2017-11-14T12:19:57-06:00 2016-12-31 PricewaterhouseCoopers LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2016-01-01 010719207 FIRST MEDICAL INSURANCE COMPANY (RRG) % MARSH MANAGEMENT SERVICES I FIRS 8028645599 C/O MARSH MANAGEMENT SERVICES INC BURLINGTON VT 05401 THOMAS J TODOROW EXECUTIVE VP & CFO 2155901000 2017-11-14 true JOANNE KRUEGER P01235586 2673303000 155.201.188.33 23522320173185000004 2017-11-14 P 11024F1F61DDAB8F52D460CAFA379D1B2DD8E070 CE88C8CFFE51E99E9DF9B7C5B75C02950C36D7D6 2016 2017-02-10 21:41:12Z THOMAS J TODOROW 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 71249055 false X N/A X 2002 VT THE ORGANIZATION PROVIDES INSURANCE FOR THE CHILDREN'S HOSPITAL OF PHILADELPHIA AND CERTAIN AFFILIATED TAX -EXEMPT ORGANIZATIONS. 4 1 0 0 0 0 0 10159508 10244432 3408985 4380382 0 0 13568493 14624814 0 0 0 0 0 0 0 0 0 6925186 11502987 6925186 11502987 6643307 3121827 106862148 97164855 43372387 46996493 63489761 50168362 THE ORGANIZATION PROVIDES INSURANCE FOR THE CHILDREN'S HOSPITAL OF PHILADELPHIA AND CERTAIN AFFILIATED TAX-EXEMPT ORGANIZATIONS. false false 11114941 10244432 INSURANCE FOR CHILDREN'S HOSPITAL OF PHILADELPHIA AND ITS TAX-EXEMPT ENTITIES. 11114941 true false false false false false false false false false false true false false true false true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false false X 4 1 false false false false true true true true true false false true true true true true true false false false X MARSH MANAGEMENT SERVICES I 8028645599 100 BANK ST STE 610 BURLINGTON VT 05401 THOMAS J TODOROW DIRECTOR & PRESIDENT 1.0 44.0 X X 0 1515234 246263 EDWARD F PRECOURT DIRECTOR & ASSISTANT TREASURER 1.0 0.0 X X 0 0 0 LYNN CALHOUN DIRECTOR & SECRETARY 1.0 39.0 X X 0 269338 17630 MICHAEL CORBO TREASURER 1.0 42.0 X X 0 345694 17078 0 2130266 280971 0 false true false WHITE WILLIAMS ONE LIBERTY PL 1650 MARKET ST STE PHILADELPHIA PA 19103 LEGAL SERVICES 2170849 POST POST LLC 200 BERWYN PARK STE 102 920 CASSA BERWYN PA 19312 LEGAL SERVICES 439297 CONRAD O'BRIEN PC 1515 MARKET STREET 16TH FLOOR PHILADELPHIA PA 19103 LEGAL SERVICES 334016 POST SCHELL PC FOUR PENN CENTER 1600 JFK BLVD PHILADELPHIA PA 19103 LEGAL SERVICES 215668 STANDISH MELLON 1 BOSTON PL 5400 BOSTON MA 02108 LEGAL SERVICES 195181 8 0 Insurance Premium earned 10244432 10244432 10244432 2446981 2446981 0 0 0 0 0 58557642 56624241 1933401 1933401 1933401 0 0 0 0 0 0 0 0 0 0 14624814 10244432 0 4380382 0 0 0 0 0 0 0 0 0 0 91000 91000 13864 13864 38120 38120 0 0 195181 195181 29247 29247 0 0 0 0 0 1937 1937 0 0 0 0 0 0 Losses & Loss Adjustment 7923984 7923984 PROVISION FOR IBNR 2864390 2864390 POLICY ACQUIS & UNDERWRITING 326567 326567 GENERAL & ADMINISTRATIVE 18697 18697 11502987 11114941 388046 0 X 3533718 3284661 0 0 0 0 0 0 0 0 0 0 0 0 0 0 184708 164628 0 0 41430290 38983904 61713432 54731662 0 0 0 0 0 0 106862148 97164855 169277 188802 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43203110 46807691 43372387 46996493 X 0 0 5149516 5150516 58340245 45017846 63489761 50168362 106862148 97164855 X 3121827 223774 0 0 0 -16667000 X false true X true false X X X 12 THE CHILDREN'S HOSPITAL OF PHILADELPHIA 231352166 3 true 0 0 THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION 232237932 7 true 0 0 THE CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATION 232311482 10 true 0 0 CHOP CLINICAL ASSOCIATES INC 223548970 10 true 0 0 CHILDREN'S ANESTHESIOLOGY ASSOCIATES LTD 232592835 10 true 0 0 CHILDREN'S ANESTHESIOLOGY ASSOCIATES OF NEW JERSEY INC 223405673 10 true 0 0 CHILDREN'S HEALTH CARE ASSOCIATES INC 222785804 10 true 0 0 CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY INC 233036699 10 true 0 0 CHILDREN'S SURGICAL ASSOCIATES LTD 232589322 10 true 0 0 CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY INC 223348481 10 true 0 0 RADIOLOGY ASSOCIATES OF THE CHILDREN'S HOSPITAL INC 232665855 10 true 0 0 CHILDREN'S RADIOLOGY ASSOCIATES OF NEW JERSEY PC 811626790 10 true 0 0 12 0 0 false true false false true true false false false false false false false false false false true false SCHEDULE A, PART IV, SECTION A, LINE 1 FMIC PROVIDES INSURANCE TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA ("CHOP") AND CERTAIN AFFILIATED TAX-EXEMPT ORGANIZATIONS. CHOP IS THE ONLY NAMED ENTITY IN FMIC'S ARTICLES OF INCORPORATION AND BYLAWS. PROFESSIONAL LIABILITY INSURANCE IS PROVIDED TO CHOP AFFILIATES WHO REQUIRE SUCH INSURANCE, SUCH AS PHYSICIAN PRACTICE PLANS. THESE PHYSICIAN PRACTICE PLANS ARE UNDER THE COMMON CONTROL OF CHOP. GENERAL LIABILITY INSURANCE IS PROVIDED TO CERTAIN CHOP CONTROLLED AFFILIATES. A SUPPORTED ORGANIZATION IS DESIGNATED BY ITS STATUS AS A CONTROLLED AFFILIATE OF CHOP. THE ORGANIZATIONS CURRENTLY SUPPORTED HAVE BEEN SUPPORTED FROM THE TIME FMIC WAS FORMED, OR FROM THE TIME SUCH OTHER ORGANIZATIONS WERE FORMED, AND ARE EXPECTED TO CONTINUE TO BE SUPPORTED SO LONG AS THEY REMAIN CHOP CONTROLLED AFFILIATES. SCHEDULE A, PART IV, SECTION A, LINE 2 TWO OF THE SUPPORTED ORGANIZATIONS THE CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATION AND CHOP CLINICAL ASSOCIATES INC. HAVE AN IRS DETERMINATION STATUS UNDER 509(A)(3). BOTH OF THESE ORGANIZATIONS, HOWEVER, MEET THE SUPPORT TEST REQUIRED UNDER 509(A)(2) AS MOST, IF NOT ALL, OF THEIR REVENUE IS PROGRAM SERVICE REVENUE. SCHEDULE A, PART IV, LINE 5A DURING CALENDAR YEAR 2016, FMIC ADDED CHILDREN'S RADIOLOGY ASSOCIATES OF NJ, P.C. (EIN: 81-1626790) AS A SUPPORTED ORGANIZATION. CHILDREN'S RADIOLOGY ASSOCIATES OF NJ, P.C. IS AN AFFILIATE OF CHOP AND UNDER COMMON CONTROL OF CHOP, THE NAMED SUPPORTED ORGANIZATION IN FMIC'S ARTICLES OF INCORPORATION AND BYLAWS. SPONSORED ENTERPRISES 15795259 F ASSET-BACKED SECURITIES 6109231 F COMMERCIAL MORTGAGE BACKED SEC 3292737 F MUNICIPAL BONDS 4891633 F ACCRUED INTEREST 437292 FOREIGN GOVERNMENTS 21553 CORPORATE DEBT SECURITIES 24183957 F 54731662 0 LOSSES PAYABLE 537177 UNEARNED PREMIUM RESERVES 5205858 LOSS ADJUSTMENT EXPENSES 41064656 46807691 14653407 223774 223774 14429633 195181 195181 14624814 11307806 11307806 195181 195181 11502987 false true false false false false false false false THOMAS J TODOROW DIRECTOR & PRESIDENT 0 713996 0 693170 0 108068 0 216335 0 29928 0 1761497 0 0 LYNN CALHOUN DIRECTOR & SECRETARY 0 220861 0 48109 0 368 0 5300 0 12330 0 286968 0 0 MICHAEL CORBO DIRECTOR & TREASURER 0 284785 0 60909 0 0 0 5300 0 11778 0 362772 0 0 SCHEDULE J, PART II, LINE 4B THOMAS J TODOROW - 98,240 SCHEDULE J, PART II, COLUMN (C) THE AMOUNT REPORTED HERE MAY INCLUDE CHANGES IN ACTUARIAL VALUES OF SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS ("SERPS") AS REQUIRED TO BE REPORTED BY THE IRS. FORM 990, PART VI, SECTION A, LINES 6 AND 7 THE FOLLOWING ORGANIZATIONS ARE MEMBERS OF FIRST MEDICAL INSURANCE COMPANY (RRG): - THE CHILDREN'S HOSPITAL OF PHILADELPHIA - THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION - THE CHILDREN'S HOSPITAL OF PHILADELPHIA PRACTICE ASSOCIATION - CHOP CLINICAL ASSOCIATES, INC. - CHILDREN'S ANESTHESIOLOGY ASSOCIATES, LTD. - CHILDREN'S ANESTHESIOLOGY ASSOCIATES OF NEW JERSEY - CHILDREN'S HEALTH CARE ASSOCIATES, INC. - CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY, INC. - CHILDREN'S SURGICAL ASSOCIATES, LTD. - CHILDREN'S SURGICAL ASSOCIATES OF NEW JERSEY, INC. - RADIOLOGY ASSOCIATES OF THE CHILDREN'S HOSPITAL, INC. - CHILDREN'S RADIOLOGY ASSOCIATES OF NEW JERSEY, P.C. FORM 990, PART VI, SECTION A, LINE 7B UNDER FMIC'S BYLAWS, MEMBERS HAVE THE AUTHORITY TO ELECT OR REMOVE THE DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FMIC RECEIVES AUDITED FINANCIAL STATEMENTS. A PUBLIC ACCOUNTING FIRM PREPARES THE FORM 990 BASED ON THESE FINANCIAL STATEMENTS AS WELL AS OTHER INFORMATION GATHERED. ONCE PREPARED, THE FORM 990 WAS REVIEWED BY THE FINANCE OFFICE OF CHOP AS WELL AS THE DIRECTORS AND BOARD MEMBERS OF FMIC PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12B ALL OFFICERS, DIRECTORS OF FMIC ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. FORM 990, PART VI, SECTION B, LINE 12C FMIC HAS A CONFLICTS OF INTEREST POLICY. THAT POLICY APPLIES BY ITS TERMS TO THE DIRECTORS AND OFFICERS OF FMIC WHO ARE EMPLOYEES OF THE CHILDREN'S HOSPITAL OF PHILADELPHIA; BY VIRTUE OF ITS ADOPTION BY FMIC, THE POLICY ALSO APPLIES TO THE DIRECTORS AND OFFICERS OF FMIC WHO ARE NOT EMPLOYEES OF THE CHILDREN'S HOSPITAL OF PHILADELPHIA, WITH RESPECT TO THEIR DUTIES REGARDING FMIC. (FMIC DOES NOT HAVE ANY EMPLOYEES.) PURSUANT TO THE POLICY, ANNUAL CONFLICTS OF INTEREST STATEMENTS ARE COMPLETED BY ALL COVERED PERSONS, INCLUDING ALL DIRECTORS AND OFFICERS OF FMIC. THE STATEMENTS ARE REVIEWD BY FMIC BOARD FOR FURTHER REVIEW AND FOLLOW-UP AS NEEDED. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, FINANCIAL STATEMENTS, AND THE CONFLCITS OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES DISTRIBUTION FROM UNASSIGNED FUNDS: ($16,668,000) ISSUANCE OF MEMBERSHIP UNIT: $1,000 TOTALS ($16,667,000) THE CHILDREN'S HOSPITAL OF PHILADELPHIA 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 231352166 HEALTHCARE PA 501(C)(3) 3 CHOP FND true CHOP FOUNDATION 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 232237932 SUPPORT PA 501(C)(3) 7 NA false CHOP PRACTICE ASSOCIATION 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 232311482 HEALTHCARE PA 501(C)(3) 12 III - FI CHOP true CHOP CLINICAL ASSOCIATES INC 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 223548970 HEALTHCARE NJ 501(C)(3) 12 III - FI CHOP true CHILDREN'S ANESTHESIOLOGY ASSOC LTD 3401 CIVIC CTR BLVD philadelphia PA 19104 232592835 HEALTHCARE PA 501(C)(3) 10 CHOP true CHILDREN'S ANESTHESIOLOGY ASSOC OF NJ 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 223405673 HEALTHCARE NJ 501(C)(3) 10 CHOP true CHILDREN'S HEALTH CARE ASSOCIATES INC 100 PENN SQ E 9TH FL PHILADELPHIA PA 19107 222785804 HEALTHCARE PA 501(C)(3) 10 CHOP true CHILDREN'S HEALTH CARE ASSOCIATES OF NJ 51 HADDONFIELD ROAD CHERRY HILL NJ 08002 233036699 HEALTHCARE NJ 501(C)(3) 10 CHOP true CHILDREN'S SURGICAL ASSOCIATES LTD 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 232589322 HEALTHCARE PA 501(C)(3) 10 CHOP true CHILDREN'S SURGICAL ASSOCIATES OF NJ 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 223348481 HEALTHCARE NJ 501(C)(3) 10 CHOP true PGH DEVELOPMENT CORPORATION 426 CURIE BLVD PHILADELPHIA PA 19104 232351015 SUPPORT PA 501(C)(3) 12 I NA false SURGICAL ASSOCIATES RESEARCH & EDUCATION 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 232181768 RESEARCH PA 501(C)(3) 12 III - FI CHOP true RADIOLOGY ASSOCIATES OF CHOP 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 232665855 HEALTHCARE PA 501(C)(3) 10 CHOP true CHILDREN'S RADIOLOGY ASSOCIATES OF NJ 100 PENN SQUARE EAST PHILADELPHIA PA 19107 811626790 HEALTHCARE PA 501(C)(3) 10 CHOP true 4865 MARKET ASSOC 3401 CIVIC CTR BLVD PHILADELPHIA PA 19104 461341918 REAL ESTATE PA NA HAYSTACK INFORMATICS INC 3401 MARKET ST STE 200 PHILADELPHIA PA 19104 472433511 TECHNOLOGY DE NA C CORP false false false false false false false false false false false false false false false false false false false false