In 2009, the people of UnitedHealth Group delivered a strong performance while advancing our mission to help people live healthier lives, despite a very difficult economy. We demonstrated consistency in effectively managing medical costs and continued to reduce our own operating costs. Our businesses again steadily delivered in service and practical innovation. We continued to combine national scale with local responsiveness and further diversified our products, services and markets. We built stronger relationships with the people we serve across the health care community. Our balance sheet grew stronger — our investments performed well and our leverage decreased.

As a result, we entered 2010 a much stronger enterprise. We are positioned for the next generation of growth, in both health benefits and health services. While we cannot predict what changes ultimately will be introduced to the health care system, we understand that in any setting we must combine consistent fundamental execution with our proven ability to adapt to core market demands and continuously innovate in practical ways across the health care experience.

The extraordinary, national debate over the future of health care in the United States serves to shine a spotlight on a key challenge: How do we modernize the health care system, in a fiscally responsible manner, to make quality health care accessible and affordable for all Americans?

Finding innovative, practical and financially responsible answers to that question has been our objective for more than two decades. This annual report highlights just a handful of the many ways we are helping create a more modern and effective health care system. We continue to make it easier for people to get the care they need, to personalize and simplify their health care experience, to strengthen the bonds between patients and their physicians, to foster the introduction of modern technology and to find new ways to control the rising costs of health care.