controlling medical costs requires a comprehensive and integrated approach to organize and advance the full range of interrelationships among patients/consumers , health professionals , hospitals , pharmaceutical/technology manufacturers and other key stakeholders . medical costs include estimates of our obligations for medical care services rendered on behalf of insured consumers for which we have not yet received or processed claims , and our estimates for physician , hospital and other medical cost disputes . in every reporting period , our operating results include the effects of more completely developed medical costs payable estimates associated with previously reported periods . our medical care ratio , calculated as medical costs as a percentage of premium revenues , reflects the combination of pricing , rebates , benefit designs , consumer health care utilization and comprehensive care facilitation efforts . operating costs . operating costs are primarily comprised of costs related to employee compensation and benefits , agent and broker commissions , premium taxes and assessments , professional fees , advertising and occupancy costs . we seek to improve our operating cost ratio , calculated as operating costs as a percentage of total revenues , for an equivalent mix of business . however , changes in business mix , such as increases in the size of our health services businesses may impact our operating costs and operating cost ratio . cash flows we generate cash primarily from premiums , service and product revenues and investment income , as well as proceeds from the sale or maturity of our investments . our primary uses of cash are for payments of medical claims and operating costs , payments on debt , purchases of investments , acquisitions , dividends to shareholders and common stock repurchases . for more information on our cash flows , see “ liquidity ” below . business trends our businesses participate in the u.s. health economy , which comprises approximately 18 % of u.s. gross domestic product and has grown consistently for many years . we expect overall spending on health care in the u.s. to continue to grow in the future , due to inflation , medical technology and pharmaceutical advancement , regulatory requirements , demographic trends in the u.s. population and national interest in health and well-being . the rate of market growth may be affected by a variety of factors , including macro-economic conditions and enacted health care reforms , which could also impact our results of 30 operations . in 2012 , we expect increasing unit costs to continue to be the primary cost driver of medical cost trends and we project steadily increasing medical system utilization over the course of the year . we also expect an increase in prescription drug costs . we will continue to work to manage medical cost trends through care management programs , affordable network relationships , pay-for-performance reimbursement programs for care providers , and targeted clinical management programs and initiatives focused on improving quality and affordability . additionally , employers are continuing to select products with benefit designs that shift more of the costs to the employee . this cost shifting continues to mitigate increases in medical cost trends . our businesses focus on affordability , consumer empowerment , wellness and prevention , payment innovations , and enhanced distribution to better serve our customer and consumer needs and demands . these business objectives are consistent with the goals of health care reform . we expect that the portion of our costs that is tied to incentive contracts that reward providers for outcome-based results and improved cost efficiencies will continue to increase . care providers are facing market pressures to change from fee-for-service models to new delivery models focused on the holistic health of the consumer , integrated care across care providers and pay-for-performance payment structures . this is creating the need for health management services that can coordinate care around the primary care physician and for investment in new clinical and administrative information and management systems . the impact of such changes on our results of operations is uncertain but , we expect them to moderate the rate at which medical costs increase . this trend also provides growth opportunities for our optumhealth and optuminsight businesses . we attempt to price our products consistent with anticipated underlying medical trends , while balancing growth , margins , competitive dynamics and premium rebates at the local market level . we seek to sustain a stable medical care ratio for an equivalent mix of business . however , changes in business mix , such as expanding participation in comparatively higher medical care ratio government-sponsored public sector programs and health reform legislation may impact our premiums , medical costs and medical care ratio . in 2012 , we continue to expect reimbursements to be under pressure through government payment rates and continued market competition in commercial products . regulatory trends and uncertainties in the first quarter of 2010 , the health reform legislation was signed into law . the health reform legislation expands access to coverage and modifies aspects of the commercial insurance market , the medicaid and medicare programs , chip and other aspects of the health care system . hhs , the dol , the irs and the treasury department have issued or proposed regulations on a number of aspects of health reform legislation , but final rules and interim guidance on other key aspects of the legislation , all of which have a variety of effective dates , remain pending . the health reform legislation and the related federal and state regulations will impact how we do business and could restrict growth and restrict premium rate increases in certain products and market segments , increase our medical and administrative costs , or expose us to an increased risk of liability , any or all of which could have a material adverse effect on us . story_separator_special_tag in our medicare part d stand-alone business , we estimate that we entered january 2012 down approximately 625,000 people , primarily as a result of the loss of approximately 470,000 of our auto-assigned low-income subsidy medicare part d beneficiaries in a number of regions being automatically reassigned to other plans as part of the annual bid process managed by cms . we believe that we will grow from this level throughout the course of the year in the open retail market . in february 2012 , we added 117,000 medicare advantage members from the acquisition of xlhealth corporation . optum . total revenue for these businesses increased in 2011 due to business growth and acquisitions at optumhealth and optuminsight and growth in customers served through pharmaceutical benefit management programs at optumrx . optum 's operating margin for the year ended december 31 , 2011 was down compared to 2010. the decrease was due to changes in business mix within optum 's businesses and realignment of certain internal business arrangements . the results by segment were as follows : optumhealth increased revenues at optumhealth for the year ended december 31 , 2011 were primarily due to expansions in service offerings through acquisitions in clinical services , as well as growth in consumer and population health management offerings . earnings from operations for the year ended december 31 , 2011 and operating margin decreased compared to 2010. the decreases reflect the impact from internal business and service arrangement realignments and the mix effect of growth and expansion in newer businesses such as clinical services . optuminsight increased revenues at optuminsight for the year ended december 31 , 2011 were due to the impact of organic growth and the full-year impact of 2010 acquisitions , which were partially offset by the divestiture of the clinical trials services business in june 2011. the increases in earnings from operations and operating margins for the year ended december 31 , 2011 reflect an increased mix of higher margin services in 2011 as well as the effect on 2010 earnings from operations and operating margin of the goodwill impairment and charges for a business line disposition of certain i3-branded clinical trial service businesses . see note 6 of notes to the consolidated financial statements for further detail on the goodwill impairment . 37 optumrx the increase in optumrx revenues for the year ended december 31 , 2011 was due to increased prescription volumes , primarily due to growth in customers served through medicare part d prescription drug plans by our unitedhealthcare medicare & retirement business , and a favorable mix of higher revenue specialty drug prescriptions . intersegment revenues eliminated in consolidation were $ 16.7 billion and $ 14.4 billion for the years ended december 31 , 2011 and 2010 , respectively . optumrx earnings from operations and operating margins for 2011 decreased as the mix of lower margin specialty pharmaceuticals and medicaid business and investments to support growth initiatives including the in-sourcing of our commercial pharmacy benefit programs more than offset the earnings contribution from higher revenues and greater use of generic medications . we will consolidate and manage the majority of our commercial pharmacy benefit programs internally when our contract with medco health solutions , inc. expires at the end of 2012. the investments in our infrastructure and to expand our capacity will likely cause a decrease in earnings from operations and operating margin as in 2012 , optumrx expects to absorb approximately $ 115 million of the $ 150 million consolidated in-sourcing related operating costs . as a result of this transition , optumrx expects to add 12 million members on a staged basis in 2013. see item 1a , “ risk factors ” for a discussion of certain risks associated with the transition of our commercial pharmacy benefit programs to optumrx . 2010 results of operations compared to 2009 results consolidated financial results revenues the increases in revenues for 2010 were primarily due to strong organic growth in risk-based benefit offerings in our public and senior markets businesses and commercial premium rate increases reflecting underlying medical cost trends . growth in customers served by our health services businesses , particularly through pharmaceutical benefit management programs , increased revenues from public sector behavioral health programs and increased sales of health care technology software and services also contributed to our revenue growth . medical costs and medical care ratio medical costs for 2010 increased primarily due to growth in our public and senior markets risk-based businesses and medical cost inflation , which were partially offset by net favorable development of prior period medical costs . for 2010 and 2009 , there was $ 800 million and $ 310 million , respectively , of net favorable medical cost development related to prior fiscal years . the medical care ratio decreased due to a moderation in overall demand for medical services , successful clinical engagement and management and the increase in prior period favorable development discussed previously . operating costs operating costs for 2010 increased due to acquired and organic growth in health services businesses , which are generally more operating cost intensive than our benefits businesses , goodwill impairment and charges for a business line disposition at optuminsight , which is discussed in more detail below , an increase in staffing and selling expenses primarily due to the change in the medicare advantage annual enrollment period , costs related to increased employee headcount and compensation , increased advertising costs , and the absorption of new business development and start-up costs . income tax rate the increase in our effective income tax rate for 2010 as compared to 2009 resulted from a benefit in the 2009 tax rate from the resolution of various historical state income tax matters and an increase in the 2010 rate related to limitations on the future deductibility of certain compensation due to the health reform legislation . reportable segments unitedhealthcare the revenue growth in unitedhealthcare for 2010 was primarily due to growth

capital resources and uses of liquidity in addition to cash flow from operations and cash and cash equivalent balances available for general corporate use , our capital resources and uses of liquidity are as follows : commercial paper . we maintain a commercial paper borrowing program , which facilitates the private placement of unsecured debt through third-party broker-dealers . the commercial paper program is supported by the $ 3.0 billion bank credit facility described below . as of december 31 , 2011 , we had no commercial paper outstanding . bank credit facility . in december 2011 , we amended and renewed our five-year revolving bank credit facility with 21 banks , which will mature in december 2016 . the amendment included increasing the borrowing capacity to $ 3.0 billion . this facility supports our commercial paper program and is available for general corporate purposes . there were no amounts outstanding under this facility as of december 31 , 2011 . the interest rate on borrowings is variable based on term and amount and is calculated based on the libor plus a credit spread based on our senior unsecured credit ratings . as of december 31 , 2011 , the annual interest rate on this facility , had it been drawn , would have ranged from 1.2 % to 1.7 % . our bank credit facility contains various covenants , including requiring us to maintain a debt to debt-plus-equity ratio below 50 % . our debt to debt-plus-equity ratio , calculated as the sum of debt divided by the sum of debt and shareholders ' equity , was 29.1 % and 30.1 % as of december 31 , 2011 and december 31 , 2010 , respectively . we were in compliance with our debt covenants as of december 31 , 2011 . long-term debt .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```capital resources and uses of liquidity in addition to cash flow from operations and cash and cash equivalent balances available for general corporate use , our capital resources and uses of liquidity are as follows : commercial paper . we maintain a commercial paper borrowing program , which facilitates the private placement of unsecured debt through third-party broker-dealers . the commercial paper program is supported by the $ 3.0 billion bank credit facility described below . as of december 31 , 2011 , we had no commercial paper outstanding . bank credit facility . in december 2011 , we amended and renewed our five-year revolving bank credit facility with 21 banks , which will mature in december 2016 . the amendment included increasing the borrowing capacity to $ 3.0 billion . this facility supports our commercial paper program and is available for general corporate purposes . there were no amounts outstanding under this facility as of december 31 , 2011 . the interest rate on borrowings is variable based on term and amount and is calculated based on the libor plus a credit spread based on our senior unsecured credit ratings . as of december 31 , 2011 , the annual interest rate on this facility , had it been drawn , would have ranged from 1.2 % to 1.7 % . our bank credit facility contains various covenants , including requiring us to maintain a debt to debt-plus-equity ratio below 50 % . our debt to debt-plus-equity ratio , calculated as the sum of debt divided by the sum of debt and shareholders ' equity , was 29.1 % and 30.1 % as of december 31 , 2011 and december 31 , 2010 , respectively . we were in compliance with our debt covenants as of december 31 , 2011 . long-term debt .
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 Suspicious Activity Report : controlling medical costs requires a comprehensive and integrated approach to organize and advance the full range of interrelationships among patients/consumers , health professionals , hospitals , pharmaceutical/technology manufacturers and other key stakeholders . medical costs include estimates of our obligations for medical care services rendered on behalf of insured consumers for which we have not yet received or processed claims , and our estimates for physician , hospital and other medical cost disputes . in every reporting period , our operating results include the effects of more completely developed medical costs payable estimates associated with previously reported periods . our medical care ratio , calculated as medical costs as a percentage of premium revenues , reflects the combination of pricing , rebates , benefit designs , consumer health care utilization and comprehensive care facilitation efforts . operating costs . operating costs are primarily comprised of costs related to employee compensation and benefits , agent and broker commissions , premium taxes and assessments , professional fees , advertising and occupancy costs . we seek to improve our operating cost ratio , calculated as operating costs as a percentage of total revenues , for an equivalent mix of business . however , changes in business mix , such as increases in the size of our health services businesses may impact our operating costs and operating cost ratio . cash flows we generate cash primarily from premiums , service and product revenues and investment income , as well as proceeds from the sale or maturity of our investments . our primary uses of cash are for payments of medical claims and operating costs , payments on debt , purchases of investments , acquisitions , dividends to shareholders and common stock repurchases . for more information on our cash flows , see “ liquidity ” below . business trends our businesses participate in the u.s. health economy , which comprises approximately 18 % of u.s. gross domestic product and has grown consistently for many years . we expect overall spending on health care in the u.s. to continue to grow in the future , due to inflation , medical technology and pharmaceutical advancement , regulatory requirements , demographic trends in the u.s. population and national interest in health and well-being . the rate of market growth may be affected by a variety of factors , including macro-economic conditions and enacted health care reforms , which could also impact our results of 30 operations . in 2012 , we expect increasing unit costs to continue to be the primary cost driver of medical cost trends and we project steadily increasing medical system utilization over the course of the year . we also expect an increase in prescription drug costs . we will continue to work to manage medical cost trends through care management programs , affordable network relationships , pay-for-performance reimbursement programs for care providers , and targeted clinical management programs and initiatives focused on improving quality and affordability . additionally , employers are continuing to select products with benefit designs that shift more of the costs to the employee . this cost shifting continues to mitigate increases in medical cost trends . our businesses focus on affordability , consumer empowerment , wellness and prevention , payment innovations , and enhanced distribution to better serve our customer and consumer needs and demands . these business objectives are consistent with the goals of health care reform . we expect that the portion of our costs that is tied to incentive contracts that reward providers for outcome-based results and improved cost efficiencies will continue to increase . care providers are facing market pressures to change from fee-for-service models to new delivery models focused on the holistic health of the consumer , integrated care across care providers and pay-for-performance payment structures . this is creating the need for health management services that can coordinate care around the primary care physician and for investment in new clinical and administrative information and management systems . the impact of such changes on our results of operations is uncertain but , we expect them to moderate the rate at which medical costs increase . this trend also provides growth opportunities for our optumhealth and optuminsight businesses . we attempt to price our products consistent with anticipated underlying medical trends , while balancing growth , margins , competitive dynamics and premium rebates at the local market level . we seek to sustain a stable medical care ratio for an equivalent mix of business . however , changes in business mix , such as expanding participation in comparatively higher medical care ratio government-sponsored public sector programs and health reform legislation may impact our premiums , medical costs and medical care ratio . in 2012 , we continue to expect reimbursements to be under pressure through government payment rates and continued market competition in commercial products . regulatory trends and uncertainties in the first quarter of 2010 , the health reform legislation was signed into law . the health reform legislation expands access to coverage and modifies aspects of the commercial insurance market , the medicaid and medicare programs , chip and other aspects of the health care system . hhs , the dol , the irs and the treasury department have issued or proposed regulations on a number of aspects of health reform legislation , but final rules and interim guidance on other key aspects of the legislation , all of which have a variety of effective dates , remain pending . the health reform legislation and the related federal and state regulations will impact how we do business and could restrict growth and restrict premium rate increases in certain products and market segments , increase our medical and administrative costs , or expose us to an increased risk of liability , any or all of which could have a material adverse effect on us . story_separator_special_tag in our medicare part d stand-alone business , we estimate that we entered january 2012 down approximately 625,000 people , primarily as a result of the loss of approximately 470,000 of our auto-assigned low-income subsidy medicare part d beneficiaries in a number of regions being automatically reassigned to other plans as part of the annual bid process managed by cms . we believe that we will grow from this level throughout the course of the year in the open retail market . in february 2012 , we added 117,000 medicare advantage members from the acquisition of xlhealth corporation . optum . total revenue for these businesses increased in 2011 due to business growth and acquisitions at optumhealth and optuminsight and growth in customers served through pharmaceutical benefit management programs at optumrx . optum 's operating margin for the year ended december 31 , 2011 was down compared to 2010. the decrease was due to changes in business mix within optum 's businesses and realignment of certain internal business arrangements . the results by segment were as follows : optumhealth increased revenues at optumhealth for the year ended december 31 , 2011 were primarily due to expansions in service offerings through acquisitions in clinical services , as well as growth in consumer and population health management offerings . earnings from operations for the year ended december 31 , 2011 and operating margin decreased compared to 2010. the decreases reflect the impact from internal business and service arrangement realignments and the mix effect of growth and expansion in newer businesses such as clinical services . optuminsight increased revenues at optuminsight for the year ended december 31 , 2011 were due to the impact of organic growth and the full-year impact of 2010 acquisitions , which were partially offset by the divestiture of the clinical trials services business in june 2011. the increases in earnings from operations and operating margins for the year ended december 31 , 2011 reflect an increased mix of higher margin services in 2011 as well as the effect on 2010 earnings from operations and operating margin of the goodwill impairment and charges for a business line disposition of certain i3-branded clinical trial service businesses . see note 6 of notes to the consolidated financial statements for further detail on the goodwill impairment . 37 optumrx the increase in optumrx revenues for the year ended december 31 , 2011 was due to increased prescription volumes , primarily due to growth in customers served through medicare part d prescription drug plans by our unitedhealthcare medicare & retirement business , and a favorable mix of higher revenue specialty drug prescriptions . intersegment revenues eliminated in consolidation were $ 16.7 billion and $ 14.4 billion for the years ended december 31 , 2011 and 2010 , respectively . optumrx earnings from operations and operating margins for 2011 decreased as the mix of lower margin specialty pharmaceuticals and medicaid business and investments to support growth initiatives including the in-sourcing of our commercial pharmacy benefit programs more than offset the earnings contribution from higher revenues and greater use of generic medications . we will consolidate and manage the majority of our commercial pharmacy benefit programs internally when our contract with medco health solutions , inc. expires at the end of 2012. the investments in our infrastructure and to expand our capacity will likely cause a decrease in earnings from operations and operating margin as in 2012 , optumrx expects to absorb approximately $ 115 million of the $ 150 million consolidated in-sourcing related operating costs . as a result of this transition , optumrx expects to add 12 million members on a staged basis in 2013. see item 1a , “ risk factors ” for a discussion of certain risks associated with the transition of our commercial pharmacy benefit programs to optumrx . 2010 results of operations compared to 2009 results consolidated financial results revenues the increases in revenues for 2010 were primarily due to strong organic growth in risk-based benefit offerings in our public and senior markets businesses and commercial premium rate increases reflecting underlying medical cost trends . growth in customers served by our health services businesses , particularly through pharmaceutical benefit management programs , increased revenues from public sector behavioral health programs and increased sales of health care technology software and services also contributed to our revenue growth . medical costs and medical care ratio medical costs for 2010 increased primarily due to growth in our public and senior markets risk-based businesses and medical cost inflation , which were partially offset by net favorable development of prior period medical costs . for 2010 and 2009 , there was $ 800 million and $ 310 million , respectively , of net favorable medical cost development related to prior fiscal years . the medical care ratio decreased due to a moderation in overall demand for medical services , successful clinical engagement and management and the increase in prior period favorable development discussed previously . operating costs operating costs for 2010 increased due to acquired and organic growth in health services businesses , which are generally more operating cost intensive than our benefits businesses , goodwill impairment and charges for a business line disposition at optuminsight , which is discussed in more detail below , an increase in staffing and selling expenses primarily due to the change in the medicare advantage annual enrollment period , costs related to increased employee headcount and compensation , increased advertising costs , and the absorption of new business development and start-up costs . income tax rate the increase in our effective income tax rate for 2010 as compared to 2009 resulted from a benefit in the 2009 tax rate from the resolution of various historical state income tax matters and an increase in the 2010 rate related to limitations on the future deductibility of certain compensation due to the health reform legislation . reportable segments unitedhealthcare the revenue growth in unitedhealthcare for 2010 was primarily due to growth

