Unaudited Balance Sheet As of January 31 Total Enrollment: 371 Assets: Cash $ 1,408,868 $ 1,375,117 Invested Cash 4,664,286 4,136,167 Premiums Receivable 94,152 91,261 Prepaid 32,270 33,421 Assessments Receivable - - Total Assets $ 6,199,577 $ 5,635,967 Liabilities and Members' Equity: Reserve for Unpaid Losses $ 1,700,000 $ 1,700,000 Accrued Loss Adjustment 75,500 75,500 Reserve for Unearned Premiums 256,018 296,444 Accrued Expense 11,714 36,396 Assessments Payable - - Abandoned Claim Reserve 454 12,678 Total Liabilities 2,043,687 2,121,018 Unassigned Surplus 4,155,890 3,514,949 Total Liabilities and Unassigned Surplus $ 6,199,577 $ 5,635,967 1
Unaudited Statement of Operations Total Member Months: 371 492 Premium Income $ 314,722 $ 341,962 Pharmacy Rebate Income - - Incurred Claim Loss - Medical 588,161 653,051 Incurred Claim Loss - Pharmacy 176,662 275,966 Total Incurred Claim Loss 764,823 929,017 Operating : PMPM Administrative Expense 32,850 33,961 Variable Admin Expense 6,529 12,395 Salary and Professional Expense 7,695 22,777 Prescription Admin Expense 1,956 2,892 Agent Commissions - - Other Expense 3,833 2,400 Total Operating 52,862 74,424 Underwriting Loss (502,963) (661,479) Realized Gain (Loss) 1,820 708 Interest Income 6,789 90 Other Income - - Changes to Unassigned Surplus $ (494,354) $ (660,681) HIPIOWA - IOWA COMPREHENSIVE HEALTH ASSOCIATION Statement of Changes in Unassigned Surplus Unassigned Surplus at Beginning of Year $ 4,650,244 $ 4,175,630 Changes to Unassigned Surplus (494,354) (660,681) Member Assessments - - Unassigned Surplus $ 4,155,890 $ 3,514,949 2
Statement of Cash Flows Funds Provided (Used) from Operations: Changes to Unassigned Surplus $ (494,354) $ (660,681) Add (Deduct) Items Not Requiring Cash Funds: (Inc) Dec in Premiums Receivable (78,496) (85,054) (Inc) Dec in Prepaid 451 539 (Inc) Dec in Assessment Receivable - - Inc (Dec) in Reserve for Unpaid Losses - - Inc (Dec) in Accrued Loss Adjustment - - Inc (Dec) in Reserve for Unearned Premiums 210,057 179,205 Inc (Dec) in Accrued Expense (35,827) 8,067 Inc (Dec) in Assessments Payable - - Inc (Dec) in Abandoned Claim Reserve - - Total from Operations (398,169) (557,924) Other Sources of Funds: Member Assessments - - Change in Cash and Invested Cash (398,169) (557,924) Beginning of Period Cash 6,471,324 6,069,208 End of Period Cash and Invested Cash $ 6,073,155 $ 5,511,284 3
HIPIOWA Budgeted Cashflow 2017 Budget JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC January YTD YTD Membership 1) 371 369 368 367 366 365 364 363 362 361 360 359 371 4,375 BEGINNING OF MONTH $6,471,329 $5,917,211 $5,182,548 $4,600,496 $3,865,941 $3,070,504 $2,482,630 $8,116,122 $8,871,130 $8,175,682 $7,360,189 $6,475,006 Premium 5) 446,074 268,229 384,463 291,845 241,778 414,414 305,776 227,682 341,552 282,853 224,669 218,322 446,074 3,647,656 Assessment 2) - - - - - - 6,400,000 1,600,000 - - - - - 8,000,000 Claim 8,189 11,123 11,259 11,397 11,536 11,677 11,820 11,964 12,110 12,258 12,407 12,559 8,189 138,300 Pharmacy Rebates - - 50,000 - - 50,000 - - 50,000 - - 50,000-200,000 Realized Gain - - - - - - - - - - - - - - Interest 324 306 270 241 204 164 135 416 454 419 379 334 324 3,646 Total 454,586 279,658 445,992 303,483 253,518 476,256 6,717,730 1,840,062 404,116 295,531 237,455 281,215 454,586 11,989,602 Assessment - - - - - - - - - - - - - - Premium 8,252 4,962 7,113 5,399 4,473 7,667 5,657 4,212 6,319 5,233 4,156 4,039 8,252 67,482 Total 8,252 4,962 7,113 5,399 4,473 7,667 5,657 4,212 6,319 5,233 4,156 4,039 8,252 67,482 Medical Claim 3) 734,518 741,516 750,599 759,788 769,084 778,487 788,000 797,622 807,356 817,203 827,163 837,239 734,518 9,408,576 Pharmacy Claim Expense 4) 199,357 201,256 203,721 206,215 208,738 211,290 213,872 216,484 219,126 221,798 224,502 227,236 199,357 2,553,595 PMPM Admin Expense 32,987 32,970 32,962 32,954 32,946 32,938 32,930 32,922 32,914 32,906 32,898 32,890 32,987 395,219 Variable Admin Expense 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 150,000 Pharmacy Admin Expense 2,592 2,616 2,648 2,681 2,714 2,747 2,780 2,814 2,849 2,883 2,919 2,954 2,592 33,197 Salary and Professional Expense 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 192,000 Other 2,500 2,500 2,500 2,500 2,500 2,500 12,500 2,500 2,500 2,500 2,500 2,500 2,500 40,000 Total 1,000,452 1,009,359 1,020,932 1,032,639 1,044,482 1,056,462 1,078,582 1,080,843 1,093,245 1,105,791 1,118,481 1,131,319 1,000,452 12,772,587 END OF MONTH $5,917,211 $5,182,548 $4,600,496 $3,865,941 $3,070,504 $2,482,630 $8,116,122 $8,871,130 $8,175,682 $7,360,189 $6,475,006 $5,620,863 Actual JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC YTD TOTAL Membership 371 371 BEGINNING OF MONTH $ 6,471,329 Premium 449,317 449,317 Assessment - - Claim 1,258 1,258 Pharmacy Rebates - Realized Gain (Loss) 1,820 1,820 Interest 6,784 6,784 Total 459,179 - - - - - - - - - - - 459,179 Assessment - - Premium 823 823 Total 823 - - - - - - - - - - - 823 Medical Claim Expense 589,419 589,419 Pharmacy Claim Expense 176,662 176,662 PMPM Admin Expense 32,399 32,399 Variable Admin Expense 12,259 12,259 Pharmacy Admin Expense 2,076 2,076 Salary and Professional Expense 39,883 39,883 Other 3,833 3,833 Total 856,531 - - - - - - - - - - - 856,531 Available 6,073,155 - - - - - - - - - - - Inc(Dec) in Escheat Check Reserve Month Ending $ 6,073,155 $ - - $ - $ - $ - $ - $ - $ - $ - $ - $ - Claims PMPM 2,062 2,062 (1) Projected 1% enrollment drop in January 2017. Enrollment trended to decline by 1 member per month thereafter. (2) Forecasted assessment in June ($8,000,000). (3) Assumes annual medical claims expense trended with a 10% PMPM increase. (4) Assumes annual pharmacy claims expense trended with a 10% PMPM increase. (5) Assumes Premiums trended with 15% rate increase. 4
HIPIOWA 2017 Cash Flow Forecast Actual (Bold) JAN FEB MAR APR MAY JUN Forecast JUL AUG SEP OCT NOV DEC TOTAL Membership 1) 371 369 368 367 366 365 364 363 362 361 360 359 4,375 Beginning Cash 6,471,329 6,073,155 5,583,441 5,001,398 4,266,853 3,471,426 2,883,562 8,517,063 9,272,080 8,576,642 7,761,158 6,875,985 Premium 5) 449,317 223,518 384,463 291,845 241,778 414,414 305,776 227,682 341,552 282,853 224,669 218,322 3,606,189 Assessment 2) - - - - - - 6,400,000 1,600,000 - - - - 8,000,000 Claim 1,258 7,460 11,259 11,397 11,536 11,677 11,820 11,964 12,110 12,258 12,407 12,559 127,707 Pharmacy Rebates - 50,000 - - 50,000 - - 50,000 - - 50,000 200,000 Realized Gain 1,820 - - - - - - - - - - - 1,820 Interest 6,784 304 279 250 213 174 144 426 464 429 388 344 10,198 Total 459,179 231,283 446,001 303,492 253,527 476,265 6,717,740 1,840,072 404,126 295,540 237,464 281,225 11,945,914 Assessment - - - - - - - - - - - - - Premium 823 4,135 7,113 5,399 4,473 7,667 5,657 4,212 6,319 5,233 4,156 4,039 59,225 Total 823 4,135 7,113 5,399 4,473 7,667 5,657 4,212 6,319 5,233 4,156 4,039 59,225 Medical Claim 3) 589,419 497,361 750,599 759,788 769,084 778,487 788,000 797,622 807,356 817,203 827,163 837,239 9,019,322 Pharmacy Claim Expense 4) 176,662 153,533 203,721 206,215 208,738 211,290 213,872 216,484 219,126 221,798 224,502 227,236 2,483,178 PMPM Admin Expense 32,399 32,970 32,962 32,954 32,946 32,938 32,930 32,922 32,914 32,906 32,898 32,890 394,631 Variable Admin Expense 12,259 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 12,500 149,759 Pharmacy Admin Expense 2,076 1,996 2,648 2,681 2,714 2,747 2,780 2,814 2,849 2,883 2,919 2,954 32,061 Salary and Professional Expense 39,883 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 16,000 215,883 Other 3,833 2,500 2,500 2,500 2,500 2,500 12,500 2,500 2,500 2,500 2,500 2,500 41,333 Total 856,531 716,861 1,020,932 1,032,639 1,044,482 1,056,462 1,078,582 1,080,843 1,093,245 1,105,791 1,118,481 1,131,319 12,336,166 Inc(Dec) in Escheat Check Reserve Ending Cash 6,073,155 5,583,441 5,001,398 4,266,853 3,471,426 2,883,562 8,517,063 9,272,080 8,576,642 7,761,158 6,875,985 6,021,852 (1) Projected 1% enrollment drop in January 2017 and trended to decline by 1 member per month thereafter. (2) Forecasted assessment in June ($8,000,000). (3) Assumes annual medical claims expense trended with a 10% PMPM increase. (4) Assumes annual pharmacy claims expense trended with a 10% PMPM increase. (5) Assumes Premiums trended with 15% rate increase. 5