2011-11-14T13:04:31-06:00 2010-12-31 HARPER RAINS KNIGHT & COMPANY PA 1052 HIGHLAND COLONY PARKWAY SUITE RIDGELAND MS 39157 990 2010-01-01 640805837 COMPREHENSIVE HEALTH INSURANCE RISK POOL ASSOCIATION COMP 6013620799 PO BOX 13748 JACKSON MS 39236 STEVEN SCHOUWEILER 6013620799 2011-08-23 1 BILL FELDER CPA 6016050722 2011-08-23 2010 2016-02-24 21:20:13Z STEVEN SCHOUWEILER PO BOX 13748 JACKSON MS 39236 34505471 0 X HTTP://WWW.MISSISSIPPIHEALTHPOOL.ORG/ X SCH-O NONPROFIT LEGAL ENTITY 1991 MS TO PROVIDE HEALTH AND ACCIDENT INSURANCE COVERAGE TO THOSE CITIZENS OF MISSISSIPPI WHO BECAUSE OF HEALTH CONDITIONS CANNOT SECURE SUCH COVERAGE, OR DESIRE TO OBTAIN OR CONTINUE HEALTH INSURANCE COVERAGE UNDER ANY STATE OR FEDERAL PROGRAM DESIGNED TO ENABLE PERSONS TO OBTAIN OR MAINTAIN HEALTH INSURANCE COVERAGE. 7 7 0 0 0 0 1832040 1162710 26165465 26319037 759491 725710 0 0 28756996 28207457 0 0 24631117 27649521 257303 270432 0 0 0 1934899 3359897 26823319 31279850 1933677 -3072393 25668165 25183637 26153429 26892920 -485264 -1709283 X TO ALLOW THE AVAILABILITY OF A HEALTH INSURANCE PROGRAM AND TO ALLOW THE AVAILABILITY OF HEALTH AND ACCIDENT INSURANCE COVERAGE TO THOSE CITIZENS OF THE STATE OF MISSISSIPPI WHO BECAUSE OF HEALTH CONDITIONS CANNOT SECURE SUCH COVERAGE, OR DESIRE TO OBTAIN OR CONTINUE HEALTH INSURANCE COVERAGE UNDER ANY STATE OR FEDERAL PROGRAM DESIGNED TO ENABLE PERSONS TO OBTAIN OR MAINTAIN HEALTH INSURANCE COVERAGE. 0 0 30791120 PURSUANT TO MISSISSIPPI STATUTE, THE ORGANIZATION PROVIDES HEALTH AND ACCIDENT INSURANCE COVERAGE TO THOSE CITIZENS OF MISSISSIPPI WHO BECAUSE OF HEALTH CONDITIONS CANNOT SECURE SUCH COVERAGE, OR DESIRE TO OBTAIN OR CONTINUE HEALTH INSURANCE COVERAGE UNDER ANY STATE OR FEDERAL PROGRAM DESIGNED TO ENABLE PERSONS TO OBTAIN OR MAINTAIN HEALTH INSURANCE COVERAGE. 30791120 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X LANNY CRAFT 6018999967 PO BOX 13748 JACKSON MS 39236 AMER NAT INS CO-STEVEN SCHOUWEILER 0.50 X X 0 0 0 UNITD HEALTHCARE OF MS INC-STAN NEE 0.50 X 0 0 0 DAN DAVIS 0.50 X 0 0 0 LARRY FORTENBERRY 0.50 X X 0 0 0 MICHAEL LIVINGSTON MD 0.50 X X 0 0 0 WILLIAM O TOWNSEND 0.50 X X 0 0 0 BCBS OF MS - JOHN PROCTOR 0.50 X 0 0 0 LANNY CRAFT 40.00 X 0 270432 0 0 270432 0 0 0 1 0 CORESOURCE 5200 77 CENTER DRIVE CHARLOTTE NC 28217 ADMINISTERING INSURER 1174834 LANNY CRAFT PO BOX 13748 JACKSON MS 39236 EXECUTIVE DIRECTOR 270432 BLUE CROSS BLUE SHIELD PO BOX 23071 JACKSON MS 39215 ADMINISTERING INSURER 173265 WATKINS LUDLAM WINTER STENNIS 190 EAST CAPITOL STREET JACKSON MS 39201 LEGAL SERVICES 104444 4 1162710 1162710 PREMIUMS 524298 18075559 18075559 OPERATIONAL ASSESSMENT 524298 8243478 8243478 26319037 767769 767769 6255955 6298014 -42059 -42059 -42059 28207457 26319037 0 725710 27649521 27649521 270432 270432 104444 104444 20821 20821 1348099 1348099 16228 16228 11928 11928 3032 3032 INCREASE IN POLICY CLAI 1736000 1736000 AGENT REFERRAL FEES 57500 57500 ACTUARIAL 32078 32078 MISCELLANEOUS 29767 29767 31279850 30791120 488730 0 4623390 3258059 1144427 1435763 1928427 2087550 941 941 0 0 17816355 17939546 155566 462719 25668165 25183637 983442 976004 695215 986561 24474772 24930355 26153429 26892920 X -485264 -1709283 -485264 -1709283 25668165 25183637 X -3072393 1848374 X X 0 1 1 X 1 1 941 941 0 0 RSV FOR ASSESSMENT OVERPAYMENTS 394040 POLICY CLAIMS & BENEFITS PAYABLE 3795000 PREMIUMS RECEIVED IN ADVANCE 850315 BENEFIT RESERVES 19891000 24930355 28207457 31279850 -3072393 -126167 -69459 2044000 1848374 -1224019 28011831 -126167 -126167 28137998 69459 69459 28207457 31279850 0 31279850 0 31279850 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ASSOCIATION IS RECOGNIZED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(26) OF THE INTERNAL REVENUE CODE. THERE WERE NO UNCERTAIN TAX POSITIONS IDENTIFIED RELATED TO THE CURRENT YEAR AND THE ASSOCIATION HAS NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2010 FOR WHICH LIABILITIES HAVE BEEN ESTABLISHED. THE ASSOCIATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX BENEFITS AS A COMPONENT OF INCOME TAX EXPENSE. THE TAX YEARS THAT REMAIN OPEN FOR FEDERAL AND STATE INCOME TAX JURISDICTIONS ARE 2007 AND FORWARD. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN ACCOUNTING ESTIMATE FOR BENEFIT RESERVE X 0 0 0 LANNY CRAFT 0 270432 0 0 0 0 0 0 0 0 0 270432 0 0 BLUE CROSS BLUE SHIELD OF MISSISSIPPI A MUTUAL INSURANCE COMPANY ADMINISTERING INSURER 173265 PROCESSING AND ADJUDICATION OF CLAIMS. 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ASSOCIATION IS COMPRISED OF ALL INSURANCE COMPANIES, NONPROFIT HEALTH CARE SERVICES PLANS, FRATERNAL BENEFIT SOCIETIES, HEALTH MAINTENANCE ORGANIZATIONS, ANY SELF-INSURANCE ARRANGEMENT COVERED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT TO THE EXTENT CONSISTENT WITH FEDERAL LAW AND ANY OTHER ENTITY PROVIDING A PLAN OF HEALTH INSURANCE OR HEALTH BENEFITS SUBJECT TO STATE INSURANCE REGULATION, ANY HEALTH INSURANCE REINSURER IN MISSISSIPPI, AND THIRD PARTY ADMINISTRATORS PAYING OR PROCESSING HEALTH INSURANCE CLAIMS FOR ANY MISSISSIPPI RESIDENT. ALL SUCH ENTITIES, AS A CONDITION OF DOING BUSINESS, SHALL BE MEMBERS OF THE ASSOCIATION. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO MISSISSIPPI STATUTE THE MEMBERS OF THE ORGANIZATION ARE EVERY ENTITY AUTHORIZED TO WRITE HEALTH INSURANCE IN THE STATE OF MISSISSIPPI. THE MEMBERS OF THE ORGANIZATION APPOINT THREE (3) MEMBERS TO THE ORGANIZATION'S BOARD OF DIRECTORS (GOVERNING BODY). FORM 990, PART VI, SECTION A, LINE 7B PURSUANT TO MISSISSIPPI STATUTE CERTAIN DECISIONS OF THE ORGANIZATION'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MISSISSIPPI COMMISSIONER OF INSURANCE. FOR EXAMPLE, ADOPTION OF THE ORGANIZATION'S ARTICLES, BYLAWS AND OPERATING RULES, ADOPTION OF THE ORGANIZATION'S MAJOR MEDICAL EXPENSE COVERAGE AND AMENDMENTS THERETO, RATES FOR COVERAGE ISSUED BY THE ORGANIZATION, RESIDENCY REQUIREMENTS IN CONNECTION WITH ELIGIBILITY FOR COVERAGE, AND ENTERING INTO CONTRACTS WITH SIMILAR ORGANIZATIONS OF OTHER STATES FOR THE JOINT PERFORMANCE OF COMMON ADMINISTRATIVE FUNCTIONS OR WITH PERSONS OR OTHER ORGANIZATIONS FOR THE PERFORMANCE OF ADMINISTRATIVE FUNCTIONS ARE SUBJECT TO THE APPROVAL OF THE MISSISSIPPI COMMISSIONER OF INSURANCE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS AND REVIEWED BY THE ORGANIZATION'S EXECUTIVE DIRECTOR. A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES) IS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S GOVERNING BODY REVIEWS THE FORM 990, APPROVES THE FORM 990 FOR FILING WITH THE INTERNAL REVENUE SERVICE, AND AUTHORIZES OFFICERS OF THE ORGANIZATION TO EXECUTE THE FORM 990 ON BEHALF OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, AND EXECUTIVE DIRECTOR SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST AND BUSINESS ETHICS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE ORGANIZATION IS A TAX EXEMPT ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION TO ANNUAL SIGNED STATEMENTS THE ORGANIZATION CONDUCTS PERIODIC REVIEWS TO ENSURE THE ORGANIZATION IS IN COMPLIANCE WITH ITS CONFLICT OF INTEREST AND BUSINESS ETHICS POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE EXECUTIVE DIRECTOR INCLUDES REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS OF THE ORGANIZATION, USE OF COMPARABILITY DATA AND CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS OF THE BOARD REGARDING THE COMPENSATION AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -126,167. INVESTMENT EXPENSES: -69,459. CHANGE IN ACCOUNTING ESTIMATE FOR BENEFIT RESERVE 2,044,000. TOTAL TO FORM 990, PART XI, LINE 5: 1,848,374. FORM 990, PART XII, LINE 2C: THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR.