2020-05-08T05:53:29-05:00 2019-12-31 521446779 JOHNSON LAMBERT LLP 4242 SIX FORKS ROAD SUITE 1500 RALEIGH NC 27609 990 2019-01-01 820648671 PENN TREATY PROTECTED CELL OF LTC RE PENN 8028641711 1050 CONNECTICUT AVE NW NO 700 WASHINGTON DC 20036 BRENDA J CUSHING CFO 8028641711 2020-05-08 1 J CALVIN MARKS P01226973 9197196400 34.233.173.235 2020-05-08 05:53:25 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5CA57564C3F4EED809CA878CC7A574EC5BA228EA 2019 2020-09-23 17:36:50Z BRENDA J CUSHING 1050 CONNECTICUT AVE NW NO 700 WASHINGTON DC 20036 315160366 0 6262 X N/A X 2016 DC LTC RE IS A PROTECTED CELL CAPTIVE INSURANCE COMPANY FORMED BY THE NATIONAL ORGANIZATION OF LIFE AND HEALTH GUARANTY ASSOCIATIONS, WHOSE MEMBERS ARE LIFE AND HEALTH INSURANCE STATE GUARANTY ASSOCIATIONS AFFECTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY. THE MEMBERS REINSURE THEIR OBLIGATIONS TO LTC RE TO SERVICE THE COVERED POLICYHOLDERS. 11 11 0 20 0 0 0 0 11343900 -131946331 62692041 70478740 0 0 74035941 -61467591 0 0 0 0 0 0 0 0 0 -5437471 80331761 -5437471 80331761 79473412 -141799352 2569370062 2365738389 2544033895 2342425622 25336167 23312767 X LTC RE IS A PROTECTED CELL CAPTIVE INSURANCE COMPANY FORMED BY THE NATIONAL ORGANIZATION OF LIFE AND HEALTH GUARANTY ASSOCIATIONS, WHOSE MEMBERS ARE LIFE AND HEALTH INSURANCE STATE GUARANTY ASSOCIATIONS AFFECTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY. THE MEMBERS REINSURE THEIR OBLIGATIONS TO LTC RE TO SERVICE THE COVERED POLICYHOLDERS.THE GUARANTY ASSOCIATIONS PROVIDE THE INSURANCE INDUSTRY AND ITS CONSUMERS WITH A SAFETY NET IN THE EVENT A LIFE AND HEALTH INSURANCE COMPANY BECOMES INSOLVENT AND UNABLE TO PAY CLAIMS. 0 0 THE GUARANTY ASSOCIATIONS PROVIDE THE INSURANCE INDUSTRY AND ITS CONSUMERS WITH A SAFETY NET IN THE EVENT A LIFE AND HEALTH INSURANCE COMPANY BECOMES INSOLVENT AND UNABLE TO PAY CLAIMS 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BRENDA J CUSHING 8028641711 1050 CONNECTICUT AVE NW STE 700 WASHINGTON DC 20036 X ERIC RANGEN PRESIDENT 2.00 1.00 X X 0 0 0 PETER GALLANIS SECRETARY 1.00 1.00 X X 0 0 0 CARL MCDONALD TREASURER 1.00 1.00 X X 0 0 0 AARON BALL DIRECTOR 1.00 1.00 X 0 0 0 FREDERIC FUTTERMAN DIRECTOR 2.00 1.00 X 0 0 0 CHARLES GULLICKSON DIRECTOR 1.00 1.00 X 0 0 0 MARGARET PARKER DIRECTOR 1.00 1.00 X 0 0 0 RUSSEL SMITH DIRECTOR (FROM FEB '19) 1.00 1.00 X 0 0 0 JOHN STENSON DIRECTOR (TO FEB '19) 1.00 1.00 X 0 0 0 NICOLE STYKA DIRECTOR 1.00 1.00 X 0 0 0 G THOMAS SULLIVAN DIRECTOR 1.00 1.00 X 0 0 0 JAMES YABLECKI DIRECTOR 1.00 1.00 X 0 0 0 BRENDA CUSHING CHIEF FINANCIAL OFFICER 13.50 1.50 X 0 0 0 JODI ANATOLE CHIEF OPERATING OFFICER 12.00 1.30 X 0 0 0 0 0 0 0 0 0 0 PENN TREATY NETWORK AMERICA PO BOX 7066 ALLENTOWN PA 18105 THIRD PARTY ADMIN/ACCOUNTING SERVICES 11275025 TRIPLUS SERVICES INC 35 PARKWOOD DR SUITE 150 HOPKINTON MD 01748 THIRD PARTY ADMIN/ACCOUNTING SERVICES 4278443 WELLINGTON ASSET MANAGEMENT 280 CONGRESS ST BOSTON MA 02210 INVESTMENT MANAGEMENT 1511821 DRINKER BIDDLE & REATH 1500 K STREET NW STE 1100 WASHINGTON DC 20005 LEGAL SERVICES 924179 LONG TERM CARE GROUP 1210 NORTHBROOK DR STE 100 TREVOSE PA 19053 ACTUARIAL SERVICES 480632 9 REINSURANCE PREMIUMS 900099 -131946331 -131946331 -131946331 68400615 68400615 378706082 376627957 2078125 2078125 2078125 -61467591 -131946331 0 70478740 131537 924179 744556 1655866 525748 24494 4320 361162 CLAIMS PAID 261267271 LOSS ADJUSTMENT EXPENSE 8743493 THIRD PARTY ADMINISTRAT 6458714 CHANGE IN RESERVES -200600152 90573 80331761 3162637 10834783 101185 149235447 97005422 56274 97185 1410727933 1497961173 699903 -546394 1005386683 760386220 2569370062 2365738389 765396 1857499 17723819 15984004 2525544680 2324584119 2544033895 2342425622 X 0 0 0 0 25336167 23312767 25336167 23312767 2569370062 2365738389 -141799352 139775952 0 X 0 1 X 1 0 0 GUARANTY ASSOCIATION RECEIVABLES 716069892 FUNDS HELD IN TRUST BY TPA 30296450 ACCRUED INVESTMENT INCOME 14019878 760386220 POLICY RESERVES 1818289280 CLAIMS RESERVES 493043746 LAE RESERVES 12960283 DUE TO BROKER 174563 UNCLAIMED PROPERTY 116247 2324584119 X PART X, LINE 2: MANAGEMENT HAS CONCLUDED THAT LTC RE, PTNA PC AND ANIC PC HAVE PROPERLY MAINTAINED THEIR FEDERAL AND STATE TAX-EXEMPT STATUS AND HAVE NOT TAKEN ANY UNCERTAIN TAX POSITIONS WHICH WOULD JEOPARDIZE THEIR FEDERAL INCOME TAX-EXEMPT STATUS. BC CONSULTING LLC ENTITY OWNED MORE THAN 35% BY BRENDA CUSHING, CFO 249310 CFO MANAGEMENT SERVICES FOR GROUP 0 ENDEAVOUR CONSULTING LLC ENTITY OWNED MORE THAN 35% BY JOANNE ANATOLE, COO 131537 COO MANAGEMENT SERVICES FOR GROUP 0 FORM 990, PART VI, SECTION A, LINE 3 PTNA PC CONTRACTED WITH CONSULTANTS, PROFESSIONAL SERVICE PROVIDERS, AND THIRD PARTY ADMINISTRATORS TO PERFORM SUBSTANTIALLY ALL NECESSARY CLERICAL AND MANAGERIAL FUNCTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE CAPTIVE HAS ONE CLASS OF MEMBERS. EACH LIFE & HEALTH INSURANCE GUARANTY ASSOCIATION LOCATED IN THE UNITED STATES WHO IS ALSO A MEMBER OF THE NATIONAL ORGANIZATION OF LIFE & HEALTH INSURANCE GUARANTY ASSOCIATIONS AND WHO WAS IMPACTED BY THE INSOLVENCY OF PENN TREATY NETWORK AMERICA INSURANCE COMPANY AND/OR ITS WHOLLY OWNED SUBSIDIARY, AMERICAN NETWORK INSURANCE COMPANY IS ELIGIBLE TO BECOME A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE FOLLOWING INDIVIDUALS WILL BE DIRECTORS: CHAIR OF THE NOLHGA PTNA/ANIC TASK FORCE, CHAIR OF THE NOLHGA MEMBERS PARTICIPATION COUNCIL, AND THE PRESIDENT OF NOLHGA. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, LEGAL COUNSEL, CAPTIVE MANAGER, AUDIT AND RISK ADVISORY COMMITTEE, AND BY THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COVERED PERSONS ARE UNDER A CONTINUING OBLIGATION TO DISCLOSE ANY SITUATION THAT PRESENTS A CONFLICT OF INTEREST. ANY COVERED PERSON WHO BECOMES AWARE OF A CONFLICT OF INTEREST OR POTENTIAL CONFLICT OF INTEREST IS REQUIRED TO BRING IT TO THE ATTENTION OF AN EXECUTIVE OFFICER. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. LTC REINSURANCE PCC 1050 CONNECTICUT AVE NW STE 700 WASHINGTON DC 20036 812155730 MANAGEMENT COMPANY DC 501(C)(6) N/A 0 ANIC PROTECTED CELL OF LTC RE 1050 CONNECTICUT AVE NW STE 700 WASHINGTON DC 20036 820630879 REINSURANCE DC 501(C)(6) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0