ANNUAL STATEMENT OF THE MCS

Transcription

1 ANNUAL STATEMENT OF THE MCS Advantage Inc. of San Juan in the state of Puerto Rico 2013 TO THE Insurance Department OF THE STATE OF Puerto Rico For the Year Ending December 31, 2013 HEALTH 2013

2 Document Code: 201 ANNUAL STATEMENT For the Year Ending December 31, 2013 OF THE CONDITION AND AFFAIRS OF THE MCS Advantage Inc. NAIC Group Code 1301, 1301 NAIC Company Code Employer's ID Number (Current Period) (Prior Period) Organized under the Laws of Puerto Rico, State of Domicile or Port of Entry Puerto Rico Country of Domicile United States of America Licensed as business type: Life, Accident & Health[ ] Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[ ] Dental Service Corporation[ ] Vision Service Corporation[ ] Health Maintenance Organization[X] Other[ ] Is HMO Federally Qualified? Yes[ ] No[ ] N/A[X] Incorporated/Organized 03/17/2004 Commenced Business 02/01/2007 Statutory Home Office Suite Ponce de León Avenue, San Juan, PR, (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office Suite Ponce de León Avenue (Street and Number) San Juan, PR, (787) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address PO Box , San Juan, PR, (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records Suite Ponce de León Avenue (Street and Number) San Juan, PR, (787) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address N/A Statutory Statement Contact David P Schaffer (787) (Name) (Area Code)(Telephone Number)(Extension) davids@medicalcardsystem.com ( Address) (Fax Number) Daniel Agroskin Gerald Landgraf Jay Wagner James O'Drobinak Robert VanHees Name James O'Drobinak David Scanavino David Schaffer Martiza Munich OFFICERS OTHERS Title CEO President CFO Secretary DIRECTORS OR TRUSTEES Paul S Levy Cyril Meduña Alexander Castaldi Carmen Conde State of County of Puerto Rico ss The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of the 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: (1) state law may differ; or, (2) 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. (Signature) (Signature) (Signature) James O'Drobinak David Schaffer (Printed Name) (Printed Name) (Printed Name) Chief Executive Officer Chief Financial Officer 0 (Title) (Title) (Title) Subscribed and sworn to before me this a. Is this an original filing? Yes[X] No[ ] day of, 2014 b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached (Notary Public Signature)

3 2 ANNUAL STATEMENT FOR THE YEAR OF THE 2013 MCS Advantage Inc. ASSETS Current Year Prior Year Net Admitted Nonadmitted Assets Net Admitted Assets Assets (Cols.1-2) Assets 1. Bonds (Schedule D) ,762, ,762, ,309, Stocks (Schedule D) 2.1 Preferred stocks Common Stocks Mortgage loans on real estate (Schedule B): 3.1 First liens Other than first liens Real estate (Schedule A): 4.1 Properties occupied by the company (less $...0 encumbrances) Properties held for the production of income (less $...0 encumbrances) Properties held for sale (less $...0 encumbrances) Cash ($...16,135,466, Schedule E Part 1), cash equivalents ($...0, Schedule E Part 2) and short-term investments ($...0, Schedule DA) ,135, ,135, ,128, Contract loans (including $...0 premium notes) Derivatives (Schedule DB) Other invested assets (Schedule BA) Receivables for securities Securities Lending Reinvested Collateral Assets (Schedule DL) Aggregate write-ins for invested assets Subtotals, cash and invested assets (Lines 1 to 11) ,897, ,897, ,437, Title plants less $...0 charged off (for Title insurers only) Investment income due and accrued , , , Premiums and considerations: 15.1 Uncollected premiums and agents' balances in the course of collection ,076, ,076, ,601, Deferred premiums, agents' balances and installments booked but deferred and not yet due (Including $...0 earned but unbilled premiums) Accrued retrospective premiums ,076, ,076, ,932, Reinsurance: 16.1 Amounts recoverable from reinsurers Funds held by or deposited with reinsured companies Other amounts receivable under reinsurance contracts Amounts receivable relating to uninsured plans ,384, ,384, ,277, Current federal and foreign income tax recoverable and interest thereon ,143, ,458, ,684, ,087, Net deferred tax asset ,365, ,365, Guaranty funds receivable or on deposit Electronic data processing equipment and software Furniture and equipment, including health care delivery assets ($...0) Net adjustment in assets and liabilities due to foreign exchange rates Receivables from parent, subsidiaries and affiliates ,335, ,450, ,885, ,560, Health care ($...4,563,859) and other amounts receivable ,563, ,563, ,872, Aggregate write-ins for other than invested assets ,722, ,722, Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25) ,020, ,997, ,023, ,095, From Separate Accounts, Segregated Accounts and Protected Cell Accounts Total (Lines 26 and 27) ,020, ,997, ,023, ,095,080 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 11 from overflow page TOTALS (Lines 1101 through 1103 plus 1198) (Line 11 above) Intangible asset Prepaids and other assets ,722, ,722, Summary of remaining write-ins for Line 25 from overflow page TOTALS (Lines 2501 through 2503 plus 2598) (Line 25 above) ,722, ,722,

4 3 ANNUAL STATEMENT FOR THE YEAR OF THE 2013 MCS Advantage Inc. LIABILITIES, CAPITAL AND SURPLUS Current Year Prior Year Covered Uncovered Total Total 1. Claims unpaid (less $...0 reinsurance ceded) ,794, ,794, ,010, Accrued medical incentive pool and bonus amounts ,518, ,518, ,705, Unpaid claims adjustment expenses Aggregate health policy reserves, including the liability of $...0 for medical loss ratio rebate per the Public Health Service Act Aggregate life policy reserves Property/casualty unearned premium reserves Aggregate health claim reserves Premiums received in advance General expenses due or accrued ,149, ,149, ,208, Current federal and foreign income tax payable and interest thereon (including $...0 on realized capital gains (losses)) Net deferred tax liability Ceded reinsurance premiums payable Amounts withheld or retained for the account of others ,928, ,928, ,871, Remittances and items not allocated ,936, ,936, ,916, Borrowed money (including $...0 current) and interest thereon $...0 (including $...0 current) Amounts due to parent, subsidiaries and affiliates Derivatives Payable for securities Payable for securities lending Funds held under reinsurance treaties (with $...0 authorized reinsurers, $...0 unauthorized reinsurers and $...0 certified reinsurers) Reinsurance in unauthorized and certified ($...0) 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 $...0 current) , , , TOTAL Liabilities (Lines 1 to 23) ,927, ,927, ,312, Aggregate write-ins for special surplus funds Common capital stock Preferred capital stock Gross paid in and contributed surplus , , Surplus notes Aggregate write-ins for other than special surplus funds Unassigned funds (surplus) ,455, ,142, Less treasury stock, at cost: shares common (value included in Line 26 $...0) shares preferred (value included in Line 27 $...0) TOTAL Capital and Surplus (Lines 25 to 31 minus Line 32) ,095, ,782, TOTAL Liabilities, Capital and Surplus (Lines 24 and 33) ,023, ,095,080 DETAILS OF WRITE-INS Statutory Deposits , , , Summary of remaining write-ins for Line 23 from overflow page TOTALS (Lines 2301 through 2303 plus 2398) (Line 23 above) , , , Summary of remaining write-ins for Line 25 from overflow page TOTALS (Lines 2501 through 2503 plus 2598) (Line 25 above) Summary of remaining write-ins for Line 30 from overflow page TOTALS (Lines 3001 through 3003 plus 3098) (Line 30 above)

5 4 ANNUAL STATEMENT FOR THE YEAR OF THE 2013 MCS Advantage Inc. STATEMENT OF REVENUE AND EXPENSES Current Year Prior Year Uncovered Total Total 1. Member Months ,490, ,352, Net premium income (including $...0 non-health premium income) ,173,785, ,146,434, Change in unearned premium reserves and reserve for rate credits Fee-for-service (net of $...0 medical expenses) Risk revenue Aggregate write-ins for other health care related revenues Aggregate write-ins for other non-health revenues TOTAL Revenues (Lines 2 to 7) ,173,785, ,146,434,799 Hospital and Medical: 9. Hospital/medical benefits ,145, ,315, Other professional services Outside referrals Emergency room and out-of-area Prescription drugs ,054, ,366, Aggregate write-ins for other hospital and medical Incentive pool, withhold adjustments and bonus amounts ,873, ,135, Subtotal (Lines 9 to 15) ,073, ,816,757 Less: 17. Net reinsurance recoveries TOTAL Hospital and Medical (Lines 16 minus 17) ,073, ,816, Non-health claims (net) Claims adjustment expenses, including $...0 cost containment expenses ,123, ,287, General administrative expenses ,572, ,496, Increase in reserves for life and accident and health contracts (including $...0 increase in reserves for life only) TOTAL Underwriting Deductions (Lines 18 through 22) ,169,770, ,122,600, Net underwriting gain or (loss) (Lines 8 minus 23) ,014, ,834, Net investment income earned (Exhibit of Net Investment Income, Line 17) ,616, ,223, Net realized capital gains (losses) less capital gains tax of $ (429,526) ,313, Net investment gains (losses) (Lines 25 plus 26) ,186, ,537, Net gain or (loss) from agents' or premium balances charged off [(amount recovered $...0) (amount charged off $...0)] Aggregate write-ins for other income or expenses Net income or (loss) after capital gains tax and before all other federal income taxes (Lines 24 plus 27 plus 28 plus 29) X X X ,201, ,372, Federal and foreign income taxes incurred ,476, , Net income (loss) (Lines 30 minus 31) ,725, ,337,645 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 6 from overflow page TOTALS (Lines 0601 through 0603 plus 0698) (Line 6 above) Summary of remaining write-ins for Line 7 from overflow page TOTALS (Line 0701 through 0703 plus 0798) (Line 7 above) Summary of remaining write-ins for Line 14 from overflow page TOTALS (Lines 1401 through 1403 plus 1498) (Line 14 above) Other income Summary of remaining write-ins for Line 29 from overflow page TOTALS (Line 2901 through 2903 plus 2998) (Line 29 above)

6 STATEMENT OF REVENUE AND EXPENSES (Continued) CAPITAL & SURPLUS ACCOUNT 1 2 Current Year Prior Year 33. Capital and surplus prior reporting year ,782, ,580, Net income or (loss) from Line ,725, ,337, Change in valuation basis of aggregate policy and claim reserves Change in net unrealized capital gains (losses) less capital gains tax of $ Change in net unrealized foreign exchange capital gain or (loss) Change in net deferred income tax ,049, (5,272,248) 39. Change in nonadmitted assets (7,461,802) (7,862,778) 40. Change in unauthorized and certified reinsurance Change in treasury stock Change in surplus notes Cumulative effect of changes in accounting principles Capital Changes: 44.1 Paid in Transferred from surplus (Stock Dividend) Transferred to surplus Surplus adjustments: 45.1 Paid in Transferred to capital (Stock Dividend) Transferred from capital Dividends to stockholders Aggregate write-ins for gains or (losses) in surplus Net change in capital and surplus (Lines 34 to 47) , ,202, Capital and surplus end of reporting year (Line 33 plus 48) ,095, ,782,663 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 47 from overflow page TOTALS (Lines 4701 through 4703 plus 4798) (Line 47 above)

7 6 ANNUAL STATEMENT FOR THE YEAR OF THE 2013 MCS Advantage Inc. CASH FLOW 1 2 Current Year Prior Year Cash from Operations 1. Premiums collected net of reinsurance ,143,165, ,145,502, Net investment income ,775, ,842, Miscellaneous income Total (Lines 1 through 3) ,144,941, ,148,345, Benefit and loss related payments ,005,679, ,237, Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts Commissions, expenses paid and aggregate write-ins for deductions ,862, ,887, Dividends paid to policyholders Federal and foreign income taxes paid (recovered) net of $...0 tax on capital gains (losses) Total (Lines 5 through 9) ,185,542, ,145,125, Net cash from operations (Line 4 minus Line 10) (40,600,863) ,220,248 Cash from Investments 12. Proceeds from investments sold, matured or repaid: 12.1 Bonds ,150, ,511, Stocks Mortgage loans Real estate Other invested assets Net gains or (losses) on cash, cash equivalents and short-term investments Miscellaneous proceeds Total investment proceeds (Lines 12.1 to 12.7) ,150, ,511, Cost of investments acquired (long-term only): 13.1 Bonds ,319, ,887, Stocks Mortgage loans Real estate Other invested assets Miscellaneous applications Total investments acquired (Lines 13.1 to 13.6) ,319, ,887, Net increase (decrease) in contract loans and premium notes Net cash from investments (Line 12.8 minus Line 13.7 minus Line 14) (19,169,487) ,624,685 Cash from Financing and Miscellaneous Sources 16. Cash provided (applied): 16.1 Surplus notes, capital notes Capital and paid in surplus, less treasury stock Borrowed funds Net deposits on deposit-type contracts and other insurance liabilities Dividends to stockholders Other cash provided (applied) ,777, (7,214,854) 17. Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6) ,777, (7,214,854) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 18. Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17) (56,992,563) ,630, Cash, cash equivalents and short-term investments: 19.1 Beginning of year ,128, ,497, End of year (Line 18 plus Line 19.1) ,135, ,128,029 Note: Supplemental Disclosures of Cash Flow Information for Non-Cash Transactions:

8 7 ANNUAL STATEMENT FOR THE YEAR OF THE 2013 MCS Advantage Inc. ANALYSIS OF OPERATIONS BY LINES OF BUSINESS Comprehensive Federal (Hospital Employees Title Title & Medicare Dental Vision Health XVIII XIX Other Other Total Medical) Supplement Only Only Benefits Plan Medicare Medicaid Health Non-Health 1. Net premium income ,173,785, ,173,785, Change in unearned premium reserves and reserve for rate credit Fee-for-service (net of $...0 medical expenses) Risk revenue Aggregate write-ins for other health care related revenues Aggregate write-ins for other non-health care related revenues TOTAL Revenues (Lines 1 to 6) ,173,785, ,173,785, Hospital/medical benefits ,145, ,145, Other professional services Outside referrals Emergency room and out-of-area Prescription drugs ,054, ,054, Aggregate write-ins for other hospital and medical Incentive pool, withhold adjustments and bonus amounts ,873, ,873, Subtotal (Lines 8 to 14) ,073, ,073, Net reinsurance recoveries TOTAL Hospital and Medical (Lines 15 minus 16) ,073, ,073, Non-health claims (net) Claims adjustment expenses including $...0 cost containment expenses ,123, ,123, General administrative expenses ,572, ,572, Increase in reserves for accident and health contracts Increase in reserves for life contracts TOTAL Underwriting Deductions (Lines 17 to 22) ,169,770, ,169,770, Net underwriting gain or (loss) (Line 7 minus Line 23) ,014, ,014, DETAILS OF WRITE-INS Summary of remaining write-ins for Line 5 from overflow page TOTALS (Lines 0501 through 0503 plus 0598) (Line 5 above) Summary of remaining write-ins for Line 6 from overflow page TOTALS (Lines 0601 through 0603 plus 0698) (Line 6 above) Summary of remaining write-ins for Line 13 from overflow page TOTALS (Lines 1301 through 1303 plus 1398) (Line 13 above)