,442         2,201        536,643          497,780         5,138        502,918   

Premium tax

     191,150             191,150        124,360             124,360   

Health insurer fee

     141,445             141,445        0             0   

Other ACA fees

     97,557             97,557        2,530             2,530   

Administrative expenses

     1,027,718           94,494        1,122,212        949,927           6,877        956,804   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total general and administrative

     1,457,870           94,494        1,552,364        1,076,817           6,877        1,083,694   

Selling

     262,338             262,338        239,428             239,428   

Depreciation and amortization

     29,704           82        29,786        38,589             38,589   

Interest

     31,376             31,376        32,614             32,614   

Asset impairment

          88,536        88,536            
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Total expenses

     13,089,039        534,442         185,313        13,808,794        10,273,995        497,780         12,015        10,783,790   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income (loss) from operations before income taxes

     315,572        69,533         (185,313     199,792        207,482        74,486         (12,015     269,953   

Income tax provision (benefit)

     169,340        28,256         (143,433     54,163        73,621        30,900         (4,694     99,827   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Income (loss) from operations

   $ 146,232      $ 41,277       $ (41,880   $ 145,629      $ 133,861      $ 43,586       $ (7,321   $ 170,126   
  

 

 

   

 

 

    

 

 

   

 

 

   

 

 

   

 

 

    

 

 

   

 

 

 

Basic earnings (loss) per share

   $ 1.84      $ 0.52       $ (0.53   $ 1.83      $ 1.68      $ 0.55       $ (0.09   $ 2.14   

Diluted earnings (loss) per share

   $ 1.81      $ 0.51       $ (0.53   $ 1.80      $ 1.67      $ 0.54       $ (0.09   $ 2.12   

Basic weighted average shares outstanding

     79,602        79,602         79,602        79,602        79,455        79,455         79,455        79,455   

Diluted weighted average shares outstanding

     80,777        80,777         79,602        80,777        80,404        80,404         79,455        80,404   

Pretax margin

     2.4            2.0       

Commercial premium yield

     0.1            2.7       

Commercial premium PMPM

   $ 385.42             $ 385.13          

Commercial health care cost trend

     -3.0            -1.0       

Commercial health care cost PMPM

   $ 319.82             $ 329.75          

Commercial MCR

     83.0            85.6       

Medicare Advantage MCR

     91.5            90.6       

Medicaid MCR

     82.1            80.4       

Dual Eligibles MCR

     86.1                     

Health plan services MCR

     84.6            85.6       

Administrative expense ratio

     7.7            9.1       

Total G&A expense ratio

     10.9            10.3       

Selling costs ratio

     2.0            2.3       

 

1 Includes the operations of the company’s commercial, Medicare, Medicaid and, in 2014, Dual Eligibles health plans in California, Arizona, Oregon and Washington, as well as the operations of the company’s health and life insurance companies, primarily in Arizona, California, Oregon and Washington, and the operations of the company’s behavioral health and pharmaceutical services subsidiaries in several states including California, Arizona and Oregon.

 

2 Includes administrative services provided under the T-3 Managed Care Support Contract for the TRICARE North Region and other health care-related Department of Defense and Veterans Affairs government contracts.

 

3 Includes litigation reserve true-up related to previous accrual for litigation and related legal expenses. Also includes severance expenses.

 

4 Primarily includes costs related to the company’s comprehensive outsourcing arrangement with a third party and related asset impairment. Also includes litigation reserve true-up related to previous accrual for litigation and related legal expenses, severance expenses and $72.6 million income tax benefit.

 

16


Health Net, Inc.

Disclosures Regarding Non-GAAP Financial Information

($ in millions)

Set forth below is a reconciliation of adjusted days claims payable (DCP), a non-GAAP financial measure, to the comparable GAAP financial measure, DCP. DCP is calculated by dividing the amount of reserve for claims and other settlements (claims reserve) by health plan services cost (health plan costs) during the quarter and multiplying that amount by the number of days in the quarter. In this press release, management presents an adjusted DCP metric which subtracts capitation, provider and other claims settlements and Medicare Advantage-Prescription Drug (MAPD) payables/costs from the claims reserve and health plan costs.

Management believes that adjusted DCP provides useful information to investors because the adjusted DCP calculation excludes from both claims reserve and health plan costs amounts related to health care costs for which no or minimal reserves are maintained. Therefore, management believes that adjusted DCP may present a more accurate reflection of DCP than does GAAP DCP, which includes such amounts. This non-GAAP financial information should be considered in addition to, not as a substitute for, financial information prepared in accordance with GAAP.

You are encouraged to evaluate these adjustments and the reasons we consider them appropriate for supplemental analysis. In evaluating the adjusted amounts, you should be aware that we have incurred expenses that are the same as or similar to some of the adjustments in the current presentation and we may incur them again in the future.

Our presentation of the adjusted amounts should not be construed as an inference that our future results will be unaffected by unusual or nonrecurring items.

 

     Q4 2014     Q3 2014     Q4 2013     FY 2014     FY 2013  

Reconciliation of Days Claims Payable:

          

(1) Reserve for Claims and Other Settlements - GAAP

   $ 1,896.0      $ 1,733.3      $ 984.1      $ 1,896.0      $ 984.1   

Less: Capitation, Provider and Other Claim Settlements, and MAPD Payables

     (467.2     (407.1     (93.9     (467.2     (93.9
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

(2) Reserve for Claims and Other Settlements - Adjusted

   $ 1,428.8      $ 1,326.2      $ 890.2      $ 1,428.8      $ 890.2   

(3) Health Plan Services Cost - GAAP

   $ 3,038.2      $ 3,104.0      $ 2,229.3      $ 11,307.8      $ 8,886.5   

Less: Capitation, Provider and Other Claim Settlements, and MAPD Costs

     (1,161.8     (1,236.0     (815.0     (4,553.7     (3,348.9
  

 

 

   

 

 

   

 

 

   

 

 

   

 

 

 

(4) Health Plan Services Cost - Adjusted

   $ 1,876.4      $ 1,868.0      $ 1,414.3      $ 6,754.1      $ 5,537.6   

(5) Number of Days in Period

     92        92        92        365        365   

= (1) / (3) * (5) Days Claims Payable - GAAP Basis (using end of period reserve amount)

     57.4        51.4        40.6        61.2        40.4   

= (2) / (4) * (5) Days Claims Payable - Adjusted Basis (using end of period reserve amount)

     70.1        65.3        57.9        77.2        58.7   

 

17


Health Net, Inc.

Reconciliation of Reserves for Claims and Other Settlements

($ in millions)

 

     Health Plan Services  
     FY 2014     FY 2013     FY 2012  

Reserve for claims (a), beginning of period

   $ 807.4      $ 808.7      $ 720.8   

Incurred claims related to:

      

Current Year (f)

     5,613.0        4,666.0        4,950.9   

Prior Years (c)

     (14.6     (56.2     34.5   
  

 

 

   

 

 

   

 

 

 

Total Incurred (b)

     5,598.4        4,609.8        4,985.4   

Paid claims related to:

      

Current Year

     4,443.2        3,872.5        4,156.6   

Prior Years

     776.3        738.6        740.9   
  

 

 

   

 

 

   

 

 

 

Total Paid (b)

     5,219.5        4,611.1        4,897.5   
  

 

 

   

 

 

   

 

 

 

Reserve for claims (a), end of period

     1,186.3        807.4        808.7   

Add:

      

Claims Payable (d)

     175.4        67.0        91.6   

Other (e)

     534.3        109.7        137.7   
  

 

 

   

 

 

   

 

 

 

Reserves for claims and other settlements, end of period

   $ 1,896.0      $ 984.1      $ 1,038.0   
  

 

 

   

 

 

   

 

 

 

 

(a) Consists of incurred but not reported claims and received but unprocessed claims and reserves for loss adjustment expenses.

 

(b) Includes medical claims only. Capitation, pharmacy and other payments including provider settlements are not included.

 

(c) This line represents the change in reserves attributable to the difference between the original estimate of incurred claims for prior years and the revised estimate. Negative amounts in this line represent favorable development in estimated prior years’ health care costs. Positive amounts in this line represent unfavorable development in estimated prior years’ health care costs. The favorable developments related to prior years that were recorded in the years ended December 31, 2014 and December 31, 2013, respectively, do not directly correspond to an increase in our operating results for those periods because any favorable prior period reserve development increases current period net income only to the extent that the current period provision for adverse deviation (see footnote (f)) is less than the benefit recognized from the prior period favorable development). The favorable development related to prior years that was recorded in the year ended December 31, 2014 consisted of $36.6 million in unfavorable prior year development primarily due to the existence of moderately adverse conditions and a release of $51.2 million of the provisions for adverse deviation held at December 31, 2013. We believe that the $36.6 million in unfavorable development for the year ended December 31, 2014 was primarily due to unanticipated benefit utilization in our commercial business arising from dates of service in the fourth quarter of 2013 as a result of an uncertain environment related to the ACA. For a detailed description of reserve development for fiscal years 2013 and 2012, see Note 2 to the Consolidated Financial Statements in the company’s Annual Report on Form 10-K for the year ended December 31, 2013.

 

(d) Includes amount accrued for litigation and regulatory-related expenses.

 

(e) Includes accrued capitation, shared risk settlements, provider incentives and other reserve items.

 

(f) Our IBNR estimate also includes a provision for adverse deviation, which is an estimate for known environmental factors that are reasonably likely to affect the required level of IBNR reserves. Such amounts were $78 million, $53 million and $53 million as of December 31, 2014, December 31, 2013, and December 31, 2012, respectively.

 

18

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