ANNUAL STATEMENT For the Year Ending DECEMBER 31, 2014 OF THE CONDITION AND AFFAIRS OF THE Arkansas Superior Select, Inc.

Transcription

1 Document Code: 201 ANNUAL STATEMENT For the Year Ending DECEMBER 31, 2014 OF THE CONDITION AND AFFAIRS OF THE Arkansas Superior Select, Inc. NAIC Group Code 0000, 0000 NAIC Company Code Employer's ID Number (Current Period) (Prior Period) Organized under the Laws of Arkansas, State of Domicile or Port of Entry Arkansas Country of Domicile United States of America Licensed as business type: Life, Accident & Health[ ] Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[ ] Dental Service Corporation[ ] Vision Service Corporation[ ] Health Maintenance Organization[X] Other[ ] Is HMO Federally Qualified? Yes[ ] No[X] N/A[ ] Incorporated/Organized 11/13/2012 Commenced Business Statutory Home Office 1401 West Capital, Suite 430, Little Rock, AR, US (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 1401 West Capital, Suite 430 (Street and Number) Little Rock, AR, US (501) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address 1401 West Capital, Suite 430, Little Rock, AR, US (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 1401 West Capital, Suite 430 (Street and Number) Little Rock, AR, US (501) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address Statutory Statement Contact Jerry Sams (479) (Name) (Area Code)(Telephone Number)(Extension) jsams@cancinc.com (479) ( Address) (Fax Number) OFFICERS Tom Coble Michael Morton Jerry D. Sams Name Tom Coble David Norsworthy Jerry D. Sams Jim Cooper Title President Asst. Secretary CFO/Treasurer/Secretary Vice President OTHERS DIRECTORS OR TRUSTEES Jim Cooper David Norsworthy State of County of ss The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of the said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. (Signature) (Signature) (Signature) Tom Coble David Norsworthy Jerry D. Sams (Printed Name) (Printed Name) (Printed Name) President Asst. Secretary CFO/Treasurer/Secretary (Title) (Title) (Title) Subscribed and sworn to before me this a. Is this an original filing? Yes[X] No[ ] day of, 2015 b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached (Notary Public Signature)

2 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. 17 Exhibit 1 - Enrollment By Product Type NONE 18 Exhibit 2 - Accident and Health Premiums NONE 19 Exhibit 3 - Health Care Receivables NONE 20 Exhibit 3A - Analysis of Health Care Receivables Collected and Accrued..... NONE 21 Exhibit 4 - Claims Unpaid NONE 22 Exhibit 5 - Amounts Due From Parent NONE 23 Exhibit 6 - Amounts Due to Parent NONE 24 Exhibit 7 - Pt 1 - Summary Trans. With Prov NONE 24 Exhibit 7 - Pt 2 - Summary Trans. With Interm NONE 17-24

3 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. EXHIBIT 8 - FURNITURE, EQUIPMENT AND SUPPLIES OWNED Book Value Assets Net Accumulated Less Not Admitted Description Cost Improvements Depreciation Encumbrances Admitted Assets 1. Administrative furniture and equipment , , , Medical furniture, equipment and fixtures Pharmaceuticals and surgical supplies Durable medical equipment Other property and equipment , , , TOTAL , , ,

4 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. 30 Arkansas EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) Document Code: 430 REPORT FOR: 1. CORPORATION: 2. LOCATION: NAIC Group Code 0000 BUSINESS IN THE STATE OF ARKANSAS DURING THE YEAR NAIC Company Code Comprehensive (Hospital & Medical) Federal Employees Medicare Vision Dental Health Benefits Title XVIII Title XIX Total Individual Group Supplement Only Only Plan Medicare Medicaid Other TOTAL Members at end of: 1. Prior Year First Quarter Second Quarter Third Quarter Current Year Current Year Member Months TOTAL Member Ambulatory Encounters for Year: 7. Physician Non-Physician TOTAL N O N E Hospital Patient Days Incurred Number of Inpatient Admissions Health Premiums Written (b) Life Premiums Direct Property/Casualty Premiums Written Health Premiums Earned Property/Casualty Premiums Earned Amount Paid for Provision of Health Care Services Amount Incurred for Provision of Health Care Services (a) For health business: number of persons insured under PPO managed care products...0 and number of persons insured under indemnity only products...0. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...0

5 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. 30 Grand Total EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) Document Code: 430 REPORT FOR: 1. CORPORATION: 2. LOCATION: NAIC Group Code 0000 BUSINESS IN THE STATE OF GRAND TOTAL DURING THE YEAR NAIC Company Code Comprehensive (Hospital & Medical) Federal Employees Medicare Vision Dental Health Benefits Title XVIII Title XIX Total Individual Group Supplement Only Only Plan Medicare Medicaid Other TOTAL Members at end of: 1. Prior Year First Quarter Second Quarter Third Quarter Current Year Current Year Member Months TOTAL Member Ambulatory Encounters for Year: 7. Physician Non-Physician TOTAL N O N E Hospital Patient Days Incurred Number of Inpatient Admissions Health Premiums Written (b) Life Premiums Direct Property/Casualty Premiums Written Health Premiums Earned Property/Casualty Premiums Earned Amount Paid for Provision of Health Care Services Amount Incurred for Provision of Health Care Services (a) For health business: number of persons insured under PPO managed care products...0 and number of persons insured under indemnity only products...0. (b) For health premiums written: amount of Medicare Title XVIII exempt from state taxes or fees $...0

6 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. 31 Schedule S - Part 1 - Section NONE 32 Schedule S - Part NONE 33 Schedule S - Part 3 - Section NONE 34 Schedule S - Part NONE 35 Schedule S - Part NONE 36 Schedule S - Part NONE 31-36

7 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. SCHEDULE S - PART 7 Restatement of Balance Sheet to Identify Net Credit For Ceded Reinsurance As Reported Restatement Restated (net of ceded) Adjustments (gross of ceded) ASSETS (Page 2, Col. 3) 1. Cash and invested assets (Line 12) ,408, ,408, Accident and health premiums due and unpaid (Line 15) Amounts recoverable from reinsurers (Line 16.1) Net credit for ceded reinsurance All other admitted assets (Balance) , , TOTAL Assets (Line 28) ,420, ,420,173 LIABILITIES, CAPITAL AND SURPLUS (Page 3) 7. Claims unpaid (Line 1) Accrued medical incentive pool and bonus payments (Line 2) Premiums received in advance (Line 8) Funds held under reinsurance treaties with authorized and unauthorized reinsurers (Line 19, first inset amount plus second inset amount) Reinsurance in unauthorized companies (Line 20 minus inset amount) Reinsurance with Certified Reinsurers (Line 20 inset amount) Funds held under reinsurance treaties with Certified Reinsurers (Line 19 third inset amount) All other liabilities (Balance) , , TOTAL Liabilities (Line 24) , , TOTAL Capital and Surplus (Line 33) ,415, X X X ,415, TOTAL Liabilities, Capital and Surplus (Line 34) ,420, ,420,173 NET CREDIT FOR CEDED REINSURANCE 18. Claims unpaid Accrued medical incentive pool Premiums received in advance Reinsurance recoverable on paid losses Other ceded reinsurance recoverables TOTAL Ceded Reinsurance Recoverables Premiums receivable Funds held under reinsurance treaties with authorized and unauthorized reinsurers Unauthorized reinsurance Reinsurance with Certified Reinsurers Funds held under reinsurance treaties with Certified Reinsurers Other ceded reinsurance payables/offsets TOTAL Ceded Reinsurance Payables/Offsets TOTAL Net Credit for Ceded Reinsurance

8 39 ANNUAL STATEMENT FOR THE YEAR OF THE 2014 Arkansas Superior Select, Inc. SCHEDULE T - PART 2 INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN ALLOCATED BY STATES AND TERRITORIES Direct Business only Disability Long-Term Life Annuities Income Care (Group and (Group and (Group and (Group and Deposit-Type States, Etc. Individual) Individual) Individual) Individual) Contracts Totals 1. Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) American Samoa (AS) Guam (GU) Puerto Rico (PR) U.S. Virgin Islands (VI) Northern Mariana Islands (MP). 57. Canada (CAN) Aggregate other alien (OT) TOTALS N O N E

9 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. 41 SCHEDULE Y PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM Name of Directly Type of Control Securities Name of Relation- Controlled (Ownership, If Control NAIC Exchange Parent, Domic- ship to by Board, is Ultimate Comp- if Publicly Subsidiaries iliary Report- (Name of Management, Ownership Controlling Group any ID FEDERAL Traded (U.S. or Loca- ing Entity / Attorney-in-Fact, Provide Entity(ies) Code Group Name Code Number RSSD CIK or International) Affiliates tion Entity Person) Influence, Other) Percentage / Person(s) * Tom Coble OK.... UIP Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Michael Morton AR.... UIP Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Jerry Sams AR.... UIP Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Jim Cooper AR.... UIP Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy David Norsworthy AR.... UIP Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Select Founders, LLC AR... UDP. Tom Coble Ownership, Board of Directors Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Select Founders, LLC AR... UDP. Michael Morton Ownership, Board of Directors Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Select Founders, LLC AR... UDP. Jerry Sams Ownership, Management Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Select Founders, LLC AR... UDP. Jim Cooper Ownership, Board of Directors Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Select Founders, LLC AR... UDP. David Norsworthy Ownership, Board of Directors Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Arkansas Superior Select, Inc... AR.... RE.. Select Founders, LLC Ownership Tom Coble, Michael Morton, Jerry Sams, Jim Cooper, David Norsworthy Asterisk Explanation

10 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. SCHEDULE Y PART 2 - SUMMARY OF INSURER'S TRANSACTIONS WITH ANY AFFILIATES Purchases, Sales Income/(Disburse- Any Other Reinsurance or Exchanges of ments) Incurred in Material Activity Recoverable/ Loans, Securities, Connection with Management Income/ not in the (Payable) Real Estate, Guarantees or Agreements (Disbursements) Ordinary on Losses NAIC Mortgage Undertakings and Incurred Under Course of and/or Reserve Company ID Names of Insurers and Parent, Shareholder Capital Loans or Other for the Benefit Service Reinsurance the Insurer's Credit Taken/ Code Number Subsidiaries or Affiliates Dividends Contributions Investments of any Affiliate(s) Contracts Agreements * Business Totals (Liability) ARKANSAS SUPERIOR SELECT INC ,195, ,195, Select Founders, LLC (3,195,000) (3,195,000) Control Totals Schedule Y Part 2 Explanation: 42

11 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES The following supplemental reports are required to be filed as part of your statement filing unless specifically waived by the domiciliary state. However, in the event that your domiciliary state waives the filing requirement, your response of WAIVED to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason, enter SEE EXPLANATION and provide an explanation following the interrogatory questions. Response MARCH FILING 1. Will the Supplemental Compensation Exhibit be filed with the state of domicile by March 1? Yes 2. Will an actuarial opinion be filed by March 1? Waived 3. Will the confidential Risk-based Capital Report be filed with the NAIC by March 1? Yes 4. Will the confidential Risk-based Capital Report be filed with the state of domicile, if required by March 1? Yes APRIL FILING 5. Will Management's Discussion and Analysis be filed by April 1? Yes 6. Will the Supplemental Investment Risks Interrogatories be filed by April 1? Yes 7. Will the Accident and Health Policy Experience Exhibit be filed by April 1? See Explanation JUNE FILING 8. Will an audited financial report be filed by June 1? Yes 9. Will Accountants Letter of Qualifications be filed with the state of domicile and electronically with the NAIC by June 1? Yes AUGUST FILING 10. Will Communication of Internal Control Related Matters Noted in Audit be filed with the state of domicile by August 1? Yes The following supplemental reports are required to be filed as part of your statement filing. However, in the event that your company does not transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but it is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. MARCH FILING 11. Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March 1? No 12. Will the Supplemental Life data due March 1 be filed with the state of domicile and the NAIC? No 13. Will the Supplemental Property/Casualty data due March 1 be filed with the state of domicile and the NAIC? No 14. Will Schedule SIS (Stockholder Information Supplement) be filed with the state of domicile by March 1? No 15. Will the actuarial opinion on participating and non-participating policies as required in Interrogatories 1 and 2 on Exhibit 5 to Life Supplement be filed with the state of domicile and electronically with the NAIC by March 1? No 16. Will the actuarial opinion on non-guaranteed elements as required in Interrogatory 3 to Exhibit 5 to Life Supplement be filed with the state of domicile and electronically with the NAIC by March 1? No 17. Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March 1? No 18. Will an approval from the reporting entity's state of domicile for relief related to the five-year rotation requirement for lead audit partner be file electronically with the NAIC by March 1? No 19. Will an approval from the reporting entity's state of domicile for relief related to the one-year cooling off period for independent CPA be filed electronically with the NAIC by March 1? No 20. Will an approval from the reporting entity's state of domicile for relief related to the Requirements for Audit Committees be filed electronically with the NAIC by March 1? No APRIL FILING 21. Will the Long-Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April 1? No 22. Will the Supplemental Life data due April 1 be filed with the state of domicile and the NAIC? No 23. Will the Supplemental Property/Casualty Insurance Expense Exhibit due April 1 be filed with any state that requires it, and, if so, the NAIC? No 24. Will the Supplemental Health Care Exhibit (Parts 1, 2 and 3) be filed with the state of domicile and the NAIC by April 1? No 25. Will the regulator only (non-public) Supplemental Health Care Exhibit's Allocation Report be filed with the state of domicile and the NAIC by April 1? No AUGUST FILING 26. Will Management's Report of Internal Control Over Financial Reporting be filed with the state of domicile by August 1? No Explanations: 7. Company has no written premium for The Company has no written premium as of the reporting date. 12. The Company has no written premium as of the reporting date. 13. The Company has no written premium as of the reporting date. 14. The Company has only one stockholder. N/A 15. The Company has no written premium as of the reporting dae. 16. The Company has no written premium as of the reporting date. 17. The Company has no written premium as of the reporting date. 18. Not necessary. 19. Not necessary. 20. Not necessary. 21. The Company has no written premium as of the reporting date. 22. The Company has no written premium as of the reporting date. 23. The Company has no written premium as of the reporting date. 24. The Company has no written premium as of the reporting date. 25. The Company has no written premium as of the reporting date. 26. The Company has no written premium as of the reporting date. Bar Codes: Statement of Actuarial Opinion / Certification Medicare Supplement Insurance Experience Exhibit Document Code: 440 Health Life Supplement Document Code: 360 Health Property / Casualty Supplement Document Code: Document Code:

12 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. Schedule SIS SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES (continued) Actuarial Opinion on Participating and Non-Participating Policies Document Code: 420 Statement of Non-Guaranteed Elements for Exhibit Document Code: 371 Medicare Part D Coverage Supplement Document Code: 370 Approval for Relief related to five-year rotation for lead Audit Partner Document Code: 365 Approval for Relief related to one-year cooling off period for inde. CPA Document Code: 224 Approval for Relief related to Require. for Audit Committees Document Code: 225 LTC Supplemental Interrogatorries Document Code: 226 Health Life Supplement - LHA Guaranty Association Reconciliation Document Code: 306 Health Property/Casualty Supplement - Insurance Expense Exhibit Document Code: 211 Supplemental Health Care Exhibit Document Code: 213 Supplemental Health Care Exhibit's Expense Allocation Report Document Code: Document Code: 217 Management's Report of Internal Control over Financial Reporting Document Code:

13 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. OVERFLOW PAGE FOR WRITE-INS 44

14 INDEX ANNUAL STATEMENT FOR THE YEAR OF THE 2014 Arkansas Superior Select, Inc. INDEX TO HEALTH ANNUAL STATEMENT Analysis of Operations By Lines of Business Assets Cash Flow Exhibit 1 - Enrollment By Product Type for Health Business Only Exhibit 2 - Accident and Health Premiums Due and Unpaid Exhibit 3 - Health Care Receivables Exhibit 3A - Analysis of Health Care Receivables Collected and Accrued Exhibit 4 - Claims Unpaid and Incentive Pool, Withhold and Bonus Exhibit 5 - Amounts Due From Parent, Subsidiaries and Affiliates Exhibit 6 - Amounts Due To Parent, Subsidiaries and Affiliates Exhibit 7 - Part 1 - Summary of Transactions With Providers Exhibit 7 - Part 2 - Summary of Transactions With Intermediaries Exhibit 8 - Furniture, Equipment and Supplies Owned Exhibit of Capital Gains (Losses) Exhibit of Net Investment Income Exhibit of Nonadmitted Assets Exhibit of Premiums, Enrollment and Utilization (State Page) Five-Year Historical Data General Interrogatories Jurat Page Liabilities, Capital and Surplus Notes To Financial Statements Overflow Page For Write-ins Schedule A - Part 1 E01 Schedule A - Part 2 E02 Schedule A - Part 3 E03 Schedule A - Verification Between Years SI02 Schedule B - Part 1 E04 Schedule B - Part 2 E05 Schedule B - Part 3 E06 Schedule B - Verification Between Years SI02 Schedule BA - Part E07 Schedule BA - Part E08 Schedule BA - Part E09 Schedule BA - Verification Between Years SI03 Schedule D - Part 1 E10 Schedule D - Part 1A - Section SI05 Schedule D - Part 1A - Section SI08 Schedule D - Part 2 - Section E11 Schedule D - Part 2 - Section E12 Schedule D - Part 3 E13 Schedule D - Part 4 E14 Schedule D - Part 5 E15 Schedule D - Part 6 - Section E16 Schedule D - Part 6 - Section E16 Schedule D - Summary By Country SI04 Schedule D - Verification Between Years SI03 Schedule DA - Part E17 Schedule DA - Verification Between Years SI10 Schedule DB - Part A - Section E18 Schedule DB - Part A - Section E19 Schedule DB - Part A - Verification Between Years SI11 Schedule DB - Part B - Section E20 Schedule DB - Part B - Section E21 Schedule DB - Part B - Verification Between Years SI11 Schedule DB - Part C - Section SI12 Schedule DB - Part C - Section SI13 Schedule DB - Part D - Section E22 Schedule DB - Part D - Section E23

15 ANNUAL STATEMENT FOR THE YEAR 2014 OF THE Arkansas Superior Select, Inc. INDEX TO HEALTH ANNUAL STATEMENT Schedule DB - Verification SI14 Schedule DL - Part E24 Schedule DL - Part E25 Schedule E - Part 1 - Cash Schedule E - Part 2 - Cash Equivalents Schedule E - Part 3 - Special Deposits Schedule E - Verification Between Years SI15 Schedule S - Part 1 - Section Schedule S - Part Schedule S - Part 3 - Section Schedule S - Part Schedule S - Part Schedule S - Part Schedule S - Part Schedule T - Part 2 - Interstate Compact Schedule T - Premiums and Other Considerations Schedule Y - Information Concerning Activities of Insurer Members of a Holding Company Group Schedule Y - Part 1A - Detail of Insurance Holding Company System Schedule Y - Part 2 - Summary of Insurer's Transactions With Any Affiliates Statement of Revenue and Expenses Summary Investment Schedule SI01 Supplemental Exhibits and Schedules Interrogatories Underwriting and Investment Exhibit - Part Underwriting and Investment Exhibit - Part Underwriting and Investment Exhibit - Part 2A Underwriting and Investment Exhibit - Part 2B Underwriting and Investment Exhibit - Part 2C Underwriting and Investment Exhibit - Part 2D Underwriting and Investment Exhibit - Part E26 E27 E28 INDEX.1

16 Document Code: 201 ANNUAL STATEMENT For the Year Ending DECEMBER 31, 2014 OF THE CONDITION AND AFFAIRS OF THE Arkansas Superior Select, Inc. NAIC Group Code 0000, 0000 NAIC Company Code Employer's ID Number (Current Period) (Prior Period) Organized under the Laws of Arkansas, State of Domicile or Port of Entry Arkansas Country of Domicile United States of America Licensed as business type: Life, Accident & Health[ ] Property/Casualty[ ] Hospital, Medical & Dental Service or Indemnity[ ] Dental Service Corporation[ ] Vision Service Corporation[ ] Health Maintenance Organization[X] Other[ ] Is HMO Federally Qualified? Yes[ ] No[X] N/A[ ] Incorporated/Organized 11/13/2012 Commenced Business Statutory Home Office 1401 West Capital, Suite 430, Little Rock, AR, US (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 1401 West Capital, Suite 430 (Street and Number) Little Rock, AR, US (501) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address 1401 West Capital, Suite 430, Little Rock, AR, US (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 1401 West Capital, Suite 430 (Street and Number) Little Rock, AR, US (501) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address Statutory Statement Contact Jerry Sams (479) (Name) (Area Code)(Telephone Number)(Extension) jsams@cancinc.com (479) ( Address) (Fax Number) OFFICERS Tom Coble Michael Morton Jerry D. Sams Name Tom Coble David Norsworthy Jerry D. Sams Jim Cooper Title President Asst. Secretary CFO/Treasurer/Secretary Vice President OTHERS DIRECTORS OR TRUSTEES Jim Cooper David Norsworthy State of County of ss The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of the said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. (Signature) (Signature) (Signature) Tom Coble David Norsworthy Jerry D. Sams (Printed Name) (Printed Name) (Printed Name) President Asst. Secretary CFO/Treasurer/Secretary (Title) (Title) (Title) Subscribed and sworn to before me this a. Is this an original filing? Yes[X] No[ ] day of, 2015 b. If no, 1. State the amendment number 2. Date filed 3. Number of pages attached (Notary Public Signature)

17 2 ANNUAL STATEMENT FOR THE YEAR OF THE 2014 Arkansas Superior Select, Inc. ASSETS Current Year Prior Year Net Admitted Nonadmitted Assets Net Admitted Assets Assets (Cols.1-2) Assets 1. Bonds (Schedule D) Stocks (Schedule D) 2.1 Preferred stocks Common Stocks Mortgage loans on real estate (Schedule B): 3.1 First liens Other than first liens Real estate (Schedule A): 4.1 Properties occupied by the company (less $...0 encumbrances) Properties held for the production of income (less $...0 encumbrances) Properties held for sale (less $...0 encumbrances) Cash ($...2,108,894, Schedule E Part 1), cash equivalents ($...0, Schedule E Part 2) and short-term investments ($...300,069, Schedule DA) ,408, ,408, , Contract loans (including $...0 premium notes) Derivatives (Schedule DB) Other invested assets (Schedule BA) Receivables for securities Securities Lending Reinvested Collateral Assets (Schedule DL) Aggregate write-ins for invested assets Subtotals, cash and invested assets (Lines 1 to 11) ,408, ,408, , Title plants less $...0 charged off (for Title insurers only) Investment income due and accrued Premiums and considerations: 15.1 Uncollected premiums and agents' balances in the course of collection Deferred premiums, agents' balances and installments booked but deferred and not yet due (Including $...0 earned but unbilled premiums) Accrued retrospective premiums Reinsurance: 16.1 Amounts recoverable from reinsurers Funds held by or deposited with reinsured companies Other amounts receivable under reinsurance contracts Amounts receivable relating to uninsured plans Current federal and foreign income tax recoverable and interest thereon Net deferred tax asset Guaranty funds receivable or on deposit Electronic data processing equipment and software , , Furniture and equipment, including health care delivery assets ($...0) , , Net adjustment in assets and liabilities due to foreign exchange rates Receivables from parent, subsidiaries and affiliates Health care ($...0) and other amounts receivable Aggregate write-ins for other than invested assets , , , TOTAL Assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25) ,457, , ,420, , From Separate Accounts, Segregated Accounts and Protected Cell Accounts TOTAL (Lines 26 and 27) ,457, , ,420, ,888 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 11 from overflow page TOTALS (Lines 1101 through 1103 plus 1198) (Line 11 above) Deposits , , Receivable Under Letter of Intent with Universal/Pyramid , Summary of remaining write-ins for Line 25 from overflow page TOTALS (Lines 2501 through 2503 plus 2598) (Line 25 above) , , ,453