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ANNUAL STATEMENT FOR THE VEAR ENDING DECEMBER 31, 2013

OF m E co~rrlON AND AFFAIRS OF TliE

Coventry Health Care o1loWiI, Inc.

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In~ Web SiIlt Add<~ ~~~~~~~~~~~~~~~===~.~-~~""~.~w~.~=~~i~~~~~~~~~===== ~w.ry St.lIleroenl eont:lCl CAROlE L SWANSON _., CJ..SWANSON@CV!Y_COM

OFFICERS N~.

ALAN R GARD

"CE._""!!~' OTHER OFFICERS \1Ct PRESIDENT AND

DIRECTORS OR~T~R~U~S~T~E~E~S~~~ CHARlES STAAl< DAVID fiELDS JAMES CHRISTENSE.N

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OAl l;G MACKH PRESIDENT" ANO CEO

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ALAN RGAAD ACTUARY

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ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Coventry Health Care of Iowa, Inc.

LIABILITIES, CAPITAL AND SURPLUS

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ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Covenlry Hulth Cllr~ of Iowa, Inc.

STATEMENT OF REVENUE AND EXPENSES CO""", ~.'" - ,~

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ANNUAL STATEMENT FOR THE VEAR 2013 OF THE Covenlry Health Care of Iowa, Inc.

STATEMENT OF REVENUE AND EXPENSES Continued) , , c""~v_ PnoIV_,

CAPfIAL& 5 UMPlU I.o.CCOUNT

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ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Coventry Health Care of 10_. Inc.

ANALYSIS OF OPERATIONS BY LINES OF BUSINESS 2 l , 6 6 , • ,

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ANNUAL STATEMENT FOR THE YEAR 201 J OF THE CovenlTy Health Caore of Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART'

~ ,

Cornp,. .. -, , , . , . ,

• ,

,.

• , "lIderai EtI1I...,. •• ~II> B..,et;flO 15.031.651 " .• ' e T1tIo lCVIII • " . .,,, ~.~ "."''''

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ANNUAL STATEMENT FOR THE YEAR 201 3 OF THE Coventry Health Care of Iowa. Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2 - CLAIMS INCURRED DURING THE YEAR , , • , • , • • r_r.,

C<wnpr.~oj", - " ' (fUpr,",l&

101., __

~~ ~';'. "wo l'l\Io.lW I

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'-~~==~==~~~-+---'I-----~--~---~---+--,-+----+---t----I------I I ,e,..,., ~~ D __ ll, r_,.ar ""'" Part 2.o.: :; ~::_"oo ___ __ __ _ _____ .. J.~~~ f--____ .2~~~ ~I_--,-----.,,-{~ I--_--.. ,,---.--'~ I--_-.,,-.,,--... _-.. ".a I--.. ____ '~~~.~ f--.- >.9El.:~~ .. _ .. __ .. _~ 1---,-.,,-.. -'-: f--.. ----...

a:3 I1 __ "<tI<*lId _____ ... __ , __ ._. '--___ ~ ' 3 .I l~ "01 Q 12V:B ___ .. -lJ !l 0 • . ( Nil! _._ . ...--J .~i9 , 5S1 r--.-~ ,9.1'.~ r--.---.~ _. ___ ~ __ __._0 r···_·_-S12.488 r---........ ,B.12 .419 ___ • ____ ---..JI ___ .~ _______ ... f!

9.CIllf'l .......... De-.. 31, P"'" ~"'!ftrn p..,2 D

:.~ ~::.....,=:.:c_::::::~;------___ --I_-, __ -__ --__ -_~~ I--I--, __ --__ --'~ I--I_-,----,-!-Jl __ • __ fI ____ _ __ a 1--____ _ __ .11 1---_ _Jl 1--.. -__ --__ -,--'-: _ .. __ _ ___ .J f------- _ .. j] 03R: .. _......, f_----~p _____ ---'l l--___ . __ D r--------Jl .. ______ .. _--D ...-_______ J 1-------11 9 , NI'I ____ ._ .il r-------..Jl r--------.1I ______ .. .0 __________ 0 r·--------·D r-------. .!1 ________ -.Ji _________ -0 r-------... a

10 .laruo<I"""""uO """"'M """. _rabon ... , p<KIt~""_+ ___ _ ~ f------' 1 ____ -' f_----' -- () 1------. r--'---~ _______ -11 .....-l1 f_----' 1

11 ,~_._._f~ __ .~.~_._It'&~-_-____ '_'_, P~_'_··_f-----'4_-----',4------'+--___ -"4_-----'4------'+-------'-+-----"'4_-----'+------'1 12. I..",....,beoefi,, ;

12.1 Dir'tCl ______ , __ ... __________ .. J4 ./64 .3301 '--___ 5II.02'J.OZI "-______ Jl ____ 116.437 __________ 0 1--___ .11 ,lSIl.609 1---__ '09 .l5!i , 2tli ________ ..-11 IUJIa. ....... .... . .....,od _ I I I ----1J 1 \ ~ l-... ...... _ ma.l4l ~,W 0 0 0 0 M.W 0 12.4 N,ot __ __ __ !II)S • • ,U •• "',.. 0 0 0 0 0 0 0 l' W _t.. 10.,.",_ O)prtWOo<sno" ... _"_d

_________ J 1---------, , , • o

ANNUAL STATEMENT FOR THE YEAR 201] OF THE CovenlTy Health Caore o f Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2A - CLAIMS LlABILrTY ENO OF CURRENT YEAR

, , • • , • • " fl!de/~

~-~ .... £""IOjI .... \Ho".'a~ "~~ ~. "- ..... rIM ~vr • Tilll XIX ~~ ~'*

" "~'" , -~ ~Plon ~alta'" ~.'" ~ .. '*""-'"

I , RII_dJnProceu<l/~tI....re

\ ' l , O~---________ f_--''''' ~ lCi/l, 891 ).514 f_----+ -----f-----I I 2- FI.~ .. --"ed _____________ . ________ --0 -----------------1------- --------- --------. --------r------- --------- --------I ,! , I'!.'_CII.-a ______________ _______ --..J) --------------.---1------- --------- --------. -------1-------- ---------- --------1 ( 111M ~.«l5 ,/191 ,5'. 1-____ ~ ~-----' I-____ ~

1 Ina",.d b<.Ol UN ........ '" 2.1 , O~ _______________ . __ .. __ 9.803,&.l9 __ .. _~,2IJ.7al ~ ______ ~ ______ _ . ____ . ____ r-___ .. J n ,so.! .. ___ 3,1~.~2E f------.. .. ____ .. ___ .. _______ _ l'FI~ .. -*".,-------f_-----"f_----+_----_+----_II-----+_-----f----_I-----+_-----f-----I 2.3, FI-......ao.-d ________ f __ -1 •• , f_--"~,111 f_----+ -----+-----f_----+ ---'rro.916 f_----+ -----f-----I U , NM . __ . _______________ . _____ g .OjJ. 152 ____ U16.99l ______ -0 t-------.D ________ D . _____ ..J7I .~ .. ___ H~,15.5o!l ______ .~ __________ -1) _________ ~

3 "'""uI'll6 ....,W'I~.wfft>t:'IhldC"' ".u""~_ ..

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" roT-'LS: ~, I, Dteo= ________________ . _____ I0,2n ,4i3.5 _ .. _~.67:; . .;I1 ______ J t-------.i} _______ ., ______ In .~ ____ U3S ,I4£l r-____ •

"'-.-~---1-----' I--~~:::::: I--==::I===:" ~----'I----=;;;:' t ==:' 1- --' f-==:: "l.~.IMUI'~I\al....,.d___ __+ ___ 'ftJ .U7 f-- .111 f-- I-- a >--___ --..Jl f- IroJ 70 D 1-----"1--

_________ -1l ________ -D

9 ,~I6. r.a 5,01I.IlJ C C a m ,~ 17Z/.16-I ,

ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Coventry Heal th Care of !o ...... , Ine.

UNDERWRITING AND INVESTMENT EXHIBIT PART2B - A N L A YSIS OF CLA IMS UN A -p I Y - N P 10 R OR EAR NET OF REI SURANCE

c .. "'II,I ..... _C .. n • • "" .... "'tJlIIr N'_ ,., 0'_11/11"'"-I\' .... , , , • b\ifNlOdo. ...

~ ..... a.... OnCl~I_ OnClo~.1JIIP'114 Clo:ftl,u......,,,,, l.t.-ily Frior1D J......,., \ On~-1ho'Y.':" ~1\1lI o...tk.O&m,"",,~ :O~V~l ~31~r

l ...... rB"u,"'" do"Nll\' .... PA/>I\'tIo>, ''''''\'8&1

1. ~ ... IIO ... t.o.~:aI& .... _ ...,) 4.221 .lIf1 ___ 49.~ .09~ ! .(lIj.I.aa r-__ 4•nUe7 ~ .91 • .• 3!i

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• V.IoROr>.,.

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II. Ho .. ", . .. "".,1..ftIrIII 1 .. al 1.2l/ .m f--~. 1l3 1 ,ola o _--..J .584,493 .m.Er. .m .~

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" TO\:oI. l .... ~'O.".'l UfI .iJ15 &5 11:1 1 61 0 • 9. M~ .!..OJ 1:1n m a,s19.S>£l

ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Coventry Health Care of Iowa. Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C - DEVELOPMENT OF PAID AND INCURRED HEALTH CLAIMS

(000 Omitted) Section A _ Paid Health Claims - Hos Ital and Medical

\ 2 3 ~ 5 V_<l1M1:tol_W. .. I..,...,..., 21)09 2010 lOll 2(llt tOll

1«I.~7C ~ .S7a ~ .61C 149.SI[J 1~. S70 2. 2OaI _____________________ . _________ _

3 20\0 ~ 201L.. .. _ .. 5 lOt)

Section B Incurred liealtl'l Claims - HOSDltill ilIl'I!:! Medical Sumo!o..mulolw. HOOC""""",," Palde"" CIon. lollll loly,

a..w. r.t __ od _II...roj .. POOl."" 1tIo ..... ~ClJ.. • f "" '" 'I.", , 201S

U S;' 2 20011 !.24' 7a ,4&1 ,a , ~il 8.010$1 1a,"1 ), 20\0-.... ________ .. _ .. __ .. ____ .. ____ .. _________________ .. _ .. ____ .. ____ .. ______________ .. __ . ___ .1),L_ .. _ f----.. -IIJ ,,30 f--___ -19.613 .... _ .. __ 19.til:l ._ .. ____ 19.11tJ

, 20" 1.1.. 2.8.J! 9l.1~ f------c '.I4i! s, 201L. .. _____________________________________________________________________ .. __ . ___ .J.IC ____ r---.tR---- t---..... bl...-,..----___ .. _ .. 46.l!il! ______ .4.5 .0(1

6, alll 1):1 III ~il HI su~

SaCllon C -Inc urred Year Health Claims and Claims AdJustmenl EKpanlR Ratio _ HOlipltal and Mi!tdlcal , , , • , • , • • " 0.. . ... 0100'" To"'o-..-.:I "" .... "'., .. 0 .... YIN" ",,,,1\dI CIo ... )O<ij.I.".."., -- linpo'd CIo'flS "'"-, Pi"")., ....... .. EMNd ."" C I>"'~ "'- (Col l'l! ~~" (Co l.Y"l 1

CIO""O lito .., 1rUJu • ...", E-ro,r:--~';'!'a- (clII !r1l ", ... 1"""",, PIwn ...... r~ a ..... ~ - ~-. ,-, 01 . >3 ,.- , 00' '"-1 . 2~ __ -- -- -- -_. ". ~ .'-!I •• lUll ., 8.4&' ,., , lO\O-.. _________________ . __ .. ----S7,5/l'> r----J~.6!ll ._---- ______ ........!l .C ____ .. -19.69.1 r----"".1 ------------- ... ___ J9.M _____ .. ..lIll , 2011 II~, CJ\ J.141i •• .,. 1.0 ". , ..

4 , :011-.. _______________ . __ .. -'~.I n; ____ .. ~.oce -----= ______ ........ll 0 ____ t5.00! f-----~- ! ----·c=_ -----"'" t-.. ___ •5.0Cll . ___ .. ..JO.l ~ , : 013 n ,41\ . ,., 4.773 ... \J ,m 15.2 ~.Ull • . . ., au

ANNUAL STATEMENT fOR THE YEAR 2013 OF THE Covenuy Health Caore of Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C. DEVELOPMENT OF PAlO ANO INCURRED HEALTH CLAIMS

(000 Dmlttad) Ser::tton A - Paid Health Claims - Qentll Onl

, "'" I. p""",_-________________________________ f_--;;;--'·D 1---.... .. Jl _.... ..._0 .... .Jl

2. 2009 _ J 3)10_ ••• ________________ .... _ .... ___________________ .... _ .... _... ... ________ .--.m .... _ t--.... .Ill _ .. . ~. alll .. ...1.1"-. .. _ t--... n,l. .. - _ ... . 5 3),L. •.. ., '"

Seclion B-Inr::urred Heaoltn Claims· Dental Only

'"

. JlI ~f---__ -__ --_-_ _':f."

.. lSi ~... .."!II ,. ,

20,3 .. .. ...Jl

I P~"'_. ____________________________________________________ ..... _ .... _ .ll t--..... - ... ~ _ ... __ .... 0 r-.. --... ..Jl .... J 2. lOOQ .. .... .D t--.... .. .. 0 _... .. • .0 ~... .. .. .Jl ..... ...Jl 3. 20'0 III 31 II 31 • . 20" .J:J.'L...... I---... ~n... ...191 .... .1!Ooi ....... .1(\1

Setllon C -IntuITed Year Haalin Claims and Claims Ad u&.lmant Ex ense Fbtlo - Dental Onl , , , • • • , • • '" 0-'11",.",,00 ... Toto! QaIm$ .,", "4<e_ 0_

V .. II"' .... 1lt:II CioIo" Mju_ ... n, "- ~e>a"CIo"'. Mru ..... M p_..",. .... ,. Eal'l ... d.r>dr::~.",. "'- (Ga, M) ~-. (COl Si"li A1/oJ_' E>o:>Irul"QJOOId (Cel Q/I I

.. ..,.1 ..... ....:1 -,-,,~ o • • -~ Pa .... nW; P.ran , - •• • ' .. Gal 5-0 7' P.,aM

1. 200II -- ... ..1J .- ... .....lI --- -----. .. ......1J 0 .... , .. -----1) 0 --- --- f---- ---- --- ---' --- .. .--0.0 , ,,, '" .0 " 0 ,. .0

3. 2011 ___________________ ~-----"

1-_____ ._1904 ------ _____ .. -'1.0 ._-----"< __ .. .-2Ol.~ ----- 1--------___ .... 1511 ____ ... 206 ~

• 10'2 ,. .0 '" ',>0 '" "" • ,,, ,. 0.0 .. 0.0 ,. 0.0

ANNUAL STATEMENT fOR THE YEAR 2013 OF THE Covenuy Health Cillre of Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C _ DEVELOPMENT OF PAID AND INCURRED HEALTH CLAIMS

(000 Omlttad) Settlon A - PaId Heallh Claims· Federal Employees Health Banaflts Plan Pramlum

I 2 1 4 5 lOO'J 2tlla 201 2012 2013

I. Prior _____ 43.1J11--_ .. __ ~J.20l __ .. _ U2(13 .. ~J.2Cll __ ~UOJ

, . """-------------------------------------------r---;;;c ·I1 .!),IjJ 12.178 IV?! 12.17~ 1-___ 12. 17~ J allO-.____________________________________________________________ _ __ pL ___ 1-------21 ,d5 ____ --'!.14.1 ~----"a.l(l _.Ja.74.1

: ' ::~ - _.lXL ___ I--___ ~:L-- ---- I ___ .Il ~--- 1i~~ --1~:-;

a, ~m til m XU XIX lO.m

Section B • Incurred Health Claims· feder.ll Emllloyees Health Beneflt& Plilln Premium

\ p~"' _________________ _ ___________________________________ ... ________ '8 ,311 1--_ .. ___ I~ ,a9~ ____ I ~.8l\oI r------I ~.&901 __ IU91

2. 2tlOQ.~======================================I=--==.j--§-='~1 ~."''41-==--=--;-:::i'2 , 17& _____ 12.17S ~-----12. m _______ 12.17a 3. 20'0 . ~,'16 .!.7.:.1 5.i41 ,ill t . 20" __ .. ________ . _____ . ____ .. ____ .. ________ .. ____ .. _ .. __ .. ____ .. ____ ._ .. __ .. ____ .. ____ .. _____ . ..IX L ._ .. _ I--_ .... ~II. .. _ .. ____ ._ .. _ ... _O .. _ .. __ .. _ .. _..1l __ .. __ .. _ .• .-0

5. 20" I U 12.219 Il2. ,01 6. 21),3 xn III III HI: 11.l\\

Section C -Incurred Year Heallh Claims and Claims AdluSlmenl Ex an8e Ratio _ Faderal Em 10 HI; Heahn Benefit .. Plan Pramlum

• , , • • • , • • 10 a . l",.rooOon, 'OUII Clam. .,01

""Ulrnet>I 0_ V .. III1" ... ~tI> CioU" kIju ...... , ...... ~oa" CIo .... Mru ..... M

p_Utno .... ,. Earl'OlOd.rooCIo·",. .... - (Coil' M) ~-. (COl S/"IJ ~1iJ_' E>I>I_'"QJ, ... d (Cel Q/ll ...... ,""""....:1 -,- .. ~ o • • -~ Pa .... "'" P.~" , - ,., • • ' .. ~., P.'GeIII 1. 200II -- 19.2.15 .. - .12.178 .. - .. _ ... .. -----D O _ .. 12 178 __ -----t.; .3 --- .. - f---- .. ---- 12.176 .. - _ .. ~l.3 ,

'" "'" .,. •• '" lIS.'; B. 741 1155 3, 2011 ___ . ____ . ___ .. _______ ~------' 1-------' ------- _______ -".0 ._-_ .. _-, ___ .----1l .~ ------ 1_-------------' ______ J a

• 2Q,2 lUSJ 13,1Ci1 .0 13 .1 01 BU 13,101 ., • '" '~ , a!kl lQ,m 0.0 'IJ .. 57l ••• m 11.)51 1~ .2

ANNUAL STATEMENT fOR THE YEAR 201 3 OF THE Covenuy Health Co.re of Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C . DEVELOPMENT OF PAID AND INCURRED HEALTH CLAIMS

(000 Dmlttad) SectIon It . PaId Heallh Claims· Medltare

I 2 1 4 5 ~ Mia 2012 20ll

I. Prior ..... _41.71. 1--..... 47716 _ .... 4/. 71E .. 41.7 1~ .. 4/ .71/i

,. """-------------------------------------------f---;;;c~~.~) !f.IS .99i ,Q9l I---~ ... J 2010-. ••• ________________ .... _ .... ___________________ .... _.... .._.m .... _ t--.... -21 ,d5 _ ... ---2!.I(J ~ ... --,a.l(] • .lS.I41

4, 2011 .. ..:o:L .. _ t--.... UL.-_... 19.461 ~ ... -1:).301 • ..23.39 5 20 ;1-, I I 4 OIl ~

Sectlon B -Incurred lieatth Claims - Medicare

\ P~"' _._______________ _ __________________________________ ..... __ ... .....1> ,'11 t--..... ~.IJI _... 1'>,731 r--... --J5.7J1 • ..15.IJt

2. MOQ.~======================================I~ .. ==.j .. ~--;=-"":""~9+1-==--=--;--"~.993 _ ... _ Scl,9Qe ~ ... -..0(1.9!'i1l .... _._~.9$ 3. 21) ,0 . ..9OA ~.I'-l a ,14l ,;43 ~. 20 ,,_ ... __ .. ___ .... __ .... _ ..... _ ..... _____ .... __ ..... __ .... __ .... __ .... _ .... _ ..... _ ..... ______ .J:J.L.... .m' ..... ___ .. --2U,,. ...... _ . .n.8'J7 ...... _ • .l;'l.3&' 5. W'? I U .II-tl 6.2-«l 6. 21m xxx xxx III nx 29.19:1

Sec:llon C _Incurr.d Year Health ClaIms and ClaIms Ad u .. tment Ell .nse Ratio _ Medicare

• , , • 0 • , • • " O Jol",.rooOon. Toto! Qa\m$ .,",

""'Ulmer>! 0_ Vall " " ... ~ti>

CioIo"Mju _ _ n, .... - ~oa" 0. .... Mru_M P_....". .... '- EMI'!6d.rooC~·"'6 "'- (Ga, M) ~-. (COl Y1J A1f,J_' E>I>I_I"QJ, ... d (Cel Q/1I .. .,.,n"",.... -,-.. ~ o ",.P - Pa "..ntr; P.raM , - ,., , • ' .. ~., P.IG6II'

, . 200II .. ~l .m .... • ..;:),9'iIfi .. - .. _. .. .......!l 0 .... J! ,o/.Ia .. ---<e.0 --- .. - f--- .. -- _ .. --"O,~ •.. ...J!! .O , '" '" a./(! •• '" ttU a.7oll • 3, 20', ___ . ____ . ___ .. _______ _.--'47,9Zi 1-____ .j~.J/i7 .. _--- .. ___ .. -'1.0 . __ ... .Jl .3f!/ ------", ----- 1_-----_ .. --23.3€1 ____ .. JJ.1

• 2Q,2 ... . ~«l •• . ,~ ~ . .,. 9.' 0 '" ll900 26.02:1 ., '.' ;ti ,~ n.9 3 d'S Q 311. 1<16 .. ,

ANNUAL STATEMENT FOR THE YEAR 2013 OF THE CovenlTy Health Caore of Iowa, Inc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C . DEVELOPMENT OF PAlO ANO INCURRED HEALTH CLAIMS

(000 Dmlttad) Si!ttion Ii. - Paid Health Claolms - Tltla XIX Mi!dltald

1 2 J 4 5 lOO'oI M IG 20 1 2012 201)

I. Prior • ... 16.MS 1--..... 16 ,085 _.... 16 .0as . 1~,0a5 ..... _

,. """----------------------------+--;;;----"" '" '" f---~'. f-----I J 3) 10_._. _________________ ... __ ... ___________________ .... _ .... _... ... ________ --.m .... - t__.... I.m _ ... __ t .;t!, f--... .'. ~ .... _ .... _ ~, 3)" .. ".n:L .. - t__ ... ~:L---... I .... 2 f--... .. . ..2 -.. .. .. -5 3). L. ...

Seello" B -Incurred Heaolth Claims .. nUe XIX Mi!dicaoid

1 p~", ------------------------------------------------------.. --------t__-.. -------. --------r--------- ---------!: :~:::::==============================~-=::;;---:t---.t-----------.--.. ------ f---------- ---------. , 3) " .J).L._.. _ .. m: ... __ __ .. __ __ .. __ 5. 3)" I U

'" Secllon C _ Incurred Year H&allh Claims and Claims Ad ustment ElI:eenl>& Raile _ Title XIX Medltald , , , • • • , • • 10

O-'ll", ,,,,,,Q';,,, TO!.III Caitrto.,OI --, 0 _

v ..... "' .... "'''' Cio '"~.fft-.I!! ...... U ...... o_ ........ .... 111 p_..",. ....... EM",d . i>d 0 ..... [ "CO ..... (Col JI ') Piol"'"nta (CO l "" 1 .o.q ..... ~ --- (Col 9111

..... , ..... ....:1 1ft"",.,.. . ~ 0 -, -- -- ~-, ~ . . , _ . ~ .. ,', - ... ~~.

I, 200g __ .. _--16-5 _ .. _ .. - --~ ~ .. -. ---- I- - ___ .J] 0 .. __ ... ------" -- .. __ ..J 0 -- .. _ .. - .. _ .. .. _-- ..- ._ .. _ .. - .. _.0 1---- _._0,0 , "'. • • C C., 3. 3)1 ' _________________ --_ .. _---. ---.. ----~ ~-------- t----.. ----...a-o .--------~ ________ ..J.O ------------- ._---------_. _ .. _-----, 1------ .0,0 .. ZOl 2 • co C • • ~" • •• • ••• • • ••

ANNUAL STATEMENT fOR THE YEAR 201 3 OF THE Covenuy Health Co.re o f Iowa, Inc,

UNDERWRITING AND INVESTMENT EXHIBIT PART 2C. DEVELOPMENT OF PAID AND INCURRED HEALTH CLAIMS

(000 Omlttad) Se ttlon A. . Paid Haahh Claims - Grand Total

I 2 1 4 5 ~ 2010 lOl 2012 ZOll

I, Prior ,. __ ..J3U7~ 1--_ ... _--25Ii,87~ __ .... ~,e7~ 2!,E,&lJ .14cl.!oIS , . """------------- ------------------------------ r---;;;I:g.206 1oC2.S19 1~2_~19 '-I2.S19 I-___ 1~1.6~ J 1Il1O-______________________________________________________ ________________ _ __ J:n _____ t------ '15 ,W _____ IJU~ r __ .. _ 11Ul5 _l.i7.3 Wl ~, 1011 ._ . :O:L ___ t--_ .. _UL ____ .. _ ~ , I17 ~___ 1I6,71ll _116,70; 5 <alL .. __ I I ,8M ~ ,$1

S et lkln B _ Int un-ed Heal th Claims _ Grilnd Total

~ 2010 ~. 20 11

y .. , ,, w>~ L.aI.>M_"'~

5. 1012-___________________ . _____ . _____ . ______________________ _

8. 20Il

Setllon C _ Int urred Year Health Claims lind Claims AdluSlme nl Ex , , , • • Ci.oirlla r<l Oo ...

-"<Ii"''''.''' y ... ~In'"~i<.II CIal<T>A<I~~\ .~-P..."..."."",roo Ear.-..d,,"" CiII'u .,... (Co~~) "".r::: • , _ .. "" E."...., a..,.,,~~ ~-. ,-, , , .. ~1.lia W,6.51 a.o W.651 , 201~_ .. ___ .. ___ .. ______ .. _ .. _._._,49.!WoC f- ___ 1J i .3'O ---_ .. --" .. __ .. ..-J.O . _____ 11'.310 , '011 ._. t,jJ . Q~ f--- 116,101 -- ---" .. ~O _ .. _ tlE.101

• 2012-.. __ _ .. -- - 1t2,26! '." .0 "' • '"' IJI'!.419 &5.;;00 S.Xla .. , .'"

. , 2 S 4 5

2010 lOll 2012 20'1 t~.tn 130.622 1l<l.D22 1.3(1,6» WI.tiS1 Wl.iS tH .W t4!.O&'

_ .. __ Il~ , 7'i1 __ .. _. 101 .:100 1lI.1a2 _Il7,;OO ~ 11 1,730: "Ul1l-___ II~ .}07

----~~----- t-----~:~---- ----::~-- ~--- 11.1 J5.~ ')~::'

ense Rat io _ Grand ToUI • , • • " 10.0 .... ""

0_ Ur>~tI Cio m. IIdjutlm .... ,

(Co\·5111 ~oI,,*,' E"4> .... '_a (C" , ~I ~e~ .. ,,- ~ •• CeIi.5-<-1>a Ft.'''''"'

•• • I ~U:.s .. ____ ~ a ----_ ... f---------' _____ IJUWl _____ 31 a

__ ..--!I .6 ___ __A f----- --~ __ 11001 -- __ ...!I ~ , . .., " is .S .... " I,:',HI:\ us

ANNUAL STATEMENT FOR THE YEAR 2013 OF THE Coventry Health Care of lowa.1 nc.

UNDERWRITING AND INVESTMENT EXHIBIT PART 20 AGGREGATE RESERVE FOR ACCIDENT AND HEALTH CONTRACTS ONLY . , , , • , , , • •

F..,.,001 """" .. t_""",,, £",,10\'-'

( Ho~""'ll Sa-~" -"'" IIU!!I I!ono!J f$ IlV_1 faloXIX ". ~ ... - ,' ~."" ,~ ~ .... -~

~,

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" RIolroo"' ...... ....,td

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" l.~ Ne tll". , "" 5/.195 ~1 . 1l9S 0 " • • " " •

DElAtLS OF MITE-IN !;

~, ---' .

~" · . ~, ._-, f-------,-" .. _ ..... t1f ...... II"OI"ii_""' ...... 5 fn. "CNWII""'_ . .. ____ J ________ -!l I-._--.. -D

_ .. __ .-' t-. __ .. ..1> _________ ....!J r--------....ll ____ .. ____ J t-.-_.-'

"" l"0UI .. IU,.. .. 0501~ .... -" .. Ur>.5.ot>_ " • " • " • " • " 1101,

1102,

"03

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UNDERWRITING AND INVESTMENT EXHIBIT P,ART J - ANALYSIS OF EXPENSES

~ .. , , , , , ~ -,- ~M~

C"",oInorI"", .... JI' ....... ~<Imonosnl .. ~ 'n ... "",,"' , - ,. - , ,. I. 1'1.." (I ___________ 1« OOC"s-f"Y <'10..., _ro\U _ . ______ ._ __.---lI9.W !--_..-l fil) .Z5Ii 1-______ t---._...2!I5.M'I

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J. 1::""",",_ r-' _ .. ___ .. _ .. ____ ~ 0 ....

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4. l..,..-...... ~_.,., ______________ I------j_---~ ... l--~16.m ~-----_j---c4(r.lIoIl

5. 1::....,;_ ...... O<~ ..... _. ____ •• ____ ••• __ ._ •• ___ ._ •• _ ----- -f----- -f------ j----'

1. l"'.""g """"" ...... ----------------f---" ."" ~---47 ,5'i2l--- 16.121 ~-----_j----'" ,9T4 I!. ..... _0\1 ."" •••• n .... ~ ____________ . _______ _

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11. (}£cU/>*f><Y".d_ .... ~ ___ .. _ .. ____ ... __ . _______ _ _____ . __ +-._..-l21 , m 1-- .. ___ .. _ +-. ___ J2T,I~] ll. EQIoipm",," _____________________ _

__ __ .7 . • , . f--_..-1. 60Z I-------.t-- . __ '5 .DI!

13. c_ ", deproc_ col U)P oquIpmo", ... d - ... -----I__-----+-----_j----"",. ~-----_j----" ,. 14. 0" ........ _ ~ ... ~ EIiP, ........ """ __ • __ . __ -'~.I15 __ .. ______ +-._---1IU, ' Z( 1-- .. ____ .. _ +-. ..1. 438 .259

1~. Boto/do., WI ...... """ ~..... . ____ !I2 .f.il _______ +----19.015 1-______ t-- . __ ~! ,HI

16. 1mutar><e,~ ...... """*e ... 'e ___________ +-----_j----., "'~--- 1 5.6.13 ~-----_j---- ?i ,O '.

17. I::~""''''''' _ <""''1" __ ._ .. _______ .. _ _ .. __ .. - _____ . __ +-. ___ ._. +-.. __ 1' ow.; 1---. __ l~ ,W 16. 0""", oeM«> _ •• _ foocoa. __________________ _ ------ -f-------- t------I-----' 19. lI_utMmenlS Of _rod 1', .... ________________ 1-_____ _1_------1__--- 2II>,V!)I~-----_j----".2115.2/a 1

:10. R ........ ~ .. . "'" "";," "",''''........,,,,, ___ .. ____ .. _ . ______ .. _ ------ -f---- - j- -- - j---.

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~~ , SIzoIo """ ""'"' ....... ,'" ....... ----------1--------U~ S .... pr.mlwn"""'. ____ . _______________ I__-----+-----_j----",,~ ~-----_j----'" "' ~3 l '1"'9'1'1\'>0' 0I.IhD01tY l....,..,. _ .... ""'. ________ .. _ .. ____ .. _ ------ -f----- j- ---- j-----' ~J ~ Poyral laMto.----------------f------_f----' . ... f----"', m f------_I---.... , l.~

l15 01/00;"(", .1."",,'1_""_."" '00l-' .. "., ___ .".1__-----+-----_j---- I, m 1,11;\

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~. M'...,..;i .... ....,\<0 .... "'" .. p......,.. .--------------f----'~"'.'m"'-I_--..J""'·,~"-I_---.""~"-I_-----''t---' .. ''''''''1 ltI. lO ... e~''''''''''''(U ..... ' ~1~) _________ I_--,.&5II,!I!IO ~.l!W g,;, f----10,W .2ffl 16 41lS _--,5,511,I2S

n . l ...... ' 1"""'" '-"'PO", 0e<emb...-~1 .''''''''' 1<""' ... ____ ... _ . _____ 110 ,000 ________ +-_..-J ,l 2e, 1)5O 1-_______ t--.. .J,dj5JI5CI

ltI. AD<Ia."""..,..""'""'De .. _11 , """' ~ ... ' ______ _+-----'12.CIQ) ______ .....JJ f-._.-2.Z5Il,.w6 I-------J 1---_.2 . .'6~. )4(i

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2.~96\ .'" 2<;~1. ~' r.<1I lI .n ... " E.<POf1< ... ' ______________ I~ ___ .. ·m f-----"I~ .~ f---- 81,Ul 1------_1----'" •• 1511l. ""'_I 01 Eo<fIlIML-.. ______________ . ______ _

1503. In l .'~1 0' ________ . _____ . _________ .. _ . ______ .. _ ------ j------t------ f------' .... _---+-- ----- j- -_ .. - j-----'

2S9I!. Sumf?oW)'<>!,......"'ong-."""l ... 2S.""''''''''''''"' _ __ f _____ ~I_-----''f-----' I-----J f-----J 111 )II; aI,SOiI •

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'" ,. • , .. , . .. • , ..

EXHIBIT OF NET INVESTMENT INCOME

~.1~~~";~-==-------------------------'-- r.~·-:-:-:-:-=-:--:-:-""'~"'~·i OIhe.rIw:>ndo'''''-''''''i (00). 124 .62:5 1IoI\d. of .1Iii.t •• _____ ______________________________________ r.\. ___________ • ~ ... "" >lOde. ("~_T • • ) ________________________________ . __ /01 .•.. ________ ..• Pr ........ _. "'-." .. _________ .. _______________________ .. _____ .. _____ . /0\._ .. _____ .. ___ •

C~ ....... (UrI",~~:,:":~:"'.::=========================j ________ • ~ Ok><Jo;.<>/.IIII, • .,. ~ _______ • l..IoItGoge "'", _ _ __ 1>:). ____________ _

""oJ .. _ .•... _____ ... ___ .. ____ .. _______ .. _____ .. ___ ..•.. ___ ..•.. ___ .. __ «1). _____ .. _____ ..•

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, . ___ .-Jl,!6'I

MIi .627

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._---_. !rIl 711

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D'lDt . ~,.

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• •

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(11)1""""''''' ' __________ .-'O""_.n_ . ndS ________ .. "_""~ """"

(II 1n<Jw<j.,. I ""loft""'''''' "" ,eo! ......,~ ond S d<~""" "" ",nto" ;". ... "'" _ .

EXHIBIT OF CAPITAL GAINS (LOSSES)

l .... IR._ C.piIooI G .... Cl_)

Co"""". t . ~

o.aoe·'" U"",_f"'"'9/1 &<.naoec C"'"'-" ~~

t . u.s Goo_"'''''_ ... " " " ' " "

S .... H .. «"I'/rolnU.s. ,.. 1.0001 (~ .90!2) <;I) l 1Z

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Pre ............ ~. 01 .mi.,.. 0 C""""",,..-. ~""'I _________ .. _ . ______ .........0 ____ ._~ ____ ---' __ .. _---0 _____ •

", ,-_ ... _... I-:===;"-==~I-==::::I-==:'. l . r..IonoJo~a 0- r-- r-- r-- r-O. ""III _ __--II _~ _ __---0 _________ .. _ .. ___ •

~ . em ...... 1oano .. , .. C. .... , ouII ~er>b 1 M............" ... """""",IS .

o.. ..... t .... """"""" ... 0 ................ _ .. _. _____ . _____ _

g . AQ9""l'" ........... "" _"'" g .... C\OUO.) IQ. T_I ..... g .... 1<1....".

rn:TAIU Of WRrr~~NS

------- .. ---.. -- --.. -~ f--.. ---' -----. _______ -----1) _____ -' _____ ---' ____ --D __ . __ •

• 61 .<a.l •. W SII .m •

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11903.

.--------------- ._----- ._----- ------' -------------

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------- ---------.. ----' 1--,,--,,--------______ .........0 ________ ~ ______ ---' _______ ~ ______ •

• •

15

EXHIBIT OF NONADMITIED ASSETS , , , Cl\II'Qt" TOil' c....-y .... r_ PtiorY_T_1 Noo.<lmlned .......... ... """ ..... _ ....... .. Il0'0_ ........ C..r. 1 _C". ,

, 6<w\ .. rS<IleduI< C I--. 0 , SIO<Io, rS<Jo_w Dj:

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l . ' F ..... ""' .. ~ 0

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" Pr."""",. __ •

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" """""" ..... oquI_ .... ~_ <Me.......".,.. .... R2-04

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~ Re""'_._I*C"' . ..-........._~ "

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~ ~911"'11· ... _I0! __ ,.....,_s ..... .'21 m.a!02 {161 .!i65I ~ '_ . ... "e.~""'_A<-.~~A' __

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~AA.S DFWflflIO·INS

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"ro ". s-..v"',~"" ....... !Gfu..e l l_0 __

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16

ANNUAL STATEMENT FOR THE YEAR 201 J OF THE Covenuy Health Caore 01 Iowa, Inc.

EXHIBIT 1 • ENROLLMENT BY PRODUCT TYPE FOR HEALTH BUSINESS ONLY , , , .

p, Yur ,.. ... IO""n61 ..:or> Oua"", 11> rIf, • ~IYn'

fIooo:t. ..-....... a_ 0r0ar>1uI""'~~~~~~~~~~~~~~~~~~~~~~~~~~_r ______ ..J2,O:)9 . ______ ...lI.~49 1---------'4.152 __ .. _--lC.'la1 r----~-.~ , 8I:G _____ .. 40-1.376

2. F<"<I ..... ,.st.MaIorgorli ... t\O... !I f_~~~~+~~~~-f~~~~~f_~~~~+~~~~_I 3 "'fIf.~ ~det01l"".llIII<I~'--.. __________________________________________ .. ____ '"-_ .. ____ .. _. ~ ______ .. __ . __ .. ____ .. _. .._. __ .. _ .. ____ .. __ .. _ .. __

• PolI>lof50Noo..~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~__t--------, --------- t------------ --------- r---------~ ---------3. IM~~o.~'~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~f_~~~~,f_~~~~-f_~~~~-f~~~~~f_~~~~+~~~~_I 8 ~_ ... ~ .... Ior ctl>tfl"_ ofl:u."" .. __________________________________________ -..0 . __ .. ____ .D 1----.. ____ .. 11 __ . ____ .. _.0 __ .. ____ .. _J .. _ .. __ .. _ .. _J

1. TCII I J2.m 31 .949 .l..l152 J.I.'lA1 ~.Ml .0...376

DETAILSOF 'NRrTE~NS

~', -----------------------~--~f__--~~----f_---f__--_+---~ 0!I01 _. ______________________________________________________ .. ___ --1J . _________ .1-_________ . __ .. ______ . ___________________ _

~, ~--------------------------------------- --------, --------- t--------- --------- r---------~ ----------0611 •. s..nrnA')of"''''" .. ".,Q''''"'''"''''!OrU\~ .fmm_I'>OO~~~~~~~~~~~~~~~~~~~~+~~~-' f_~~~-' f_~~~-"f_~~~-' f_~~~-" f_~~~-"

0!19~ 1 ..... LJt>o.D6011hrou CECJ \usOOll!)(u ... elObo .. o o o

NOTES TO FINANCIAL STATEMENTS

Summary of Significant Accounllng Poifties

A. Accounting Prachces

B.

The accompanying stalUtory fiMndal slatements of the Company have been prepared in conformity with accoul1ti'1g practices prescribed or permint!(! by the Iowa InsuIsnce Department1. The Iowa Insurance Departrnenl recognizes only STatutory accounting pra(1tces pre!'.criled or pennined by the Slate of Iowa for determming and reporting the financial condition Bnd resul1s of operations of en Insurance oompany, whiCh i/laude accounting praCticl;ls and plOcedures adopted by the National Assoch:lhon of Insurance Commissioners' r NAte") Accounting Pf}jelic.es and Procedures Manu!'!1 rNAte SAP"). The Company's net income and capilel and surplus as stated on II NAte SAP basis and on the basis 01 practices presuioocl or permitTed by tho Slate of Iowa were the sarna as of and for the years ended December 31, 2013 and 2012.

The Iowa Department of InsVrance recognizes only statutory accounling practices prescribed or permittad by the Slate of Iowa for determining tlnd reporting the fW'lancial condition and results of operations of an insurance company. 101 determining its soillflncy under Iowa insurance laws. The National AssodatJon 01 Insurance Commissioners' (NAIC) Accounting Prllctic.es and Procedures Mllnual (NAIC SAP) has been adopted as a component of prescnbed or pemlJt1ed practices by the SIal/! of 10wlI. The Stale 01 Iowa has not adopted any prescribed accounting practices Ihat dttter from Those found in NAIC SAP

The accompanyirog statutOI)' rtnancia l statements helle been prepared in conformity with Slelulory Al::c.ounting Pfllctices ('SAP") and are not intended 10 conform with U.S generally accepted accounllng princlples ("U.S. GAAP"). Significant variances between NAIC SAP and U.S. GAAP are as fOllows:

Certain assets deSignated as non ·adrrutted (e.g. recelllables greater than 90 days old, prepaid ass.ets, intangible assets, certain amounts of property and equipment, notes recell/able and defelred taxes) ale excluded Irom the balance sheet by a direct chtlrge 10 surptus,

Bonds generally am staled al amortized cots, axcept for bonds thaI are ra ted by the NAIC as class 3·6 which ere reported !IS the lower of emortlzed cost or fair market value.

Deferred lax assets and liabilities lire determined and admitted in accordance with SSAP No, 101, Incoma Taxes - A Replacement of SSAP No. 10R and SSAP No 10 (,SSAP No. 101'). SSAP No. 101 became euthoritative guidance for accounbng and reporting of income taxes beginnlOg January 1, 20 12 and replaced SSAP No, l OR, Income Texes - ReVised, A Temporary ReplacemenT of SSAP No, 10, Changes in net daferred \aX assels and liabllkies are reflected as changes m surplus. Undar U.S. GAAP, changes in such asselS and liabi lities are renacted in nat income. In addition, statutory accounting requires an admissibi lity test for deferred tex assets, whiCh is nOI r&(Juited under U.S. GAAP.

State DI 201l 2012 Domicile

(I ) Nel Income Iowa stata basis IA 6,323,285 9,420,43J

(2) State Prescribed Practices (Income): Depreciation of fixed assets

(3) State Permitted Practicas (Income): Depreciation, home offICe property

(4) Nellncome, NAIC SAP IA 6,323,285 9,420,433 (5) Statutory Surplus baStS I. 21,069,639 24;216.402 (6) Slate f'll esrdbed Practices (Surplus):

Goodwill. nal: F)xed Assets, net

(7) Slate Permitted Practlces (Surplus) Home Office Property

(8) STatutory Surplus, NAIC SAP IA 21,069,839 24,216,402 Use of Estimates In the Preparation of Ihe Financial Statements

The preparation of finanoal statements in conformity with Ihe Statutory Accounling Principles requTres management to make eSTimales and assumptIons 1hat effect the reported ameunts of aSSElts and liabiflnes. It also requires disclosure of contingent assets and liabiliTies- at the date of the fmancisl statements and the reponed amounts of revenue and expenses during the period. Actual results could dlffel from those estimates.

C, Accounting Policy

The Company appl ies the follOWing siglllficant accounting poIides

Health premiums ere earned ra lebly ovel the terms of the related insurance and remsurance oontrtlcts or poliCies. Expenses Incurred in connection wHh Bcqumng new Insurance bus WIess, indud:ng acquisiTion costs such as sales commissions, are charged to operations as incufled.

In addition, l1]e company uses the foUowmg accounting pofraes.

26

Inves.lmenlS: 1. Ca5h, cash eQuivalents and silort·lenn fnvestmcrrts

Cash and cash equivalents include III highly liquid mSlluments readily convenible to C8!'.h with a maturity of three months or less from the date of purchase_ Short_term Investments primarily consist of investments purchased with an orlginel maturity of one yellr OJ less. The (alTYlng amounts of cash and cash eQuivalents and shon_Term W1vestments reponed In the accompanying STatutory Statements of Assets applOKimate faii value. Drafts thai have not been presented for peymenl end remain outstandil")g at the balance sheet dare are reponed as a liability in the SlatulolY STatements of liabilities, Capital find Surplus

2. Bonds Bonds, whtCh include sp&Ciel depoSIts. are eamed at amortized cost except tor those bonds with an NAle designation of 3 through 6 which Ille reponed at the lower of amortized cost or fair valuc_ The amount reported at fair value IS not material to the financlal statements. Bond premiums and discounts are timor/ired using the scientific inlmest methocL When QlKlted prtces in active ITla(kets for identical assals are available, the Company uses these Quoted market prices to determine the fair value of bonds. This is used pnmarily for U.S. government securities In olher cases whare a quoted market price for idenb.c&t !lssets in an ~ti>.le marXet fs mtller not available or nol observable. the Company eslimates toir values using VAluation methodologies besed on aveilAbie and observable market [nformaUon or by using a matrill' priCing modeL If qUOll!d marXet prices are not available, the Company determines fair vakJe using broker 4Uotas or an internal analysIS of each mvestment"5 finantial performance end cash tlow protections. The Compenv had no Investments where fair value was determined using brokel quO(as or an intemel al18lysis 01 financial performance and cash flow projectionS at December 31. 2012 and 20 1 I Bonds Indude all investrr"lents whose maturity IS greater than one year whan purchased. The Company periodically reviews its bonds 10 determi~ whether A decline In lair vnlue below the carrying value IS other-then temporary_ For boncls, other than loan·backed end structured secunbes, anothel·then. temporary impairment ("OTTn sha. be recorded it it is probable that the Company will be unable to collect alt amounts due according 10 the contractual terms in effect At the date of aCQuisilion_ Yield-related impsirments ere deemed other-than-temporary when tha Company Intends 10 sell an investment at the reporting dale hefOle recovery of the cost of the investment Dadines deemed to be onl are recognizee! as reat1zed capital tosses. For 10an_Dacked and structured securities. the Company records onl when the fair value of the loan backed or structured security is less than the amortized cost basis at the balance sheet date end (1) the Company intends to sell \he. Investment, or (2) the Company does not have the mtent end ability to retem the inV€stment for the time sufflclenl to recover the amortized COS! basis. or (3) tha Company does not expect to recover lhe entira amoruzed cost basis of the security, even rr It does not intend to sell the seCtJrity and has the intent and ability to hold. If 11 is determined an onl has occurred because of (1) Of (2), the amount of the OTTI IS equal 10 thl;! difference between Ihe amortLZed Cosl and tile fal( va lue of the seruriry at the balance sheet date and this difference IS recorded as a realized cap-ftel loss. If II is determined an OTTI has occurred because of (3), the. !!mount of the onl is equal to the difference betw&en ltIe amortized cost end the present value of cash flows expected 10 be collected, discounted at Ihe loan-backed or slrucrure(! securlty 'S effective interest rate and this difference is also accounted for as a realLZed capHelloss. The Company analyzes all relevant facts and d rcumstances for each I1vestmenl when performing its analysis to determine whether an OTTI impairment exlsts _ Among the factors considered in evatuating whether e decline is OItler·tnan-tempOItlry. management considers wtlether the decline in f!llr velue results Irom a change In the Quality of the investment security Itself. whether tha dedine resu lts from a downward rnovemllnt In Iha market as tl whola. the prosP!Jos for realizing the carrymg value of the bond based on Ihe Investee's current and short.lerm prospects for recovery and other factors_ The risks inherent in assessing the Impairment of an investment include the risk that mar1<et tactors may dflfar from our expectations and the risk that t!Jets and circumstances factored into our essessment mey change with too passage of time. Unexpected changes to marker factors and drcumstances that werp. nol present in past reporting periods may result in e current period decision to sell securities that were not other-than temporarily imp!l!red in prior reporting periods.

3. The Company dId not own any oommon stock al December 31, 2013 4 The Company did not own any prefened stock at Dacember 31. "20 13 5. The. Company did not have any mortgage loans at December 31. 2013 6. The Company did not have any securities on toan at December 3 t, 2013 7. The Company has 1"10 investments in subsidiaries, controlled and affiliated compartles_ 8. The Company did not have any investments in any joint ventures. partnerships and limited liability

companies lit December 3 1. 20 t3 9 The Company did not have any derivatives at Dacamber 31. 20 t 3 10. Premium deficiency celculations do not uHlLZe ar1l1c1pated rn ves trnent Income as a factor. 11 _ Unpaid losses ond loss ad justment expenses indude an amount determined from individual case

estimates and loss reports end an amount, based on past experience, for losses incurred but1)(lt reponed. Such lJabi lities are necessary based on assumptions and esllmeles and, while management beHeves that amount is adeQuate. the ulbmate liabi'ity may be in excess of or less than the amount prOVldOO. The methods for makrng such es.limates and for establishing the resulting li3bilHies are conbnually raviewed and any adjustments ere reneeted In the period determined .

12. The Company has not modified its capitaliza tion policy from Ihe prrOf period. 13. Feelersl and slate income taxes.

In accordance with B written tax shanng agreement with an affinate, the Company's current Federal and stete Income tax prOVISionS are generaMy computed as if the Company were filing 8 sepamte

26.1


Federal and st6te Income. tall return: ament mome IlIlI be.netits, lncN(hog thOse resulting from net operaring losses, ole remgniZOO to the extent lealtted In the consolidated relum Pursuant to this agreemool, the CoIT'4lMY has the enforceable rrght to recoup Federelend stete moma taxes paki IJ)

PfIOf yeats" the event of MUle nellosses, wtlkh it mily II'IWf. 01 10 rocoup its nellosses mried I01Wl:lrd ItS en oltset to ruwre net ncome subted to FadefalltfJd .state IN:ome taxes

Oelerred Income tax assets ("OTM., end labllifies rOlu', represent the eYpec\8d IUtu re talC consequences of lempomry (]itfCfences oenernted by sta1unry ."oun~ 8S definM in SSAP No, 101 OTAs end Olls are c.omputad by means 01 identifying lempoulIY dilf6lenc6S which are measured uSoino a bela1lC8 shoot approach whereby sttIlllklfV lind 18l! basis balance sheets are compared CllIT8IlI Income laIC reCOV{l/abies indude ell current hcome lex85. tOdudrng intemsL reaSOf'8b~ expeoed 10 be recovered in 8 stbsAquent accounting period

PUISUMI to SSAP No 101, gross OTAs rue n,si reduced by II SlArutorv vll!u8hon 6lowance 8dJuSlmenl to an 8moont that is more I,kelv then not to be realized ('adjusted gross 01 As"). AdfI,Isled gross OTAs Ire then I'Idmittad in 8n amount equal TO the sr.tm 01 perlgl8phs 8, b. Ind c... below,

8 F"ooeral income taKes palO in prior yel!lrs that ctln btl recoverod through loss U1rrybacks lor I!IXI5TillQ temporal'( differences thai reverse during a brnelHlmo C1)ITespondlog wilh InTernal Revenue Sorv(ce (' IRS·) tax loss canyback provisIons,

tl Tho amounl of ad[u!'.lod gross OTAs, aftor the oppl lc.ntlon 01 paragroph 8 tloova, expacted to be realized wlthtn the applicable penod and that [5 00 018111er Ihan the applicable percentage as determined using the applicable Relllization Threshold LrmttaTloo Table The app~C8b10 period refers to the numb&!" 01 years in whkh the OTA 1'1111 reverseln the Company's laA return and the eppHcable percenillge relers 10 the percenTage of the Company's statuIOf)' cap!tal and SUllllus as rl!quired to be shown onihe Slll.tu1ory ba{ance sheelllCljusted 10 excJude MY neT DTAs, electronic data pl/xessing equtptOOn1aOO opemling system softwere end Iny net positIVI goodwlft eStal Cap E.oTA·),

The Rellhzatioo Threshold lImitalioo Tables allow OTAs to be ftd/T\!UOd basGO' upon eifh8f rea!iz81lOn within 3 years 1100 15 pen:ent of Stal Cap ExOTA. 1 vear and 10 pelCeN of Sfal Cap ExOTA, 01' no OTA &dmfl1ed pufSuan( 10 this paragraph b, In gen8(/I~ the Reattzebon rtw-eshokllmlletion Tables allow the Compeny to adrnn more OlM If tollli OTAs 85 reponed by the Company ere a sma!lBf perce,.age ot SllItutory cepRaI and surplus

t The amount of gross OTAs, after Itwt appircatlOn ol palagraphs a and b etlove UIlIt can be of1sec ag&n!ot eXisting gross Ofu, In ~og thiS Olfsel, the Company ConSO:lIS the character (I.e. OIdlnatV V8I'SUS cnprtaI) oIlhe DTAs and OlLs such that offsetlltlO would be pernlltted If1 !h& lax relom under e~tlf1g enadoo federel tncome Ti!Ilt laws and reoulahons Bnd the reversal patterns of rempofllry differences.

OTAs tor the yaer endng December 31, 2011 were rllCt'llculal&d PlJ/5Uam to SSAP No, 101. It Iectllculation resulled in an 3O/USlment 10 Iho December 31, 2011 admttted DTA. balanCfl, a ·cumulative effect of changes in accounling principle" was rOCOldGd In 20 12 as 8 S8plltllle component of surplus ("CumulatIVe efted 01 changes In accounllng pnncljl les")

Changlls tn OTA.s 8nd DTLs are recogmzed 85 a soparll te COli'lf)onunl of gains and losses to sUllllus ('Change In nol defelToo mcoma tax") eXCepllo the elltant allocated to c.hllllgoS In unrealized gains end lOsses Changes in 01 As and DTls altocetoo to unrll8hzod gams end losses ero netted egainst tile reialeO changes III unre81ized gams and losses entl 81e reported 8S 'Change In nal unretllized capitel gains (IoSS8S)~, /1150 /I separate componenl of gains 8nd losses In 5U1plus

Tht! Compony IS subjt!O to state tncome l al(85 In verrOlJS slates Stll\O IncOlTl8 tax expense IS recof(jed in g6f161el administrallve eltpOOSes in the Sltttulory SUII6fll6flts at Oporalions. For the years ended December 31,20\3 :loci 2012, lhe Compony incUlred slate Income Llllr eJilpenses of S93,896 !lnd $76,883, resped'!Vety. The Comp.!InY's STate mc.ome tax plyable ~ S2,5504 11 ilnd $26,513.28 at December 31 , 2013 lind 2012, I'85pectJlI6ty, was II'ICIIJded 1\ general iilJtpef1S8S due M accrued In the SlnlUlory Statements at Uabi[1ies, CaPfliJl and SWplus The Company had no state tnoome tax recetvtlble al OecembOf 31. 2013 and 2012.

The Company is Sllbject 10 premium taltes n V800US stat8S. These lal expenses are remrded in gellflai admrnisnflve expenses In the Stetutory Stalomants fA Operations The expenses for these taxes were $595.037 end s.so5,852 forlhe yellrs ended December 31 , 2013 end 2012, raspecwaty, 'The CompMy's pi'emilJm tu payable of 5714,056 lind $119,021 al December 31, 2013 lind 2012. lespoclivoty 8r8 indoded ill genernJ oxpenses dull Ind acaued 11\ the Statutory Statemants of liabltfties, Capilllt and Surplus. The Company had prepaid premlJm IIIIIIIS Of SO and SO at December 31. 20 13 and 2012, respectl\'e/y, whlc.h weul tnduded as III wllle,ln in the Statutory Statements of Assets Health pl'flrriums are eemed ratably over ttlll temlS 01 tho related InSll(ance end reinsurance conVacts or policies. Expenses incurred In tonnec.bOn with lIcqurlng new insunmce business, Includmg acquisition costs SUCh lIS 5al05 comm~sfons , "re chlllgod to operalions as Incurred,

~ ACCOlIllTtng Changes ~md Corrections of Enors

26.2

During the audited financial slatement preparation, the Company discovered an error in the reporting of admftled and non·admitted defef7ed tax assets. In the prior yael, F&delsl Bnd foreign income lax recoverableand interest thereon (Asset page. line 19, Column 1) was overstated by 526,641l This resulted In the calculation of the r:orresponding non-admittad Federal and forei!)" income lax recoverable and mterest thereon (Asset page, Una 19, column 2) 10 be overstated by $2£,648, lines 4702 end 4703 on the Statement of Revenue and Expense (continued) page have been adjusted in the currefll year to correct the 9fTor In the reporting of deferred lAX assets.

3. Business Combinations and Goodwin

A Statulol)l Purchased Method NONE

B. Statutory Merger Method NONE

~ Assumption Reinsurance NONE

D. ImpaIrment Loss6$' NONE

" . Discontinued ()perIltiOl1s

NONE

5 Investmenls

A. Mortgage Loans. fntludir)g Meuanine Real Estate Loans

NONE

B. De!)1 Restructuring

NONE

C. Reverse Mortgeges

NONE

D. lmm-Backao SecurJILes I . Prepayment assumptions for single class and multi·class mortgage becked/asset backed

securities were ob/ained from industry market sources. 2 The Company had no orher. than.temporary impairment rOnl") losses during 20 1 J on loan-backed and

structured sacumies in which the Company had the (1) intent to sell. (2) did not have tl'le intent and abAify to ret~n for a period of lime sufficient to recover Ihe emortized cost basi!> or (3) present value of cash flows expecte<lto be collected is less thtln Ihe amortized Cosi basis of the securitle5 in accO/dance wi1h SSAP No. 43R. Loan.Bacl(oo and SlIucfumd Securrtf6s ('SSAP No. 4:lR")

J. rhe Company had flO recognized Onion loan· backed and structured securities currently held. in which the presenl value 01 cash flow !> expected to be collected IS less than lhe amortized cost ba5ls, al December .11.20n

,( At December 31.2013, there ale no strucnJled securities that are In 8n Urllealized loss IXIsilioo . Therefore, the table shOWing unrealized losses on s1ruclUfed securities that are grellter and tes5 Than a year has no! been p/OvidDd . OThe structured securities hilve been In

a conOnuous unrealIZed loss posili"on for lass /tIan 12 months. There ara no structured !>acurities thai have been in ill conTinuous unrealized loss positIOn lor 12 months or Ionger_

5. The Company has reV/ew6CI the loaned·batked end SllUctllred securities in ecco/dance wilh SSAP No. 4JR in the loole ab.ove and has concluded that Ihase are performing 85sets generating investment income to support the needs of the busine5s. FurttulITl1ore, the Company· has no intention 10 sell the securities at December 31, 20 13 befora their cost can be ri;rcovered and does have Ihe intent aod ab~tty to retain the securiTies for the lime sufficent to racaverlhe amortized cost basis; therefore, no onl wriT" down 10 lail value was determined to have occurred on Ihese securitles.

E Repurchase Ag/eements ahd/or Securilies lending Transactions

NONE

F Real Estate

NONE

G_ Investments In Iow.income housing credits

26.3

NONE

H. Restricted Assets NONE


6. JOint Ventures, Partnersnlps and lJmited Uabilrty Companies

NONE

7. Investment Income

A There was no Investmem Income d\Je and accrued exduded from surplus at Docember 31, 2013 m(cep' in bonds where col lection of interest was uncertain

B. NONE

B. Derivative Instruments

NONE

9. Income Taxes

A.l . The components of the net DTA recognized in the Company's Assels, liabilities, Surplus and Other Funds

ere !IS follows: 1V

Ordinary --, TOlal of gloss deferred lex assets Statutory Valuation Allowance Adjustment Adjusted gross deferred tax !IsseIs Deferred lax assel nonadmitted Subtotal Net Admltted Defalred T8X Assel Deferred lax habilllles NBC Admitted Deferred Tex Assetl(Net Deferred Tax Uabilily)

541,874 o

541 .874 (150,089)

391,785 o

391,785

A. 2. The amount of admitted gross deferred tax assets admitted under each component of SSAP

A J.

101. 1V

Ordinery --,

(a) Federal Income Taxes Paid In Prior Years Rer..overeble ThfOugh Loss Carryback.s

(bl Adjusted Gross Deferfed Tax Assets Expected to be Reehzed (Excluding The Amount of Deferred Tax Assets) After Applicalion of lhe Threshold

lImflaUon (the lesser of 2(b)1 and 2(b)2 below)

(1, Adtw;ted Gross Deferred lax AssetS I J 10 b! f<e811Zed FoIIOwlll9lhe Balance Shoo1 Dale

t2J A~~ed Gri)ss OelarrW TalC, Assets AlIow9(l per

39 1,785

o

o

(C) Adjusted Gross Deferrad Tax Assets (ExcJudlng the emOllnt of Deferred 0 Tax Assets From 2(e) and 2(b) above) Offset by Gross Deferred TalC'

Uabi~tie5

(d) Deterred Tax Assets Admil1ed es the result of epplfcatlon of SSAP 101 r--~""miii"-"'1 (Total (a)+(b~(C»), ... _____ .....

20 t 3 (a) Ratio Percentage Used 10 DeTermine Recovery Penod And Threshold r -="':;40B"1%'--

limite lIOn Amount (b) Amount of AdJUSTed Capilel And Surplus Used To Determine Recovery 20,676,482

Petiod end Threshold limItation in 2(b)2 above

26.4


Impad Of Tal( Planning Strategies

(a) (1) Adjusted Gross OrA's (2) Percentage ortotal adJus~ed gross OTAs (3) Net Mm!1ted Adjusted Gross OTAs (fro,.n Note 9A1(e) (4) Nel Admlltad AdJUSled GlOSS DTAs (% oftolal nel adm',lted adjusted)

(b) Does the Company's ta~ ·planntng strategies Include the use of No reinsurance? (Ye.sJNo)

B. There are no deferred tax liabilities that ara nol recognized.

C.I , The pro .... isions for Incurred Taxes on earnings forlna periods ended December 31, 20 13 and

Decemher 31, 2012 a18:

Federal income tax on operations Federallncorne tax on net capital gains Other Fedarlllincome taxes incurred

C.2. The tax effects of Temporary differences thai give rir.e to significant portions of the deferred lax assets and lIabl~ites are as follows

C.2 Defel1ed Tax Assets:

Ordinal)'. Discounted Losses Payable Unearned Premium

Contingency O lher Nonadmitted·Receivables

Total ordll'lary deferred tax assets Nonadmitted ordinary deferred tax assets

Admitted ordInary deferred tax assets

Caprtal: Investment!.

Toral AdmItted capital deferred tax assets Nonadmined capital deferred lax assets

Admitted capital deferred lax assets

Admitted defmred lax assels

C _J. Delerred lax Habililles:

Ordinary.

Other Ordinary deferred tax liabilities

Caprtai: Investments

Capital deferred tax Ilabillties

Total Oeferred tal( liabiUlles

C 4. Net admitted deferred tllX assets

26.5

Ordinal), %

541 ,674 0%

391,785 0%

1213 112013

3,479,476 (26,:165)

o 3,453,093

12/3112013 36,091

155,601 o

13,589 121 ,430 136,500

1,475 76,966

541,674 (150,069)

391,785

3,144 3,144 (584) 2,560

394,345

o o o

988 988

". 393,357

The change in net deferred Income taxes I!'. comprised of the foUowin!T

TotAl deferroo tax assets.. Total deferred lax lillb:flties Net deferred tax assel (liability) Tal( effect of unrealIZed galn~(losses )

Change in net defelled income tax

12131 /2013

545,018 (9S8)

544,030

The valuat!on allowance adlus1ment to gross deferred tax assets as of December 31 , 201 J and December 3' $0,00 and $0 00, r

D. The provision for federallocome tllKBS Incurred is different (rom rhal which would be obtained by applying Itle stetutOIY Federal Income Tax rate 10 Income before income texes, The si{jniflCBnt items causing this difference are 8S tollows:

Pro'<ision computoo at statutory rare

Pemanent Ilems Change in oonedmltted asse1s Prior Year RelUm to Provision Adjustment and Other Prim period adjustment to defef7ed tax asset STAT 10 GAAP Adjustment Total

Federal and foreign income taxas Incurred ChaMe In ~I deferred income tliXes Tolal slaftJtOf)' i l'lCome taxes

E-l . As of De<:ember 31, 2013, tha Company has no net capllal loss or net operating loss carrylorwards for tax purposes.

E.2. The amount of Federal Income taxes incurred Ihat lire 81/1l1Iabie for recoupment in the el/enl of fulu re net lOsses are:

Yeal Amount 201 3 3,.(55,506 2012 3,282,291

1213112013

3,421 ,732

(100.935) (16.136)

60 28.648 9,581

:'1 ,342,949

3,453,O\')) (110.145)

.3,342,948

E.3. The Company had no deposits with the Inlalnal SeIVi(.e under Setton 6603 {jf the Internal Rel/enue Sell/iee Code at December :11 , 2013.

F,l From January 1/ 2013 th rough Mav 6, 2013, the Company's Federal Income Tall' Rerum Is consolidated wit h thl"<

(nll()wing e ntities:

AhiU!i Health PlallS, mc. CovenIT)' Health CaJ'C: ofFlorid.t. Iuc. Coveotry Health CMe of Georgia, Ine. Coveulf)' Health Cal'l~ ofLoui~ialla. Illc. CovenII)' HClI.h.h Cue ofNebrasb. Inc. CHC Ca~\Ia l ty Ri4. Retention Group, Inc. Coveotry Health Plan of Florid!, Inc. Coveut!"y Health Can: ofJlIiuol~. tnc.

26.6

COVl:lltry Health Care ofMi\souri.lnc. CovclltryCarc. of Michip:aur luc. CovcuU'y Hc:~hh Cue ofViripina. Inc. Coventry Health Care of Dc\,&wan:. lue .

Covc-utry Hnlth Care of Iowa. loc. Co,,~try Health Care ofK.M!.\ds.lnc. Cov~uy Health Care of the Clll'Olullts. Inc. Coventry HClIhh Care ofPcnnsyl ... :mi~ . Inc. Coventry Health Care ofTc;u~.lnc. Coventry Summit Health Plm. me, Coventry Health .anel Life lmuTanc.: C01l.Ipany Co"~UY H~ltb Care, we. Cillubridgc: Life In~IIIlCC Company Fir>r Health Group Corp. FiNl Health Life aad Hedlrh In\lIDI.O~C: Company Florida Health Plan Anl)lini~IfHIOn.. LLC HcahhC.a.rc USA ofMiS$Olm. LLC Hc:alrhA.mc:rica PCl(I5.y] ... ":UI..ia. Inc. WcllParh of South Carolina. Inc . Hc:althA~sw'aflce PClIll\ylvania. Inc. Coventry Hc:~hhCare MaOllgewcnr Corporarioll Mental HeI!.lt.h A~~ciarc~. Inc. Menial Health NeTwork ofNc:wYork TPA . Inc. MHNc::t Life aud Hc~lth Insurance Company MHNc:r ofPlorida.lnc. Cl"i.ul~ Adtninimal;an Corporation

COV«ltry CO~1lUler Adv.mtllp:e, Inc. Coventry Finallcial Management Services. Inc. Coventry Health Can: National Ac.c.ounts. Inc. Coventry Health £:aT(, WOlken' Cornp'n$~tion . Inc .

Coventry ManagcmCllt Scr.;c.e~. Inc. Coventry PrescripTion M:lillIg:eDlent SCTY1CI!1O. we.. Coventry Tr:tmpllUll NeTWOrk. Inc. Fir-;t S.mpl Nem'ork Sm.·icC's, lIlc. HealthAs~urau~ Financial S~·;cc~. Inc. FOCUS Health.:-:m- M3.0~gemetlt. Inc. MdmComp, 1.ue. CoveulTy HealUi Care National Network. Inc. AcTru! .Bener Health [nc. (Tennes\ee) (flkJa HcahhCarc USA ofT .:rtIJ<:s:;ce. me.) Coveotry HealUi Cafe of West Virginia. Inc. Coveotry Rcllabilitalion Sel"\;ees, Inc. (£(k·"~ Fin-I HealTh Stralegie~. Inc .) Carefree wnr,lllce Services. Inc.

From May 7. 2013 through December 31, 20 13, ~he Company's Federal Income Tax Return 15 consolidated with the

enlitie~ above BS well as with the following e ncilies:

Aema toe. - Pare1ll COIupany

@ CT"Cdentials me.

Active Health Managema1t1.u o:..

Admineo, Inc. Adrnwi~lfalive Enterprise. tu.:-. A.E fOl1l1ec:n. loco!pol1lh:.:i AET HealUi Can! Pb.n. Inc. Aema ACO Holdings. Inc.

Ac:n", !kIter Health Inc. (Connecticut)

Aema Bener Health [nc . (Florida)

Aenla Beller Heahb Inc. (Geolgia)

Aenlll Belter Healtb IDc. (Illinois)

Aetna Belt~ Health Lac. (Louisiana)

Aet1lll Better HealJh Inc. (New Jersey)

Aen"lil Better Health Inc. (New York) Aen"lil B.:ue:r Health loco (Ohio)

Adna B':l1er Health Inc. (Prnn~yI\">l.D..ig )

Aen'" IknII\IIlC. (New 1eney) A(b\A (kat_lIne:, (rClWo)

Ac:bw. Dcmal ofCalifurnU. ln~ .

1oC:"" Htslth aud Life: hw.wancc (:(lmpany

lUow Hnhh. Finane¢. Ine. Actnl. Hnltb hle. (Conneenc:ut) Actnl H.e.tkh Inc:. (Florida) AerN Huhl:! IIX- (OC:OrPl)

Actn.l Hnltb lue. (Maine) Aetna Health me. (Micl!ipn)

AdUl Hultb l.11c . (New Jeney)

Aetna IInhb rue. (New York)

MIlia '-lea hl:! I.ue. (pc:unsyl vallil) Ac:hlll H".1th II}(: , (Tc:u~)

AetnA HC'~hh lilj,\ll'P.llcc: Compa/ly

Ac:nlOl Hr~hb II\~urallcc: Compa.oy of NI;W York Aefllol Hcalm of Clli{om.i~ Inc.

Aetna h,,,U'IUlcc Compauy of Connec::t~UI Acllla Intcpt'C'd lnfonu.atic~, 1nc:.

Acnu. tnlUlllriolUl\lnc. Ac:tn.1ltcbnd rue. Ac:nv Life afId Ca\ll3.hy (BcfTl\~) till AeTl\ol Life: As~IJlllua\l Cour.pa.ny

A~\11 Life: 11\5U .... 0I:( COIllJnllY

Ac:tnI Ri~ lncknVlolry COOipallY Limitul. Acme SlUdall Huhh Apcy Inc.

AMP Ho1d.ing\. lue: Allvi401 CorporlItion Ant(rican Hnlth Hold:ina. lnc.

AUSHC Hold~s. tnc. Bmad~pi.n: National Sc:n.;cc: ~. Inc.

Cbidr:criua Clai.w.\ Adruiuio;tf210r,;, ltx:

Co.fi.uity, Inc:. Oelawue: Ph)'\id~ CUt, I.ncorponl1cd Health IIIld Hunwn R.t~o\1.rcc Ccnfer. Int . Hutth Dala & M'aoagC:IOC1It Solutions, Inc Huhb R.c . lncorpol'3tcd J,pIW MeritT S\,Jb ~idiary. lnc.

L\lc"gctl~ t.ilnilcd MAI~ped em Coordiualof\. Inc.

Mcdll:uy 1n<:. Meri,,,in licahb.. l.nc. Mu \oun Clin. I.ncorpor:llled

Nl.JMII Re. Ine. P,yFtell: Holdia,s. !.nc. P,yFlcll: Sy\~ USA, lne.. Pcrfontu.lI:, Inc. PruiSiOll B~fil Sc:rv\ces, IDc. Prin)C: NrI. I.nc. ,

Prodi,y H~b GToup, loc. Profcs"oOllI Risl: Managerncol. 1nc:. Rt5OW'l:et {Of Liv\nj. LtC SdlAl!cr AodeMooo Medical Aruo..i!liWaIOt\. loCQrpol'lllCQ

Stnl1e,;c RCMlI.l.1'CC Comll:UlY The V'~I\Cl. Gmup ll1c.

U.S. Hc,hhcuc Propcnic\, loc. Work II11d F~1l1i1y Benc{il\. we. Group OCllla1 SCTVic~ we.

26 .8

Group Daml Service of MuyjlUld. lnt..

F 2 As explained In Nola I , Ille Company pal1icipalM In a /all shenog agreement The cCompany was pall 01 .. leX Shilling agreement wilh its tonne, parenl Coventry Health ellle,lnc.. IOf lhe penod JanU8'Y I, 2013 ItlfOUgh May 6, 2013 Upon !tie &cqur>1Ion dale of MlIY 7, 20 13 !tie Company par1ltipeles 10 a laIC shallng agfeemenl WItt'I Aelna Inc ("Aelna1 and Aetnlt's OINK s ubsldia/'l~S

10 In'Ofmabon Concaming Parel'll, Sobsidt.aries, Alfilillies and Olhef Related Partles A.c.. The Comparty has management -SefVIC.6 agreements wi'lh ns Parenl compaoy and ConSUl atflbl8s, In

which the Pat'ent and affiliates ptOYtda IfIkHmatfon lec.hndogy • .seMel!! canlBr and oenef81 adrn:nlStTllllWI suPPOIt S8MC8S. The Company also plovodes cerulln admtnistra1NB 5eMces to VIIOOUS wholly owned subsidwles ollhe Parel'\l

The Company paid a cash dividend 10 I1'l8 pelOn! company, Collen/ry Health Care. Inc.. 00 0613012013, 10lahn9 $9,400,000.

o Amounts due From related parnes and due 10 r(la,,'ed p6!11OS as 01 Oocembe, 3 1, 20 13 6.8 8S folloWs:

Doe 110m Relatod Parties. looN/dual Premium Col/oded by Coventry (HPS due 10 Iowa).

Duo 10 RBieled Pftrtres COV9fl/ry Hfla/lh and Ufa. CooIontry In/(Jf(;ompany Aevvity /n/&rcompnny MIJnagement Fees I/II00eOfflPSny , Ta"t

Sl04,236

S4,090,3S3 t,130,447

fO,032 J39,5'~

The tel'ms of seltlement require Ihatlhese IJmoonlS &Ie senlod Wllhin 30 days

E NONE

F TOO Compar.y ISCetlieS certa'Jl management seMC8S from vanous affilrated compar»es These IMl\89omenllees ata refleaed as generalaod Itdmlfl\Sln'lllVe exponses Refo/To Schedule Y, Pan '2 fOIlha amountS of any Slgnific&llt aansattlons with affiW6(as

TIle Parent Company prOVIdes cerUlm managemenf, consulting, CDtnOUler and adm'nlstra/ive servICes 10 tile Co'l1P81l'1 The Company also l elmoorS8S tlla Palenl fOl' certain expenses paid by the P,UfInT on bellaM of the Company. The maMgelTl6nt fee 10 the Palene IS based on monthly mombershT9 and the current year expense is Included III Schedule V, Part 2

The Compllny carnes reinsUtllne& coversge lor IIlSlances in whICh medical cosls 'Of an illdMdu;ll mombel excee<l certain limitations, Th,s covelage IS CUlrontl~ through Covontry l1etllth IIlld life InStJI'III'ICo Company (CHAl), an affiliate of CovontIy The Company Is conlingenUy liable 101 i1s rolnsurad losses 10 the eKlent tIlat the roTnsufI'Ince company c::lnno! moet Its obliglloons undel the rOlllsurence cOI'Itrecls.

G On AU9tJ~ 19, 2012, the Company's parenl Coventry Hellfih care, Inc ('eoventry"), Aetna lot. rAelnll") and Jaguar Me'get Subsldlary, Inc rMOIOor Sub') enlared m!o an Agreement and Plan 01 Mergor (1lS amended, alld 85 may be rurtfler omondod), pursUtlnl 10 whi<:h, <;.ub/9ctlo lhe Stllisfactron or W3IVO! 01 cello!n conditions, Marner Sub WIll be motged With aM Inlo CoventI)', with Coventry survtv.ng lhe merger as a WhoIty.owned sub!.td.aty 01 Aetnll (the "Merge".

The consummallOl1 of the Merger is SUCIOd 10 cuslomaty doSIng condnoos, inclUdIng, among others. tho aooptlon of Ihe Merger Agreemenl by Covenlly"s slodchoidets, lhe. absonce 01 cenal'! legal ImpedimeoIS 10 the consummation 01 the Mefger , 0\8 rece~t of speafied govemmentBl consents and 8Jl(JtCNilts, lhe etlriy !OITT'IIneibn or eX!Y,fMon of the w8ltlng period under the Hafl·Scon·Rod!no Ant.truSi Impl'Ovemel\l. Ad of 1976, and, subt8c1 to C8fllllfl exceptIOnS. the acc.1JI8Cy of tepte$8nI!lDons and wIIIl8nbes made I)y the Coventry end Aema, 18SP~, and romp!laflCe by !he CoYenlry and Aetna 'Mth !heir respective obllgalions undet lIIe .... arger Agfeemenl. The Mergel closed on May 1, 2013

H - l. NONE

10. Dobl

NONE

II Retllemen! PlaITs. Detelled Co/'nj)ensanon, Post·employment Beneft$ lind Componsalod Absences and Olhlll P05t.folhomenl Oenolil PlAns

A Tila Company docs not sponsor II Defrned 6enofit Plan, o Tllb Company dOOS not sponsor II Defined Benefit Plan C Tile Company doos not spon$Ol a Defined Benefit Pilln.

26.9


o The Company does not sponsor a Delined Beflefil Plan E Tha Comp8ny's em~ lire el~!bllI to participate ill 8 -40 1(k) dchned CIDtltnbutr(ll'l plan sponsored

by Il1e Paleot EfTl)!oyees become eUg bh! to p3(tK:1p8f'8 In the pMn upon their firsl dey of employmenT Sub;ect to certall tim-utions. emploY6fls moy c.ontlbule 75% of thIN' .saI8lV to 100 pltm Wf'oIdl lhe Company rM"t\es at a r&'B of 100% up '0 the first 3% lind 50% of tho next 3% of each employee's (on1J1bulions to It maXImum of 4.5% of th8It lalIIl 5lI1ary rhe Company coolrbJtElO S ' « ,802 to the ~ Ol (kJ plan [n 2013 and S 139,160 In 2012

F The Company does not ofter rmftipM-flmployeJ plans

G Tha Company does not oner cooMllidated I holding company plens

H nil Company does not helle 811 obkgatiGn fCM" any posl·empkJyment benefits or compensated ebs&ntes

I. The Company does nol. have any impatt on any postretirement benefits related to the Medkare ModOletlon Act

12. Cllpil81 tlnd Surp lus, Divl(:!end Restrictions and Ouosi.ReQ(ganllelions 1) The Company hes 1.000,000 shares of common capital srock IIUlhorl?ed, Issuad and outstanding by

Itie Compllny with a par value at 55 per share.

21 'The Compllny has no preferred sTock aU1hoflzed or outslancllng

31 Dlvidonds on the Company's CO/lYIlon caprtal stock artI paid as dec.lared by lis Boerd 01 DIrectors, from earned surplus of !he Company, noT lrldudmg surplus /lrisinQ Irom the Sllie of suxk.

'1 An 8xtra·orOma'Y I O1dinary dMdeod In the amoun! lit $9,"00,000 on 06lJ012013 was paid by lhe Company to its Parenl_

SI Wrth:.n the ~mM6ons of 3) abow!, INl/e Ille no other reszrictions placed on IIle pol1lon 01 Comp8ny protflS that mIIY be paid as ordioPJry dMdeods 10 !he wxxtIotder

61 Thf!fe we no otrm reslnclions on the Company's surplus

71 Tho Company cIoes not M\f8 any 1IlNant85 JO surplus nol/epald

8) There 31e no omoonlS of the Company's common caprtal stock berng held Jar speoal purposes

Q) The Compeny has no speciel surplus funds

10) The portion at unassigned funds (surplus) represented 01 reduced by cumuLatr,-,a unreehled gain and losses IS So.

t 1) Tho ComPllny hilS no surplUs debemures or sImilar oblrgtlhOlIS outstanding,

12) Thll Company has no prior quasl·roorganlzaHons

13) The Compllny has no Quasl-reorgamzations.

13 Contlngendos

A Contmgoot Comm:tmeflTS

NONE

e Assessments

E.&ch YeN, the Company is required 10 contnbute 10 the Iowa Hel!ltih In5Ulance Pool based 01'1 pt'1Ol yeats premiums. The Company eszlmated a IJabll«y and estabeshed a reserve in the ilmount 01 $568,464 ." OecemtM!r 3t , 20 13

;J NONE

C Galn Conhl\genoes

NONE

0 , Claims Related Extra CMtrectLl8l Obligation and Bad Falth Losses StemmlfI!iJ rrom lewsorts

NONE

E A~ Other Conhng6nCies

26.10

NOTES TO FINANCIAL STATEMENTS The Company Is Involved in various legal actions alising in the normal course of business_ After reI/leW, induding consultation WIth legal counsel, man<IQement beheves any ultimate Nabllily thaI could alise from these actions would not malanally affect the Company's financial position The Company has no assets thaI it considers to be impelred.

The Company Is contingemlV liable for certain costs in the event that a cepttaled provide! is unable 10 meer liS contractual obltgallons. The Company has comml11ecl no additIonal reSeNeS 10 rover eny malenal continge/llliebUities.

The Company establishes and routinely monitors the allowance for uncollectlOle accounts. Management considers Ihe allowance to be sdeQuale,

1 ~ Leases

A Lessee Operating Lease

Th« Company leases rts offIce faCilities and cerlein office equipment under non-cancelable opel"8tmg leases expiring in venous years through 2[J 15. Rent expense for the years ended December 3 I, 2013 and 2013 was S225.127 end S225,714. resp&etlvely.

2) Cenain rental commitments hava nmewal options extending through the yeer 2015 Some 01 these. renewals are subJoct 10 adjustments in future periods.

2014: $1' B.902 20t5 $120.3 16

3) The Company is not involved In any sales lEaseback transactions..

B . U'lSSOI leases

NONE

15, Intormanon About Rnandal Instruments With Ott·Balance Sheet Risk And Rnancial Ins1ruments With Concentrations of Credrr Risk

NONE

16. Sale, franstels and Servicing or FinanCIal Assets and Erllllgui~ment of 1mbilrties

NONE

17 Gain or Loss to the. Repornng Entity ftom Uninsured Plans and the Uninsured Ponion of Paflrally Insured Plans A.

AdmmlStrative Se-rvice Only IASO) PlansThe g.Un frotu ~tJ<>PS &()III Ad!:ni.uismrP"e StJVic~s OO.nJy (AW) noin-n""dpt..m.lllld tb~ =d portioo ofp.mi.o..Uy imurcd plam .... ~. u foUOW!; It:.ough Der:ember1 1 2013;

(I)

• Nfl rr:imbunt:mnlt for ~dnJ.mi.<lnIti,.., Eltpo:::ns.es (incl\ldi.na .dmJtri$lrallvc f~e<) 1..0 tore"" of.ocrual e<"pC""MelO , Tow [ll:T otber Inc""", or ""'"JIC"S"" (including inrr:re<.t pald!<o or ~tcived

&om ptAnS)

C NeT g ...... or (leKS) U-ODI open"'''''' d. T0181 c"'iro. JIolyaocnt vohuu~

, 24 .~ 20

SO

$24.420 S9~.OS6,n2

(' )

Unmqu¢d

~ PoUfl' .&11y

"",",dPbm

S

S

S S·

(3)

SHA20

5 "M.420 594,086,1"ll

B. Administletrve Service Contract (ASe ) Plans

NONE

C. Medicare or SimilarlY Structured Cost Basad Reimbur!>ement Contl1!CI

1. Revenue from the Company's Medicare (or si/Tll ierly structuroo COS! based reimOOI!>emenl contract) (".Dnueet lor the year 2013. consisted of $32.771.384 for medical and hospItal related servrces end ~ 1,203.061 for edmimstrative expenses.

26.11


2_ As of December 31 2013, the Company lias no (if appllcableJ recorded receivables from payors whose account balances lire greater then 10% of the Company's receivables hom uninsured acddent and heallt1 plans.

3 In c.onnedion WiTh the Compeny's Medicare (or similarly structured cost based mimbU/sernent contract) contract, lh.e Company has recruded no allowance or reserves as of December 31, 2013_

4. Centers for Medltal{j & Medicaid S6IVICes (' eMS") periodically performs audItS of Medicare ravenue end may seek return of premium payments made 10 the Company If risk adjustment factors are not properly supported by mooical record dale We estlrne te and record reserves for eMS audits btlsed on fnformallon available lit lhe Time me est imates are made Although we beliave the Company mainlams appropriate resel\'es for its exposure to tna CMS audits, actull i results couk! cliffet materially from lhasa estimates.

la. Direct Prp.miom WnttenlProduced by Malla.gmg General AgentsfThird Party Administrators

NONE

19. Fair Value Measurements

A ,- 3 The Company had no material assets or IlabilitJes measured and reported at fait vaille aI 12131/2013

4. The fo"owing are the levels ol the hierarchy and II bnef descnptlon of the tYpe of va!uanOT1 inputs thai are used 10 estebl'sh each lev~1.

lavell - Unadjusted Quolad prices ror identical assets or Ilabikoes in active markets. Level 2 - Inputs other than Levell thaI are based on observable market dala . These include: quoted prices for simj lar assets in active markets. quoted prices for Identical assets in inactive markets, "inputs that are observabte that are not pnces (such as rnteres1l1l tes, credit risks, eTC .) and Ilputs that are denlloo from or corroborated by obselVilble markets. uwel 3 - Developed from unobservable data, renecting our own assumpMns. When Quoted pnces in aertlle markats for identical assets !lnd liabilities are availahle, the Company uses these quoted markel prices to determine the fair lIarue of financial assets and liabilities and claSSify these assets and ~ebilitles as Lellel 1. In other cases whelil a quoted mark.et price for identica l assets and liabilines in an actllle maf1(el is either not alialiBbIe or nol obseNable. we est imate fair values using valuation methodologies based on available and observable. market mformatron or by uSing a matrix prrdng model. These financiel assets and liabilities woulo then be classlfred as Lellel 2. IF quoted market prkes are nOI available.. the Company determines fair value usmg broker QUotes or an internal anatysis of each [nvestmenfs financial performance and ClIsh flow projections. In these instances, financial assets and liab)l lties will be classified based upon Ihe lowest leVi'l l of input Ihal IS significant 10 the va luation Thus, ~nondal assets and liabillbes may be dassified In Level 3 ellen though there may be some signirltilnt lnputs that may be readily available

B The Company had ® matenal assets or liab~itjes measured Bnd reponed al faJrvalue a11 2)31rX) 13 C

Financial Instrument Aggregate Fair Carrying Value (Level' l Value

Bonds $29.179.2 14 529,206,037

20. Other Ilems

A . Elttraordrnary Items

NONE

B Troubled Deb! Restructuring: Debtors

NONE

C. Other Disclosures and Unusual Jtems

NONE

o . BusIness Interruption Insurance Recoveoes

NONE

E Slate Tfansferab\e and Non·Transferahia Talr Credits

NONE

F Subpnme...Mortgage·Related Risk Exposure

26.12

(Level 2) Total

529.179.214 S 29.179,21

1 The Co~y's exposure 10 subpnmo lendt/lg IS in !hc fIXed mllluury (bono) ll"lveslmenl portfolio Which coota.ns serunlies coIlater8llZed by Inort,gageS IMI hllV9 chatactefisIK.s 01 &lbpnme lending such a!'. low HCO SCOI'es, oo;,Jstabie rllte mortg!Jg8S al'ld altemative doaJmentation mongages_ These mvesltnenls ate In the k)lm of oS~I·bac.hcl serurmes and coll8te,81ized fI'\OItg&g8 obligations which are col131ert1hzed by subpnme morTgages 8S of Oec.ember31 , 2013

~ NONE , NONE • NONE

G. Rellllne(l Assets

NONE

21 Events Subsequom

SuhseQuent events have been considemd lhloogh 12131120' 3 for the 51t1IUlory annual statemenT filed on 03101120 14.

On January 1,2014, the Company wID be sub/Od 10 an annual roe under section 9010 0/ the A,trordl'lble Cel l:! Act (ACA)_ ThIs annual fee Will be eWoClltod 10 IndN~ health insur6(s bftSed (Ill the 18110 of 1he amount 01 the entity's net premiums wInton dvrtng the p(oceding calendar year 10 the ameuo! 0/ health insurance for 8~ US. MaUll nslc !hat is wflTWn dUl lng the preceding clIlendar year, A health insurance enllty's portIOn of lho tlnnutll becomes p&yeble once Ihe enuty PIO~'d&S health insurance for an US. heal(h nsk for each calendar year beginnilg on or afl81 January 1, 20 14 As or Oecamber 31, 20 13, Ihe Company has wrliion h_Ul insurance SUbjecllO !he ACA asSMSttlenl, elq)OCls 10 condun health insUianc.e bus!IIess In 2OH , and estimates !tIeir punion ot ltle annual heallh Il\StJIance InduslJ'y fee 10 ba payable on Seplomber 3D, 2014 10 be S 1,800,000 This assessmenl is 8l1.'pected 10 implla fl51! based ~ltlll by 8 5%

22 RomsurarlCb

A Cedad Re:nSUlBnce Repon

Sea,on 1 - General lnlerrogelOlles

Ata any ol lha rsinSlJlers, IiSled in Schedule S as Mn-eIfiI·aIOO. owned In excess 01 10% Of conuolled, eilher do'rectty or Indnua/v, by the compllny Of by any (ftpfesentau~e, officer, lruslee. Of director cd me company? Yes (I No (X) if VOS, give full details.

2. H!I~e eny policies issued' by the cornp.'lnY been relf'l5urod with a (Olrlpnny chartered It S oounlry other Ihan the UniTed Stales (8kcludm{l U.S. Br..,nches of such companios) that is owned In sxcess 01 10% or con trolled diredi..,. 01 indlreclly b..,. lin Insured. a beneficiary, 8 credItor or an insured or any Other person 001 prlmmily OI'I~god in tho insulence businEtss? Yes( I N~X) If yes. gi~e full details.

SeLhon 2 - Cedecs Reinsurance Repon - Part A

Does lhe company have any lelnStJrance ftgreemenls in eltetl under which lhe reinsuret may unilalerally cancel any remsurance fOf ressons other Chan lor nonpayment of premium 01 OI:har Sllfl:iar aedtts,? Yes I I No(X)

a If yes . ..... hat is the eshmall!d emounl 01 the aggregate reduc:fion rn surpIos of a unilatellll cancellatioo by ItlIl r811'1WfOr as of the dete or thls SllIl l!mont. IoJ !hose agroomoots in wh1d1 alocmlalion re5ll1ts In a roel obIigotion oIlhe reporting enlJty 10 the remsurer, and for which such ob!igatlon IS nol presently a«rued? Wflera naces.stllY, Ihe r~ enlrty mey ConSIder the CUllenl or antlopatad elpenence of the busine'!is reinsured In makilg Chis esllmale

b What is Ihe lotal amount of reinsurance alKfil taken, wh .. '1her 85 an IIssel or as til recucrion of ~!lbillly 101' Ihts agreement in Ctus Slalement?

2 Does II'Ie reporting entity have any rein!UJranca tlgloomenl in eftoci such thai the amoont of losses paid Of awuad lhrough Ihe Slltlomon' daia may l osull In 8 payment 10 the reinsurel of srnoul'lts Ihaim aggregaTe 8fId II11owillO lor Offr.o, of mutUlll creditS. from other reinsurance <'Igreaments wilt!'he same relnsural. exceed tho lolal direct plemlum (O~ect under the reinsured policies? Yas () No(X) II yes. give tutl deTails.

26.13

Sadlon 3 - Ceded Relnsurance Report - Part B

L What is the estimated amount of the i!ggregate reductron in surplus, (for agreements Qlher then those under which lhe reinsurer may unilaterally cancel for reasons other than 101 nonpayment of p!'emfum or other sim~er creclns that era reneetad in Sectlon 2 above) of terminaifon 01 All reinsuHlnce 8Q1ooments, by either party, liS of the dale of this statement? Where necessary. the company may conSIder he CUllenl or enbcipat&<l experience of Ihe business reinsured in making these. C'Stimates_ bI2ru!

2. Have any new agreement been executed 01 existfng agreements amended, since January 1 ollhe year of this statement, to include pol icies or contracts that were fn force or which had eXisting reserves es1abHshoo by the (omPtiny as of the effective dete of the agreement? Yos () NO{X)

If yes, ... !hat is me amount of reinsurance Cledits, whether an asset or 0 redUCTion of Hablb!y Taken lor such new agreement or amendments?

B. UllColiectib!e Reinsurance

NONE

C. CommUTation 01 Ceded Reinsurance NONE

D. Certrfied Reinsurer Rating DowngllKled or StaTUS SubJect 10 RellOUllion NONE

23, Respectillely Rated Contracts and Contracts Subjoct to Radel'ermination

A . The Company estimates retrospect!lIe premium adjustments basecl on actuat daims experience adjusted for estimates of claims unpaid.

B The Company records accruod retrospectille premium as an adjustment TO eamed premiums.

C. The amount of net prermums wntten by the Company al December 31,2013 Th aT w&re subject to retrospective rating features was $0 mllUon, thaI represenTed 0% of tota t net premiums wrinen. No other net premiums written by the Company are sub jected 10 retrospective rating r~atures.

D.

Medical loss fatlo rebates required pursuant to PUbl ic Health Service Act

DO. 'S

Smell Large w~n

R,'" IndrVidual Group Group ,,, TOTal

Plior Rf!90rting Year (I) Moolcal loss ratio rebates incUlTed 0 0 117,899 0 117,899 (2) Medical loss raUo rebates paid 0 0 0 0 0 (J) Medical loss rebBles unpaid 0 0 117,899 0 117,899 (4) Plus re insurance assumed amounts XXX XXX XXX XXX XXX (5) Less reinsurance ceded amounts XXX XXX XXX XXX XXX (6) Rebates unpaid net of reinsurance XXX XXX XXX XXX XXX

Current Reporting Year_To..QaTe (7) Medical loss ra tio rebales incuITed 0 0 1,948,98 1 U 1,948.981 (S) Medical loss latio rebates paid 0 0 0 0 0 (9) Medk:alloss rebates unpaid 0 0 1,9-48,08 1 0 1,948,981 (1 O)Plus remsuranC8 assumed amounlS XXX XXX XXX XXX XXX (11)less reinsurance ceded amounts XXX XXX XXX XXX XXX (t2)Rebates unpaid net of reinsurance XXX XXX XXX XXX XXX

24. Change in Incurred Losses and Loss AdjustmenT Expenses

Res9fVes as of December 31, 20 12 were $8,579,592 As of December 3 1, 20 13, $7,247,675 has been paid (0/ IOcurred lossfls and loss adjustmenl expenses attributable to insured ellents of pr ior years. Reserves remaining lor prior year ale now $0 liS a resu lt of re_estimation 01 unpaid IoSSolS /!ioo loss adjustment expanses. fherelors,

26.14

NOTES TO FINANCIAL STATEMENTS there has been $1.331 ,917 favorable prior year development since December 31,2012. This in(reas~ldecrease

Is. generally the result of ongoing analysis of 18cenlloss developmenllrends_ Original estimates lire Increesed or decreased as addillonal infO/malion becomes known regarding individual claims. There are no retrospectivelv rated conlrllcts subject 10 redetermination. Howflver. the business 10 which it relates is subject to premium adjustments,

25. Intercompany Pooling Arrangements

26. Struc1ured SetUements

NONE

27 Health Carn Receivables

A. Pharmaceutical Rebates Receivables None

B. Ri$k Shanng Rec.eN!lbles None

2B. ParticJpatmg PoUdes

NONE

.. 9 Premium DefICiency ReselVes

NONE

30. Antrdpated Salvage and Subrogation

NONE

26.15

'( He.lth

GENERAL INTERROGATORIES PART 1 - COMM ON INTERROGA.TORIES

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GENERAL INTERROGATORIES

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27.3

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27.5

GENERAL INTERROGATORIES PART 2· HEALTH INTERROGATORIES

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l a , t rtlP I

GENERAL INTERROGATORIES PART 2 - HEALTH It(fERROGATORIES

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28.1

TIS r I I '"' I

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• YOI'< No I ~ I ~-------

FIVE · YEAR HISTORICAL DATA , , , • , ~" ~" ~n :1110 ~

Bol.Ol\<. Sl>UI lP"IIe. J."" 31

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29

.:;ell tDtJL£ , ' . lNfOIl MATIO,.. CONtr.RN IN(; A{:TJ'¥'/Tlts or IN.~U M'''''1c:t; ,"'!: .'lUr.R..~ Of .\ tlCU ... DJN(; C(I .\IPAN\,,'(;ROUr

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~H.EDl!l. e: \' . li"1fOR~lAT 10/'i COlo/ce:~!'IIC'lG ACT! V \T1F.~ OF 1:'ll$UltANCE o\1EIVtDEUS OF ~ 'IVl.Dl"l(; CO,\'WA;.IV c.:~OU1 ·

PART 1_ OR(";Ar-.·lloATI(},' ·A1,. CH<\RT ,-M. ,. ...... _1 ...

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snn:OliLE \ ' . INFORMATI~'· CONCERNING ACTIV ITIES OF lNSURA..'1CE M EMliEMS OF A HOLOL'l/G COMJ'AN" ( ;~OUI'

, .\.IIT I· ORG"''''UT10(,; ,\l Cn AAT -, A_"_ .... _~l.C

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40.3

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sCR:€Dt~r. V . l"FORMATIO!ll CONc.:'ERi\' II\'G ACTIVITI f.$ OF l/1.·SURAI'o'C'S ~ 1£M I)[RS OF A 1\01.""'(; COMl".~i"Y r.nOl:T'

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40.4

SCHEL>ULE V ~ INFORMATION CONCERNING A CfrvrTl ES OF rN SUR"NCE MEi\lBERS OF II HOLOrNG COMPAr"!'Y GRour rART J- ORGANIZAT IONAL CUART

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SCII £DIIJ.r. \' . II'lirOIl."'ATION GO/'Il"'[ ltrlil/llC..,crl\·IrIES 01' I~SU~"/IICt MF.M8U\S or "- ItOI.IlINe (;OMI'.,NV Gi\oor

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......... -........ ... -.-_, .. n

." .. ,' .... ,-..........

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40.7

..~ ... ... 'ron» .. ...

.. ....... -,

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,-<>_._ .... -"'-" '-... ...... . " •. ,

ALPHABETICAL INDEX

AN~UALSTATEMENTBLANK

AnalYsIS 01 OperllftOnS BV lines of Business .... ~ Cash FlOw

uhi!);( t - Enmltm£O( By P10dUCI Type for Health Buslness On~

Elchittlt 2 - Acedent and Heekh Premtums Due and Unoaid

ElIhrblt J - Health Care Recewabh~s ElIhiblt 3A - Anal'r'!Js rJ Heallh Care RecelVlIbies Collected and At.CJ\..I6d

Exhi-tnt" - Chums Unp!:l.id and IncentIVe POOl, Withhold ana Bonus

Exhibtt 5 - Amoolllo;. Due From Parent. Subsidiaries and Allil lates

ElIhlbll 6 - AmOllnts Due fo Parent, Subsidiaries and Affi~&It! s

ExhIbit 7 - Part 1 - Summary of rransections With Provtders

Exhibit 7 - Pllrt 2 - Summary of Transactions With IntcrmodillnOS

ExhIbit 8 - Furniture, EQuipment and Supplies Owned

Exll lOlI of CAPital G81ns (losses)

Exhibit 01 Nellnvestmenl Income

ElIhlbiC of Nonedmitte<i Assets

ExIIlOIt of Premiums, Enro! lmenl ond UlI!ization (51019 Page)

Fille-Year Ht51otK:a1 Data

Gen6I'81lntelrogatOlies

Jutal Page

llllbl4lueS, Capital and SlJrpkJs

Notos To F'mllooaJ StlIlBmenlS

Overflow Paga FOI Write_ins

Schedule A - Pall 1

Schedule A - Plln 2

Schtodule A- Part 3

Sdlooule A - VeflflCl lLoo BeTW&efL Yeers

Schedule e - Plln I

Schedule B - Part 2

ScJH:xjulI:! 0 - PILI! 3

Schedule B - Vor itice tlon Batwoen YeDls

Schedule BA - PIlII 1

ScJ18dule BA - Pell 2

Schooul ll BA - Pert J

Schedulo BA - Veritk:aiicn Between Years

Sc.hedule 0 - Pert I

INDEX1

7 , , " 18

19

'" " 22

2J

24 ·24

25

" " " 30 29

27

3

" 44

EO'

EO' E03

5102

E04

E05 E06 sm E01

EOB

E09 5103

flO

ALPHABETICAL INDEX

ANNUAL. STATEMENT BLANK !Continutd)

Schedule 0 - Part I A - Sec1ion I Sl05

Schedule 0 - Part IA - Section 2 5 108

SclledulcO - Part2 - Saction l Elt

Schedule 0 - Part 2 - SectIOn 2 El 2

Schedule 0 - Part J Ell Sclledulc 0 - P8(l4 EH

Schedule 0 - Part 5 E15

Schedule 0 - Part 6 - Section 1 E16

Schedule O - Part 6-Section 2 El i)

Schedule 0 - Summary By COUnifY 5104

& hedule 0 - VeriflClltiofll3otweOfl Yeals 5 103

Schedule OA - Pan 1 E11

Schedule OA - Verification Between Vears SilO

Schedule DB -p,," A- Settlon 1 f iB Schedule DB - Pan A - Sectlon 2 E19

Schedule DB - Pari A - Vefificalion BetWeen Years 5111

Schedule DB - Pan B - Section 1 E20

Schedule DB - Pan G - Scctton 2 El l

Sd\edule DB - Pan B - Verification BetWeen Years 5111

Schedule DB - Pan C - Section 1 5 11 2

Schedule DB - Pan C -5ge:llOn "2 5 11 3

Schedule DB - Pert 0 - Sadlon 1 E22

Sc:lledule DB - Pan 0 - Seclion 2 E2l

Schedule DB - Venlltallan 5 114

Schedule Dl - Part 1 E24

Schedule Dl - ParI 2 E25

Schedule E - Pafl 1 - Cash E26

Schedule E - Pan 2 - cash EqUIvalents E27

5chooule E - Pafl3 - Speoal Oeposlfs E2f!

Schedule E - Ver'ifiCCllioo BelWeen Years 5115

Schedule 5 - PM 1 - Section 2 31

Schedule S - Pafl2 32

Schedule S - Paft 3 - Section 2 33

5chadule S - Part 4 34

Schedule 5 - Paf1 5 35

ScMdule S - Part I) 36

Schadule S' - Pan 7 37

Schedule T - Part 2 - Interstate Compact 39

Sc hedule T - Premiums and Dlher Consideratrons 3f1

Schedule Y - Informlilion Concemin9 Activities 0/ Insurer Members of a Holding Company G/ouP 40

Schedule Y- Paft l A - Detllrl 01 Insurance Holding Company System 41

Schedule Y - Paf1 2 - Summary of Insurer's Transactions With Any Affi liates 42

Statement 01 Revenue 8nd Expenses 4

Summary Inveymenl Schedule SID 1

INDEX2

ALPHABETICAL INDEX

ANNUAL STAT£MENT 8LANK (ContitlU!4l

SUpplementsl Exhibi1s an(l Schedules InlerfCIgalorics

Underv.rriling and Invesrmenl Exhibit - Part 1

UndorwmlOg and Investment Exh!bil - Pl'lI12

Ulldel\N'litfng ond InVOSlmeof Exhibil - P3rt 2A

UndelWOtmg end Investment ExhIbil - Part 28

Under""ntmg &nd Investment El:hlbil - Pan 2C

Under.orritfng ond Invo!>lmOOf Exhibil - P.vr 20

UrodelWlllrng and Investment Exhlbil - Part 3

INDEX3

" • • 10

" 12 13

"

.l:'lNCAL ST A Tr.ME~"'T FOR THE \,!:.\J( lOIJ OF nre COUI1'n Unld. Cau .. f JOWI , laC.

INDEX4

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Documents