2018-08-21T07:14:42-05:00 2017-12-31 621199757 LBMC PC 2095 LAKESIDE CENTRE WAY SUITE 220 KNOXVILLE TN 37922 990 2017-01-01 453124969 CONSUMERS' CHOICE HEALTH INSURANCE COMPANY IN LIQUIDATION CONS 4809484351 9821 N 95TH STREET NO 105 SCOTTSDALE AZ 85258 MICHAEL J FITZGIBBONS SPECIAL DEPUTY RECEIVER 4809484351 2018-08-17 1 AMANDA P HENSLEY CPA P01524172 8656919000 2018-08-07 2017 2022-09-23 18:48:47Z X CONSUMERS' CHOICE HEALTH PLAN MICHAEL J FITZGIBBONS 9821 N 95TH STREET STE 105 SCOTTSDALE AZ 85258 230319 0 X WWW.CCHPSC.ORG X 2011 SC HAS PROVIDED HEALTHCARE BENEFITS TO ITS MEMBERS - PRESENTLY IN LIQUIDATION. 0 0 3 0 0 0 0 0 -8846415 126412 -1063744 103907 0 0 -9910159 230319 0 0 0 0 1985859 258043 0 0 0 -11220560 -2284819 -9234701 -2026776 -675458 2257095 49963858 53600624 85221141 84177461 -35257283 -30576837 HAS PROVIDED HEALTHCARE BENEFITS TO ITS MEMBERS - PRESENTLY IN LIQUIDATION. 0 0 THE COMPANY CEASED PROVIDING HEALTH INSURANCE COVERAGE AFTER DECEMBER 31, 2015, AND WAS PLACED IN RECEIVERSHIP ON JANUARY 8, 2016. COVERED CLAIMS ARE NOW BEING PAID BY THE SOUTH CAROLINA LIFE AND ACCIDENT AND HEALTH GUARANTY ASSOCIATION. 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 23 0 1 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 SC X MICHAEL J FITZGIBBONS 4809484351 9821 N 95TH STREET SUITE 105 SCOTSDALE AZ 85258 X MELISSA CRUZE CONTROLLER 40.00 X 123636 0 3447 JANET ADAMS VP CLAIMS & MEMBER SERVICES 40.00 X 113074 0 0 236710 0 3447 2 0 0 0 NELSON MULLINS RILEY & SCARBOROUGH LLP 150 FOURTH AVE N STE 1100 NASHVILLE TN 37219 LAW SERVICES 534483 FITZGIBBONS AND COMPANY INC 9821 N 95TH ST STE 105 SCOTTSDALE AZ 85258 SPECIAL DEPUTY SERVICES 276455 JONATHAN LEONARD 809 HILLSHIRE DR BIRMINGHAM AL 35244 CLAIMS CONSULTING SERVICES 137093 JAMES F MITCHELL 517 MITCHELL RD SE CLEVELAND TN 37323 ACCOUNTING CONSULTING SERVICES 106125 4 ADMINISTRATIVE SERVICE 524298 157501 157501 PREMIUMS 524298 -31089 -31089 126412 103227 103227 680 0 680 680 680 230319 127092 0 103227 X 230870 3798 23375 542463 26669 313753 2053 47953 11417 33908 DOI ASSESSMENT & FEES 402701 CLAIMS ADJUSTMENT EXPEN 241446 STATE PREMIUM TAX EXPEN 60738 COMPUTER SOFTWARE 29728 -3997648 -2026776 3456556 3274539 10149042 11276111 36066065 38853117 125963 126000 166232 70857 49963858 53600624 63303180 62499620 3208161 2968041 18709800 18709800 85221141 84177461 X 0 0 68868408 68868408 -104125691 -99445245 -35257283 -30576837 49963858 53600624 X 2257095 2423351 X X 0 0 0 0 1 X 0 PART IV, LINE 2B: DURING 2016, COMMUNITY HEALTH ALLIANCE MUTUAL INSURANCE COMPANY (CHA) WAS VOLUNTARILY WINDING DOWN ITS BUSINESS AND PREPARING TO DISSOLVE UNDER THE SUPERVISION OF THE TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE (TDCI). EFFECTIVE OCTOBER 1, 2016, CHA ENGAGED CONSUMERS' CHOICE HEALTH INSURANCE INSURANCE COMPANY IN LIQUIDATION (CCHP) TO MANAGE THE DAILY OPERATION AND DISSOLUTION OF CHA AND TO SHARE IN THE COST OF THESE EFFORTS WITH CCHP AS CCHP LIQUIDATES ITS ASSETS AND DISSOLVES ITS CORPORATE ENTITY. THESE MANAGEMENT FUNCTIONS WERE TO INCLUDE (I) OVERSIGHT AND PAYMENT OF REMAINING CLAIMS, (II) PREPARATION AND DISSEMINATION OF ALL FINANCIAL REPORTS, REGULATORY FILINGS AND PAYMENT OF EXISTING VENDOR OBLIGATIONS, (III) OVERSIGHT OF ALL BUSINESS FUNCTIONS RELATED TO FINANCE, ACCOUNTING, CLAIMS, CUSTOMER SERVICE, APPEALS, HUMAN RESOURCES, MEDICAL MANAGEMENT, PROVIDER RELATIONS AND EXECUTION OF CHA'S WIND DOWN PLAN, (IV) COMMUNICATIONS ON BEHALF OF CHA WITH FEDERAL, STATE AND LOCAL GOVERNMENT BODIES, AND (V) COMPLETION OF OPERATIONAL REQUIREMENTS NECESSARY TO PROPERLY DISSOLVE CHA AS A CORPORATE ENTITY. CCHP AGREED TO BE RESPONSIBLE FOR ALL DIRECT EXPENSES OF CHA TO INCLUDE BUT NOT BE LIMITED TO RENT, LABOR, OFFICE, POSTAGE, COMMUNICATIONS, TECHNOLOGY, STORAGE AND PETTY CASH. CHA AGREED TO, AND DID, PAY CCHP IN ADVANCE FOR ALL ANTICIPATED EXPENSES THAT WOULD BE INCURRED BY CHA DURING THE LIFE OF THE AGREEMENT. CCHP AGREED THAT AFTER PAYMENT OF ALL CLAIMS, TRANSACTIONS AND COLLECTION ACTIONS ON BEHALF OF CHA IT WOULD REMIT WITHIN 60 CALENDAR DAYS ALL EXCESS PROCEEDS FROM CHA'S ADVANCE PAYMENT TO CCHP TO TDCI. FORM 990, PART VI, SECTION A, LINE 8A NONE - NOT APPLICABLE. FORM 990, PART VI, SECTION A, LINE 8B NONE - NOT APPLICABLE. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WAS REVIEWED BY THE SPECIAL DEPUTY RECEIVER BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C CONSUMERS' CHOICE HEALTH INSURANCE COMPANY DID REGULARLY MONITOR THE CONFLICT OF INTEREST POLICY. IT WAS PART OF THE CODE OF CONDUCT. EACH BOARD MEMBER AND MEMBER OF SR. MANAGEMENT WAS REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND DISCLOSE ANY CONFLICTS AT LEAST ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 CONSUMERS' CHOICE HEALTH INSURANCE COMPANY HAD A GOVERNANCE AND COMPENSATION COMMITTEE THAT MET AND DETERMINED A REASONABLE COMPENSATION. THE COMMITTEE WAS MADE OF INDEPENDENT PERSONS, REVIEWED COMPARABLE DATA, AND MADE A PRESENTATION TO THE DIRECTORS WHICH WAS INCLUDED IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 CONSUMERS' CHOICE HEALTH INSURANCE COMPANY MADE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HUMAN RESOURCE OUTSOURCING FEES 2,391. OUTSOURCING SERVICES 311,362. FORM 990, PART XI, LINE 9: NONADMITTED ASSETS - ACCOUNTS RECEIVABLE 2,392,477. NONADMITTED ASSETS - PREPAID EXPENSES 30,874. FORM 990, PART XII, LINE 1: THE ORGANIZATION USES THE STATUTORY-BASIS METHOD OF ACCOUNTING IN CONFORMITY WITH THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS' (NAIC) ACCOUNTING PRACTICES AND PROCEDURES MANUAL, EXCEPT TO THE EXTENT THAT THE LAWS OF SOUTH CAROLINA DIFFER FROM THESE RULES.