1 HEALTH QUARTERLY STATEMENT AS OF JUNE 0, 04 OF THE CONDITION AND AFFAIRS OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. NAIC Group Code NAIC Company Code 8 Employer's ID Number (Current) (Prior) Organized under the Laws of Arkansas, State of Domicile or Port of Entry AR Country of Domicile Licensed as business type: United States of America Health Maintenance Organization Is HMO Federally Qualified? Yes [ X ] No [ ] IncorporatedOrganized Commenced Business Statutory Home Office cocsc00 Spring Bldg,Ste 900,00 Spring St., Little Rock, AR, US 70 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 500 W. Main Street (Street and Number) Louisville, KY, US 400, (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address P.O. Box 74006, Louisville, KY, US (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 500 W. Main Street (Street and Number) Louisville, KY, US 400, (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address Statutory Statement Contact Brittany Ullrich, (Name) (Area Code) (Telephone Number) ( Address) (FAX Number) OFFICERS President & CEO Bruce Dale Broussard Sr. VP & CFO Brian Andrew Kane VP & Corporate Secretary Joan Olliges Lenahan VP & Appointed Actuary Jonathan Albert Canine OTHER George Grant Bauernfeind Vice President Elizabeth Diane Bierbower Pres, Employer Group Segment John Gregory Catron VP & Chief Compliance Officer Steven James DeRaleau Pres., HumanaOne Roy Goldman Ph.D VP & Chief Actuary Gary Edward Goldstein M.D. VP & Division LeaderCentral Division Charles Frederic Lambert, III Vice President Brian Phillip LeClaire Sr. VP & Chief Info Officer Thomas Joseph Liston President-Retail Segment Steven Edward McCulley Sr. VP & Chief Accounting Officer Bruce Devereau Perkins Pres, Healthcare Svcs Segment Richard Donald Remmers VP, Employer Group Segment Debra Anne Smith VP-Sr. Prod Strategy & Prod Dev Joseph Christopher Ventura Assistant Corporate Secretary Timothy Alan Wheatley VP-Senior Products Ralph Martin Wilson Vice President Vacancy Treasurer DIRECTORS OR TRUSTEES Roy Ainsworth Beveridge M.D. Bruce Dale Broussard James Elmer Murray State of County of Kentucky Jefferson SS: The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: () state law may differ; or, () that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. Bruce Dale Broussard Joan Olliges Lenahan Alan James Bailey President & CEO VP & Corporate Secretary Assistant Treasurer a. Is this an original filing? Yes [ X ] No [ ] Subscribed and sworn to before me this b. If no, 8th day of August, 04. State the amendment number. Date filed. Number of pages attached Michele Sizemore Notary Public January, 05
2 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. ASSETS Assets Current Statement Date 4 December Net Admitted Assets Prior Year Net Nonadmitted Assets (Cols. - ) Admitted Assets. Bonds. Stocks:. Preferred stocks. Common stocks. Mortgage loans on real estate:. First liens. Other than first liens 4. Real estate: 4. Properties occupied by the company (less encumbrances) 4. Properties held for the production of income (less encumbrances) 4. Properties held for sale (less encumbrances) 5. Cash ( ), cash equivalents ( ) and short-term investments ( ) 6. Contract loans (including premium notes) 7. Derivatives 8. Other invested assets 9. Receivables for securities 0. Securities lending reinvested collateral assets. Aggregate write-ins for invested assets. Subtotals, cash and invested assets (Lines to ). Title plants less charged off (for Title insurers only) 4. Investment income due and accrued 5. Premiums and considerations: 5. Uncollected premiums and agents' balances in the course of collection 5. Deferred premiums, agents' balances and installments booked but deferred and not yet due (including earned but unbilled premiums) 5. Accrued retrospective premiums 6. Reinsurance: 6. Amounts recoverable from reinsurers 6. Funds held by or deposited with reinsured companies 6. Other amounts receivable under reinsurance contracts 7. Amounts receivable relating to uninsured plans 8. Current federal and foreign income tax recoverable and interest thereon 8. Net deferred tax asset 9. Guaranty funds receivable or on deposit 0. Electronic data processing equipment and software. Furniture and equipment, including health care delivery assets ( ). Net adjustment in assets and liabilities due to foreign exchange rates. Receivables from parent, subsidiaries and affiliates 4. Health care ( ) and other amounts receivable 5. Aggregate write-ins for other than invested assets 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5) 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 8. Total (Lines 6 and 7) DETAILS OF WRITE-INS 98. Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98)(Line above) Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 through 50 plus 598)(Line 5 above)
3 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. LIABILITIES, CAPITAL AND SURPLUS Covered Current Period Uncovered Total Prior Year 4 Total. Claims unpaid (less reinsurance ceded). Accrued medical incentive pool and bonus amounts. Unpaid claims adjustment expenses 4. Aggregate health policy reserves, including the liability of for medical loss ratio rebate per the Public Health Service Act 5. Aggregate life policy reserves 6. Propertycasualty unearned premium reserve 7. Aggregate health claim reserves 8. Premiums received in advance 9. General expenses due or accrued 0. Current federal and foreign income tax payable and interest thereon (including on realized gains (losses)) 0. Net deferred tax liability. Ceded reinsurance premiums payable. Amounts withheld or retained for the account of others. Remittances and items not allocated 4. Borrowed money (including current) and interest thereon (including current) 5. Amounts due to parent, subsidiaries and affiliates 6. Derivatives 7. Payable for securities 8. Payable for securities lending 9. Funds held under reinsurance treaties (with authorized reinsurers, unauthorized reinsurers and certified reinsurers) 0. Reinsurance in unauthorized and certified ( companies. Net adjustments in assets and liabilities due to foreign exchange rates. Liability for amounts held under uninsured plans. Aggregate write-ins for other liabilities (including current) 4. Total liabilities (Lines to ) 5. Aggregate write-ins for special surplus funds XXX XXX 6. Common capital stock XXX XXX 7. Preferred capital stock XXX XXX 8. Gross paid in and contributed surplus XXX XXX 9. Surplus notes XXX XXX 0. Aggregate write-ins for other than special surplus funds XXX XXX. Unassigned funds (surplus) XXX XXX. Less treasury stock, at cost:. shares common (value included in Line 6 ) XXX XXX. shares preferred (value included in Line 7 ) XXX XXX. Total capital and surplus (Lines 5 to minus Line ) XXX XXX 4. Total liabilities, capital and surplus (Lines 4 and ) XXX XXX DETAILS OF WRITE-INS 0. " Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98)(Line above) 50. ""%&'( XXX XXX 50. XXX XXX 50. XXX XXX 598. Summary of remaining write-ins for Line 5 from overflow page XXX XXX 599. Totals (Lines 50 through 50 plus 598)(Line 5 above) XXX XXX 00. XXX XXX 00. XXX XXX 00. XXX XXX 098. Summary of remaining write-ins for Line 0 from overflow page XXX XXX 099. Totals (Lines 00 through 00 plus 098)(Line 0 above) XXX XXX
4 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. STATEMENT OF REVENUE AND EXPENSES Current Year To Date Uncovered Total Prior Year To Date Total Prior Year Ended December 4 Total. Member Months XXX. Net premium income ( including non-health premium income) XXX. Change in unearned premium reserves and reserve for rate credits XXX 4. Fee-for-service (net of medical expenses) XXX 5. Risk revenue XXX 6. Aggregate write-ins for other health care related revenues XXX 7. Aggregate write-ins for other non-health revenues XXX 8. Total revenues (Lines to 7) XXX Hospital and Medical: 9. Hospitalmedical benefits 0. Other professional services. Outside referrals. Emergency room and out-of-area. Prescription drugs 4. Aggregate write-ins for other hospital and medical 5. Incentive pool, withhold adjustments and bonus amounts 6. Subtotal (Lines 9 to 5) Less: 7. Net reinsurance recoveries 8. Total hospital and medical (Lines 6 minus 7) 9. Non-health claims (net) 0. Claims adjustment expenses, including cost containment expenses. General administrative expenses. Increase in reserves for life and accident and health contracts (including increase in reserves for life only). Total underwriting deductions (Lines 8 through ) 4. Net underwriting gain or (loss) (Lines 8 minus ) XXX 5. Net investment income earned 6. Net realized capital gains (losses) less capital gains tax of 7. Net investment gains (losses) (Lines 5 plus 6) 8. Net gain or (loss) from agents or premium balances charged off [(amount recovered ) (amount charged off )] 9. Aggregate write-ins for other income or expenses 0. Net income or (loss) after capital gains tax and before all other federal income taxes (Lines 4 plus 7 plus 8 plus 9) XXX. Federal and foreign income taxes incurred XXX. Net income (loss) (Lines 0 minus ) XXX DETAILS OF WRITE-INS 060. XXX 060. XXX 060. XXX Summary of remaining write-ins for Line 6 from overflow page XXX Totals (Lines 060 through 060 plus 0698)(Line 6 above) XXX 070. XXX 070. XXX 070. XXX Summary of remaining write-ins for Line 7 from overflow page XXX Totals (Lines 070 through 070 plus 0798)(Line 7 above) XXX Summary of remaining write-ins for Line 4 from overflow page 499. Totals (Lines 40 through 40 plus 498)(Line 4 above) Summary of remaining write-ins for Line 9 from overflow page 999. Totals (Lines 90 through 90 plus 998)(Line 9 above) 4
5 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. STATEMENT OF REVENUE AND EXPENSES (Continued) Current Year to Date Prior Year to Date Prior Year Ended December CAPITAL AND SURPLUS ACCOUNT. Capital and surplus prior reporting year 4. Net income or (loss) from Line 5. Change in valuation basis of aggregate policy and claim reserves 6. Change in net unrealized capital gains (losses) less capital gains tax of 7. Change in net unrealized foreign exchange capital gain or (loss) 8. Change in net deferred income tax 9. Change in nonadmitted assets 40 Change in unauthorized and certified reinsurance 4. Change in treasury stock 4. Change in surplus notes 4. Cumulative effect of changes in accounting principles 44. Capital Changes: 44. Paid in 44. Transferred from surplus (Stock Dividend) 44. Transferred to surplus 45. Surplus adjustments: 45. Paid in 45. Transferred to capital (Stock Dividend) 45. Transferred from capital 46. Dividends to stockholders 47. Aggregate write-ins for gains or (losses) in surplus 48. Net change in capital & surplus (Lines 4 to 47) 49. Capital and surplus end of reporting period (Line plus 48) DETAILS OF WRITE-INS " Summary of remaining write-ins for Line 47 from overflow page Totals (Lines 470 through 470 plus 4798)(Line 47 above) 5
6 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. Cash from Operations CASH FLOW Current Year To Date Prior Year To Date Prior Year Ended December. Premiums collected net of reinsurance. Net investment income. Miscellaneous income 4. Total (Lines to ) 5. Benefit and loss related payments 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts 7. Commissions, expenses paid and aggregate write-ins for deductions 8. Dividends paid to policyholders 9. Federal and foreign income taxes paid (recovered) net of tax on capital gains (losses) 0. Total (Lines 5 through 9). Net cash from operations (Line 4 minus Line 0) Cash from Investments. Proceeds from investments sold, matured or repaid:. Bonds. Stocks. Mortgage loans.4 Real estate.5 Other invested assets.6 Net gains or (losses) on cash, cash equivalents and short-term investments.7 Miscellaneous proceeds.8 Total investment proceeds (Lines. to.7). Cost of investments acquired (long-term only):. Bonds. Stocks. Mortgage loans.4 Real estate.5 Other invested assets.6 Miscellaneous applications.7 Total investments acquired (Lines. to.6) 4. Net increase (or decrease) in contract loans and premium notes 5. Net cash from investments (Line.8 minus Line.7 and Line 4) 6. Cash provided (applied): Cash from Financing and Miscellaneous Sources 6. Surplus notes, capital notes 6. Capital and paid in surplus, less treasury stock 6. Borrowed funds 6.4 Net deposits on deposit-type contracts and other insurance liabilities 6.5 Dividends to stockholders 6.6 Other cash provided (applied) 7. Net cash from financing and miscellaneous sources (Line 6. through Line 6.4 minus Line 6.5 plus Line 6.6) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 8. Net change in cash, cash equivalents and short-term investments (Line, plus Lines 5 and 7) 9. Cash, cash equivalents and short-term investments: 9. Beginning of year 9. End of period (Line 8 plus Line 9.) Note: Supplemental disclosures of cash flow information for non-cash transactions: 6
7 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION Comprehensive (Hospital & Medical) Total Individual Group Medicare Supplement Vision Only Dental Only Federal Employees Health Benefit Plan Title XVIII Medicare Title XIX Medicaid Other Total Members at end of:. Prior Year. First Quarter. Second Quarter 4. Third Quarter 5. Current Year 6. Current Year Member Months Total Member Ambulatory Encounters for Period: 7 Physician 7 8. Non-Physician 9. Total 0. Hospital Patient Days Incurred. Number of Inpatient Admissions. Health Premiums Written (a). Life Premiums Direct 4. PropertyCasualty Premiums Written 5. Health Premiums Earned 6. PropertyCasualty Premiums Earned 7. Amount Paid for Provision of Health Care Services 8. Amount Incurred for Provision of Health Care Services (a) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees
8 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD AND BONUS (Reported and Unreported) Aging Analysis of Unpaid Claims Account - 0 Days - 60 Days Days Days 6 Over 0 Days 7 Total Claims Unpaid (Reported) Individually listed claims unpaid Aggregate accounts not individually listed-uncovered Aggregate accounts not individually listed-covered Subtotals Unreported claims and other claim reserves Total amounts withheld Total claims unpaid Accrued medical incentive pool and bonus amounts
9 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. UNDERWRITING AND INVESTMENT EXHIBIT Line of Business ANALYSIS OF CLAIMS UNPAID - PRIOR YEAR - NET OF REINSURANCE Claims Paid Year to Date On Claims Incurred Prior to January of Current Year On Claims Incurred During the Year Liability End of Current Quarter 4 On Claims Unpaid Dec. of Prior Year On Claims Incurred During the Year 5 6 Claims Incurred in Prior Years (Columns + ) Estimated Claim Reserve and Claim Liability December of Prior Year. Comprehensive (hospital and medical). Medicare Supplement. Dental Only 4. Vision Only 5. Federal Employees Health Benefits Plan 6. Title XVIII - Medicare 9 7 Title XIX - Medicaid 8. Other health 9. Health subtotal (Lines to 8) 0. Healthcare receivables (a). Other non-health. Medical incentive pools and bonus amounts. Totals (Lines 9-0++) (a) Excludes loans or advances to providers not yet expensed.
20 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. GENERAL INTERROGATORIES PART - COMMON INTERROGATORIES GENERAL. Did the reporting entity experience any material transactions requiring the filing of Disclosure of Material Transactions with the State of Domicile, as required by the Model Act?. If yes, has the report been filed with the domiciliary state?. Has any change been made during the year of this statement in the charter, by-laws, articles of incorporation, or deed of settlement of the reporting entity?. If yes, date of change:. Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of which is an insurer? If yes, complete Schedule Y, Parts and A.. Have there been any substantial changes in the organizational chart since the prior quarter end?. If the response to. is yes, provide a brief description of those changes. 4. Has the reporting entity been a party to a merger or consolidation during the period covered by this statement? 4. If yes, provide the name of the entity, NAIC Company Code, and state of domicile (use two letter state abbreviation) for any entity that has ceased to exist as a result of the merger or consolidation. Name of Entity NAIC Company Code State of Domicile 5. If the reporting entity is subject to a management agreement, including third-party administrator(s), managing general agent(s), attorneyin-fact, or similar agreement, have there been any significant changes regarding the terms of the agreement or principals involved? If yes, attach an explanation. 6. State as of what date the latest financial examination of the reporting entity was made or is being made. 6. State the as of date that the latest financial examination report became available from either the state of domicile or the reporting entity. This date should be the date of the examined balance sheet and not the date the report was completed or released. 6. State as of what date the latest financial examination report became available to other states or the public from either the state of domicile or the reporting entity. This is the release date or completion date of the examination report and not the date of the examination (balance sheet date). 6.4 By what department or departments? Arkansas Department of insurance 6.5 Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial statement filed with Departments? 6.6 Have all of the recommendations within the latest financial examination report been complied with? 7. Has this reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by any governmental entity during the reporting period? 7. If yes, give full information: 8. Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board? 8. If response to 8. is yes, please identify the name of the bank holding company. 8. Is the company affiliated with one or more banks, thrifts or securities firms? 8.4 If response to 8. is yes, please provide below the names and location (city and state of the main office) of any affiliates regulated by a federal regulatory services agency [i.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Federal Deposit Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify the affiliate's primary federal regulator. Affiliate Name Location (City, State) FRB 4 OCC 5 FDIC 6 SEC
21 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. GENERAL INTERROGATORIES 9. Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions) of the reporting entity subject to a code of ethics, which includes the following standards? (a) Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships; (b) Full, fair, accurate, timely and understandable disclosure in the periodic reports required to be filed by the reporting entity; (c) Compliance with applicable governmental laws, rules and regulations; (d) The prompt internal reporting of violations to an appropriate person or persons identified in the code; and (e) Accountability for adherence to the code. 9. If the response to 9. is No, please explain: 9. Has the code of ethics for senior managers been amended? 9. If the response to 9. is Yes, provide information related to amendment(s). 9. Have any provisions of the code of ethics been waived for any of the specified officers? 9. If the response to 9. is Yes, provide the nature of any waiver(s). FINANCIAL 0. Does the reporting entity report any amounts due from parent, subsidiaries or affiliates on Page of this statement? 0. If yes, indicate any amounts receivable from parent included in the Page amount: INVESTMENT. Were any of the stocks, bonds, or other assets of the reporting entity loaned, placed under option agreement, or otherwise made available for use by another person? (Exclude securities under securities lending agreements.). If yes, give full and complete information relating thereto:. Amount of real estate and mortgages held in other invested assets in Schedule BA:. Amount of real estate and mortgages held in short-term investments: 4. Does the reporting entity have any investments in parent, subsidiaries and affiliates? 4. If yes, please complete the following: Prior Year-End BookAdjusted Carrying Value Current Quarter BookAdjusted Carrying Value 4. Bonds 4. Preferred Stock 4. Common Stock 4.4 Short-Term Investments 4.5 Mortgage Loans on Real Estate 4.6 All Other 4.7 Total Investment in Parent, Subsidiaries and Affiliates (Subtotal Lines 4. to 4.6) 4.8 Total Investment in Parent included in Lines 4. to 4.6 above 5. Has the reporting entity entered into any hedging transactions reported on Schedule DB? 5. If yes, has a comprehensive description of the hedging program been made available to the domiciliary state? If no, attach a description with this statement..
22 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. GENERAL INTERROGATORIES 6. For the reporting entity s security lending program, state the amount of the following as of the current statement date: 6. Total fair value of reinvested collateral assets reported on Schedule DL, Parts and. 6. Total book adjustedcarrying value of reinvested collateral assets reported on Schedule DL, Parts and 6. Total payable for securities lending reported on the liability page. 7. Excluding items in Schedule E - Part - Special Deposits, real estate, mortgage loans and investments held physically in the reporting entity s offices, vaults or safety deposit boxes, were all stocks, bonds and other securities, owned throughout the current year held pursuant to a custodial agreement with a qualified bank or trust company in accordance with Section, III - General Examination Considerations, F. Outsourcing of Critical Functions, Custodial or Safekeeping Agreements of the NAIC Financial Condition Examiners Handbook? 7. For all agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following: Name of Custodian(s) Custodian Address "% "&'() 7. For all agreements that do not comply with the requirements of the NAIC Financial Condition Examiners Handbook, provide the name, location and a complete explanation: Name(s) Location(s) Complete Explanation(s) 7. Have there been any changes, including name changes, in the custodian(s) identified in 7. during the current quarter? 7.4 If yes, give full information relating thereto: Old Custodian New Custodian Date of Change 4 Reason 7.5 Identify all investment advisors, brokersdealers or individuals acting on behalf of brokerdealers that have access to the investment accounts, handle securities and have authority to make investments on behalf of the reporting entity: Central Registration Depository Name(s) Address 8. Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Securities Valuation Office been followed? 8. If no, list exceptions:.
23 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. GENERAL INTERROGATORIES PART - HEALTH. Operating Percentages:. A&H loss percent. A&H cost containment percent. A&H expense percent excluding cost containment expenses. Do you act as a custodian for health savings accounts?. If yes, please provide the amount of custodial funds held as of the reporting date. Do you act as an administrator for health savings accounts?.4 If yes, please provide the balance of the funds administered as of the reporting date
24 NAIC Company Code ID Number Effective Date STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. SCHEDULE S - CEDED REINSURANCE 4 Name of Reinsurer Showing All New Reinsurance Treaties - Current Year to Date 5 6 Domiciliary Jurisdiction Type of Reinsurance Ceded 7 Type of Reinsurer 8 Certified Reinsurer Rating ( through 6) 9 Effective Date of Certified Reinsurer Rating NONE
25 STATEMENT AS OF JUNE 0, 04 OF THE Humana Regional Health Plan, Inc. fka Arkansas Community Care, Inc. SCHEDULE T - PREMIUMS AND OTHER CONSIDERATIONS Current Year to Date - Allocated by States and Territories Direct Business Only Federal Employees Life and Health Annuity Accident and Benefits Premiums & Active Health Medicare Medicaid Program Other Status Premiums Title XVIII Title XIX Premiums Considerations 7 Property Casualty Premiums 8 Total Columns Through 7 9 Deposit-Type Contracts States, etc.. Alabama AL. Alaska AK. Arizona AZ 4. Arkansas AR 5. California CA 6. Colorado CO 7. Connecticut CT 8. Delaware DE 9. District of Columbia DC 0. Florida FL. Georgia GA. Hawaii HI. Idaho ID 4. Illinois IL 5. Indiana IN 6. Iowa IA 7. Kansas KS 8. Kentucky KY 9. Louisiana LA 0. Maine ME. Maryland MD. Massachusetts MA. Michigan MI 4. Minnesota MN 5. Mississippi MS 6. Missouri MO 7. Montana MT 8. Nebraska NE 9. Nevada NV 0. New Hampshire NH. New Jersey NJ. New Mexico NM. New York NY 4. North Carolina NC 5. North Dakota ND 6. Ohio OH 7. Oklahoma OK 8. Oregon OR 9. Pennsylvania PA 40. Rhode Island RI 4. South Carolina SC 4. South Dakota SD 4. Tennessee TN 44. Texas TX 45. Utah UT 46. Vermont VT 47. Virginia VA 48. Washington WA 49. West Virginia WV 50. Wisconsin WI 5. Wyoming WY 5. American Samoa AS 5. Guam GU 54. Puerto Rico PR 55. U.S. Virgin Islands VI 56. Northern Mariana Islands MP 57. Canada CAN 58. Aggregate Other Aliens OT XXX 59. Subtotal XXX 60. Reporting Entity Contributions for Employee Benefit Plans XXX 6. Totals (Direct Business) (a) DETAILS OF WRITE-INS XXX XXX XXX Summary of remaining write-ins for Line 58 from overflow page XXX Totals (Lines 5800 through 5800 plus 58998)(Line 58 above) XXX (L) Licensed or Chartered - Licensed Insurance Carrier or Domiciled RRG; (R) Registered - Non-domiciled RRGs; (Q) Qualified - Qualified or Accredited Reinsurer; (E) Eligible - Reporting Entities eligible or approved to write Surplus Lines in the state; (N) None of the above - Not allowed to write business in the state. (a) Insert the number of L responses except for Canada and Other Alien. 4
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