2021-05-12T12:48:50-05:00 2020-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2020-01-01 820630879 ANIC PROTECTED CELL OF LTC RE ANIC 2025892810 1050 K STREET NO 400 WASHINGTON DC 20001 BRENDA J CUSHING CFO 6127100935 2021-05-12 1 BRENDA CUSHING 999009999 J CALVIN MARKS P01226973 9197196400 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BRENDA J CUSHING 1050 K STREET NO 400 WASHINGTON DC 20001 123286736 0 6262 X N/A X 2016 DC LTC RE IS A PROTECTED CELL CAPTIVE INSURANCE COMPANY FORMED BY THE NATIONAL ORGANIZATION OF LIFE AND HEALTH GUARANTY ASSOCIATIONS, WHOSE MEMBERS ARE LIFE AND HEALTH INSURANCE STATE GUARANTY ASSOCIATIONS AFFECTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY. THE MEMBERS REINSURE THEIR OBLIGATIONS TO LTC RE TO SERVICE THE COVERED POLICYHOLDERS. 11 11 0 20 0 0 0 0 -241219 18676702 12778545 13247555 0 0 12537326 31924257 0 0 0 0 0 0 0 0 0 36825479 51365326 36825479 51365326 -24288153 -19441069 338638508 366936781 335297862 363316243 3340646 3620538 X LTC RE IS A PROTECTED CELL CAPTIVE INSURANCE COMPANY FORMED BY THE NATIONAL ORGANIZATION OF LIFE AND HEALTH GUARANTY ASSOCIATIONS, WHOSE MEMBERS ARE LIFE AND HEALTH INSURANCE STATE GUARANTY ASSOCIATIONS AFFECTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY. THE MEMBERS REINSURE THEIR OBLIGATIONS TO LTC RE TO SERVICE THE COVERED POLICYHOLDERS.THE GUARANTY ASSOCIATIONS PROVIDE THE INSURANCE INDUSTRY AND ITS CONSUMERS WITH A SAFETY NET IN THE EVENT A LIFE AND HEALTH INSURANCE COMPANY BECOMES INSOLVENT AND UNABLE TO PAY CLAIMS. 0 0 THE GUARANTY ASSOCIATIONS PROVIDE THE INSURANCE INDUSTRY AND ITS CONSUMERS WITH A SAFETY NET IN THE EVENT A LIFE AND HEALTH INSURANCE COMPANY BECOMES INSOLVENT AND UNABLE TO PAY CLAIMS 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BRENDA J CUSHING 2025892810 1050 K ST NO 400 WASHINGTON DC 20001 X ERIC RANGEN PRESIDENT 1.00 2.00 X X 0 0 0 PETER GALLANIS SECRETARY 1.00 1.00 X X 0 0 0 CARL MCDONALD TREASURER (TO FEB '20) 1.00 1.00 X X 0 0 0 RUSSEL SMITH TREASURER 1.00 1.00 X X 0 0 0 AARON BALL DIRECTOR 1.00 1.00 X 0 0 0 FREDERIC FUTTERMAN DIRECTOR 1.00 2.00 X 0 0 0 CHARLES GULLICKSON DIRECTOR 1.00 1.00 X 0 0 0 PATI MCCANDLESS DIRECTOR (FROM FEB '20) 1.00 1.00 X 0 0 0 MARGARET PARKER DIRECTOR 1.00 1.00 X 0 0 0 NICOLE STYKA DIRECTOR 1.00 1.00 X 0 0 0 G THOMAS SULLIVAN DIRECTOR 1.00 1.00 X 0 0 0 JAMES YABLECKI DIRECTOR 1.00 1.00 X 0 0 0 BRENDA CUSHING CHIEF FINANCIAL OFFICER 1.50 13.50 X 0 0 0 JODI ANATOLE CHIEF OPERATING OFFICER 1.30 12.00 X 0 0 0 0 0 0 0 0 0 0 TRIPLUS SERVICES INC 35 PARKWOOD DR STE 150 HOPKINTON MA 01748 THIRD PARTY ADMIN/ACCOUNTING 1437298 WELLINGTON ASSET MANAGEMENT 280 CONGRESS ST BOSTON MA 02210 INVESTMENT MANAGEMENT 291120 FAEGRE DRINKER BIDDLE & REATH LLP 1500 K ST NW STE 1100 WASHINGTON DC 20005 LEGAL SERVICES 105028 3 REINSURANCE PREMIUM 900099 18676702 18676702 18676702 11866743 11866743 92743291 91362479 1380812 1380812 1380812 31924257 18676702 0 13247555 11965 105028 85835 338409 67443 3103 319 48160 CHANGE IN RESERVES 27937583 CLAIMS PAID 21330689 THIRD PARTY ADMINISTRAT 735739 LOSS ADJUSTMENT EXPENSE 689911 11142 51365326 4958754 1571446 19277685 6936330 10797 9883 282450557 336245639 -97336 -67188 32038051 22240671 338638508 366936781 228019 218920 2259279 2310929 332810564 360786394 335297862 363316243 X 0 0 0 0 3340646 3620538 3340646 3620538 338638508 366936781 -19441069 19720961 0 X 0 1 X 1 0 0 GUARANTY ASSOCIATION RECEIVABLES 15929955 FUNDS HELD IN TRUST BY TPA 3902105 ACCRUED INVESTMENT INCOME 2408611 22240671 POLICY RESERVES 303710600 CLAIMS RESERVES 55800402 LAE RESERVE 1231514 UNCLAIMED PROPERTY 43878 360786394 X PART X, LINE 2: MANAGEMENT HAS CONCLUDED THAT LTC RE, PTNA PC AND ANIC PC HAVE PROPERLY MAINTAINED THEIR FEDERAL AND STATE TAX-EXEMPT STATUS AND HAVE NOT TAKEN ANY UNCERTAIN TAX POSITIONS WHICH WOULD JEOPARDIZE THEIR FEDERAL INCOME TAX-EXEMPT STATUS. FORM 990, PART VI, SECTION A, LINE 3 ANIC PC CONTRACTED WITH CONSULTANTS, PROFESSIONAL SERVICE PROVIDERS, AND THIRD PARTY ADMINISTRATORS TO PERFORM SUBSTANTIALLY ALL NECESSARY CLERICAL AND MANAGERIAL FUNCTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE CAPTIVE HAS ONE CLASS OF MEMBERS. EACH LIFE & HEALTH INSURANCE GUARANTY ASSOCIATION LOCATED IN THE UNITED STATES WHO IS ALSO A MEMBER OF THE NATIONAL ORGANIZATION OF LIFE & HEALTH INSURANCE GUARANTY ASSOCIATIONS AND WHO WAS IMPACTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY IS ELIGIBLE TO BECOME A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE FOLLOWING INDIVIDUALS WILL BE DIRECTORS: CHAIR OF THE NOLHGA PTNA/ANIC TASK FORCE, CHAIR OF THE NOLHGA MEMBERS PARTICIPATION COUNCIL, AND THE PRESIDENT OF NOLHGA. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, LEGAL COUNSEL, CAPTIVE MANAGER, AUDIT AND RISK ADVISORY COMMITTEE, AND BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COVERED PERSONS ARE UNDER A CONTINUING OBLIGATION TO DISCLOSE ANY SITUATION THAT PRESENTS A CONFLICT OF INTEREST. ANY COVERED PERSON WHO BECOMES AWARE OF A CONFLICT OF INTEREST OR POTENTIAL CONFLICT OF INTEREST IS REQUIRED TO BRING IT TO THE ATTENTION OF AN EXECUTIVE OFFICER. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. PENN TREATY PROTECTED CELL OF LTC RE 1050 K ST NO 400 WASHINGTON DC 20001 820648671 REINSURANCE DC 501(C)(6) N/A 0 LTC REINSURANCE PCC 1050 K ST NO 400 WASHINGTON DC 20001 812155730 MANAGEMENT COMPANY DC 501(C)(6) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0