schedule y -information concerning activities ......group company statement as of june 30, 2012 of...
TRANSCRIPT
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE Y -INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP PARTl-ORG~ATIONALCHART
Notes
All legal entities on the Organization Chart are Corporations unless otherwise indicated.
(1) Entity is a Limited Liability Company
(2) Entity is a Partnership
(3) Entity is a Non-Profit Corporation
(4) Control of the Foundation is based on sole membership, not the ownership of voting securities
(5) PacifiCare Life and Health Insurance Company is 99% owned by PacifiCare Health Plan Administrators, Inc. and 1% owned by PacifiCare Health Systems, LLC
(6) UnitedHealth Group Information Services Private Limited is 99.37% owned by UnitedHealth Group lntamational B.V .. The remaining 0.63% is owned by United Health International, Inc.
(7) United Healthcare India Privata Limited is 99.9952% owned by UnitadHealth Group lntamational B.V. and 0.0048% owned by UnitedHealth International, Inc.
(8) General partnership interests are held by Unitad HealthCare Services, Inc. (89. 77%) and by UnitedHealthcare, Inc. (10.23%). United HealthCare Services, Inc. also holds 100% of the limited partnership interests. When combining general and limited partner interests, United HealthCare Services, Inc. owns 94.18% and UnitedHealthcare, Inc. owns 5.83%.
(9) Established a branch, lngenix, Inc. -Abu Dhabi, located in Abut Dhabi, UAE.
(1 0) WeiiMed Medical Management, Inc. is 80% owned by COllaborative Care Holdings, LLC and 20% owned by WMG Healthcare Partners, L.P.
(11) Limited partnership intarest is held by United HealthCare Services, Inc. (99%). General partnership interest is held by UMR, Inc. (1%)
(12) Personal Performance Consultants India Private Limitad is 99.996% owned by OptumHealth lntarnational B.V. and 0.004% owned by United Behavioral Health.
(13) INSPIRIS of Texas Physicians Group is a Texas non-profit (taxable) whose sole member is lnspiris of Texas, Inc.
(14) Optum Saude Servi~s (Brasil) Ltda. Is 99% owned by lngenix lnnovus (Natherlands) B.V. The remaining 1% is owned by Optuml nsig ht, Inc.
(15) Optumlnsight Poland sp. z.o.o. is 99% owned by lngenix lnnovus (Netherlands) B.V. The remaining 1% is owned by Optumlnsight, Inc.
Group Code
2
Group Name
3 4
NAIC Company FederaiiD
Code Number ...... 00000 ................... . .... 00000 .... 41-1913523
... 00000 . .. 27-(l015861 .
.... 00000 .... ~.
...... 00000 ..... 3H692392 ... 0707 ... ~itedllealth Group Incorporated ............. 82406 ..... 35-1665915
... 0707 .. ~itedllealth Group Incorporated ...... . . .73130 ... 35-1744596 .
... 0707 ... ~itedllealth Group Incorporated ...... 97179 . .. BH207231 .
...... 00000 ..... 54-1743136
...... 00000 ..... 54-1743141 ... 0707 .. ~itedllealth Group Incorporated .... . ... 13178 .... 26-2481299 . ... 0707 ... ~itedllealth Group Incorporated ....... ...... 13168 ... 26-2688274 . ... 0707 .. ~itedllealth Group Incorporated ........... .J15497 .... 22-3368602
...... 00000 ..... 61-1314126
...... 00000 ..... 8H813232
... 00000 .. .... ooooo .... n-o401090
... 00000 ... 84-1544013 . ...... 00000 ..... 8IHl267857 ...... 00000 ..... 41-2011515 ...... 00000 ................... .
... 00000 .
.... 00000 .... 20-25761Di .
...... 00000 ..... 2H375685
... 0707 .. ~itedllealth Group Incorporated ...... . ... 12313 ... 20-2412936 .
... 0707 ... ~itedllealth Group Incorporated ...... 12558 . .. 45-ID6!I34 .
...... 00000 ..... 27-3536378
... 0707 .. ~itedllealth Group Incorporated .... .... 12567 .... 20-3888112 .
... 0707 .. ~itedllealth Group Incorporated ...... 14041 .... 27-5038136
...... 00000 ..... 26-1358634
... 00000 . .. 42-1464363 . .... 00000 ..
... 00000 . ...... 00000 ..... 95--4168244 ... . ...... 00000 ........................ .
... 0707 ... ~itedllealth Group Incorporated ............. 11836 ..... 1:H24nD6 .... 00000 .... 27-2337616 . ... 00000 .... 27-2337487 .
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULEY PART 1A ·DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
5
Federal RSSD
6
CIK
7 8 9 10 11 12 13 14 Type If
of Control Control (Ownenship, is
Board, Owner-Relationship Management, ship
Name of Securities Exchange Names of Domi- to Attorney-in-Fact, Provide if Publidy Traded Parent, Subsidiaries ciliary Reporting Directly Controlled by Influence, Percen-
CU.S. or lntemationall or Affiliates Location Entitv (Name of Entilv/Person) Other) laQe Ultimata Controlling Entitv{ie& l/Person<s)
.................................................... (PPCJ Ply Ltd------------------------------------- ...... AU·-·-·- _________ NIA. __________ PPC Worldwide Ply Ltd __________________ Ownership. __________________ . .100.000 ~itedlleallh Group Incorporated .. ACN Group IPA of New York, Inc . .. ··· -· .. .... NY .... __________ NIL ________ Optuntfaalth Care Solutions, Inc . . Ownership.. ... . ... . .100.000 ~itedlleallh Group Incorporated .. ACN Group of California, Inc. . . .... CA. ..... _________ JA. ___________ Optuntfaalth Care Solutions, Inc .. Ownership.. ....... ..100.000 ... ~itedlleallh Group Incorporated .
. ................................................... A-life Hospital Coding, llC --------------- ...... IE. ... __________ NIA. __________ A-life Medical, Inc . ..................... Ownership. ................. . .100.000 ... ~itedlleallh Group Incorporated . -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· A-life Medica I , Inc. ·-·-·-·-·-·-·-·-·-·-·-·-·- _______ CA. _______________ NIL ________ Optumlns ight, Inc. ·-·-·-·-·-·-·-·-·-·-·-·- Ownership___________________ . .100.000 ~i tedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· All Savers Insurance Company_____________ Golden 1\Jie Financial CorpOration ~itedlleallh Group Incorporated
....... .IN. ...... __________ j,l ___________ ------------------------------------------------------ Ownership. __________________ . .100.000 .. All Savers Life lnsuranca Company of Golden 1\Jie Financial CorpOration ~i tedlleallh Group Incorporated .
California ------------------------------------------ ....... CA. ... __________ _j,l ___________ ------------------------------------------------------ Ownership. ................. . .100.000 . American Medical Security Life Golden 1\Jie Financial Corporation ~lledlleallh Group Incorporated . Insurance Company ------------------------------- ....... 111 ....... _________ JA. ___________ ------------------------------------------------------ Ownership ___________________ . .100.000
-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· AmeriChoice CorpOration ____________________________ IE. _______________ NIL ________ ~itediealth Group IncorpOrated __ Ownership. __________________ . .100.000 ~itedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Amer iCho ice Health Services, Inc. . ...... IE. ...... _________ NIL ________ AmeriCho ice Corporal ion _______________ Ownership. __________________ . .100.000 ~i tedlleallh Group Incorporated .................................................... AmeriChoice of Connecticut, Inc . ....... ....... CT .. __________ _j,l ___________ AmeriChoice Corporation --------------- Ownership._ ................ . .100.000 ... ~itedlleallh Group Incorporated .
AmeriChoice of Georgia, Inc. . . ..... GA. ..... _________ JA. ___________ AmeriChoice CorpOration --------------- Ownership......... . .... .100.000 ... ~itedlleallh Group Incorporated . .. Amer iChoice of New Jersey, Inc . .. ... __ .. .... N.J. .... __________ JA. ___________ Amer iCho ice Corporal ion --------------- Ownership.. -·· .... . .100.000 ~i tedlleallh Group Incorporated
-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Aperture Credential ing, Inc. ·-·-·-·-·-·-·- _______ IE. _______________ NIL ________ Optumlnsight, Inc. ·-·-·-·-·-·-·-·-·-·-·-·- Ownership ___________________ . .100.000 ~i tedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Arizona Physicians IPA, Inc. ·-·-·-·-·-·-·- ~itediealthcare of Arizona, Inc. ~itedlleallh Group Incorporated
....... M.. ...... _________ NIA. __________ ------------------------------------------------------ Ownership. __________________ . .100.000 ASI Global, llC ---------------------------------- ...... JX. ...... _________ NIL ________ FrontieriEDEX, Inc. . Ownership ........ . .... .100.000 ... ~itedlleallh Group Incorporated .
.. Axolot I Corp. .. . . .... IE. .... __________ NIL ________ Optumlnsight, Inc. . .. -···· Ownership.. -·· .... . .100.000 ~i tedlleallh Group Incorporated
.. bConnected Software, Inc. . . .... IE. ..... _________ NIL ________ Connextions, Inc. Ownership.. ....... ..100.000 ... ~itedlleallh Group Incorporated . -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Behavioral Heal thcare Opt ions, Inc. __ ....... NV ....... _________ NIL ________ Sierra Health Services, Inc. ·-·-·-·- Ownership ___________________ . .100.000 ~i tedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· BP Inc. ·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· _______ IE. _______________ NIL ________ ~ i ted Ilea I thCare Services, Inc. . Ownership.__________________ . .100.000 ~i tedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Canada Health Group Internal ional Front ieriEDEX Canada HoI dings Ltd. ~i tedlleallh Group Incorporated
Lim i ted ----------------------------------------------- ....... CA. .... __________ NI "----------- ------------------------------------------------------ OwnershiP----·· .... . .100.000 .. CanReg (Europe) Limited --------------------- .. . .IE _________ NIL ________ Optumlnsight (Canada) Inc. .. Ownership. ...... .
. ................................................... Care ln.,rovement Associates of Texas, Xl.Health Corporation --------------------..100.000 ... ~i tedlleallh Group Incorporated .
~i tedlleallh Group Incorporated . Inc. ·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·- _______ IX. _______________ NIA.__________ Ownership ___________________ . .100.000
-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Care Improvement Plus Group Xl..Health CorpOration ___________________ _ ~i tedlleallh Group Incorporated Mlmagemet1t, llC ---------------------------------- ...... .IlL .... _________ NIL________ Ownership. __________________ . .100.000
.. Care Improvement Plus of Maryland, XLHealth Corporation -------------------- ~i tedlleallh Group Incorporated . Inc . .......................................................... .Ill.. __________ _j,l___________ Ownership. ................. . .100.000 . Care ln.,rovement Plus of Texas Xl.Health Corporation -------------------- ~lledlleallh Group Incorporated . Insurance Company ------------------------------- _______ IX. _____ __________ JA.___________ Ownership ___________________ . .100.000
-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Care Improvement PIus Practitioners, XL.Hea I th Corparat ion ___________________ _ ~i tedlleallh Group Incorporated llC ----------------------------------------------------- ....... Ill ....... _________ NIA.__________ Ownership. __________________ . .100.000
.................................................... Care Improvement Plus South Central XLHealth Corporation -------------------- ~i tedlleallh Group Incorporated . Insurance Company ------------------------------- ..... AIL ... _________ JA.___________ Ownership. ....... . . .... .100.000 .
.. Care ln.,rovement Plus Wisconsin Xl.Health Corporation -------------------- ~i tedlleallh Group Incorporated Insurance Company ------------------------------- ....... 111.. ..... _________ JA.___________ Ownership ___________________ . .100.000
-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Care Improvement Reinsurance Xl..Heal th Corparat ion ___________________ _ ~i tedlleallh Group Incorporated Corporal ion of America _______________________ ....... M.. ...... _________ NIL________ Ownership. __________________ . .100.000 CareMadic Systems, Inc. . . ..... IE. ...... _________ NIL ________ Optumlnsight, Inc. . . ..... Ownership ........ . .... .100.000 ... ~itedlleallh Group Incorporated .
.. ChinaGate (Hong Kong) Limited ----------- .. ... H< . _. _________ NIL ________ Opium, Inc. . ... Ownership.. ... . ... . .100.000 ~itedlleallh Group Incorporated
.. ChinaGate Company Limited ------------------ .. .... at ..... _________ NIL ________ ChinaGate (Hong Kong) Limited ______ Ownership.. ....... ..100.000 ... ~itedlleallh Group Incorporated . -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Cll Financial, Inc. ·-·-·-·-·-·-·-·-·-·-·-·-·-·- _______ CA. _____ __________ NIL ________ Sierra Health Services, Inc. ·-·-·-·- Ownership ___________________ . .100.000 ~itedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Cit ipaych Pty. Limited ·-·-·-·-·-·-·-·-·-·-·-· ______ AU ·-·-·- _________ NIL ________ PPC Wor ldllide ~it Trust ______________ Ownership. __________________ . .100.000 ~i tedlleallh Group Incorporated -·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-·-· Citrus Health Care, Inc. ·-·-·-·-·-·-·-·-·-·- ....... R.. ...... __________ u ___________ PI«: Holdings of Florida, Inc. ·-·-·- Ownership. __________________ . .100.000 ~itedlleallh Group Incorporated
.. Collaborative Care Holdings, llC _______ ..... IE. .... __________ NIL ________ Optuntfaalth Holdings, llC ------------ Ownership .... . .100.000 ~itedlleallh Group Incorporated . . . .. . .. . .. . .. . .. . . . Collaborative Care Services, Inc. . . .. ... IE. .... __________ NIL _______ Collaborative Care Holdings, LLC _ Ownership. .. ... . .. . . .100.000 ... ~itedlleallh Group Incorporated .
15
......
Group Code
2
Group Name
... 0707 .. lkliledllealth Group Incorporated ....
3 4
NAIC Company FadaraiiD
Code Number ...... 00000 ..... 27-3470466
... 00000 . . 11-3647007 .
.... 00000 .... 61-1351358 . ...... 00000 ..... 20-2581574 ...... 00000 ..... 20-1825933 ...... 00000 ..... 59-3684411
... 00000 .
..... 00000 ... 52-1811176 . ...... 00000 ..... 01-()518346 ...... 00000 ..... 52-1452809
... 52053 .... 3&--4008355 .
...... 00000 .... 41-2014834
...... 00000 ..... 3(H)238641
...... 00000 ........................ .
... 00000 . .. 84-1162764 . .... 00000 ..
... 00000 . .. 8H!I64571 .
...... 00000 ..... 3!Hl226127
...... 00000 ..... 81Hl618309
.... 00000 .. . 11-3669765 ... 00000 . .... 00000 .
...... 00000
...... 00000
... 00000 . ..... 00000 ... ~16 . ...... 00000 ..... ~14 ...... 00000 ................... . ...... 00000 ................... .
... 00000 ..
...... 00000 ..... 81Hl223385
...... 00000 ..... 8H257036
...... 00000 ................... . ... 00000 ..
... 00000 . .. 22-3314813 . ...... 00000 ..... 86-W08902 ...... 00000 ..... 06-1529471 ...... 00000 ..... 3:Hl766617 .... 00000 .. . ... 00000 ..
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULEY PART 1A ·DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
5
Federal RSSD
6
CIK
7 8 9 10 11 12 Type
13 If
Control is
Owner-
14
Name of Securities Exchange if Publidy Traded
Names of Parent, Subsidiaries
or Affiliates
Domiciliary
Location
Relationship to
Reporting Entity
Directly Controlled by (Name of Entilv/Personl
of Control (Ownenship,
Board, Management,
Attorney-in-Fact, Influence,
Other)
ship Provide Percen
tage Ultimata Controlling Entitv{ie& l/Person<s l cu.s. or lntemationall
.................................................... CollabGrative Cere Solutions, llC _____ CollabGrative Cere Services, Inc . lkli tedHaalth Group Incorporated ...... .!£ .... . _________ foliA. __________ ------------------------------------------------------ Ownership...... . ... . .100.000
.. Comfort Care Tr111sportation, llC _______ ...... JL ... _________ foliA. __________ WeiiMed Medical Management, Inc .. Ownership......... ..100.000 ... lklitedHealth Group Incorporated . . ................................................... Commonwealth Mninistrators, llC _______ ...... KL . _________ foliA. __________ l.MI, Inc. . Ownership. ................. . .100.000 ... lklitedHaalth Group Incorporated . . ................................................... Connextions t«:l ffll, Ll.C _____________________ ....... tfL .... _________ foliA. __________ Connextions, Inc .......................... Ownership .................... .100.000 lklitedHaalth Group Incorporated .................................................... Connextions t«:l, llC __________________________ ....... R.. ...... _________ foliA. __________ Connextions, Inc .......................... Ownership. ................... .100.000 lklitedHealth Group Incorporated .................................................... Connextions, Inc ....................................... R.. ...... _________ foliA. __________ ~tuntiealth Holdings, llC ____________ Ownership. ................... .100.000 lklitedHaalth Group Incorporated
.. Corporate &lpport Limited ------------------ Personal Perform111ce Consult111ts lklitedHaalth Group Incorporated . . .... J.K . __________ foliA. __________ LK Limited ------------------------------------ Ownership. ................. . .100.000 .
lllP Services of New York IPA, Inc. . . ..... foiL .. _________ foliA. __________ Dental Benefit Providers, Inc . ..... Ownership. ..... .100.000 ... lk!lledHaalth Group Incorporated . .................................................... CCG Resource ~lions, Ll.C __________________ ....... /£ ...... _________ foliA. __________ Specialty Benefits, Ll.C _______________ Ownership .................... .100.000 lklitedHaalth Group Incorporated .................................................... Dental Benefit Providers of Dental Benefit Providers, Inc. lklitedHealth Group Incorporated
California, Inc ......................................... CA. ...... __________ u___________ Ownership. ................... .100.000 . ................................................... Dental Benefit Providers of Illinois, Dental Benefit Providers, Inc . .
Inc. . . .... .JL. .... _________ JA.___________ Ownership......... . .... .100.000 . .. Dental Benefit Providers, Inc . .. ........ .... IE. .... . _________ foliA. __________ lklited HaalthCere Services, Inc . . Ownership..... . ... . .100.000
.................................................... Dist111ce Learning Network, Inc ................. IE. ...... _________ foliA. __________ ~tuntiealth Holdings, Ll.C ____________ Ownership .................... .100.000
.................................................... DunCIIl Printing Services, llC ___________ lklitedHealthcare lnsur111ce ....... SC ....... _________ foliA. __________ Col1tlfllly ----------------------------------------- Ownership. ................... .100.000
lkli tedHaalth Group Incorporated .
lkli tedHaalth Group Incorporated lkli tedHaalth Group Incorporated lkli tedHealth Group Incorporated
Electronic Network Systems, Inc. . . ..... IE. ...... _________ foliA. __________ ~tumlnsight, Inc. . Ownership ........ . .... .100.000 ... lklitedHaalth Group Incorporated . .. ELG F2E ----------------------------------------------- ..... N: . _ . _________ foliA. __________ Front ier!EDEX Limited ------------------ Ownership.. ... . ... . .100.000 lkli tedHealth Group Incorporated .. Evercere CollabGrative Solutions, Ovations, Inc. lklitedHaalth Group Incorporated .
Inc ............................................................ IE. ...... _________ foliA.__________ Ownership .................... .100.000 .................................................... Evercare HoSpice, Inc ............................... IE. ...... _________ foliA. __________ CollabGrative Care Holdings, llC _ Ownership. ................... .100.000 lklitedHealth Group Incorporated .................................................... Evercare of Arizona, Inc .......................... M.. ...... _________ foliA. __________ Ovations, Inc ............................... Ownership. ................... .100.000 lklitedHaalth Group Incorporated
.. Executive Health Resources, Inc . .. .... ...... PL .. . _________ foliA. __________ ~tumlnsight, Inc. . ....... Ownership..... . ... . .100.000 lklitedHaalth Group Incorporated
.. Exlogs EST Holdings Limited --------------- ..... ...E ..... _________ foliA. __________ Frontier!EDEX Limited ------------------ Ownership......... ..100.000 ... lklitedHealth Group Incorporated . . ................................................... Exlogs ~. Inc. (Canada) . Frontier!EDEX Canada Holdings Ltd. lklitedHaalth Group Incorporated .
. ...... CA. ...... _________ foliA. __________ ------------------------------------------------------ Ownership .................... .100.000 .................................................... Exploration for Mine Clear111ce, llC __ ..... ..IQ ...... _________ foliA. __________ Frontier!EDEX Limited __________________ Ownership. ................... .100.000 lklitedHealth Group Incorporated .................................................... Exploration Logisitics Group for Frontier!EDEX Limited__________________ lklitedHaalth Group Incorporated
Medical Services PLC LTD ------------------- .. . ..IQ _________ foliA. _________ _ .................................................... Exploration Logistics 8C Limited _______ ....... CA. ... . _________ foliA. __________ Frontier!EDEX Clllada Limited ______ _
Exploration Logistics Group Inc. . . ..... IE. ..... _________ foliA. __________ Front ier!EDEX Limited ------------------···················································· Exploration Logistics Inc ......................... IE. ...... _________ foliA. __________ Exploration Logistics Group Inc .. .................................................... Exploration Logistics Limited ___________ ..... J.K ...... _________ foliA. __________ Frontier!EDEX Limited _________________ _ . ................................................... Exploration Logistics Newfoundland Frontier!EDEX Canada Limited ______ _
Lim i ted ----------------------------------------------- ....... CA.... . _________ foil"-----------Exploration Logistics Nova Scotia Frontier!EDEX Clllada Limited ______ _
Ownership ........ ..100.000 . Ownership. ................. . .100.000 ... lkli tedHealth Group Incorporated . Ownership......... . .... .100.000 ... lk!lledHaalth Group Incorporated . Ownership .................... .100.000 lkli tedHaal th Group Incorporated Ownership. ................... .100.000 lkli tedHealth Group Incorporated
lkli tedHaalth Group Incorporated Ownership .................. . .100.000 .
lkli tedHealth Group Incorporated . Limited ----------------------------------------------- ...... CA. .... . _________ foliA.__________ Ownership. .... ..100.000
.................................................... Family Health Care Services _______________ ....... NV ....... _________ foliA. __________ Sierra Health Services, Inc ......... Ownership .................... .100.000
.................................................... Family Home HoSpice, Inc .......................... NV ....... _________ foliA. __________ Sierra Health Services, Inc ......... Ownership. ................... .100.000
.................................................... FMG Holdings, llC ------------------------------- ....... IE. ...... _________ foliA. __________ lklitedHaalth Group Incorporated __ Ownership. ................... .100.000 Focus EAP Ltd. . Persona I Perform111ce Consu I tents
.. . J.K . __ . _________ foliA. __________ LK Limited ------------------------------------ Ownership.. .. . ... . .100.000
lkli tedHaalth Group Incorporated lkli tedHealth Group Incorporated lkli tedHaalth Group Incorporated lkli tedHaalth Group Incorporated .
.. F()f', Inc. . ..... N.J. ..... _________ foliA. __________ Oxford Health Plans llC --------------- Ownership......... ..100.000 ... lklitedHaalth Group Incorporated . . ................................................... FOR t£AI..1H a= ARIZONA, lr«:. . ...... M.. ...... _________ foliA. __________ For Health, Inc ............................ Ownership .................... .100.000 lklitedHaalth Group Incorporated .................................................... For Health of Rhode lsl111d, Inc ............... RL. ..... _________ foliA. __________ For Health, Inc ............................ Ownership. ................... .100.000 lklitedHealth Group Incorporated .................................................... For Health, Inc ......................................... IE. ...... _________ foliA. __________ ln&piris, Inc ............................... Ownership. ................... .100.000 lklitedHaalth Group Incorporated
.. Frontier Medical Services Limited _____ .... J.K . _. _________ foliA. __________ Frontier!EDEX Limited ------------------ Ownership. . ... . .100.000 lklitedHaalth Group Incorporated . . . .. . .. . .. . .. . .. . . . Frontier!EDEX Clllada Holdings Ltd. . . .. ... CA. ..... _________ foliA. _________ Frontier!EDEX Limited Ownership. .. ... . .. . . .100.000 ... lklitedHealth Group Incorporated .
15
Group Code
2
Group Name
3
NAIC Company
Code ______ 00000
4
FederaiiD Number
__ _ 00000 - -- 45-5339512 -
______ 00000 --------------------______ 00000 --------------------______ 00000 --------------------
__ _ 00000 - -- 33-1219808 ---- 00000 ---- 52-2230470 -
_____ 00000 - - 04-3748582 -______ 00000 ----- 37-oe55360
___ 0707 ___ lllitedllealth Group Incorporated _____________ 62286 _____ 37-6028756
--- 00000 ---- 91Hl213198 -___ 0707 ___ lllitedllealth Group Incorporated _______ ______ 43893 ___ 13-3584296 _
___ 0707 ___ lllitedltealth Group Incorporated _____________ 95968 _____ 06-1084283 ___ 0707 ___ lllitedllealth Group Incorporated _____________ 95351 _____ 22-3241303 ___ 0707 ___ lllitedltealth Group Incorporated _____________ 95305 _____ 06-1174953
___ 00000 - -- 91Hl153069 -___ 0707 __ lllitedllealth Group Incorporated _____________ 96342 ____ 81Hl201035
__ _ 00000 -
______ 00000 ----- 95-4763349 ______ 00000 ----- 21H!910978 ---- 00000 ---- 21H!911466
____ 00000 ---- 21H!911303 -______ 00000 ----- 8H586676 ______ 00000 ----- 3&-4331825 ______ 00000 ----- --------------------
---00000 - -- 27-4603968 -
_____ 00000 - - BH477097 -______ 00000 ----- -------------------______ 00000 ----- --------------------______ 00000 ----- 62-1641102
___ 00000 - -- 27-2284945 -______ 00000 ---- 27-2831067 ______ 00000 ----- 27-1561939 ______ 00000 13-4138668 ______ 00000 ----- 13-4138665
---- 00000 ---- 21H!911466 __ _ 00000 - -- 20-5355196 -
______ 00000 ----- 26-2885572 ______ 00000 ----- 21H!911372 ______ 00000 ----- 2IHl683057
00000 - - - 3:Hl766366 ---
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULEY PART 1A ·DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
5
Federal RSSD
3057283 ---------
6
CIK
7 8 9 10 11 12 Type
13 If
Control is
Owner-
14
Name of Securities Exchange if Publidy Traded
Names of Parent, Subsidiaries
or Affiliates
Domiciliary
Location
Relationship to
Reporting Entity
Directly Controlled by (Name of Entilv/Person)
of Control (Ownenship,
Board, Management,
Attomey-in-Fact, Influence,
Other)
ship Provide Percen
tage Ultimata Controlling Entity{ie& l/Person<s) cu.s. or lntemationall
---------------------------------------------------- Front ieri!EDEX Cenadll Limited ____________ _ Cenadll Health Group International llli tedlteallh Group Incorporated _____ CA ___ __________ JollA_ __________ Limited ----------------------------------------- Ownership __ _ --- _100.000
__ Frontieri!EDEX Governement Services, FMl Holdings, LLC ------------------------- llli tedllealth Group Incorporated _ LLC ----------------------------------------------------- __ _____ IE_ ___ __________ !>11"----------- Ownership ----------------- _100.000 _
---------------------------------------------------- Frontieri!EDEX Group Limited ____________________ J.K _______________ NIL ________ FMl Holdings, LLC _________________________ Ownership ____________________ 100.000 lllitedlteallh Group Incorporated ---------------------------------------------------- Frontieri!EDEX Limited _____________________________ J.K _______________ NIL ________ Frontieri!EDEX l.K Limited ______________ Ownership ___________________ 100.000 lllitedlleallh Group Incorporated ---------------------------------------------------- Frontieri!EDEX l.K Limited _________________________ U( _______________ NIL ________ Front ieri!EDEX Group Limited _________ Ownership ___________________ 100.000 llli tedlteallh Group Incorporated
__ Frontieri!EDEX US, Inc. __ __ ____ IE_ _____ _________ NIL ________ Frontieri!EDEX Group Limited --------- Ownership ____ ____ _100.000 __ _ lllitedlteallh Group Incorporated _ ---------------------------------------------------- Frontieri!EDEX, Inc. ---------------------------- __ ____ IlL _ __________ !>11"----------- Frontieri!EDEX US, Inc. _ Ownership----------------- _100.000 ___ lllitedlleallh Group Incorporated _
Geriatrix of Mllssachusetts, Inc. _ _ _____ JN_ _______________ !>11"----------- lnspiris, Inc. _ Ownership________ _ ____ 100.000 ___ llllledlteallh Group Incorporated _ ---------------------------------------------------- Golden Rule Financial Corporation ____________ IE_ _____ _ _________ NIL ________ lllitedlteelth Group Incorporated __ Ownership ____________________ 100.000 lllitedlteallh Group Incorporated ---------------------------------------------------- Golden Rule Insurance Co"'*y ___________ Golden Rule Financial Corporation lllitedlleallh Group Incorporated
_______ _IN_ _____ _ __________ JL _________ ------------------------------------------------------ Ownership ___________________ 100.000 ---------------------------------------------------- H & W lndllmn i ty, Ltd. ------------------------- __ ____ KL __________ JollA_ __________ llli tedlteel th Group Incorporated __ Ownership __ ---------------- _100.000 ___ llli tedlteallh Group Incorporated _
Health Net Insurance of New York, Oxford Health Plans LLC --------------- lllitedlleallh Group Incorporated _ Inc. __ _ _____ NL ____________ JL_________ Ownership ____ _ 100.000
---------------------------------------------------- Health Net of Connecticut, Inc. ________________ C'L _____________ JL _________ Oxford Health Plans LLC _______________ Ownership ____________________ 100.000 llli tedlteallh Group Incorporated ---------------------------------------------------- Ileal th Net of New Jersey, Inc. _________________ .N.! _____ __________ JL _________ FOif', Inc. ------------------------------------- Ownership ___________________ 100.000 llli tedllealth Group Incorporated ---------------------------------------------------- Heel th Net of New York, Inc. _____________________ NL ______________ u ___________ Oxford Heel th Plans LLC _______________ Ownership ___________________ 100.000 llli tedlteallh Group Incorporated
Health Net Services (Bermuda) Ltd. _ _ ____ BI ____ __________ NIA_ __________ Oxford Health Plans LLC --------------- Ownership ________ _ ____ 100.000 ___ lllitedlteallh Group Incorporated _ __ Health Plan of Nevada, Inc. __ _ ___ ______ N'L ____________ JL _________ Sierra Health Services, Inc. Ownership____ _ ___ _ 100.000 lllitedllealth Group Incorporated __ Health Technology Analysts Ply Optumlnsi~t. Inc. lllitedlteallh Group Incorporated _
Limited----------------------------------------------- ______ )IJ _______________ NIL________ Ownership ____________________ 100.000 ---------------------------------------------------- Ileal thAI I ies, Inc. ------------------------------ _______ IE_ _______________ NIL ________ Optumllealth Holdings, LLC ____________ Ownership ___________________ 100.000 ---------------------------------------------------- Hospice lnspiris Holdings, Inc. ________________ JN_ _____ _ _________ NIL ________ lnspiris, Inc. ------------------------------ Ownership ___________________ 100.000
__ Hospice lnspiris of Pennsylvania, Hospice lnspiris Holdings, Inc. _ Inc. __ ___ _ JN_ _____ _________ NIL________ Ownership_ ___ ____ _100.000 _
llli tedllealth Group Incorporated llli tedlteallh Group Incorporated llli tedlteallh Group Incorporated
---------------------------------------------------- Hospice lnspiris of Texas, Inc. --------- __ _____ JN_ ___ __________ !>11"----------- Hospice lnspiris Holdings, Inc. __ _ Ownership----------------- _100.000 ___ lllitedlteallh Group Incorporated _ ---------------------------------------------------- Hospice lnspiris, LLC _______________________________ Jfi _______________ NIL ________ FOR ~TH (f ARIZONA, lr«:. _________ Ownership ____________________ 100.000 lllitedlteallh Group Incorporated ---------------------------------------------------- Hygeia Corporation----------------------------- _______ IE_ _____ _ _________ NIL ________ lllitedllealth International, Inc. _ Ownership ___________________ 100.000 lllitedllealth Group Incorporated ---------------------------------------------------- Hygeia Corporation (()Jtario) ____________________ CA _______________ NIL ________ Hygeia Corporation _______________________ Ownership ___________________ 100.000 lllitedlteallh Group Incorporated
lndllpendent Physician Management Collaborative Care Holdings, LLC _ lllitedlteallh Group Incorporated _ Services, Inc. ------------------------------------ __ ____ IE_ ___ __________ !>11"----------- Ownership----------------- _100.000 _ Informal ion Network Corporal ion -------- _____ _ );L ____ __________ JollA_ _______ _ Amer iCho ice Corporal ion --------------- Ownership _____ 100.000 ___ llllledlteallh Group Incorporated _
---------------------------------------------------- lngenix lnnovus (Nether lands) B.V. __________ M. _______________ NIL ________ Opium, Inc. ----------------------------------- Ownership ____________________ 100.000 llli tedlteallh Group Incorporated ---------------------------------------------------- lngenix l.K Holdings Limited _____________________ !.K _______________ NIL ________ Optum, Inc. ----------------------------------- Ownership ___________________ 100.000 lllitedllealth Group Incorporated ---------------------------------------------------- Ingram & Associates, LLC ___________________ Payment Resclution Services, Inc. lllitedlteallh Group Incorporated
__ _____ JN_ ___ __________ JollA_ __________ ------------------------------------------------------ Ownership __ ---------------- _100.000 _ lnspiris of Alabama, Inc. _ _ _____ JN_ ______________ NIA_ __________ lnspiris, Inc. _ Ownership _____ 100.000 ___ lllitedllealth Group Incorporated _ lnspiris of Maryland, Inc. ___________ JN_ ___ ___________ NIL ________ lnspiris, Inc. Ownership ____ _ 100.000 lllitedlteallh Group Incorporated lnspi ris of Michigan, Inc. _______ Jfi _______________ NIL ________ lnspi r is, Inc. ------------------------------ Ownership ____________________ 100.000 llli tedlteallh Group Incorporated INSPIRIS of New York IPA, Inc. _________________ NL ___ __________ NIL ________ lnspiris, Inc. ------------------------------ Ownership ___________________ 100.000 lllitedllealth Group Incorporated INSPIRIS of New York Management, Inc. lnspiris, Inc. ------------------------------ lllitedlteallh Group Incorporated ----------------------------------------------------------- _____ _ NL ____________ NIA___________ Ownership_________ _ ____ 100.000 _ lnspiris of Pennsylvania, Inc. ______________ JN_ ___ ___________ NIL ________ lnspiris, Inc. Ownership____ _ ___ _ 100.000 lllitedllealth Group Incorporated lnspi r is of Tennessee, Inc. __ __ ___ _ JN_ _____ _________ NIL ________ lnspi r is, Inc. Ownership_ ___ ____ _JOO.OOO __ _ llli tedlteallh Group Incorporated _ INSPIRIS of Texas Physician Group ____________ n _______________ NIL ________ lnspiris of Texas, Inc. ________________ Ownership ____________________ 100.000 lllitedlteallh Group Incorporated lnspi r is of Texas, Inc. _____________________________ Jfi _______________ NIL ________ lnspi r is, Inc. ------------------------------ Ownership ___________________ 100.000 llli tedllealth Group Incorporated lnspi r is Services Company _________________________ JN_ _____ _ _________ NIL ________ lnspi r is, Inc. ------------------------------ Ownership ___________________ JOO.OOO llli tedlteallh Group Incorporated lnSPiris Inc. __ _ __ IE___ NIA_ Collaborative Care Holdinas. LLC _ OwnershiP _ __ _100.000 __ lllitedlteallh Group Incorporated __
15
m 0 ?I -"
CUSIP Ident
ification .. 31281'1'-!L-1 .. 3128PP-!L-1 --312fii'IH!IHI .. 3128Pil-IIH .. 312~ . . 312MHS-4 .. 312MHS-4 . . 312MHS-4 . 312~
.. 31~
. . 312~ - 3128PT-R.-4 .. 3128PT-R.-4 .. 3128PT-R.-4 --3128PT -fF-ll --3128PT -fF-ll --3128PT -fF-ll . . 3128RHW-6 .. 3128RHW-6 . . 3128RHW-6 . 3128RI-~
.. 3128RI-~
. . 3128RI-~ - 3121RHP-li .. 3121RHP-li .. 3121RHP-li .. 31211RHHi .. 31211RHHi .. 31211RHHi . . 3128RI-VZ-ll .. 3128RI-VZ-ll . . 3128RI-VZ-ll . 312~-2
.. 31~-2
. . 312~-2 - 31281'\'-A4-2 --31281'\'-A4-2 --31281'\'-A4-2 --312fii'"H'3-ll --312fii'"H'3-ll --312fii'"H'3-ll . . 3128P"HIHI .. 312W-IIH . . 3128P"HIHI - 31281"1'-LY-4 .. 31281"1'-lY-4 . . 31281"1'-LY-4 - 3128I'"HIH .. 3128I'"HIH .. 3128I'"HIH .. 3128PH2-0 .. 3128PH2-0 .. 3128PH2-0 .. 3128PY--tlh'l .. 312908-F.Z-6 . . 312908-F.Z-6 - 312908-F.Z-6 .. 31292&-21'-2 .. 31292&-21'-2
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE D • PART 4 Show All Long-Term Bonds and Stock Sold, Redeemed or otherwise Disposed of During the Current Quarter
2 3 4 5 8 7 8 9 10 Chance In BookiA<fusted Carrvina Value
Number of For- Disposal Nama Shares of
Description eign Date of Purchaser stock FIUI: Pool J10715 I& 4.5001 09101124 ______________ _1)5/01/2012 __ Paydown __________________________________________ _ FIUI: Pool J10715 I& 4.5001 09101124 .. _ -------- .06/0112012 __ Paydown ----------------------FIUI: Pool J11381 I& 4.0001. 12101124 .. ________ _ 04/01/2012 __ Paydown ---------------------- _ FIUI: Pool J11381 I& 4.0001. 12101124 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J11381 I& 4.0001. 12101124 .... .06/0112012 __ Paydown----------------------FIUI: Pool J12851 I& 4.500107/01125 .. . .. -------- .04101/2012 __ Paydown ---------------------- - ---·-·- -·-·-·- -·-FIUI: Pool J12851 I& 4.5001 07101125 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J12851 I& 4.5001 07101125 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool 12385 I& 4.5001 06/01125 .. _ -------- .04101/2012 __ Paydown ---------------------- ______ _______ _ _ FIUI: Pool 12385 I& 4.5001 06/01125 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _
FIUI: Pool 12385 I& 4.5001 06/01125 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J13771 I& 3.5001 12101125 ____ _04/01/2012 __ Paydown ---------------------- -------------------FIUI: Pool J13771 I& 3.5001 12101125 ______________ .05101/2012 __ Paydown __________________________________________ _ FIUI: Pool J13771 I& 3.5001 12101125 .. _ -------- .06/0112012 __ Paydown ----------------------FIUI: Pool J13858 I& 4.0001. 12101125 .. ________ _ 04/01/2012 __ Paydown ---------------------- _ FIUI: Pool J13858 I& 4.0001. 12101125 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J13858 I& 4.0001. 12101125 .... .06/0112012 __ Paydown ----------------------FIUI: Pool J14807 I& 4.5001 03/01126 .. ___ -------- .04101/2012 __ Paydown ---------------------- ________ _______ __ _ FIUI: Pool J14807 I& 4.5001 03101126 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _
FIUI: Pool J14807 I& 4.5001 03101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J15073 I& 4.0001. 04/01126 .. _ -------- .04101/2012 __ Paydown ---------------------- ______ _______ _ _ FIUI: Pool J15073 I& 4.0001. 04/01126 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _ FIUI: Pool J15073 I& 4.0001. 04101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J15090 I& 4.5001 04/01126 ____ _04/01/2012 __ Paydown ---------------------- -------------------FIUI: Pool J15090 I& 4.5001 04/01126 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J15090 I& 4.5001 04101126 .. _ -------- .06/0112012 __ Paydown ----------------------FIUI: Pool J15148 I& 4.5001 04/01126 .. ________ _ 04/01/2012 __ Paydown ---------------------- _ FIUI: Pool J15148 I& 4.5001 04/01126 ______________ .05101/2012 __ Paydown __________________________________________ _ FIUI: Pool J15148 I& 4.5001 04101126 .... .06/0112012 __ Paydown ----------------------FIUI: Pool J15228 I& 4.5001 04/01126 .. ___ -------- .04101/2012 __ Paydown ---------------------- ________ _______ __ _ FIUI: Pool J15228 I& 4.5001 04/01126 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _ FIUI: Pool J15228 I& 4.5001 04101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J18282 I& 3.5001 08/01126 .. _ -------- .04101/2012 __ Paydown ---------------------- ______ _______ _ _ FIUI: Pool J18282 I& 3.5001 08101126 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _
FIUI: Pool J18282 I& 3.5001 08101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J15427 I& 4.5001 05/01126 ____ _04/01/2012 __ Paydown ---------------------- -------------------FIUI: Pool J15427 I& 4.5001 05101126 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J15427 I& 4.5001 05101126 .. _ -------- .06/0112012 __ Paydown ----------------------FIUI: Pool J15588 I& 4.5001 08/01126 .. ________ _ 04/01/2012 __ Paydown ---------------------- _ FIUI: Pool J15588 I& 4.5001 06101126 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J15588 I& 4.5001 06101126 .... .06/0112012 __ Paydown ----------------------FIUI: Pool J15831 I& 4.0001. 08/01126 .. ___ -------- .04101/2012 __ Paydown ---------------------- ________ _______ __ _ FIUI: Pool J15831 I& 4.0001. 06101126 ______ _ _______ .05101/2012 __ Paydown ______________________ _ ___________________ _
FIUI: Pool J15631 I& 4.0001. 06101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J15743 I& 3.5001 07/01126 .. _ -------- .04101/2012 __ Paydown ---------------------- ______ _______ _ _ FIUI: Pool J15743 I& 3.5001 07/01126 ______________ .05101/2012 __ Paydown __________________________________________ _ FIUI: Pool J15743 I& 3.5001 07101126 .. -------- .06/0112012 __ Paydown ---------------------- . FIUI: Pool J15863 I& 4.0001. 08/01126 ____ _04/01/2012 __ Paydown ---------------------- -------------------FIUI: Pool J15863 I& 4.0001. 06101126 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J15863 I& 4.0001. 06101126 .. _ -------- .06/0112012 __ Paydown ----------------------FIUI: Pool J18453 I& 3.5001 09/01126 .. ________ _ 04/01/2012 __ Paydown ---------------------- _ FIUI: Pool J18453 I& 3.5001 09/01126 ______________ .05101/2012 __ Paydown __________________________________________ _
FIUI: Pool J18453 I& 3.5001 09101126 .... .06/0112012 __ Paydown ----------------------FIUI: Pool J18148 I& 3.0001. 04/01127 .. ___ -------- .06/01/2012 __ Paydown ---------------------- ________ _______ __ _ FIUI: Rl\1105 Clo EZ 00 7.9501 07/01121 . ________ .04/01/2012 __ Paydown __________________________________________ _ FIUI: F1ll 1105 Cis EZ 00 7.9501 07101/21 . -------- .0510112012 __ Paydown ---------------------- . FIUI: F1111105 Cis EZ 00 7.950107/01121 . -------- .06/01/2012 __ Paydown ---------------------- - ------- ------ _ = ~:: :::: :::: =1~: :::··- :::::::: :~1~1~ :: ~=~ :::::::::::::::::::::: ::·:::::::·:::::::·::
Consideration
__________ .35.108 __________ .85.3&8 ____________ 4.190
------------4.478 ____________ 4.481 ____________ 2.345 ____________ 2.358 ____________ 5.425 ____________ 5.191 ____________ 5.347 ____________ 5.385 ____________ 7.314 ____________ 7.832 ____________ 7.780 ____________ 8.195 ____________ e.eea __________ .84.616 __________ .34.718 ____________ 1.1185 ___________ 48.439 __________ .57.213 ___________ 14.161 ___________ 45.1181 ____________ 8.488
------------2.913 __________ 19.814 ____________ 4.405 ____________ 4.170 ____________ 4.474 ____________ 3.710 ____________ 3.9118 ____________ 3.539 ____________ 2.317 ____________ 2.178 ____________ 2.196 __________ _13.830
------------2.923 ____________ 3.044 ____________ 3.819 ____________ 3.810 ____________ 3.838 __________ _18.038 ____________ 8.838 ___________ 11.315 ____________ 1.121
------------1.818 ____________ 1.515 __________ _13.3&8 ___________ 17.261 ____________ 6.038 _______________ 393 _______________ 341 ______________ .340 ____________ 8.978 ________________ J4 ________________ J3 ________________ J1 __________ 2,7.735
.. .. 1.311
Par Value ............ 35, 108
. .. .. 85,388 __ ________ ____ 4, 190
.............. 4,478 .... 4,481
__ _______ __ .2,345
............. .2,358
.... ........ . .5,425 _______ ____ _5,191
............. .5,347 . . .5,385
............ .7,314 ............. .7,832
______ 7,780
-- ------------'· 195 _____________ .a,esa ..... 84,616
__ _______ _ 34,718
............. .1,885
.... ........ 48,4311 _______ ___ 57,213
............. 14,161 _,45,881
_____________ 8,488
............. .2,913 . .. . 111,814
__ ________ ____ 4,405
.............. 4, 170 .... 4,474
__ _______ __ .3,710
............. 2-,988
.... ........ . .3,539 _______ ____ .2,317
............. .2, 178 . . .2,196
............ 13,830 ............. .2,923
. .. . . .3,044 .... ........ . .3,819 ............. 2-,810
... .3,838 __ _______ __ 18,038
............. .8,838
.... ........ 11,315 _______ ____ _1, 121
............. .1,616 . . .1,515
............ 13,398 ............. 17,281
. .. . .. B.039 __ ________ ______ :!113 ________________ 341
...•.• 340 __ _______ __ .8,978 __________________ 14 __ ________ ________ 13 ____ ____ ____ ____ _ _11
............ :II' 735
.. . ------- . .1 ,311
Actual Cost
............ 36 ,544 --- 88,894
___ ________ ___ 4,248 ______________ 4,539
... 4,541 ___ _______ _ .2,487 _____________ .2,501 ___ ________ __ .5,754 ________ ___ .5,485 _____________ _5,850
. .5,691 ........... 1,368
_____________ 1,887 . .. . 1,835
___ ________ __ .8,483 _____________ .6,887
.... 87,3711 ___ _______ 36,8311 _____________ .2,000 ..... ...... 51,398 ________ __ 59,019
............ J4 ,808 .47,329
........... .11,1181 _____________ .3,090
--- 84,&65 ___ ________ ___ 4,882 ______________ 4,433
... 4,755 ___ _______ _ _3,947 ______________ 4,243 ___ ________ __ .3,766 ________ ___ .2,439 _____________ .2,2113
.2,312 .......... J4 ,495
_____________ .3,109 ____ .3,237
___ ________ ___ 4,124 ______________ 4,051
... 4,080 --- _______ _ j8 ,847 _____________ 1,144 ___ ________ _ J1,822 ________ ____ 1,181 ______________ 1,704
. . 1,597 .......... J4 ,083
............ J8,147 ____ .6,349
•.•.•.•.•.•.•.•. A14 ________________ 358
..... 358 ___ _______ _ j,431 __________________ 14 ___ ________ _______ 13 _____ ____ ____ _____ 11
............ 38 ,430 ---- ------- .1,335
Prior Year Book/
Adjusted Carrying Value
............ 38,440 . .. . .. 88,641
________ ______ 4,242
.............. 4,534 ...... 4,5J/
_______ ____ .2,484
............. .2,4&7
.. ........ .. . .5,748 _____ ______ .5,472
............. .5,838 . .. . .5,/m
............. .7,383
............. .7,885 ________ 7,833
.. ........ ... .8,452
............. .8,818 .... 87,270
-·-·-·- . .. 38, 1115 ............. .1,997 .. ........ .. 51,337 ----- -- . .. 58, 969 ............. 14,588
..• A7.289 .............. 8,852 ............. 2-,088
--- . .. 84,554 ________ ______ 4,815
.............. 4,427 ...... 4,749
_______ ____ .3,942
.............. 4,2J/
.. ........ .. . .3,7&0 _____ ______ .2,4J/
............. .2,291 . .. . .2,310
............ 14,474
............. J., 104 . .. . .. . .3,232
________ ______ 4, 119
.............. 4,045 ...... 4,075
_______ ____ 18,833
............. .7, 139
.. ........ .. 11,813 _____ ______ _1, 180
............. .1,702 . .. . .1,585
............ 14,088
............. 18, 129 . .. . .. . .6,343
________ ________ -414 ________________ 358
........ 359 -- ·-·-·· -- ·-·-·· -- ·D __________________ 14 ________ ________ __ 13 __ ____ ____ ____ ____ 11
............ 38,420
. ------- ... .1,335
11 12 13 14 15 Total Total
Current Change in Foreign Year's Book/ Exchange
Current Other Than Adjusted Change in Unrealized Year's Temporary Carrying Book Valuation (Amor- Impairment Value /Adjusted Increase/ lization)l Raoog- (11 + 12 - Carrying Decrease Accretion nized 13) Value
_______________ J) ......... (1 ,333) _______________ .o _________ (1.333) _______________ J)
_______________ J) . .•.. (3,243) - --- .. .. .0 _________ (3.243) --- .. . Jl _______________ J) _______ ______ (52) _________ ______ .o ____________ .{52) __ ________ ______ 0 _______________ J) _____________ (58) _______________ .o _____________ (58) _______________ J)
_______________ J) ...•.. (58) ...... .0 _____________ (56) . . .... Jl _______________ J) _______ __ ___ (139) --- ------ -- ---- .0 ___________ .(139) -- -- ------ -- ----0 _______________ J) ............ (139) _______________ .o ___________ .(139) _______________ J)
_______________ J) .•.•.• .•.• (321) _________ ______ _o ___________ .(321) .... ........ .. . Jl _______________ J) ----- -- -·- (281) - ----- -- . .. .. .0 ___________ .(261) -- ----- -- _____ 0 _______________ J) ............ (288) _______________ .o ___________ .(2119) _______________ J)
_______________ J) ·· ·-·- .• (292) - .. .. .0 ___________ .(292) .. . Jl _______________ J) _____________ (4&) _______________ .o ____________ .{4&) ....•.•.....•.• 0 _______________ J) _____________ (53) _______________ .o _____________ (53) _______________ J) _______________ J) _____ ____ (52) - _____ ____ .o _____________ (52) _____ ___ J)
_______________ J) ------- ---- (257) _________ ______ .o ___________ .(257) __ ________ ______ 0 _______________ J) ............ (20&) _______________ .o ___________ .(209) _______________ J)
_______________ J) •...• (2,&54) ...... .0 _________ (2.654) . . .... Jl _______________ J) _______ __ (2 ,077) - -·-·-·- . .. .. .0 ________ .(2.077) -- -·-·-·- _____ 0 _______________ J) ............ (113) _______________ .o ___________ .(113) _______________ J)
_______________ J) ------ (2 ,888) _________ ______ _o _________ (2.8911) .•.•.•.•.• .•.•. Jl _______________ J) _____ ____ (1 ,758) - ----- -- . .. .. .0 ________ .(1.758) -- ----- -- _____ 0 _______________ J) ............ (435) _______________ .o ___________ .(435) _______________ J)
_______________ J) ·· ·-·- (1,408) - .. .. .0 _________ (1.408) .. . Jl _______________ J) ___________ _ (384) _______________ .o ___________ .(384) ............... 0 _______________ J) ............ (173) _______________ .o ___________ .(173) _______________ J)
_______________ J) . .•.. (4,740) - --- . .. .. .0 _________ (4.740) --- ____ J) _______________ J) ------- ---- (271) _________ ______ .o ___________ .(271) __ ________ ______ 0 _______________ J) ............ (258) _______________ .o ___________ .(258) _______________ J)
_______________ J) ---- (275) ...... .0 ___________ .(275) . . .... Jl _______________ J) _______ __ ___ (232) --- ------ -- ---- .0 ___________ .(232) -- -- ------ -- ----0 _______________ J) ............ (249) _______________ .o ___________ .(249) _______________ J)
_______________ J) .•.•.• .•.• (221) _________ ______ _o ___________ .(221) .... ........ .. . Jl _______________ J) _____ ____ ___ (120) ___ ____ ____ ____ .o ___________ .(120) ____ ____ ____ ____ 0 _______________ J) ............ (113) _______________ .o ___________ .(113) _______________ J)
_______________ J) ·· ·-·- .• (114) - .. .. .0 ___________ .(114) .. . Jl _______________ J) ___________ _ (844) _______________ .o ___________ .(844) ............... 0 _______________ J) ............ (181) _______________ .o ___________ .(181) _______________ J)
_______________ J) --- .• (188) - --- .. .. .0 ___________ .(1118) --- .. . Jl _______________ J) _______ _____ (239) _________ ______ .o ___________ .(239) __ ________ ______ 0 _______________ J) ............ (235) _______________ .o ___________ .(235) _______________ J)
_______________ J) ---- (2JI) ...... .0 ___________ .(237) . . .... Jl _______________ J) _______ __ ___ (1115) --- ------ -- ---- .0 ___________ .(795) -- -- ------ -- ----0 _______________ J) ............ (301) _______________ .o ___________ .(301) _______________ J) _______________ J) _______ _____ (498) _________ ______ _o ___________ .(469) .. .. ...... .. .. . Jl _______________ J) _____ ____ ____ (59) ___ ____ ____ ____ .o ____________ .{59) ____ ____ ____ ____ 0 _______________ J) _____________ (85) _______________ .o _____________ (85) _______________ J)
_______________ J) -·-·-·- _____ (80) - . .. .. .0 ____________ .(80) . .. . Jl _______________ J) ___________ _ (813) _______________ .o ___________ .(873) ............... 0 _______________ J) ............ (888) _______________ .o ___________ .(1188) _______________ J) _______________ J) _____ ___ (304) - _____ ____ .o ___________ .(304) _____ ___ J) _______________ J) _______ ______ (21) _________ ______ .o ____________ .{21) __ ________ ______ 0 _______________ J) _____________ (18) _______________ .o _____________ (18) _______________ J)
_______________ J) ...•.. (18) ...... .0 _____________ (18) . . .... Jl _______________ J) _______ __ ___ (453) --- ------ -- ---- .0 ___________ .(453) -- -- ------ -- ----0 _______________ J) _______________ .o _______________ .o _______________ J) _______________ J) _______________ J) _______ ________ .o _______________ _o _______________ J) .• .•.•.•.• .•.•. Jl _______________ ll _____ ____ ______ _ o _______________ .o _______________ ll ____ ____ ____ ____ o _______________ J) ............ (885) _______________ .o ___________ .(1185) _______________ J)
________ J) ------- .... (24) -- ------- .... .0 _____________ (24) .. . ------- ... Jl
18
Book/ Adjusted Carrying Value at Disposal
Date ............ 35, 108 -- -- _______ 85,398 ____ ________ __ 4, 190
.............. 4,478 ..... 4,481
. __ _______ .2,345
............. .2,358
...... ....... .5,425 __ _______ ___ .5, 191
............. .5,347 . .5,385
.......... 1,314 ............. .7,832
. .. 1,180
--------------'· 195 ............. .6,669
......... 84,616 . __ _______ 34,718
.............. 1,885 ____ ________ o!8,431l __ _________ 57,213
............ 14, 161
. __ _______ ,46,881
.......... .6,488 ............. .2,913 __ _________ 711,814 ____ ________ __ 4,405
.............. 4, 170 ..... 4,474
. __ _______ .3,710
............. 2-,988 ____ ________ _ 2,,539 __ _______ __ .2,317
............. .2,178 . .2,196
......... 13,830 ............. .2,923
. .. . 2-,044 ____ ________ _ .3,819
............. 2-,810 .... 2-,838
. -- . .. .... 18,038
............. .6,838 ____ ________ 11,315 __ _______ ___ _1, 121
.............. 1,616 . . .1,515
......... 13,398 ............ 17,261
. .. . .6,039 ____ ________ ____ :!113 ________________ 341
...• 340 . __ _______ _ .8,978 __________________ 14 ____ ________ ______ 13 __ ____ ____ ____ ___ .11
............ :II' 735 ----- ...... . .1,311
17
Foreign Exchange
Gain (LoBB) on Disposal
_______________ .o _____ ____ _o
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ _o ___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ _o ________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ _o ___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ _o ________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ _o ___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ _o ________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ _o ___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ _o ________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ _o ___ ____ ____ ____ _ 0 _______________ .o . . ...... . .... .0
18
Realized Gain
(Loss) on Disposal
_______________ .o _______ .o
_______________ .o _______________ .o
.... .0 --- -- ------ -- --.0 _______________ .o _______________ .o _____ ____ ____ __ j)
_______________ .o . .. .0
_____________ j)
_______________ .o _______ .o
___ ________ ____ j)
_______________ .o .... .0
--- -- -- ---- -- -- j) _______________ .o _______________ .o _____ ____ ____ __ j)
_______________ .o . .. .0
_____________ j)
_______________ .o _______ .o
___ ________ ____ j)
_______________ .o .... .0
--- -- -- ---- -- -- j) _______________ .o _______________ .o _____ ____ ____ __ j)
_______________ .o . .. .0
_____________ j)
_______________ .o _______ .o
___ ________ ____ j)
_______________ .o .... .0
--- -- -- ---- -- -- j) _______________ .o _______________ .o _____ ____ ____ __ j)
_______________ .o . .. .0
_____________ j)
_______________ .o _______ .o
___ ________ ____ j)
_______________ .o .... .0
--- -- -- ---- -- -- j) _______________ .o _______________ .o _____ ____ ____ __ j)
_______________ .o ... . ...... . .. .0
19
Total Gain (Loss) on Disposal
_______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
___ J)
20
Bond lntsrast/ stock
Dividends Received
During Year ________________ !58
. .. . .1,921 ____ ________ ______ 58 _________________ .75
...... 90 . -- -- ------ -- ----35 ------------------« ___ ________ _____ 122 __ ____ ____ ____ ___ .78 _________________ 100
. .. 121 _______________ 65
_________________ 114 . .. . .. . 136
___ ________ ____ 109 _________________ 111
.... .1,692 . __ _______ ___ 521 __________________ 35 ___ ________ _ _1,090
__ ____ ____ ____ __ 183 ________________ 236
. .. ll18 _______________ 97
__________________ 55 . .. . .1,1116
____ ________ ______ 88 _________________ .78
.... 101 . -- -- --·--- -- ----58 _________________ .75 ____ ________ ______ 80 __ ____ ____ ____ ____ 27 __________________ 32
_____ 36 _____________ 204
__________________ 55 _____ ____ 68
____ ________ ______ 58 _________________ .71
...... 86 . __ _______ ___ 241 _________________ 114 ___ ________ ____ 22&
__ ____ ____ ____ ____ 13 __________________ 24
_____ 27 _____________ 1711
________________ 288 . .. . .. . 121
____ ________ ______ _ 5
-------------------5 ....... 6
. -- -- ------ -- ----22 ___________________ D
------------------ -D -- -----------------D ________________ 755
----- ------- .... 33
21 22
NAIC Designation
Staled or Con- Market
tractual In-Maturity dicator
Date (a) .09/0112024 -- 1. ............ . .0910112024 .. L .. .1210112024 -- 1. .. . .1210112024 -- 1. ............ . .1210112024 -- 1. ...... . .07/0112025 -· 1. -·-·-·- ----_07/0112025 -- 1. ............ . .0710112025 .. L . .06/0112025 -- 1. ------- -·-· .0610112025 -- 1. ............ . .0610112025 . L ..... . .1210112025 -- 1. ............ . .1210112025 -- 1. ............ . .1210112025 .. L .. .1210112025 -- 1. .. . .1210112025 -- 1. ............ . .1210112025 -- 1. ...... . _03/0112026 -· 1. -·-·-·- ----_0310112026 -- 1. ............ . .0310112026 .. L . .04/0112026 -- 1. ------- -·-· .04/0112026 -- 1. ............ . .0410112026 -· 1. -------_04/0112026 -- 1. ............ . .04/0112026 -- 1. ............ . .0410112026 .. L .. .04/0112026 -- 1. .. . .04/0112026 -- 1. ............ . .0410112026 -- 1. ...... . .04/0112026 -· 1. -·-·-·- ----_04/0112026 -- 1. ............ . .0410112026 .. L . .06/0112026 -- 1. ------- -·-· .0810112026 -- 1. ............ . .0810112026 . L .. ... . _05/0112026 -- 1. ............ . .0510112026 -- 1. ............ . .0510112026 .. L .. .08/0112026 -- 1. .. . .0610112026 -- 1. ............ . .0610112026 -- 1. ...... . _06/0112026 -· 1. -·-·-·- ----_0610112026 -- 1. ............ . .0610112026 .. L . .07/0112026 -- 1. ------- -·-· .07/0112026 -- 1. ............ . .0710112026 -· 1. -------_06/0112026 -- 1. ............ . .0610112026 -- 1. ............ . .0610112026 .. L .. .09/0112026 -- 1. .. . .09/0112026 -- 1. ............ . .0910112026 -- 1. ...... . .04/0112027 -· 1. -·-·-·- ----_07/0112021 -- 1. ............ . _07/0112021 __ L . .07/0112021 -- 1. ------- -·-· .0810112038 -- 1. ............ . .0810112038 . 1..
m 0 (11
N
CUSIP Ident
ification .. 31292&-21'-2 .. 312!17HH .. 312!17HH .. 312!17HH .. 31321JH1-2 .. 31321JH1-2 .. 31321JH1-2 .. 31385HI-3 - 31385X-EI-3 .. 31385X-EI-3 .. 3138U-.';Y-ll - 3138U-.';Y-ll .. 3138U-.';Y-8 --31381o&-2Q-1 --31381o&-2Q-1 --31381o&-2Q-1 •. 313&111-TT--8 •. 313&111-TT--8 .. 313&111-TT-8 . . 3138oiD-fH . 3138oiD-fH .. 313M>-FH --313&1E-ZT -3 - 31381t-ZT-3 --313&1E-ZT -3 --3138.\F-Git-2 --31311.1F-{l,H --3138.\F-Git-2 .. 3138.\G-XI'-li . . 3138Nl-XI4i --3138.\G-XI'-li --3138/dl-ll)-3 - 3138/dl-ll)-3 --3138/dl-ll)-3 •. 3138/oK-U-6 - 3138/oK-U-6 .. 3138N(..LS.3 .. 313!~/~HT-ll .. 313~~/~HT-ll .. 313~~/~HT-ll --3138.IM-lil-1 --3138.IM-lil-1 --3138.IM-lil-1 --3138o111-81Hl - 3138o111-81Hl --3138o111-81Hl --3138olfLDI4) - 3138111-Y.Hl .. 313W-Y.Hl .. 313W-Y.Hl .. 31310-YII-7 --31311E.\-SG4 --31311E.\-SG4 •. 314021HUH! .. 314021HUH! •. 314021HUH! . 31~
.. 31~
. . 31~
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE D • PART 4 Show All Long-Term Bonds and Stock Sold, Redeemed or otherwise Disposed of During the Current Quarter
2 3 4 5 8 7 8 9 10 Chance In BookiA<fusted Carrvina Value
Number of For- Disposal Nama Shares of
Description eign Date of Purchaser stock FIUI: Pool A80782 I& 6.0001 08101/38 ______________ JlS/01/2012 __ Paydown __________________________________________ _ FIUI: Pool 819325 I& 5.0001 05101/20 .. _ -------- .04/0112012 __ Paydown ----------------------FIUI: Pool 819325 I& 5.0001 05/01/20 .. ________ _ 06/01/2012 __ Paydown ---------------------- . FIUI: Pool 819325 I& 5.0001 05101/20 ...... ________ .DS/01/2012 __ Paydown __________________________________________ _ FIUI: Pool Q06344 I& 4.0001 02101/42 .... .04/0112012 __ Paydown ----------------------FIUI: Pool Q06344 I& 4.0001 02/01142 .. ___ -------- .06/01/2012 __ Paydown ---------------------- . _______ _______ __ _ FIUI: Pool Q06344 I& 4.0001 02101/42 ...... ________ .DS/01/2012 __ Paydown ______________________ _ ___________________ _ FNM Pool 555548 I& 5.0001 06101/18 ........ -------- .04/0112012 __ Paydown ---------------------- . FNM Pool 555548 I& 5.0001 Oll/01/18 .... __ -------- .06/01/2012 __ Paydown ---------------------- ______ _______ _ _ FNM Pool 555548 I& 5.0001 06101/18 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool AIQ6&2 I& 3.50M 01/01/26 .... __ -------- .04/0112012 __ Paydown ---------------------- . FNM Pool AIQ6&2 I& 3.50M 01101/26 . . _06/01/2012 __ Paydown---------------------- -------------------FNM Pool Nt28S2 I& 3.50M 01/01/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool A111782 I& 4.0001 03101/26 .... __ -------- .04/0112012 __ Paydown ----------------------FNM Pool A111782 I& 4.0001 03/01/26 ........ ________ _ 06/01/2012 __ Paydown ---------------------- . FNM Pool A111782 I& 4.0001 03101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Alll561 I& 3.50M 08101/26 . . .04/0112012 __ Paydown----------------------FNM Pool Alll561 I& 3.50M Oll/01/26 .... __________ .06/01/2012 __ Paydown ---------------------- . _______ _______ __ _ FNM Pool Alll561 I& 3.50M 08101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al0160 I& 4.0001 04/01/26 ........ -------- _04/0112012 __ Paydown ---------------------- . FNM Pool AI0160 I& 4.0001 04/01/26 .... __ -------- .06/01/2012 __ Paydown ---------------------- _ ... .... . .. ... _ FNM Pool AI0160 I& 4.0001 04/01/26 ________________ .DS/01/2012 __ Paydown __________________________________________ _
FNM Pool Al1663 I& 4.50M 04/01/26 .... __ -------- .04/0112012 __ Paydown ---------------------- . FNM Pool Al1853 I& 4.50M 04/01/26 . . _06/01/2012 __ Paydown---------------------- -------------------FNM Pool Al1853 I& 4.50M 04/01/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al1992 I& 4.0001 05101/26 .... __ -------- .04/0112012 __ Paydown ----------------------FNM Pool Al1992 I& 4.0001 05/01/26 ........ ________ _ 06/01/2012 __ Paydown ---------------------- . FNM Pool Al1992 I& 4.0001 05101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al3381 I& 4.0001 06101/26 . . .04/0112012 __ Paydown----------------------FNM Pool Al3381 I& 4.0001 Oll/01/26 .... __________ .06/01/2012 __ Paydown ---------------------- . _______ _______ __ _ FNM Pool Al3381 I& 4.0001 06101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al4338 I& 4.0001 06101/26 ........ -------- _04/0112012 __ Paydown ---------------------- . FNM Pool Al4338 I& 4.0001 Oll/01/26 .... __ -------- .06/01/2012 __ Paydown ---------------------- ______ _______ _ _ FNM Pool Al4338 I& 4.0001 06101/26 ________________ .DS/01/2012 __ Paydown __________________________________________ _
FNM Pool Al5747 I& 4.0001 06101/26 .... __ -------- .04/0112012 __ Paydown ---------------------- . FNM Pool Al5747 I& 4.0001 Oll/01/26 . . _06/01/2012 __ Paydown---------------------- -------------------FNM Pool Al5747 I& 4.0001 06101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al8009 I& 3.50M 08101/26 .... __ -------- .04/0112012 __ Paydown ----------------------FNM Pool Al8009 I& 3.50M Oll/01/26 ........ ________ _ 06/01/2012 __ Paydown ---------------------- . FNM Pool Al8009 I& 3.50M 08101/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al8060 I& 3.50M 10/01/26 . . .04/0112012 __ Paydown----------------------FNM Pool Al8060 I& 3.50M 10/01/26 .... __________ .06/01/2012 __ Paydown ---------------------- . _______ _______ __ _ FNM Pool Al8060 I& 3.50M 10/01/26 ........ ________ .DS/01/2012 __ Paydown __________________________________________ _ FNM Pool Al81175 I& 3.50M 09101/26 ........ -------- _04/0112012 __ Paydown ---------------------- . FNM Pool Al81175 I& 3.50M Oi/01/26 .... __ -------- .06/01/2012 __ Paydown ---------------------- ______ _______ _ _ FNM Pool Al81175 I& 3.50M 09/01/26 ________________ .DS/01/2012 __ Paydown __________________________________________ _
FNM Pool Al9109 I& 4.0001 05101/42 .... __ -------- . llli/0112012 __ Paydown ---------------------- . FNM Pool AJ3412 I& 3.50M 11101/26 . . _04/01/2012 __ Paydown---------------------- -------------------FNM Pool AJ3412 I& 3.50M 11/01/26 ........ ________ .05/01/2012 __ Paydown __________________________________________ _ FNM Pool AJ3412 I& 3.50M 11/01/26 . _____ -------- . llli/0112012 __ Paydown ----------------------FNM Pool Nl5211 I& 3.0001 04/01127 ........ ________ _ llli/01/2012 __ Paydown ---------------------- . FNM Pool N<5818 I& 4.0001 03101/42 ........ ________ .05/01/2012 __ Paydown __________________________________________ _ FNM Pool N<5818 I& 4.0001 03101/42 . . .llli/0112012 __ Paydown----------------------FNM Pool 735009 I& 5.0001 05/01/18 .... __________ .04/01/2012 __ Paydown ---------------------- . _______ _______ __ _ FNM Pool 735009 I& 5.0001 05101/19 ........ ________ .05/01/2012 __ Paydown __________________________________________ _ FNM Pool 735009 I& 5.0001 05101/19 ........ -------- .llli/0112012 __ Paydown ---------------------- . FNM Pool 735881 I& 5.m 12101111 __ ____________ .04/01/2012 __ Paydown ---------------------- ______ _______ _ _ = ~: ~=1 : ~:= 1:1~1~ ::·:···· :::::::: :~1~1~ :: ~=~ :::::::::::::::::::::: ::·:::::::·:::::::·::
Consideration
__________ 18.554 ____________ 3.134 ____________ 9.849 ____________ 9.530 ____________ 4.042 __________ .21.159 ____________ 3.894 __________ .64.538 __________ .53.388 __________ .55.433 ____________ 3.104 __________ .31.818
------------2.971 ---------------____________ 1.045 ______________ .875 ____________ 3.1189 ____________ 3.1!58 ____________ 3.1187 ____________ 3.233 ____________ 9.878 ____________ 3.254 ____________ 2.458 ____________ 2.373 ____________ 2.370 __________ .13.474 __________ 18.582 ___________ 15.2118 ____________ 4.715 ____________ 3.180 ____________ 3.143 ___________ 10.142 ____________ 7.131 ____________ &.843 __________ 22.705 ____________ 5.592 ____________ 5.388 ____________ 2.543 ____________ 2.481
------------2.550 __________ .10.962 __________ .10.538 ___________ 1Q.S77 ____________ 5.804 ____________ 8.002 ____________ 5.909 ____________ 7.547 ___________ 18.729 __________ 22.181 __________ 20.6211 __________ .15.195 ____________ 4.359 ____________ 4.375 ____________ 8.891 ____________ 9.859 ____________ 7.921 __________ .88.782 __________ .88.935 __________ B3.1191
Par Value ............ 78,554
. .. . . .3,134 .... ......... .9,848 ............. .9,e30
.... 4,042 __ _______ _ 21, 159
............. .3,1194
.... ........ 54,838 ·- ----- -- .53,388 ............ 55,433
. . .3,104 ........... 31,818 ............. .2,971
_____ ____ B&Q
.... ........ . .1,045
................ 175 ... .3,889
-- -----·- -·.3,858 ............. .3,887 .... ........ . .3,233 _______ ____ .9,178
............. .3,284 . . .2,458
............ .2,373 ............. .2,370
.. 13,474 .... ........ 78,582 ............. 15,288
.... 4,715 -- -----·- -·.3, 180 ............. .3, 143 .... ........ . 10,142 _______ ____ _7,131
............. J,843 22,705
............ .5,592 ............. .5,388
. .. . . .2,543 .... ......... .2,481 ............. .2,850
... 10,962 -- ------- --10,538 ............. 10,877 .... ........ . .5,804 _______ _____ 8,002
............. .5,909 . .. 7,547
............ 18,729 ............ 22, 181
. .. . 20,6:!8 .... ........ . 15, 195 .............. 4,388
.... 4,375 ·· -·· ·-·- -·.e,8111 ............. .9,858 .... .......... 7,921 ·- ----- -- .88, 782 ............ 88, 935 .. . ...... .. 93,891
Actual Cost
............ 80 ,002 . .. . .3,070
..... ........ .9,454
............. .9,435 ... 4,251
--- -·-·-·- 22,295 .............. 4,103 ..... ...... 57,188 --- ------- 55,323 ............ 57 ,443
. .3,256 .......... 33 ,380
............. .3,117 _____ ___ 899
..... ......... 1,092
................ .915 ... 4,092
--- ------- --4,080 .............. 4,090 ..... ........ .3,387 --- . .. .... . .10 ,348 ............. .3,420
.2,611 ........... 2,522
............. .2,519 . .. . .14,049
..... ...... Ja ,84i
............ .15 ,940 ... 4,947
___ _______ _ _3,337
............. .3,298
..... ....... .10 ,676 ________ ___ 1,508
............. 1,203 . 23,856
........... .5,878 ............. .5,861
. .. . 2,680 ..... ........ 2,593 ............. 2,782
.... .11,480 ___ _______ _ .11,rm
............ .11,172
..... ........ .6,106 ________ ___ .6,314
............. .6,216 . .8,144
.......... .18,616 ............ 23,231
. .. 21,604 ..... ....... .15,i81 .............. 4,822
... 4,629 ___ _______ _ _8,735
............. .11,887
..... ........ 1,793 __________ as ,536
........... .116 ,702 ---- ...... 102 ,092
Prior Year Book/
Adjusted Carrying Value
............ 79, 980 . .. . .. . .3,081
.. ........ ... .9,487
............. .9,488 ... D
-- ·· ·-·· -- ·· ·-·· -- ·D ___________________ D .. ........ .. &6,716 ----- -- . .. 54, 934 ............ 57' 038
. .. . .3,253 ............ 33,350 ............. .3,114
_____ ______ B88
.. ........ ... .1,091
................ .914 ...... 4,089
-- ------ -- ----4,058 .............. 4,087 .. ........ .. . .3,384 _____ _____ 10,338
............. .3,417 . .. . .2,608
............. .2,518
............. .2,515 ... .... 14,035
.. ........ .. 79, 770
............. 15,925 ...... 4,942
------- ---·.3,334 ............. .3,295 .. ........ .. 10,665 ------- .... .7,4811 ............. .7, 196
. .. 23,833 ............. .5,870 ............. .5,858
. .. . .. . 2,571 .. ........ ... .2,581 ............. .2,789
.... 11,454 ------- ----11,022 ............. 11, 188 .. ........ .. . .6,100 __ ____ ____ ____ 8,308
............. J,210 .. D
............ 19,608
............ 23,218 . .. . .. 21,593
.•.•.•.•.•.•.•.•.•. D ___________________ D
... D -·-·-·- -·-·.e,785 ............. .9,719 .. ........ .... 7,809 _____ _____ 95,581
............ 95, 745
. ...... . . 101,081
11 12 13 14 15 Total Total
Current Change in Foreign Year's Book/ Exchange
Current Other Than Adjusted Change in Unrealized Year's Temporary Carrying Book Valuation (Amor- Impairment Value /Adjusted Increase/ lization)l Raoog- (11 + 12 - Carrying Decrease Accretion nized 13) Value
_______________ J) ......... (1 ,428) ............... .0 _________ (1.425) ............... Jl _______________ J) _____ _____ 53 _____ ____ .o ______________ 53 _____ ___ J)
_______________ J) ------------.16:! . .. ........ .... .0 ____________ .162 .... ........ .. .. 0 _______________ J) ............ .182 ............... .0 ____________ .162 ............... Jl _______________ J) ---- (217) ...... .0 -----------1217) . . .... Jl _______________ J) _______ __ (1' 138) - -·-·-·- . .. .. .0 ________ .(1.138) ·- -·-·-·- . .. .. 0 _______________ J) ............ (209) ............... .0 -----------1209) ............... Jl _______________ J) .•.•.• (1,878) . .. ........ .... .0 _________ (1.878) .... ........ .. . Jl _______________ J) _____ ____ (1 ,548) ___ ____ ____ ____ .o ________ .(1.548) ---- ---- ---- ----0 _______________ J) ......... (1 ,606) ............... .0 _________ (1.SOS) ............... Jl _______________ J) ·· ·-·- .• (150) - .. .. .0 -----------1150) .. . Jl _______________ J) ..•.•.... (1 ,533) ............... .0 ________ .(1.533) ............... 0 _______________ J) ............ (143) ............... .0 -----------1143) ............... Jl _______________ J) _____ ____ (38) - _____ ____ .o _____________ (38) _____ ___ J)
_______________ J) -------------<48) . .. ........ .... .0 ____________ .(48) .... ........ .. .. 0 _______________ J) ............. (3&) ............... .0 _____________ (39) ............... Jl _______________ J) ---- (200) ...... .0 -----------1200) . . .... Jl ---------------1) ------- -- ---<198) --- ·-·-·- ------ .0 ........... .l1Wl -- -- --·-·· -- ·-·-0 _______________ J) ............ (199) ............... .0 -----------11911) ............... Jl _______________ J) .•.•.• .• .• (151) . .. ........ .... .0 -----------1151) .... ........ .. . Jl _______________ J) _____ ____ ___ (482) ___ ____ ____ ____ .o ___________ .(482) ---- ---- ---- ----0
_______________ J) ............ (153) ............... .0 -----------1153) ............... Jl _______________ J) ·· ·-·- .• (150) - .. .. .0 -----------1150) .. . Jl _______________ J) ..•.•.....• . (145) ............... .0 ___________ .(145) ............... 0 _______________ J) ............ (145) ............... .0 -----------1145) ............... Jl _______________ J) - -- .• (561) - --- .•.• .0 ___________ .(561) --- .•. Jl _______________ J) . .•.•.• .. (3, 188) . .. ........ .... .0 ________ .(3.188) .... ........ .. .. 0 _______________ J) ............ (838) ............... .0 -----------1538) ............... Jl _______________ J) ---- (227) ...... .0 -----------1227) . . .... Jl _______________ J) _______ __ ___ (153) --------- ------ .0 ___________ .(153) -- -- --·-·--- --·-0 _______________ J) ............ (151) ............... .0 -----------1151) ............... Jl _______________ J) ------- -----<522) •.•.•.•.•.•.•.• .0 -----------1522) .... ........ .. . Jl _______________ J) _____ ____ ___ (357) ___ ____ ____ ____ .o ___________ .(387) ---- ---- ---- ----0
_______________ J) ............ (352) ............... .0 -----------1352) ............... Jl _______________ J) -·-·-·- _(1,128) - . .. .. .0 _________ (1.128) . .. . Jl _______________ J) ..•.•.....• . (278) ............... .0 ___________ .(278) ............... 0 _______________ J) ............ (288) ............... .0 -----------1288) ............... Jl _______________ J) --- .• (134) - --- .. .. .0 ___________ .(134) --- .. . Jl _______________ J) - ------ -- -- ( 130) . .. ........ .... .0 ___________ .( 130) .... ........ .. .. 0 _______________ J) ............ (140) ............... .0 -----------1140) ............... Jl _______________ J) ---- (502) ...... .0 -----------1502) . . .... Jl _______________ J) _______ __ ___ (483) --------- ------ .0 ___________ .(483) -- -- --·-·- -- --·-0 _______________ J) ............ (490) ............... .0 -----------1490) ............... Jl _______________ J) ------------<296) ............... .0 -----------1296) ............... Jl _______________ J) _____ ____ ___ (308) ___ ____ ____ ____ .o ___________ .(308) ---- ---- ---- ----0 _______________ J) ............ (301) ............... .0 -----------1301) ............... Jl _______________ J) ·· ·-·- .• (598) - .... .0 -----------1598) ... Jl _______________ J) ..•.•.....• . (876) ............... .0 ___________ .(878) ............... 0 _______________ J) ......... (1 ,038) ............... .0 _________ (1.038) ............... Jl _______________ J) _____ ___ (985) - _____ ____ .o ___________ .(985) _____ ___ J)
_______________ J) _______ _____ (788) . .. ........ .... .0 ___________ .(788) .... ........ .. .. 0 _______________ J) ............ (253) ............... .0 -----------1253) ............... Jl _______________ J) ...• (254) ...... .0 -----------1254) . . .... Jl _______________ J) ------- -- --·.128 --------- ------ .0 ____________ _128 -- -- --·-·--- --·-0 _______________ J) ............ .140 ............... .0 ____________ .140 ............... Jl _______________ J) ------------.113 . .. ........ .... .0 ____________ .113 .... ........ .. . Jl _______________ J) _____ ____ (6,799) ___ ____ ____ ____ .o ________ .(8.799) ---- ---- ---- ----0 _______________ J) ......... (6,811) ............... .0 _________ (5.811) ............... Jl
________ J) ------ (7 . 190) - ------ .... .0 _________ (7 .190) -- ------ ... Jl
18
Book/ Adjusted Carrying Value at Disposal
Date ............ 78,554
. .. . .3,134 ...... ....... .11,84i ............. .9,630
..... 4,042 . __ _______ 21, 159
............. .3,894
...... ...... 54,838 -- -- . .. .... 53,388 ............ 55,433
. .3,104 ......... 31,816
............. .2,971 _____ __ 11&0
...... ....... .1,045
................ 175 .... .3,889
. __ _______ .3,858
............. .3,887
...... ....... .3,233
.... . .. .... .11,878
............. .3,254 . .2,458
.......... .2,373 ............. .2,370 -- -- . .. .... l3,474 ...... ...... 78,562 ............ l5,288
..... 4,715 . __ _______ .3, 180
............. .3, 143
...... ...... l0,142
.... . .. .... . .7, 131
............. .6,843
. ·- . .. .... 22, 705 .......... .5,592
............. .5,388 . .. .2,543
...... ....... .2,481
............. .2,850 ......... l0,952
. ·- . .. .... .10,536
............ l0,877
...... ....... .5,804
.... . .. .... . .6,002
............. .5,809 . . .7,547
......... .18,729 ............ 22, 181 __ _______ __ 20,6211
...... ...... .15, 185
.............. 4,389 ..... 4,375
··- -·-·-·· ·.8,8111 ............. .9,859 ...... ....... .7,921 -- -- . .. .... 88, 762 ............ 88,935 ···· · ..... 93,8111
17
Foreign Exchange
Gain (LoBB) on Disposal
............... .0 _____ ____ J)
. .. ........ ..... 0
............... .0 ...... Jl
--------- ------ -0 ............... .0 . .. ........ .... Jl ___ ____ ____ ____ _ 0
............... .0 .. .. Jl
................ 0
............... .0 _____ ____ J)
. .. ........ ..... 0
............... .0 ...... Jl
--------- ------ -0 ............... .0 . .. ........ .... Jl ___ ____ ____ ____ _ 0
............... .0 .. .. Jl
................ 0
............... .0 _____ ____ J)
. .. ........ ..... 0
............... .0 ...... Jl
--------- ------ -0 ............... .0 . .. ........ .... Jl ___ ____ ____ ____ _ 0
............... .0 .. .. Jl
................ 0
............... .0 _____ ____ J)
. .. ........ ..... 0
............... .0 ...... Jl
--------- ------ -0 ............... .0 . .. ........ .... Jl ___ ____ ____ ____ _ 0
............... .0 .. .. Jl
................ 0
............... .0 _____ ____ J)
. .. ........ ..... 0
............... .0 ...... Jl
--------- ------ -0 ............... .0 . .. ........ .... Jl ___ ____ ____ ____ _ 0
............... .0
. . ...... . .... Jl
18
Realized Gain
(Loss) on Disposal
............... .0 _____ __ .o
............... .0
............... .0 .... .0
--- -------- ----.0 ............... .0 ............... .0 _____ ____ ____ __ j)
............... .0 ... .0
............. .0 ............... .0 _____ __ .o ..... ........ .. .0 ............... .0
.... .0 --- -- ------ -- --.0 ............... .0 ............... .0 _____ ____ ____ __ j)
............... .0 ... .0
............. .0 ............... .0 _____ __ .o ..... ........ .. .0 ............... .0
.... .0 --- -- ------ -- --.0 ............... .0 ............... .0 _____ ____ ____ __ j)
............... .0 ... .0
............. .0 ............... .0 _____ __ .o ..... ........ .. .0 ............... .0
.... .0 --- -- ------ -- --.0 ............... .0 ............... .0 _____ ____ ____ __ j)
............... .0 ... .0
............. .0 ............... .0 _____ __ .o ..... ........ .. .0 ............... .0
.... .0 --- -- ------ -- --.0 ............... .0 ............... .0 _____ ____ ____ __ j)
............... .0
.... ....... .. .0
19
Total Gain (Loss) on Disposal
_______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ J)
_______________ J) _______________ J)
___ J)
20
Bond lntsrest/ stock
Dividends Received
During Year ............. .2,357
_____ ____ 52
..... ........ .. 201 ................ 241
..... .13 . -- ------- --- 141 .................. 3& ..... ....... .1,081 .... . .. .... . .1, 112 ............. .1,388
. .. .. 36 ....•.•.....• -484
.................. 52 . .. . .. . .11
------------------17 .................. 18
...... 45 . ·- -- ------ -- ----58 .................. 88 ------------------43 -- ---- ---- ---- --.185 .................. 85
. .. .. 37 ---------------45
.................. 53 . .. . .. . 180
..... ....... .1,278 ................ 308
...... &3 . ·- -- ------ -- ----53 .................. &3 ..... ........ .. . 135
-- -- ----- -- ---.119 ................. 137
. .. .303 ---------------93
................. 108 _____ ____ 30
------------------38 .................. 48
.... 128 . -- ------- ---.154 ................. 187 ------------------68 -- ---- ---- ---- ----88 ................. 103
. .. .. 25 ............. 219
----------------~3 . .. . .. 361
------------------38 .................. 15
...... 29 . -- -------- -----148 ................ 205 ..... ........ .. . 198 .... . .. .... . .1,6:!8 ............. .2,038 ···· · ...... . .2,582
21 22
NAIC Designation
Staled or Con- Market
tractual In-Maturity dicator
Date (a) .0810112038 -· 1. ............ . .0510112020 .. L .. .05/0112020 -· 1. .. . .0510112020 -· 1. ............ . .0210112042 -· 1. ...... . _02/0112042 __ L ...... ___ _ .0210112042 -· 1. ............ . .0610112018 -· 1. .. . .Oil/01/2018 -- 1. ------- -·-· .06101/2018 -· 1. ............ . _01/0112026 __ L ..... . .0110112028 -· 1. ............ . .01/0112026 -· 1. ............ . .0310112026 .. L .. .03/0112028 -· 1. .. . .0310112026 -· 1. ............ . .0810112026 -· 1. ...... . _Oil/0112028 __ L ...... ___ _ .0810112026 -· 1. ............ . .04/0112026 -· 1. .. . .04/0112028 -- 1. ------- -·-· .04/0112026 -· 1. ............ . _04/0112026 __ L ..... . .04/0112028 -· 1. ............ . .04/0112026 -· 1. ............ . .0510112026 .. L .. .05/0112028 -· 1. .. . .0510112026 -· 1. ............ . .0610112026 -· 1. ...... . _Oil/0112028 __ L ...... ___ _ .0610112026 -· 1. ............ . .0610112026 -· 1. .. . .Oil/0112028 -- 1. ------- -·-· .0610112026 -· 1. ............ . .0610112026 . L ..... . _Oil/0112028 -· 1. ............ . .0610112026 -· 1. ............ . .0810112026 .. L .. .Oil/0112028 -· 1. .. . .0810112026 -· 1. ............ . .10/0112026 -· 1. ...... . .10/0112028 __ L ...... ___ _ .10/0112026 -· 1. ............ . .0910112026 -· 1. .. . .Oi/0112028 -- 1. ------- -·-· .09/0112026 -· 1. ............ . .0510112042 . L .. ... . .1110112028 -· 1. ............ . .11/0112026 -· 1. ............ . .11/0112026 .. L .. .04/0112027 -· 1. .. . .0310112042 -· 1. ............ . .0310112042 -· 1. ...... . _05/01/2018 __ L .. .... ___ _ .05101/2019 -· 1. ............ . .0510112019 -· 1. .. . .12101/2017 -- 1. ------- -·-· .1210112017 -· 1. ............ . .1210112017 . 1..
m 0 (11
(.)
CUSIP Ident
ification --31407N-II(-4 .. 31.w7M-II<-4 --31.w7M-II<-4 .. 314078-Go\:-4 .. 314078-Gol:-4 . . 31407H.\-4 .. 3141DX-Ifi-4 .. 31410l-lfi-4 - 314101-\fi-4 --3141211-1111-7 --3141211-1111-7 - 3141211-1111-7 --314121'-AG-3 .. 314121'-AG-3 --314121'-AG-3 .. 31414f.K9-1 .. 31414f.K9-1 .. 31414f.K9-1 .. 3141~-sw . . 3141~-sw . 3141~--3X-3
.. 31415Y-t:Z--8
. . 31415Y-t:Z--8
. 31415Y-t:Z--8
.. 314111H&-3
.. 3141111-11H
.. 31411~~-f~H~
.. 31411L..f!F..G
.. 31411L..f!F..G
.. 31411L..f!F..G
.. 31411L-QY-6
.. 31411L-QY-6
. 31418..-QY-6
.. 3141~
. . 31416S-M2-4 - 31416S-M2-4 --314188-Q().f .. 31416S-QC-3 .. 31416S-QC-3 .. 314111T-2$-7 .. 31416T-2s-7 .. 31416T-2s-7 .. 3141~ . . 3141&X-lil;-ll - 31416)[--60-i .. 314171HB-2 .. 314171HB-2 - 314171HB-2 .. 31417HT-3 .. 31417HT-3 .. 31417T-8<-ll .. 31417T...fl<-e --31417T --8<--8 --31417T --IIZ--8 --31417T --IIZ--8 . . 31417T--6Z--8 . 31417Y-YY-G .. 31417Y-YY-G .. 31417Y-YY-G
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE D • PART 4 Show All Long-Term Bonds and Stock Sold, Redeemed or otherwise Disposed of During the Current Quarter
2 3 4 5 8 7 8 9 10 Chance In BookiA<fusted Carrvina Value
Number of For- Disposal Name Shares of
Description eign Date of Purchaser stock FNII\ Pool 835470 !liS 5.0001 09/01120 ________________ .04/0112012 __ Paydown __________________________________________ _
FNII\ Pool 835470 !liS 5.0001 09101120 . -·--- · -------- . ll6/01!2012 __ Paydown ----------------------FNII\ Pool 835470 !liS 5.0001 09/01120 ........ ________ _ 0610112012 __ Paydown ---------------------- _ FNII\ Pool 838083 !liS 5.0001 10/01120 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 838083 !liS 5.0001 10101120 .. .ll6/01!2012 __ Paydown----------------------FNII\ Pool 838083 !liS 5.0001 10/01120 .... __________ .0610112012 __ Paydown ---------------------- ________ _______ __ _ FNII\ Pool 900724 !liS 5.5001 08101121 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 900724 !liS 5.5001 08101/21 ........ -------- .ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool 900724 !liS 5.5001 08/01121 __ ____ -------- .0610112012 __ Paydown ---------------------- ______ _______ _ _ FNII\ Pool 935165 !liS 5.0001 05101124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 935165 !liS 5.0001 05101124 .... __ -------- . ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool 935165 !liS 5.0001 05/01124 .. _0610112012 __ Paydown---------------------- -------------------FNII\ Pool 935707 !liS 5.0001 11/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 935707 !liS 5.0001 11101124 .... __ -------- . ll6/01!2012 __ Paydown ----------------------FNII\ Pool 935707 !liS 5.0001 11101124 ........ ________ _ 0610112012 __ Paydown ---------------------- _ FNII\ Pool 9&1820 !liS 5.0001 08101123 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 964820 !liS 5.0001 08101123 .. .ll6/01!2012 __ Paydown----------------------FNII\ Pool 9&1820 !liS 5.0001 08/01123 .... __________ .0610112012 __ Paydown ---------------------- ________ _______ __ _ FNII\ Pool 983814 !liS 4.0001 11/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _ FNII\ Pool 983814 !liS 4.0001 11101124 ........ -------- .ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool 9113814 !liS 4.0001 11101124 __ ____ -------- .0610112012 __ Paydown ---------------------- ______ _______ _ _ FNII\ Pool 8113584 !liS 4.5001 04/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 8113584 !liS 4.5001 04101124 .... __ -------- . ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool 8113584 !liS 4.5001 04/01124 .. _0610112012 __ Paydown---------------------- -------------------FNII\ Pool 995182 !liS 5.5001 06101120 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool 995182 !liS 5.5001 06101120 .... __ -------- . ll6/01!2012 __ Paydown ----------------------FNII\ Pool 995182 !liS 5.5001 08/01120 ........ ________ _ 0610112012 __ Paydown ---------------------- _ FNII\ Pool wrY>/ !liS 4.5001 05101124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool wrY>/ !liS 4.5001 05101124 .. .ll6/01!2012 __ Paydown----------------------FNII\ Pool wrY>/ !liS 4.5001 05/01124 .... __________ .0610112012 __ Paydown ---------------------- ________ _______ __ _ FNII\ Pool A.\3170 !liS 4.5001 04/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool A.\3170 !liS 4.5001 04101124 ........ -------- .ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool A.\3170 !liS 4.5001 04/01124 __ ____ -------- .0610112012 __ Paydown ---------------------- ______ _______ _ _ FNII\ Pool A.\8476 !liS 5.0001 06101124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool A.\8476 !liS 5.0001 06101124 .... __ -------- . ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool A.\11476 !liS 5.0001 08/01124 .. _0610112012 __ Paydown---------------------- -------------------FNII\ Pool A.\8550 !liS 4.5001 07/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool A.\8550 !liS 4.5001 07101124 .... __ -------- . ll6/01!2012 __ Paydown ----------------------FNII\ Pool A.\8550 !liS 4.5001 07/01124 ........ ________ _ 0610112012 __ Paydown ---------------------- _ FNII\ Pool AAiiM !liS 5.0001 07/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool AAiiM !liS 5.0001 07101124 .. .ll6/01!2012 __ Paydown----------------------FNII\ Pool AAiiM !liS 5.0001 07/01124 .... __________ .0610112012 __ Paydown ---------------------- ________ _______ __ _ FNII\ Pool II2W !liS 4.5001 04/01126 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool Ml26&6 !liS 4.5001 04101126 ........ -------- .ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool II2W !liS 4.5001 04/01126 __ ____ -------- .0610112012 __ Paydown ---------------------- ______ _______ _ _ FNII\ Pool AC4465 !liS 5.0001 11/01124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool AC4465 !liS 5.0001 11101124 .... __ -------- . ll6/01!2012 __ Paydown ---------------------- . FNII\ Pool AC4465 !liS 5.0001 11101124 .. _0610112012 __ Paydown---------------------- -------------------FNII\ Pool AC8257 !liS 4.0001 12101124 ________________ .04/01/2012 __ Paydown __________________________________________ _
FNII\ Pool A!;&257 !liS 4.0001 12101124 .... __ -------- .0412612012 __ J' llorgan Chase -----------FNII\ Pool AC/173 !liS 4.0001 11101124 ........ ________ _ 04/0112012 __ Paydown ---------------------- _ FNII\ Pool AC/173 !liS 4.0001 11/01124 ________________ .ll6/01!2012 __ Paydown __________________________________________ _ FNII\ Pool AC7173 !liS 4.0001 11101124 .. .06101/2012 __ Paydown----------------------FNII\ Pool AC/187 !liS 5.0001 11101124 .... __________ .04/0112012 __ Paydown ---------------------- ________ _______ __ _ FNII\ Pool AC7187 !liS 5.0001 11/01124 ________________ .ll6/01!2012 __ Paydown __________________________________________ _
FNII\ Pool AC7187 !liS 5.0001 11101124 ........ -------- .06101/2012 __ Paydown ---------------------- . FNII\ Pool MMI630 !liS 4.0001 12101/~ __ ____ -------- .04/0112012 __ Paydown ---------------------- ______ _______ _ _ = ~: =: :::: 1:1~: ::·:···· :::::::: :~1~1~ :: ~=~ :::::::::::::::::::::: ::·:::::::·:::::::·::
Consideration
____________ 7.487 ____________ 6.~ __________ _12.797 ___________ 18.718 ____________ 3.1X12 ____________ 7.416 ______________ .9)0
____________ 1.1105 ____________ 4.1133 _________ j00.241 ____________ 9.624 _________ m.m __________ .33.703 ____________ 3.7&5 ____________ 3.838 ___________ 42.713 __________ 18.444 ____________ 7.'111 ____________ 8.974 ____________ 6.962 ___________ 10.781 ___________ 17.878 __________ .15.164 ____________ 4.435 __________ .30.283 __________ .30.347 __________ j9.187 __________ .65.~ __________ .69.138 _________ j4]. 143 ____________ 8.518 ____________ 6.611 __________ 23.825 ___________ 48.1190 __________ .10.965 __________ _10.970 __________ .83.040 __________ 18.1n
----------R.BM ___________ 10.099 __________ 14.828 __________ .61.729 ____________ 9.147 ____________ 8.749 ____________ 9.479 ____________ 3.871 ____________ 3.137 ____________ 3.502 __________ 18.848
.... .. 3.6115.787 __________ _14.711 ___________ 14.578 __________ .14.5118 __________ .53.518 ____________ 5.828 ____________ 5.6C8 __________ _14.057 __________ .22.811 __________ .12.254
Par Value ............. .7,487
... . . .6.~ .... ........ 12,797 ............. 18,716
... .3,032 __ _______ __ _7,416 ________________ iOQ
.... ........ . .1,805 ____ ____ ____ __ 4,633
........... 100,241 .. .9,624
.......... 173,711 ............ 33, 703
... . . .3,765 .... ......... .3,838 ............ 42, 713
..... 38,444 __ _______ __ _7,997
............. .6,974
.... ......... .6,962 -- ------ .. 10,781 ............. 17,878
.. 15,164 _____________ 4,435
............ 30, 283 ... .. 30,347
__ ________ __ 29, 187
............ 65, 905 .. &9,138
__ _______ _ 147, 143 ............. .8,516 .... ......... .6,611 -- _____ ____ 23,825 ............ !18,&90
.. 10,965 ____________ 10,970 ............ 83, 040
____ 78,1n
.... ........ 77 '664
............. 10,099 .. 74,828
__ _______ __ 61,729 ............. .9, 147 .... ........ . .8,749 _______ ____ .9,479
............. .3,871 .. .3,137
____________ .3,502 ____________ 38,MB
-- . .. .. 3,3&9, 230 .... ........ 14,711 ............. 14,576
... 14,588 __ _______ _ 53,516 ............. .5,826 .... ........ . .5,608 -- ------ .. 14,057 ............ 22,811 ... ------- .12,254
Actual Cost
_____________ 1,335 ___ _ _6,309
___ ________ _ 12 ,537 ____________ 18 ,350
.. 2,972 ___ _______ _ ],212 ________________ liOQ ___ ________ ___ 1,805
--- ----- - _4,833 ___________ 102 ,998
.. 9,888 ........ .178 ,488
____________ 35 ,899 .4,011
___ ________ ___ 4,086
------------~.113 .... 38,804
___ _______ _ Jl,072 _____________ ],062 ___ ________ __ 1,050 ________ ___ 10,1117 ____________ 18 ,437
.. 15,638 ___________ _ 4,574
____________ 33,113 ... 33,183
___ ________ 31,1114 ____________ 68 ,3116
.... 71,719 --- . .. ... .152 ,838 _____________ ll,819 ___ ________ __ .6,846 ________ __ :!4,874 ____________ 50 ,846
.. 11.~ .......... 11.~
____________ 85 ,248
--- 80,253 ___ ________ 19,7'E ____________ 10 ,488
.... 77 ,704 ___ _______ 64,102 _____________ .9,744 ___ ________ __ .9,320
--- ... .... . 10 ,098 ______________ 4,110
. .3,331 ___________ _3,7111
____________ 39 ,873 ______ 3,479,2!i6 ___ ________ _ 15,106 ____________ 14 ,968
.... 14,991 ___ _______ 56,1161 _____________ .5,889 ___ ________ __ .5,969 ________ ___ 14,831 ____________ 23 ,742
---- ...... . 12,753
Prior Year Book/
Adjusted Carrying Value
............. .7,380 ... . .. . .6,331
.•.•.•.•.•.• 12,580
............. 18,410 ..... 2,982
-- ------ -- ---.7,295 -----------------________ _____ _1,804 _____ _______ 4,630
........... 102,781 ... . .9,868
........... 178, 112
............ 35, 753 ... . .. . .3,994
________ ______ 4,069
------------~.058 .... 38,755
_______ ____ .6,082
............. .7,058 ________ ______ 7,044 _____ _____ 10,906
............. 18,388 ... . 15,5&7
____________ __ 4,582
............ 32, 902 ... . .. 32,971
.......... .. 31,710
............ 88, 200 .... 71,545
------- . . 152, 288 ............. .8,790 .......... .. . .6,823 _____ _____ 24,591
............ 50,888 . .. . 11,3&9
............ 11,374
............ 65, 076 --- . .. 60, 093
.......... .. 79,587
............. 10,480 .... 77,501
------- ... 83, 934 ............. .9,729 .. ........ ... .9,306 _____ _____ 10,083
______________ 4,088 ... . .3,319
............. .3,706
............ 39,590 ... .... 3,472,021 .......... .. 15,079 ............. 14,941
.... 14,964 _______ ___ 56,712 ............. .5,962 .......... .. . .5,943 _____ ______ 14,823 ............ 23, 730 . ------- ... 12,747
11 12 13 14 15 Total Total
Current Change in Foreign Year's Book/ Exchange
Current Other Than Adjusted Change in Unrealized Year's Temporary Carrying Book Valuation (Amor- Impairment Value /Adjusted Increase/ lization)l Reoog- (11 + 12 - Carrying Decrease Accretion nized 13) Value
_______________ J) ____________ .127 _______________ .o ____________ .127 _______________ J) _______________ .o ________ .109 _____ ____ .o ____________ .109 _____ ___ J) _______________ .o _____________ 217 _________ ______ .o ____________ .217 __ ________ ______ 0 _______________ J) _____________ 306 _______________ .o _____________ 308 _______________ J)
_______________ J) ...•.• . 50 ...... .0 ______________ !iO ...•. .0 _______________ .o _______ _____ _121 --- ------ -- ---- .0 ____________ _121 -- -- ------ -- ----0 _______________ J) ________________ 1 _______________ .o ________________ 1 _______________ J) _______________ .o ________________ 1 _________ ______ _o _______________ .1 __ ________ _____ .o _______________ .o _______________ .3 ___ ____ ____ ____ .o _______________ _3 ____ ____ ____ ____ 0 _______________ J) ......... (2 ,540) _______________ .o _________ (2.540) _______________ J)
_______________ .o ------ .. (244) - .. .. .0 ___________ .(244) .. . .0 _______________ J) _________ (4.~1) _______________ .o ________ .(4.~1) ............... 0 _______________ J) ......... (2,050) _______________ .o _________ (2.050) _______________ J)
_______________ .o --- --(229) - --- .... .0 ___________ .(229) --- .. . .0 _______________ .o ____________ (233) _________ ______ .o ___________ _(233) __ ________ ______ 0 _______________ J) ____________ (345) _______________ .o ___________ .(345) _______________ J)
_______________ J) ...• (311) ...... .0 ___________ .(311) . . .... .0 _______________ .o _______ ______ (65) --- ------ -- ---- .0 ____________ _(115) -- -- ------ -- ----0 _______________ J) _____________ (82) _______________ .o _____________ {112) _______________ J) _______________ .o _____________ (82) _________ ______ _o ____________ _(82) __ ________ _____ .o _______________ .o ____________ (127) ___ ____ ____ ____ .o ___________ .(127) ____ ____ ____ ____ 0 _______________ J) ____________ (510) _______________ .o ___________ .(510) _______________ J)
_______________ .o ------ .. (433) - .. .. .0 ___________ .(433) .. . .0 _______________ J) _________ ___ (127) _______________ .o ___________ .(127) ............... 0 _______________ J) ......... (2,818) _______________ .o ---------<2.818) _______________ J)
_______________ .o ..... (2,624) - --- .... .0 _________ (2.624) --- ... .0 _______________ .o _________ (2 ,524) _________ ______ .o ________ .(2.524) __ ________ ______ 0 _______________ J) ......... (2,295) _______________ .o _________ (2.295) _______________ J)
_______________ J) •...• (2 ,408) ...... .0 _________ (2.408) . . .... .0 _______________ .o _______ __ (5, 124) - ------- . .. .. .0 ________ .(5.1:!4) -- ------- _____ 0 _______________ J) ____________ (274) _______________ .o ___________ .(274) _______________ J) _______________ .o .......... (213) _________ ______ _o ___________ .(213) __ ________ _____ .o _______________ .o ____________ (768) ___ ____ ____ ____ .o ___________ _(788) ____ ____ ____ ____ 0
_______________ J) ......... (1,798) _______________ .o _________ (1.798) _______________ J)
_______________ .o ------ .. (~) - .... .0 ___________ .(403) .•. .0 _______________ J) _________ ___ (~) _______________ .o ___________ _(403) ....•.•.....•.• 0 _______________ J) ......... (2,035) _______________ .o _________ (2.035) _______________ J)
_______________ .o ..... (1,916) - ________ .o _________ (1.916) _______ J) _______________ .o _________ (1 ,904) _________ ______ .o ---------<1.904) __ ________ ______ 0 _______________ J) ____________ (381) _______________ .o ___________ .(381) _______________ J)
_______________ J) •...• (2,672) ...... .0 _________ (2.672) . . .... .0 _______________ .o _______ __ (2 ,205) - ------- . .. .. .0 ________ .(2.205) -- ------- _____ 0 _______________ J) ____________ (583) _______________ .o ___________ .(583) _______________ J) _______________ .o ____________ (558) _________ ______ _o ___________ .(558) __ ________ _____ .o _______________ .o ____________ (804) ___ ____ ____ ____ .o ___________ _(804) ____ ____ ____ ____ 0 _______________ J) ____________ (225) _______________ .o ___________ .(225) _______________ J)
_______________ .o ------ .. (182) - .... .0 ___________ .(182) .. . .0 _______________ J) ___________ _ (204) _______________ .o ___________ _(204) ....•.•.....•.• 0 _______________ J) ____________ (944) _______________ .o ___________ .(944) _______________ J) _______________ .o ________ (990) - _____ ____ .o ___________ .(990) _____ ___ J) _______________ .o ____________ (3&9) _________ ______ .o ___________ _(389) __ ________ ______ 0 _______________ J) ____________ (385) _______________ .o ___________ .(385) _______________ J)
_______________ J) -- -- (366) ...... .0 ___________ .(366) . . .... .0 _______________ .o _______ __ (3, 19fl) ________ _____ _o ________ .(3.1116) -- ------- -----0 _______________ J) ____________ (338) _______________ .o ___________ .(338) _______________ J) _______________ .o ____________ (335) _________ ______ _o ___________ .(335) __ ________ _____ .o _______________ .o ____________ (558) ___ ____ ____ ____ .o ___________ _(588) ____ ____ ____ ____ 0
_______________ J) ____________ (919) _______________ .o ___________ .(919) _______________ J)
________ J) ------ ... (483) - ------ .... .0 ___________ .(493) -- ------ ... .0
18
Book/ Adjusted Carrying Value at Disposal
Date ............. 1,481
... . .6.~ ...... ...... 12, 797 ............ 18,718
.... .3,032 . __ _______ 1,418 ________________ liOQ
...... ....... .1,805 __ _______ ____ 4,833
........... 100,:!41 . .9,624
........ 173,711 ............ 33, 703
. .. . .3,765 ...... ....... .3,838 ............ 42,713
......... 38,444 . __ _______ 1,'111
............. .6,974
...... ....... .6,962 __ _______ __ 10,781 ............ 17 ,878 . __ _______ 15,164
___________ 4,435
............ 30,283 ---- ... .... 30,347 ____ ________ 29, 187
............ 65.~ _________ &9,138
. -- . .. ... 147, 143
............. Jl,516
...... ....... .6,611 ---- _______ 23,825 ............ !18,890 . -- . .. .... 10,965
......... 10,970 ............ 83.~ -- -- ... .... 78,177 ____ ________ 77,884
............ 10,099 ......... 74,828
. __ _______ 61,729
............. .9, 147
...... ....... .8,749 __ _______ __ .9,479
............. .3,871 . .3,137
.......... .3,502 ............ 38,846 ---- ... 3,471,031 ...... ...... 14,711 ............ 14,578
......... 14,598 . __ _______ 53,516 ............. .5,626 ...... ....... .5,608 ---- ... .... 14,057 ............ 22,811 ----- ...... 12,254
17
Foreign Exchange
Gain (LoBB) on Disposal
_______________ .o _____ ____ J)
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ J)
___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ J)
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ J)
___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ J)
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ J)
___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ J)
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ J)
___ ____ ____ ____ _ 0 _______________ .o
.. .. .0 ________________ o _______________ .o
_____ ____ J)
________________ o _______________ .o
...... .0
--------- ------ -0 _______________ .o _________ ______ J)
___ ____ ____ ____ _ 0 _______________ .o . . ...... . .... .0
18
Realized Gain
(Loss) on Disposal
_______________ .o _______ .o
_______________ .o _______________ .o
.... .0 ___ __ ______ __ __ _o _______________ .o _______________ .o _____ ____ ____ __ jJ
_______________ .o . .. .0
_____________ jJ
_______________ .o _______ .o
___ ________ ____ jJ
_______________ .o .... .0
___ __ ______ __ __ jJ
_______________ .o _______________ .o _____ ____ ____ __ jJ
_______________ .o . .. .0
_____________ jJ
_______________ .o _______ .o
___ ________ ____ jJ
_______________ .o .... .0
___ __ ______ __ __ jJ
_______________ .o _______________ .o _____ ____ ____ __ jJ
_______________ .o . .. .0
_____________ jJ
_______________ .o _______ .o
___ ________ ____ jJ
_______________ .o .... .0
___ __ ______ __ __ jJ
_______________ .o _______________ .o _____ ____ ____ __ jJ
_______________ .o . .. .0
_____________ jJ
_______________ .o --- ... 214 ,756 ___ ________ ____ jJ
_______________ .o .... .0
___ __ ______ __ __ jJ
_______________ .o _______________ .o _____ ____ ____ __ jJ
_______________ .o ... . ...... . .. .0
19
Total Gain (Loss) on Disposal
_______________ J)
_______________ .o _______________ .0 _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .0 _______________ .o _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .o _______________ .0 _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .0 _______________ .o _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .o _______________ .0 _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .0 _______________ .o _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .o _______________ .0 _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .0 _______________ .o _______________ J)
_______________ J)
_______________ J) _______________ J) _______ 214.756 _______________ .0 _______________ J)
_______________ J)
_______________ J) _______________ J)
_______________ .0 _______________ .o _______________ J)
___ J)
20
Bond Interest/ stock
Dividends Received
During Year _________________ 125
... . .. . 134 ____ ________ ____ 320 ________________ 312
...... 63 . __ _______ ___ 165 __________________ 16 ____ ________ ______ 41 __ ____ ____ ____ __ 127
............. .1,871 . .. 201
___________ 4,343 ________________ S82
... .... .78 ____ ________ ______ 9fl ________________ 712
.... 601 . -- -------- ----200 __________________ 93 ___ ________ _____ 116
__ _______ _____ 216 ________________ 288
. .. 284 _____________ 100
________________ S55 _____ __ .695
____ ________ ____ ll03
-----------------____ .1,296 . __ _______ .3,311 _________________ 128 ___ ________ _____ 124
__ ____ ____ ____ __ 5311 ________________ B15
. .. 228 _____________ 274
............. .1,248 .... .1,466
___ ________ _ _1,747 _________________ 188
.... .1,5&9 . __ _______ _ _1,543 _________________ 137 ___ ________ _____ 164
__ _______ _____ 213 __________________ 65
_____ 65 _______________ 88
________________ .515 __ _______ __ 56,111 ___ ________ ____ 19fl
________________ 243 .... 2112
. -- -------- ----.892 _________________ 117
--- -- ------ -- -- -1~ __ ____ ____ ____ __ 187 ________________ 380
----- ------- .. 245
21 22
NAIC Designation
Staled or Con- Market
lractual In-Maturity dicator
Date (a) .09/0112020 -- 1. ............ . .0910112020 .. L .. _09/0112020 -- 1.... .10/0112020 -- 1. ............ . .1010112020 -- 1. ...... . .10/0112020 -· 1. ------- ----_0810112021 -- 1. ............ . .0810112021 __ L . .08/0112021 -- 1. ------- -·-· .0510112024 -- 1. ............ . .0510112024 . L ..... . _05/0112024 -- 1. ............ . .11/0112024 -- 1. ............ . .1110112024 .. L .. .1110112024 -- 1.... .0810112023 -- 1. ............ . .0810112023 -- 1. ...... . _08/0112023 -· 1. ------- ----_11/0112024 -- 1. ............ . .1110112024 __ L . .1110112024 -- 1. ------- -·-· .04/0112024 -- 1. ............ . .0410112024 -· 1. -------_04/0112024 -- 1. ............ . .0610112020 -- 1. ............ . .0610112020 .. L .. .08/0112020 -- 1.... .0510112024 -- 1. ............ . .0510112024 -- 1. ...... . _05/0112024 -· 1. ------- ----_04/0112024 -- 1. ............ . .0410112024 __ L . .04/0112024 -- 1. ------- -·-· .0610112024 -- 1. ............ . .0610112024 . L ..... . _08/0112024 -- 1. ............ . .07/0112024 -- 1. ............ . .0710112024 .. L .. .07/0112024 -- 1.... .07/0112024 -- 1. ............ . .0710112024 -- 1. ...... . .07/0112024 -· 1. ------- ----_04/0112026 -- 1. ............ . .0410112026 __ L . .04/0112026 -- 1. ------- -·-· .11/0112024 -- 1. ............ . .1110112024 -· 1. -------_1110112024 -- 1. ............ . .1210112024 -- 1. ............ . .1210112024 .. L .. .1110112024 -- 1.... .11/0112024 -- 1. ............ . .1110112024 -- 1. ...... . .1110112024 -· 1. ------- ----_11/0112024 -- 1. ............ . .1110112024 __ L . .12101~ _. 1. _____ _____ _
.12101~ .. 1. ............ .
.12101~ . 1..
m 0 (11
en
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE D • PART 4 Show All Long-Term Bonds and Stock Sold, Redeemed or otherwise Disposed of During the Current Quarter
1 2 3 4 5 8 7 8 9 10 Chance In BookiA<fustecl Carrvina Value 11 12 13 14 15
Total Total Current Change in Foreign Year's Book/ Exchange
Prior Year Current Other Than Adjusted Change in Book/ Unrealized Year's Temporary Carrying Book
CUSIP Number of Adjusted Valuation (Am or- Impairment Value /Adjusted ldant- For- Disposal Nama Shares of Consid- Actual Carrying Increase/ lization)l Raoog- (11+12- Carrying
iii cation Description eign Date of Purchaser stock eration Par Value Cost Value Decrease Accretion nized 13) Value 9899999. Total- Preferred and Common Stocks 0 XXX 0 0 0 0 0 0 0 9999999- Totals 37 311 257 XXX 38 413 738 35 &10 422 0 (332 829) 0 (332 1129) 0 (a) For all oommon stock beanng the NAIC market 1nd1calor "U" pi"OVIda: the number of such IBBues ..
18 17 18 19 20 21 22
NAIC Desig-
Book/ Bond nation Adjusted Foreign lntsrest/ Stated or Carrying Exchange Realized stock Con- Market Value at Gain Gain Total Gain Dividends tractual In-Disposal (LoBB) on (Loss) on (loss) on Received Maturity dicator
Date Disposal Disposal Disposal During Year Date (a)
0 0 0 0 0 XXX XXX 36 881 048 0 430 209 430 209 704 582 XXX XXX
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
Schedule DB - Part A - Section 1 - Options, Caps, Floors, Collars, Swaps and Forwards Open
NONE
Schedule DB - Part B - Section 1 - Futures Contracts Open
NONE
Schedule DB - Part B - Section 1 B - Brokers with whom cash deposits have been made
NONE
Schedule DB- Part D- Counterparty Exposure for Derivative Instruments Open
NONE
Schedule DL- Part 1 -Reinvested Collateral Assets Owned
NONE
Schedule DL- Part 2- Reinvested Collateral Assets Owned
NONE
E06,E07,EOB,E09,E10
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE E - PART 1 -CASH
Depository .P Morgan O!ase _________________________ New York City, NY ________________ _ Northern Trust ___________________________ Chicago, IL __________________________ _ 0199998. Deposits in ... depositories that do not exceed the allowable limit in any one depository (Sea instructions)- Open Depositoriee
0199999. Totals- Open Depositories 0299998- Deposits in___ depositories thet do not exceed the allowable limit in any one depository (See instructions)- Suspancled DePOsitories
0299999. Totals- Suapended Depositories 0399999. Total Cash on Deposit 0499999. Cash in Company's Office
0599999. Total- Cash
Month End Depository Balances 2 3 4 5
Amount of Amount of Interest Received lntereet AcciUed
Rate of During Current at Current Code Interest Quarter Statement Date
XXX XXX XXX XXX 0 0
XXX XXX XXX XXX 0 0 XXX XXX 0 0 XXX XXX XXX XXX
XXX XXX 0 0
E11
Book Balance at End of Each Month 9 During Current Quarter
B 7 8
First Month Second Month Third Month _ ____________ 4,299,542 _____________ 4, 552,946 ____________ ] ,602,983 _XXX _ _________________ 82,037 ________________ 103,125 __________________ 35,885 _XXX
XXX 4,3111,579 4,656,071 7,638,868 XXX
XXX 0 0 0 XXX
4,3111,579 4,656,071 7,638,868 XXX XXX
4,3111,579 4,656,071 7,638,868 XXX
Description
m ...... 1\:1
8699999- Total Cash Eauivalents
STATEMENT AS OF JUNE 30, 2012 OF THE UnitedHealthcare Plan of the River Valley, Inc.
SCHEDULE E ·PART 2 ·CASH EQUIVALENTS Show Investments OWned End of Current Quarter
2 3 4
Coda Dais AcQuired Rata of Interest
5
Maturitv Dais
6 Book/Adjusted CarTVina Value
7 Amount of Interest Due and Accrued
8 Amount Received
DurinaYear
~ UnitedHealthcare@
Carrier:
Date:
Valuation Date:
Subject:
COMMUNITY & STATE
Actuarial Certification
UnitedHealthcare Plan of the River Valley, Inc.
July 17, 2012
June20J2
Tenncare Claim Re.serve Estimate (IBNR) as of June 2012- Risk Business- Eastern Tennessee'-- Excluding Long Term Care
I, JedL Linfield, am Director of ActQarial Reserving Services for United HealthCare Community and State. I am a memberof the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion, the claim reserve estimate {IBNR) of$61,650,086 provides good and sufficient provision for all unpaid claim liabilities and was computed in accordance with currently accepted actuarial standards.
Note that, a<; ofJune2012, this block of business had approximately 188;000 members.
?I Jed L. Linfield, FSA, MAAA
Director of Aduarial Reserving Services
United HealthCare Community and State
12018 Sunrise Valley Drive
Reston, VA20191
(571) 262-8922
UHCEW500507-000
~ UnitedHealthcare" COMMUNITY & STATE
Actuarial Certification
Carrier: UnitedHealthcare Plan of the River Valley, Inc.
Date:
Valuation Date:
Subject:
July 17,2012
June 2012
Tenncare Claim Reserve Estimate (IBNR) as of June 2012- Risk Business- Middle Tennessee- Excluding Long Term Care
I, Jed L. Linfield, am Director of Actuarial Reserving Services for United HealthCare Community and State. I am a member of the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion, the claim reserve estimate (IBNR) of $62,705,771 provides good and sufficient provision for all unpaid claim liabilities and was computed in accordance with currently accepted actuarial standards.
Note that, as ofJune 2012, this block of business had approximately 194,000 members.
~.'I.~ v
Jed L. Linfield, FSA, MAAA
Director of Actuarial Reserving Services
United HealthCare Community and State
12018 Sunrise Valley Drive
Reston, VA 20191
(571) 262-8922
UHCEW500507 COOO
~ UnitedHealthcare"
Carrier:
Date:
V a! ualion Dale:
Subject:
COMMUNITY & STATE
Actuarial Certification
UnitedHealthcare Plan of the River Valley, Inc.
July 17, 2012
JW1e2012
Tenncare Claim Reserve Estimate (IBNR) as ofJune 2012 -Risk Business- Western Tennessee- Excluding Lung Term Care
I, Jed L. Linfield, am Director of Actuarial Reserving Services. for United Health Care Community and State. I am a member of the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion, the claim reserve estimate (IBNR) of$49,992,884 provi<!es good and sufficient provision for all
unpaid claim liabilities and was computed in accordance with currently accepted actuarial standards.
Note that, as ofJune 2012, this block of business had approximately 169,000 members.
Jed L. Linfield, FSA, MAAA
Director of Actuarial Reserving Services
United HealthCare Community and State
12018 Sunrise Valley Drive
Reston, VA 20191
(571) 262-8922
UHCEW500507 -000
~ UnitedHealthcare·
Carrier:
Date:
Valuation Date:
Subject:
COMMUNITY & STATE
Actuarial Certification
UnitedHeallhcare Plan of the River Valley, Inc.
July 17, 2012
June 2012
Tenncare Claim Reserve Estimate (IBNR) as of June 2012 -Risk Business- Eastern Tennessee- Long Term Cru:e
I, Jed L. Linfield, am Director of Actuarial Reserving Services for United HealthCare Community and State. I am a member of the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion, the claim reserve estimate (IBNR) of$23,019,848 provides good and sufficient provision for all unpaid claim liabilities and was computed in accordance with currently accepted actuarial standards.
Note that, as of Jlme 2012, this block of business had approximately 6,100 members.
Jed L. Linfield, FSA, MAAA
Director of Actuarial Reserving Scrvi ces
United HealthCare Communityand State
12018 Sunrise Valley Drive
Reston, VA20191
(571) 262-8922
UHCEW500507 .000
~ UnitedHealthcare·
Carrier:
Date:
Valuation Date:
Subject:
COMMUNITY & STATE
Actuarial Certification
UnitedHealthcare Plan of the River Valley, Inc.
July 17. 2012
June 2012
Tenncare Claim Reserve Estimate (IBNR) as of June 2012- Risk Business- Middle Tennessee- Long Term Care
I, Jed L. Linfield, am Director of Actuarial Reserving Services for United HealthCare Community and State. I am a member of the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion, the claim reserve estimate (IBNR) of $19,227,233 provides good and sufficient provision for all unpaid claim liabilities and was computed in accordance with currently accepted actuarial standards.
Note that, a~ of June 2012, this block of business had approximately 5,400 members.
Jed L. Linfield, FSA, MAAA
Director of Actuarial Reserving Services
United HealthCare Community and State
12018 Sunrise Valley Drive
Reston, VA20191
(571) 262-8922
UHCEW500507-000
~ UnitedHealthcare·
Carrier:
Date:
Valuation Date:
Subject:
COMMUNITY & STATE
Actuarial Certification
UnitedHealthcare Plan of the River Valley, Inc.
July 17, 2012
June2012
Tenncare Claim Reserve Estimate (IBNR) as of June 2012- Risk Business- Western Tennessee- Long Term Care
I, Jed L. Linfield, am Director of Actuarial Reserving Services for United HealthCare Community and State. I am a member of the American Academy of Actuaries and am qualified to render the actuarial opinion contained herein.
In my opinion; the claim reserve estimate (IBNR) of $20,488,270 provides good and sufficient provision for all unpaid claim liabilities and was computed in accordance with currently accepted actu.arial standards.
Note that, as of June 2012, this hlock of hu.•iness had approximately 4,600 mem hers.
Jed L T .infield, FSA, MAAA
Director of Actuarial Reserving Services
United HealthCare Community and Slate
12018 Sunrise Valley Drive
Reston, VA 20191
(571) 262-8922
UHCEW500507 -000
Cash received per premium tax reconciliation
Change in accruals
Change in withhold
Money follows the person incentive payments
UHC Plan ofthe River Valley
Reconciliation of Cash to Accrual Basis Accounting
As of June 30, 2012
Middle East
472,524,119 425,692,411
(9,397,543) 7,047,697
(3,659,227) (3,782,489)
{48,000) (73,000)
Payment of Premium tax recon of extra contractual amounts
Accrual basis
{315,614)
459,103,736
(80,932)
428,803,686
2A Reported premiums 459,103,736 428,803,686
Difference
Key
West Consolidated
364,615,816 1 ,262,832,346
6,743,867 4,394,020
(3,126,189) (10,567,905)
(79,000) {200,000)
{81,846) (478,392)
368,072,648 1,255,980,070
368,072,648 1,255,980,070
(a) Consistent with NAIC guidelines, UPRV records premiums on an accrual basis of accounting. The total accrued premium amount in June 2012 was $4.4M
more than the premium accrued for at Dec 2011. The change is driven by a June 2012 rate change accrual retroactive to Jan 2012 that increased revenue by
$9.2M, and a $4.8M increase to revenue created by the release of the Dec 2011 risk adjusted rate accrual-the risk adjusted rates commenced being paid in
March 2012, so that accrual was no longer necessary. The $14M total of the previous mentioned accrual activity increasing revenue is partially offset by the
June 2012 LTC members not receiving services revenue recoupment accrual reducing revenue by $9.4M more than the similar accrual made in December 2011.
(b) This item is created by the June 2012 withholds being $10.6M less than the Dec 2011 withholds as a result of the June 2012 withhold rate reduced to 5%
from the Dec 2011 withhold rate of 10%.
(c) Money follows the person bonus payments made to the healthplan are included in the premium tax calculation, but are not recorded as premium revenue.
(d) 2012 payment of a Dec 2011 Revenue receivable amount recorded in 2011 for the variance between premium tax to be paid on the extra contractual
payment amounts for service dates prior to July 2009 and the premium tax portion included in the cap rates for service dates prior to July 2009.
Accrual change is calculated as follows: Middle East West Consolidated
Reversal of December 2011 Tenncare RAR accrual (9,855,029) 8,495,754 6,197,394 4,838,118
Reversal of December 2011 accrual for Mure retro membership (6,368,921) (13,381,962) (8,114,268) (27,865,151)
Reversal of December 2011 members without services revenue recoupm 3,118,432 4,556,464 5,029,649 12,704,545
June 2012 accrual for future retro membership 7,114,634 12,191,351 8,220,869 27,526,853
June 2012 accrual for members without services revenue recoupment ac (6,671 ,340) (8,118,317) {7,260,521) {22,050,177)
June 2012 rate change accrual 3,264,681 3,304,407 2,670,744 9,239,832
Total change in accrual {9,397,543) 7,047,697 6,743,867 4,394,020
~
a b
c d
RetroAccrualln AR PaldYTD Dec 2011
12131/2011 AR balance by component
Tenncare withhold GL Accrual for future retroactive premium Gl Accrual forTenncare rete change
Tenncare Medicaid withhold
14,138,750 Tenncare LTC withhold
6,923,486
GL Accrual prem tax payable not in cap payment GL balance 12/3112010 14,138,750 6,923,466
current LTC Current Medicaid withhold on
Prior Medicaid withhold on 2011 2011 service
2012 Cash receipts related to 2011 service dates --"w~"""c"'::;':C"f';;';;'"r,""_:_Pc'''c'c'cToC~w00h;;hh0o;;ld;;;<;p:;:•l;;d.----~·0•c"'~''o'cd;o•~te;;•;..,--~•o•I;''C,',.,,-Jan-12 {14,138,750) {6,923,486) 1,804,829 149,169 Feb-12 {1,604,829) {149,169) 136,068 86,222 Mar-12 {136,068) {86,222) 567,067 114,756 Apr-12 (567,067) {114,756) 551,800 97,585 May-12 (551,600) {97,585) 179,133 29,311 Jun-12 (179,133) (29,311) 154,327 14,252 Jul-12
Aug-12 Sep-12 Oct-12 Nov-12 Dec-12
Total2012 cash deposits for 2011 retro cash
Accrual for LTC membere Tenncare rate change not receiving eervices accrual (held in account (held in account 55600- 65600-03000-24599 on
03000-24599 on 12131/2011)
{12,704,545) {4,838,118)
(12,704,545) {4,838,118)
Medicaid LTC Medicaid LTC
(A) Accrual for Future retro (A) Accrual for Future premium retro premium
21,062,236 27,865,151 27,865,151
{17,542,663)
27,865,151 31,364,725
Premium to record sent in Premium to record Total depoelts 820 remittance sent in 820 remittance related to 2011
(16,048,295) (1,491,691) {36,648,223) {28,582,215) (8,266,008) (36,648,223) (1,360,677) {862,217) {3,754,603) (2,829,439) (925,164) {3,754,603) (5,670,668) {1,147,562) {6,358,696) {5,239,669) (1,119,028) {6,358,896) {5,517,995) {975,853) {6,526,287) {5,533,263) {993,024) {8,526,287) {3,582,658) {586,217) {4,609,818) {3,955,325) (654,491) {4,609,816) {3,086,536) (285,035) {3,411,436) (3,111,342) (300,094) {3,411,436)
(35,266,829) (5,348,574) (61,509,061) (49,405,579) (12,272,060) (61,671,640)
Jul-11 65 Aug-11 133 Sep-11 204 Oct-11 285 Nov-11 370 Dec-11 454 Jan-12 569 Feb-12 689 Mar-12 889 Apr-12 1,288 May-12 2,467
Prior Month 15,911
165
Current Total 63,530 Prior Total 63,457
Increase/Decrease in Accrual 73
AmeriChoice- Tennessee Retroactive Accrual
June-12
182,568.76 89 193,547.93 185 201,106.51 280 211,488.64 390 225,393.93 507 242,666.25 622 269,701.95 786 310,446.75 956 374,162.97 1,219 545,015.60 1,705
1,050,543.88 3,011
7,258,409.39 17,986
(143,775.85) 247
27,526,852.96 27,787,248.34
(260,395.38)
228,574 232,772 244,984 270,328
310,479 341,801
393,158 457,227
573,583 783,574
1,333,788
7,930,623.31
290,245.60
174 356,402.76
364 373,836.67 551 394,483.00
765 418,897.67
991 444,388.06
1,201 480,522.92 1,501 532,861.14 1,766 622,835.14 2,156 752,170.31 2,794 1,042,307.41 4,552 1,893,868.97
29,560 12,598,215.64
(339) (406,865.13)
STATEMENT AS OF JUNE 30,2012 OF UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
PREMIUMS, ENROLLMENT AND UTILIZATION TABLE
Tennessee 1 Comprehensive 4 5 6 7 8 9 10 (Hospital & Medical) 2 3
Medicare Vision Dental Federal Employees Total Individual Group Supplement Only Only Health Benefit Plan Medicare Medicaid Other
Total Members at end of: 1. Prior Year 658,047 - 30,049 - - - XXX 59,932 568,066 -2. First Quarter 656,750 - 27,478 - - - XXX 62,242 567,030 -3. Second Quarter 657,600 - 26,264 - - - XXX 64,644.00 566,692.00 -4. Third Quarter - - - - - - XXX - - -5. Current Year - - - - - - XXX - - -6. Current Year Member Months 3,955,801 - 161,882 - - - XXX 376,825 3,417,094 -Total Member Ambulatory Encounters for Year: 7. Physician 2,342,550 - 85,064 - - - XXX 594,935 1,662,551 -8. Non-Physician 663,431 - 13,272 - - - XXX 216,865 433,294 -9. Total 3,005,982 - 98,337 - - - XXX 811,800 2,095,845 -1 0. Hospital Patient Days Incurred 1,293,656 - 3,596 - - - XXX 120,611 1 '169,449 -11. Number of Inpatient Admissions 90,045 - 823 - - - XXX 15,493 73,729 -12. Health Premiums Written 1,679,859,449 - 57,385,723 - - - XXX 366,493,656 1,255,980,070 -13. Life Premiums Direct - - - - - - XXX - - -14. Property/Casualty Premiums Written - - - - - - XXX - - -15. Health Premiums Earned 1,681,833,686 - 57,385,724 - - - XXX 368,467,892 1,255,980,070 -16. Property/Casualty Premiums Earned - - - - - - XXX - - -17. Amount Paid for Provision of Health Care Services 1 ,352,148,402 - 47,101,196 - - - XXX 292,779,171 1,012,268,035 -18. Amount Incurred for Provision of Health Care Servicies 1,338,237,890 - 43,832,130 - - - XXX 289,518,533 1,004,887,228 -
STATEMENT AS OF JUNE 30, 2012 FOR UNITEDHEAL THCARE PLAN OF THE RIVER VALLEY, INC.
EXHIBIT 2 -ACCIDENT AND HEALTH PREMIUMS DUE AND UNPAID
Individually list all debtors with account balances the greater of 10% of gross Premiums Receivable or $10,000.
Name of Debtor 1-30 Days 31-60 Days 61-90 Days Over 90 Days Total Individuals - - - -Group subscribers:
Group subscriber subtotal $ - $ - $ - $ -Premiums due and unpaid not individually listed $ 1 ,846,162 $ 124,250 $ 52,849 $ 58,076 Total group $ 1 ,846,162 $ 124,250 $ 52,849 $ 58,076 Premiums due and unpaid from Medicare entities $ 23,421,654 $ 29,383 $ 16,100 $ 29,043 Premiums due and unpaid from Medicaid entities $ 48,207,297 $ 627,045 $ 614,205 $ 10,451,866 Accident and health premiums due and unpaid (Page 2, Line 15) $ 73,475,113 $ 780,678 $ 683,154 10,538,985
Non Admitted Admitted - -
$ - $ -$ - $ 2,081,338 $ - $ 2,081,338 $ 78,459 $ 23,417,721 $ - $ 59,900,413 $ 78,459 $ 85,399,472
STATEMENT AS OF JUNE 30,2012 OF UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
Exhibit 3 - Health Care Receivables
· · · · · · · · · · · · · · · · · · · · · · · · · · · · · ········o-pium Rx · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 15,663,4:13 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·M"eiic<> R€!a1ifl soiuiioiis · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 32 ."7 45 · · · · · · · · · · · · · · · .. · · .. · · .. o 1 9999i.i ii.99 re9aie! riiar'maceuiicar R"eiiaie · R"eceiiiaiiles · · · · · · .. · · · .. · · · · · · ·
Not Individually Listed
"""""913,568 :::::::::: :1:~~-:~t~
· · · · · · · .. · · · · · · .. · · · · · · · · o i 9999~i "T otaY riia·r-mai:euilcai · R.eiJaie · R"eceiiiaiJie's · · · · · ::::::: j ~-:~~~.:i ?~ · · · · · · · · · · · · · · · · · · · · · · · · · '6:299998. ii.~i9 re9aie.· ciaim ·O"verpaym.eni · R"eceiiiaiiles · · · :::::::3i!A~~: .. :::::::::~~~;L. ::::::::):.~~~-~?~
Not Individually Listed · · · · · · · · · · · · · · · · · · · · · · · · · '629999ii "T iital· c1afm oiieii>'ayme ni ·R-eceiiiaiJies · · · · · · · · ........... ~?~--~9~ .......... ?X?,~-~9. · · · .. · · · · · ...... · · .. · · · · · '6399998. ii.~i9re9aie.· L"oa.ris · a·ria ·Advances· io · P"roviders · ........... ~?~--~9~ .......... ?X?,~-~9 . .................. ..
Not Individually Listed · · · · · · · · · · · · · · · · · · · · · · · · · o3 9999ii ·-r otai' L.oaiis · aiid '.A:dvarii:es · io · F>'rovfae.·rs · · · · · · · · · · · · · · · · · · · · · · · · · · o · · · · · · · · · · · · · · · · · · · · · · · · · o4 99998. ii.99 re9aie.· ca·prtatioii A.rraii9emeiii · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·
Receivables Not Individually Listed · · · · · · · · · · · · · · · · · · · · · · · · · '64 9999~i "T otai' caP'iiaiiori A.riaii9eimeiii Rece ivaE 1es · · · · · · · · · · · · · · · · · · · · · · · o
· · · · · · · · · · · · · · · · · · · · · · · '6599998. ii.99 re9aie.· Risk· slia.r1n9 ·Receiv.aiJies ·liloi · · · · · · · · · · · · · · · · · · · · · · · · · Individually Listed
... :::::::::::::::::::::: :q$~$~$~: :t~@: ~i~~ }~~!!0~ :~~~~)y~~!~~::::::::::: ::::::: to Plan Receivable · · · · · · siiaie.· cosi o'f ReceiiiaEies · · · · · · · · · · · · · · .. · · · · · · · · .. · .. · · · · · · · · · · · · · · · ....
· · · · · · · · · · · · · · o699998. ii.99 re9aie.· oiiier Receivaliieii Noi· iriillviCiuailii · Listed
· · · · · · · · · .. · · · · · · · · · · · · · · o699ii9~i "T oial· oilie.·r· Receiva.liles · .. · · · · · · · · · · · · · · · · · · · · .. · · · · · · · · · · · · · · .. · · · · · .. · · · · ···· .. ···G-ross· 1 · · .. R"eceiiiaiJ.Ie·s · · .. · · · · · · · · .. · ·
0 --------------------0 -----------------.--
............ !~--~?-~
............. ~--~?~
-----------.-.-.--- -----------------0
0
0 ------------------- ------"- ---------0 ------------------. 0 --------------.----
........... .?,~-~1
------.----------64 ----- ---------011
0 ------"-"--- --------0
-"-"-------------- --0
----------------.--0
............ !??.-~! ~
............ !??.-~!~ 776
:::::::::::: ):.~~~
::::::: j :~:t~:~:~ ~:~:
0
................... 6.
0 ------------------.--0 ------------.--------0 ----.---.------------0
STATEMENT AS OF JUNE 30, 2012 OF UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
Exhibit 5 -Amounts Due From Parent, Subsidiaries and Affiliates 2 3 4 5 6
Name of Affiliate 1- 30 Days 31 -60 Days 61-90 Days Over90 Days Nonadmitted 7
Current 8
Non-Current
: ::9:19~9~1:~~}\~~B~~[t~~~~~:~~!Y}~~~; !~~:::: ::: :::1~:~;?~~;9~~: ::::::::::::::::::::: :::::::::::::::::::: ::::::::::::::::::::: :::::::::::::::::::: : :::J~~;?~M~$: ::::::::::::::::::::: : ::9:1~~~~~ :!6~iY}~~~)~)[~!~~:E~~~!~~~[~~:::::::: ::::::1 ~~:?~M~~: ::::::::::::::::::::: :::::::::::::::::::: ::::::::::::::::::::: :::::::::::::::::::: :::::: 1~$;?~~;9~$: :::::::::::::::::::::
0299999 Receivables not individually listed
---ci399999- ;= aiai -!iross ·ailiau iits ·,e;c:eii\ia&ie· · · · · · · · · · ·155;:249: 696 · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·155;249: o96 · · · · · · · · · · · · · · · · · · · · · ·
0100001
STATEMENT AS OF JUNE 30,2012 OF UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.
Exhibit 6 -Amounts Due To Parent, Subsidiaries and Affiliates 1 2 3 4
Affiliate Description Amount Current 5
Non-Current
______________ ~ ~!~"!~- !:!!'.~~~~s:-~~~- ~~!":'!~~~'! !'.~, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ! !1.'~~~~-f!l.e~nv .P~>:~-~~~ _ _ _ _ _ __ . __ -~~,~~~-·~~~- ________ !l.~, ?~~ ,?:'!?. ______ . _. _______ : ___ _ -- ·ci199999- iiiCi;ii;iiuaiiiiiisieii payailies-- ----------------------------------------------- ------------------------------ -------89,539,649------- ·89;539;549· --- ·-- ----------:-------ii299999-Payailies iiiii ·;iiaiviaualiy -Jisie·a-------------------------------------------- ------------------------------ ----------------~-------------------- -_-- ·- --- ·------------:-------o399999-i' oiai ·9 ross ·payab"Jes------------------------------------------------------- ------------------------------ -------89,539,649--------89: 539; 649- ---------------------
UnitedHealthcare Community Plan -East Tennessee Report 2A- TennCare Income Statement CRA 2.30.14.3.3 and 2.30.14.3.4
Current Qtr YTD Total YTD Total as Prior Year as of
Revenues: TennCare Capitation Investment Other Revenues
Total Revenues
Estimated Expenses:
Member Months
Hospital and Medical (w/o Mental Health) Capitated Physician Services Fee-for Service Physician Services Inpatient Hospital Services Outpatient Hospital Services Emergency Room Services Dental Services Vision Services Pharmacy Services Home Health Services Chiropractic Services Radiology Services Laboratory Services Durable Medical Equipment Services Transportation Services Outside Referrals Medical Incentive Pool and Withhold Adj Occupancy, Depreciation and Amortization Nursing Facility Care HCBS Services Other Medical and Hospital Services - Write-Ins
Subtotal Medical and Hospital
Mental Health and Substance Abuse Services Inpatient Psychiatric Facility Services Inpatient Substance Abuse Treatment and Detox Outpatient Mental Health Services Outpatient Substance Abuse Treatment and Detox Housing/Residential Treatment Specialized Crisis Services Psychiatric Rehab and Support Services Case Management Forensics Other Judicial Pharmacy Lab Services Transportation Medical Incentive Pool and Withhold Adjustments Occupancy, Depreciation and Amortization Other Mental Health and Substance Abuse Services PCP and Specialist Servcies Other Mental Health Services - Write-Ins
Subtotal MH&SAS Subtotal Hospital, Medical, MH&SAS, CHOICES
LESS: Net Reinsurance Recoveries Incurred Copayments Subrogation and Corrdination of Benefits
Subtotal Reinsurance, Capay, Subrogation Total Hospital, Medical, MHS&S
Administation: Compensation Direct and Allocated Admin expenses Marketing Interest Expense Premium Tax Expense Occupancy, Depreciation, and Amortization Other Administration- Write-Ins Fines and Penalties - Other Write-Ins
Total Administration Expenses Total Expenses
Extraordinary Item Provision for Income Tax
Net Income (Loss)
Write-Ins for Other Revenues:
Total Other Revenues
Write-Ins for Other Medical and Hospital: Other Miscellaneous Other Capitated Services
Total Other Medical and Hospital
Detail of Other MH and SAS:
Total Other MH and SAS
Write-Ins for Other Administration: Administrative Services Fee Behaviorial Healthcare Services Spectera Administration Fees Other Miscellaneous
Total Other Administration
as of 6/30/2102 582,997
217,079,086
73,000 217,152,086
41,084,381 29,457,552 13,024,231 16,225,207
326,479
2,339,546
5,310,730 4,554,963 2,791,202 3,173,515
49,114,986 8,581,338
(45,811) 175,938,321
1,533,965 351,142
1,439,088 57,664
1,315,033 733,821
1,070,071 4,866,789
371,635
217,074
11,956,284 187,894,605
187,894,605
12,020,958
19,934,421 45,600
32,000,979 219,895,584
(960,224) (1,783,274)
(380,336) 334,525 (45,811)
17,367,447 1,373,855
95,129 1,143,591
19,980,021
of 6/30/2012 1,166,490
428,803,686
73,000 428,876,686
74,385,746 53,293,197 25,138,020 31,427,396
747,693
4,272,690
9,242,767 8,040,443 5,205,890 5,963,924
96,072,347 15,915,383
46,900 329,752,396
3,070,176 642,476
2,540,417 130,671
2,381,319 1,403,695 2,110,482 9,506,948
740,816
419,642
22,946,642 352,699,038
352,699,038
23,413,299
38,620,455 123,100
62,156,854 414,855,892
4,907,278 9,113,516
(621 ,725) 668,626
46,900
34,305,415 2,747,946
211,858 1,478.335
38,743,555
1) $73K is a money follows the person (MFP) incentive payment paid by Tenncare to the plan. The MFP incentive is successfully transitioning our Long term care members from institutions to home and community based environments.
12/31/2011 2,319,567
876,253,140
678 876,253,819
137,837,103 117,475,266 48,852,459 56,377,598
1,868,328
10,600,148
29,940,038 16,076,815
9,461,072 12,839,591
206,374,626 25,262,887
246,553 673,212,484
8,087,054 1,699,592 5,254,374
286,530 5,560,498 2,861,688 4,592,793
16,730,630
1,445,559
1,398,831
47,917,549 721,130,033
721,130,033
44,279,729
79,355,025 (297,276)
123,337,478 844,467,511
11,125,208 20,661,100
(1,127,342) 1,373,895
246,553
70,100,251 5,475,516
539,693
UnitedHealthcare Community Plan -Middle Tennessee Report 2A- TennCare Income Statement CRA 2.30.14.3.3 and 2.30.14.3.4
Revenues: TennCare Capitation Investment Other Revenues
Total Revenues
Estimated Expenses:
Member Months
Hospital and Medical (w/o Mental Health) Capitated Physician Services Fee-for Service Physician Services Inpatient Hospital Services Outpatient Hospital Services Emergency Room Services Dental Services Vision Services Pharmacy Services Home Health Services Chiropractic Services Radiology Services Laboratory Services Durable Medical Equipment Services Transportation Services Outside Referrals Medical Incentive Pool and Withhold Adj Occupancy, Depreciation and Amortization Nursing Facility Care HCBS Services Other Medical and Hospital Services - Write-Ins
Subtotal Medical and Hospital
Mental Health and Substance Abuse Services Inpatient Psychiatric Facility Services Inpatient Substance Abuse Treatment and Detox Outpatient Mental Health Services Outpatient Substance Abuse Treatment and Detox Housing/Residential Treatment Specialized Crisis Services Psychiatric Rehab and Support Services Case Management Forensics Other Judicial Pharmacy Lab Services Transportation Medical Incentive Pool and Withhold Adjustments Occupancy, Depreciation and Amortization Other Mental Health and Substance Abuse Services PCP and Specialist Servcies Other Mental Health Services - Write-Ins
Subtotal MH&SAS Subtotal Hospital, Medical, MH&SAS, CHOICES
LESS: Net Reinsurance Recoveries Incurred Co payments Subrogation and Corrdination of Benefits
Subtotal Reinsurance, Capay, Subrogation Total Hospital, Medical, MHS&S
Administation: Compensation Direct and Allocated Admin expenses Marketing Interest Expense Premium Tax Expense Occupancy, Depreciation, and Amortization Other Administration- Write-Ins Fines and Penalties - Other Write-Ins
Total Administration Expenses Total Expenses
Extraordinary Item Provision for Income Tax
Net Income (Loss)
Write-Ins for Other Revenues:
Total Other Revenues
Write-Ins for Other Medical and Hospital: Other Miscellaneous Other Capitated Services
Total Other Medical and Hospital
Detail of Other MH and SAS:
Total Other MH and SAS
Write-Ins for Other Administration: Administrative Services Fee Behaviorial Healthcare Services Spectera Administration Fees Other Miscellaneous
Total Other Administration
CUrrent Qtr YTD Total as of 6130/2102
602,488
232,958,554
48,000 233,006,554
46,111,216 39,145,114 11,171,677 12,085,605
601,793
4,635,199
5,259,564 5,335,139 2,760,931 5,498,937
38,969,405 9,693,712
501,405 181,769,697
2,254,926 362,081
2,874,457 25,007
1,359,253 1,019,538 2,129,324 7,666,963
367,165
253,085
18,311,799 200,081,496
200,081,496
12,810,396
22,327,790 177,780
35,315,966 235,397,462
(836,818) (1 ,554,090)
(116,014) 617,419 501,405
18,404,674 1,744,170
105,330 2,251,397
22,505,570
YTD Total as of 6/30/2012
1,203,182
459,103,735
48,000 459,151,735
83,791,014 70,059,561 20,918,477 24,235,083
1,271,411
8,028,510
9,386,188 9,281,903 5,381,476 9,974,482
77,121,611 18,866,016
1,339,513 339,655,246
4,384,851 705,954
4,758,782 40,277
2,961,727 2,132,366 4,471,202
16,614,095
777,910
493,178
37,340,342 376,995,588
376,995,588
25,988,827
42,544,939 255,472
68,789,238 445,784,826
4,678,418 8,688,491
212,171 1,127,342 1,339,513
36,270,143 3,490,140
232,863 2,807,264
42,800,411
Prior Year as of 12131/2011
2,419,816
942,991,556
604,922 943,596,478
149,302,501 134,767,254 42,335,880 43,441,637
2,704,227
16,889,677
27,575,620 17,709,914 10,407,468 19,903,549
166,663,361 29,079,152
2,810,605 663,590,846
10,566,015 2,158,535 9,246,813
377,271 6,698,310 4,358,985 7,881,109
29,752,552
1,593,978
2,186,302
74,819,869 738,410,715
738,410,715
46,849,063
85,622,648 (291 ,567)
132,180,144 870,590,859
25,551,966 47,453,652
978,035 1,832,569 2,810,605
74,496,333 6,997,048
426,383 3,702,884
85,622,648 1) $48K is a money follows the person (MFP) incentive payment paid by Tenncare to the plan. The MFP incentive is paid for successfully transitioning our Long term care members from institutions to home and community based environments.
UnitedHealthcare Community Plan -West Tennessee Report 2A- TennCare Income Statement West Tennessee CRA 2.30.14.3.3 and 2.30.14.3.4
Revenues: TennCare Capitation Investment Other Revenues
Total Revenues
Estimated Expenses:
Member Months
Hospital and Medical (w/o Mental Health) Capitated Physician Services Fee-for Service Physician Services Inpatient Hospital Services Outpatient Hospital Services Emergency Room Services Dental Services Vision Services Pharmacy Services Home Health Services Chiropractic Services Radiology Services Laboratory Services Durable Medical Equipment Services Transportation Services Outside Referrals Medical Incentive Pool and Withhold Adj Occupancy, Depreciation and Amortization Nursing Facility Care HCBS Services Other Medical and Hospital Services w Write-Ins
Subtotal Medical and Hospital
Mental Health and Substance Abuse Services Inpatient Psychiatric Facility Services Inpatient Substance Abuse Treatment and Detox Outpatient Mental Health Services Outpatient Substance Abuse Treatment and Detox Housing/Residential Treatment Specialized Crisis Services Psychiatric Rehab and Support Services Case Management Forensics Other Judicial Pharmacy Lab Services Transportation Medical Incentive Pool and Withhold Adjustments Occupancy, Depreciation and Amortization Other Mental Health and Substance Abuse Services PCP and Specialist Servcies Other Mental Health Services • Write-Ins
Subtotal MH&SAS Subtotal Hospital, Medical, MH&SAS, CHOICES
LESS: Net Reinsurance Recoveries Incurred Copayments Subrogation and Corrdination of Benefits
Subtotal Reinsurance, Copay, Subrogation Total Hospital, Medical, MHS&S
Administation: Compensation Direct and Allocated Admin expenses Marketing Interest Expense Premium Tax Expense Occupancy, Depreciation, and Amortization Other Administration- Write-Ins Fines and Penalties w Other Writewlns
Total Administration Expenses Total Expenses
Extraordinary Item Provision for Income Tax
Net Income (Loss)
Wrrte-lns for Other Revenues:
Total Other Revenues
Write-Ins for Other Medical and Hospital: Other Miscellaneous Other Capitated Services
Total Other Medical and Hospital
Detail of Other MH and SAS:
Total Other MH and SAS
Write-Ins for Other Administration: Administrative Services Fee Behaviorial Healthcare Services Spectera Administration Fees Other Miscellaneous
Total Other Administration
Current Qtr YTD Total as of 6/30/2102
521,520
188,052,139
79,000 188,131,139
27,669,081 27,770,529
6,708,039 9,407,048
321,047
2,769,074
2,725,808 2,518,283 1,594,065 3,391,212
36,162,979 8,399,188 1,117,678
130,554,029
2,507,634 166,914 849,659
30,413 1,692,983
517,911 1,410,755 4,273,976
331,009
148,577
11,929,829 142,483,858
142,483,858
10,295,916
17,349,577 35,400
27,680,893 170,164,751
6,288,236 11,678,152
(283,313) 1,400,991 1,117,678
15,421,341 908,929
92,045 962,662
17,384,977
YTD Total as of 6/30/2012
1,042,960
368,072,648
79,000 368,151 ,648
53,074,237 54,148,307 12,806,649 16,023,600
794,091
5,186,776
5,115,493 4,602,420 3,116,286 6,753,426
71,440,440 15,946,333 2,517,584
251 ,525,641
5,312,092 297,310
1,671,090 54,460
3,190,345 1,062,159 2,972,493 8,093,621
719,124
294,266
23,666,961 275,192,602
275,192,602
20,053,870
33,562,134 90,500
53,706,504 328,899,106
13,738,390 25,514,152
(207,423) 2,725,007 2,517,584
30,183,023 1,818,385
203,302 1,447,923
33,652,634
Prior Year as of 12/31/2011
2,075,390
734,068,106
734,068,106
96,191,465 123,175,859 25,312,923 32,723,179
1,940,916
11,511,184
17,781,256 9,146,039 5,967,215
14,421,699
153,832,875 22,660,462
5,104,657 519,769,729
11,360,260 624,637
2,823,138 90,627
4,918,715 2,102,687 6,107,487
16,462,660
1,313,908
933,201
46,737,319 566,507,048
566,507,048
37,259,256
67,008,075 (342, 167)
103,925,164 670,432,212
22,272,563 41,363,331
(779,495) 5,884,152 5,104,657
60,193,585 3,609,198
438,948 2,766,343
67,008,075
1) $79K is a money follows the person (MFP) incentive payment paid by Tenncare to the plan. The MFP incentive is paid for successfully transitioning our Long term care members from institutions to home and communiTy based environments.