2026-04-30T05:56:43-05:00 2025-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2025-01-01 820648671 PENN TREATY PROTECTED CELL OF LTC RE PENN 2025892810 1500 K ST NW 1100 WASHINGTON DC 20005 BRENDA J CUSHING CFO 2025892810 2026-04-30 1 J CALVIN MARKS P01226973 9197196400 2025 2025-03-06 01:10:19Z BRENDA J CUSHING 1500 K ST NW 1100 WASHINGTON DC 20005 469872842 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 -151841534 -32123950 78124892 66423702 0 0 -73716642 34299752 0 0 0 0 0 0 0 0 0 -87459177 88142042 -87459177 88142042 13742535 -53842290 1670945546 1596080337 1655577357 1581625655 15368189 14454682 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 1 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 1500 K ST NW STE 1100 WASHINGTON DC 20005 X ERIC RANGEN PRESIDENT 2.00 1.00 X X 0 0 0 KATHARINE WADE SECRETARY 1.00 1.00 X X 0 0 0 RUSSELL SMITH TREASURER 1.00 1.00 X X 0 0 0 CHARLES GULLICKSON SECURITY & PRIVACY OFFICER 1.00 1.00 X X 0 0 0 AMANDA BARBERA DIRECTOR 1.00 1.00 X 0 0 0 JEFFREY BELIGOTTI DIRECTOR 1.00 1.00 X 0 0 0 RENEE CIESLUKOWSKI DIRECTOR 1.00 1.00 X 0 0 0 IVAN CONCEPCION DIRECTOR (FROM NOV '25) 1.00 1.00 X 0 0 0 NANCY MARGOLIS DIRECTOR 1.00 1.00 X 0 0 0 FRANK MELACCIO DIRECTOR (TO NOV '25) 1.00 1.00 X 0 0 0 DENISE MERIDITH DIRECTOR 1.00 1.00 X 0 0 0 LILLIAN SUTTON DIRECTOR 1.00 1.00 X 0 0 0 BRENDA CUSHING CHIEF FINANCIAL OFFICER 6.50 1.00 X 0 0 0 JODI ANATOLE CHIEF OPERATING OFFICER 6.00 1.00 X 0 0 0 0 0 0 0 0 0 0 DAVIES LIFE & HEALTH INC 1350 MAIN ST SPRINGFIELD MA 01103 THIRD PARTY ADMIN/ACCOUNTING 7186649 WELLINGTON MANAGEMENT COMPANY LLP 280 CONGRESS ST BOSTON MA 02210 INVESTMENT MANAGEMENT 1261907 FAEGRE DRINKER BIDDLE & REATH LLP 2200 WELLS FARGO CENTER 90 SOUTH 7 MINNEAPOLIS MN 55402 LEGAL/COMPLIANCE SERVICES 671592 ILLUMIFIN CORPORATION 935 S MAIN ST GREENVILLE SC 29601 ACTUARIAL SERVICES 582828 BC CONSULTING LLC 1105 BURR OAKS DR WEST DES MOINES IA 50266 CFO MANAGEMENT SERVICES 214539 8 REINSURANCE PREMIUMS 900099 -32123950 -32123950 -32123950 62201165 62201165 439795627 435573090 4222537 4222537 4222537 34299752 -32123950 0 66423702 120638 653363 586383 1517567 601077 32137 6864 380257 CLAIMS PAID 167144991 LOSS ADJUSTMENT EXPENSE 4916456 THIRD PARTY ADMIN 2224204 CHANGE IN RESERVES -90119384 77489 88142042 8511621 5166726 65376 62977 1276727212 1260633041 339538 192985 385301799 330024608 1670945546 1596080337 1285800 1234100 10991558 9760154 1643299999 1570631401 1655577357 1581625655 X 0 0 0 0 15368189 14454682 15368189 14454682 1670945546 1596080337 -53842290 52928783 0 X 0 1 X 1 0 0 GUARANTY ASSOCIATION RECEIVABLES 295073275 FUNDS HELD IN TRUST BY TPA 23149704 ACCRUED INVESTMENT INCOME 11801629 330024608 POLICY RESERVES 1130571229 CLAIMS RESERVES 307612476 DUE TO GUARANTY ASSOCIATIONS 125527880 LAE RESERVES 6524241 UNCLAIMED PROPERTY 262948 DUE TO BROKER 132627 1570631401 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. BC CONSULTING LLC ENTITY OWNED MORE THAN 35% BY BRENDA CUSHING, CFO 214539 CFO MANAGEMENT SERVICES FOR GROUP 0 ENDEAVOUR CONSULTING LLC ENTITY OWNED MORE THAN 35% BY JODI ANATOLE, COO 120638 COO MANAGEMENT SERVICES FOR GROUP 0 FORM 990, PART VI, SECTION A, LINE 3 PTNA 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. ANIC PROTECTED CELL OF LTC RE 1500 K ST NW STE 1100 WASHINGTON DC 20005 820630879 REINSURANCE DC 501(C)(6) N/A 0 LTC REINSURANCE PCC 1500 K ST NW STE 1100 WASHINGTON DC 20005 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 1 0