BEFORE THE INSURANCE DEPARTMENT OF THE …

[Pages:10]BEFORE THE INSURANCE DEPARTMENT OF THE

COMMONWEALTH OF PENNSYLVANIA

Statement Regarding the Acquisition of Control of or Merger with Domestic Insurers:

Hospital Service Association of Northeastern Pennsylvania d/b/a Blue Cross of Northeastern Pennsylvania; First Priority Life Insurance Company, Inc.; HMO of Northeastern Pennsylvania, Inc., d/b/a First Priority Health

By Highmark Inc.

0095

HIGHMARK INC. ("Highmark") RESPONSE TO INFORMATION REQUEST 6.1.1.12 FROM

THE PENNSYLVANIA INSURANCE DEPARTMENT

REQUEST 6.1.1.12:

For (i) the Applicant; (ii) BCNEPA; and (iii) each BCNEPA Affiliate provide copies of: Provide detailed legal entity organizational charts for Highmark.

RESPONSE:

Highmark certifies that a copy of the detailed legal entity organizational chart for Highmark is attached hereto.

Highmark Inc. Fifth Avenue Place 120 Fifth Avenue Pittsburgh, PA 15222

16

HMI-000275

HIGHMARK HEALTH PA

FEIN 45-3674900

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

HIGHMARK INC.* D/B/A HIGHMARK BLUE

CROSS BLUE SHIELD and HIGHMARK BLUE SHIELD

FEIN 23-1294723 NAIC GROUP CODE 0812 -

NAIC COMPANY CODE 54771-PA

HIGHMARK HEALTH SOLUTIONS INC. PA FEIN 46-3823617

ALLEGHENY HEALTH NETWORK* PA

FEIN 45-3674924

HIGHMARK INC. SUBSIDIARIES AND AFFILIATES

HMPG INC. PA

FEIN 45-3444325

WEST PENN ALLEGHENY HEALTH SYSTEM PA FEIN: 25-0969492

JEFFERSON REGIONAL MEDICAL CENTER PA FEIN 25-1260215

SAINT VINCENT HEALTH CENTER

PA FEIN 25-0965547

SAINT VINCENT HEALTH SYSTEM

PA FEIN 25-1406710

HMPG INC. SUBSIDIARIES AND

AFFILIATES SEE PAGE 6

WEST PENN ALLEGHENY HEALTH SYSTEM

SUBSIDIARIES AND AFFILIATES SEE PAGE 7

JEFFERSON REGIONAL MEDICAL CENTER SUBSIDIARIES AND AFFILIATES SEE PAGE 8

SAINT VINCENT SUBSIDIARIES AND

AFFILIATES SEE PAGE 9

* Control is maintained through ability to

appoint the board of directors as sole

member.

1

HMI-000276

HIGHMARK INC.* D/B/A HIGHMARK BLUE

CROSS BLUE SHIELD and HIGHMARK BLUE

SHIELD FEIN 23-1294723 NAIC GROUP CODE 0812 NAIC COMPANY CODE

54771-PA

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

HIGHMARK COVERAGE ADVANTAGE INC.

PA FEIN 46-475476

HIGHMARK SELECT

RESOURCES INC. FEIN 20-2353206 NAIC COMPANY CODE 10131-PA

HIGHMARK HIE, LLC PA

FEIN 45-3999145

HIGHMARK BENEFITS GROUP INC.

PA FEIN 46-4763378

CARING FOUNDATION*

PA FEIN 25-1494238

HIGHMARK FOUNDATION*

PA FEIN 25-1876666

HIGHMARK BCBSD INC.*

DE FEIN 51-0020405 NAIC COMPANY

CODE 53287

JOINTLY CONTROLLED AFFILIATES SEE PAGE 5

PARKER BENEFITS, INC.

WV FEIN 55-0625743

THE GATEWAY GROUP, LTD

DE FEIN 51-0293417

DELAWARE ANCILLARY INSURANCE

AGENCY DE

FEIN 51-0383213

HIGHMARK WEST VIRGINIA INC.* D/B/A HIGHMARK BLUE CROSS BLUE SHIELD

WEST VIRGINIA FEIN 55-0624615 NAIC COMPANY CODE

54828-WV

WEST VIRGINIA FAMILY HEALTH

PLAN, INC. 45%

FEIN: 45-2763165 NAIC COMPANY CODE

15020-WV

HM HEALTH INSURANCE COMPANY FEIN 54-1637426 NAIC COMPANY

CODE 71768-PA

UNITED CONCORDIA COMPANIES, INC. FEIN 25-1687586 NAIC COMPANY CODE 89070-PA

HIGHMARK SENIOR

SOLUTIONS COMPANY

WV FEIN 46-4156854

UNITED CONCORDIA COMPANIES, INC.

SUBSIDIARIES

SEE PAGE 3

HIGHMARK SENIOR HEALTH

COMPANY PA

FEIN 46-4156633 NAIC COMPANY CODE 15460-PA

HVHC INC. DE

FEIN 25-1801124

JEA, INC. PA

FEIN 25-1712017

STANDARD PROPERTY CORPORATION

PA FEIN 25-1668093

24% L.P.

VISIONWORKS OF AMERICA, INC. TX FEIN 74-2337775

1% G.P.

L.P. 75%

DAVIS VISION, INC. NY

FEIN 11-3051991

JENKINS EMPIRE ASSOCIATES PA-PARTNERSHIP FEIN 25-1524682

VISIONWORKS SUBSIDIARIES SEE PAGE 4

DAVISVISION IPA, INC. NY

FEIN 11-2958041

HM INSURANCE GROUP, INC. PA

FEIN 25-1646315

HIGHMARK CASUALTY INSURANCE COMPANY PA

FEIN 25-1334623 NAIC COMPANY CODE

35599-PA

HM BENEFITS ADMINISTRATORS,

INC. PA FEIN 25-1128451

HM BROKER SERVICES, INC.

PA FEIN 23-2384777

HM LIFE INSURANCE COMPANY

PA FEIN 06-1041332 NAIC COMPANY CODE 93440-PA

HM LIFE INSURANCE COMPANY OF NEW YORK

NY FEIN 25-1800302 NAIC COMPANY CODE 60213-NY

KEYSTONE HEALTH PLAN WEST, INC. FEIN 25-1522457 NAIC COMPANY CODE 95048-PA

UNION BENEFIT MANAGEMENT,

INC. PA FEIN 25-1845908

99%

1%

EMPLOYEE BENEFIT DATA

SERVICES COMPANY

PA FEIN 25-1824465

HCI, INC. FEIN 75-3002215 NAIC COMPANY CODE 11435-VT

HIGHMARK VENTURES INC.

PA FEIN 25-1645888

HM CAPTIVE INSURANCE COMPANY

VT FEIN 65-1274122 NAIC COMPANY CODE 12720-VT

HM CASUALTY INSURANCE COMPANY PA

FEIN 87-0807723 NAIC COMPANY CODE 13016-PA

* Control is maintained through ability to appoint the board of directors as sole member.

RISK BASED SOLUTIONS, L.C.

FL FEIN 65-0611820

2

HMI-000277

HIGHMARK INC. D/B/A HIGHMARK BLUE

CROSS BLUE SHIELD and HIGHMARK BLUE

SHIELD FEIN 23-1294723 NAIC GROUP CODE 0812 NAIC COMPANY CODE

54771-PA

UNITED CONCORDIA COMPANIES, INC. FEIN 25-1687586

NAIC COMPANY CODE 89070-PA

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

UNITED CONCORDIA SERVICES, INC. NM FEIN 37-1494957

UNITED CONCORDIA DENTAL

CORPORATION OF ALABAMA FEIN 63-1028262 NAIC COMPANY CODE

47038-AL

UNITED CONCORDIA DENTAL PLANS, INC.

FEIN 52-1542269 NAIC COMPANY CODE

95253-MD

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. FEIN 23-7328765 NAIC COMPANY CODE

95789-CA

UNITED CONCORDIA INSURANCE COMPANY

OF NEW YORK FEIN 11-3008245 NAIC COMPANY CODE

60222-NY

UNITED CONCORDIA DENTAL PLANS OF THE MIDWEST, INC. FEIN 38-2289438 NAIC COMPANY CODE

96150-MI

UNITED CONCORDIA DENTAL PLANS OF

KENTUCKY, INC. FEIN 61-1012900 NAIC COMPANY CODE

52048-KY

UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. FEIN 23-2541529 NAIC COMPANY CODE

47089-PA

UNITED CONCORDIA DENTAL PLANS OF

TEXAS, INC. FEIN 74-2489037 NAIC COMPANY CODE

95160-TX

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY FEIN 23-1661402

NAIC COMPANY CODE 62294-PA

UNITED CONCORDIA INSURANCE COMPANY

FEIN 86-0307623 NAIC COMPANY CODE

85766-AZ

3 HMI-000278

HIGHMARK INC. D/B/A HIGHMARK BLUE

CROSS BLUE SHIELD and HIGHMARK BLUE

SHIELD FEIN 23-1294723 NAIC GROUP CODE 0812 NAIC COMPANY CODE

54771-PA

HVHC INC. DE

FEIN 25-1801124

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

VISIONWORKS OF AMERICA, INC. TX FEIN 74-2337775

EMPIRE VISION CENTER, INC.

NY FEIN 14-1586016

VISIONWORKS, INC. DE

FEIN 02-0677066

VISIONWORKS ENTERPRISES, INC.

DE FEIN 35-2196998

EYE DRx RETAIL MANAGEMENT,

INC. DE FEIN 74-2924030

VISIONARY RETAIL MANAGEMENT,

LLC DE FEIN 74-2849552

VISIONARY PROPERTIES, INC.

DE FEIN 74-2849554

ECCA MANAGED VISION CARE, INC.

TX FEIN 74-2759084

VISIONWORKS DISTRIBUTION SERVICES, INC.

TX FEIN 04-3742989

VISIONWORKS LAB SERVICES, INC. TX FEIN 04-3742977

4 HMI-000279

HIGHMARK INC. D/B/A HIGHMARK BLUE

CROSS BLUE SHIELD and HIGHMARK BLUE SHIELD

FEIN 23-1294723 NAIC GROUP CODE 0812 -

NAIC COMPANY CODE 54771-PA

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

*INTER-COUNTY HOSPITALIZATION

PLAN, INC. 1 50%

FEIN 23-0724427 NAIC COMPANY CODE

54763-PA

PREFERRED HEALTH SYSTEMS, INCORPORATED

PA FEIN 23-2219720

*INTER-COUNTY HEALTH PLAN, INC. 1

50% FEIN 23-2063810 NAIC COMPANY CODE

53252-PA

HMO OF NORTHEASTERN PENNSYLVANIA, INC. d/b/a FIRST PRIORITY

HEALTH 2 40% PA

FEIN 23-2413324 NAIC COMPANY CODE

96601-PA

INDEPENDENCE BLUE CROSS & HIGHMARK BLUE SHIELD CARING

FOUNDATION FOR CHILDREN 1

FEIN 22-2724721

NATIONAL INSTITUTE FOR HEALTH CARE MANAGEMENT, INC. DE L.L.C. 11 1/9%

GATEWAY HEALTH PLAN, L.P.

PA 49% L.P. 1% G.P. held by Highmark Ventures Inc. FEIN 25-1691945

Jointly Owned/Controlled with:

1.

Independence Blue Cross (50% each)

2.

Blue Cross of Northeastern Pennsylvania (NEPA) (60%)

3.

Blue Cross of Northeastern Pennsylvania (NEPA) (59.9%)

*

Control is maintained through affiliation agreements

which allow for control of the Boards of Directors

FIRST PRIORITY LIFE INSURANCE COMPANY, INC. 3

40.1% PA

FEIN 23-2905083 NAIC COMPANY CODE

60147-PA

5

GATEWAY HEALTH PLAN OF OHIO, INC.

OH FEIN 30-0282076 NAIC COMPANY CODE

12325-OH

GATEWAY HEALTH PLAN, INC. PA

FEIN 25-1505506 NAIC COMPANY CODE

969378-PA

HMI-000280

HIGHMARK HEALTH PA

FEIN 45-3674900

ALLEGHENY HEALTH NETWORK PA

FEIN 45-3674924

HMPG INC. PA

FEIN 45-3444325

MONROEVILLE ASC LLC PA

FEIN 90-0996509

PROMEDIX LLC PA

FEIN 30-0705035

HMPG PROPERTIES NORTH LLC

PA FEIN 45-3761429

PALLADIUM RISK RETENTION

GROUP, INC. 80%

VT

PROVIDER PPI LLC PA

FEIN 45-3750206 99.5% HMPG 0.5% Titusville Area Hospital

ALLEGHENY HEALTH NETWORK EMERGENCY MEDICINE

MANAGEMENT, LLC PA 50% FEIN

GOLD MIST ADVISORS LLC

PA FEIN 46-2138706

PRINCIPO ADVISORS, LLC

PA

PDL DISTRIBUTION SERVICES LLC PA

FEIN 90-0812390

HMPG PHARMACY

LLC PA FEIN 45-5080712

WEXFORD MEDICAL MALL

LLC PA

PLATINUM ADVISORS LLC

PA

SILVER RAIN MANAGEMENT,

LLC PA FEIN 27-3033308

SUMMER WIND MANAGEMENT,

LLC PA

SILVER RAIN, LP PA

FEIN 27-3035436 99% HMPG Properties

North LLC 1% Silver Rain Management, LLC

OSIRIS PROPERTIES, LLC

PA FEIN 45-5235291

6

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

HMI-000281

HIGHMARK HEALTH PA

FEIN 45-3674900

ALLEGHENY HEALTH NETWORK

PA FEIN 45-3674924

WEST PENN ALLEGHENY HEALTH

SYSTEM (WPAHS) PA

FEIN: 25-0969492

= 501(C)(3) Nonprofit Companies = Nonprofit Companies = For-profit Companies = Joint Venture Companies

^Captive PC

THE WESTERN PENNSYLVANIA HOSPITAL FOUNDATION

PA FEIN: 25-1470766

FORBES HEALTH FOUNDATION

PA FEIN: 25-1798379

SUBURBAN HEALTH FOUNDATION PA

FEIN: 25-1472073

ALLEGHENY SINGER RESEARCH INSTITUTE

PA FEIN: 25-1320493

ALLEGHENY MEDICAL PRACTICE NETWORK

(AMPN) PA

FEIN: 25-1838457

WEST PENN ALLEGHENY ONCOLOGY NETWORK

PA FEIN: 11-3683376

WEST PENN NEUROSURGERY PC

PA FEIN

BURN CARE ASSOCIATES, LTD.

PA FEIN

WEST PENN ALLEGHENY FOUNDATION, LLC PA FEIN: 20-1107650

ALLE-KISKI MEDICAL CENTER PA

FEIN: 25-1875178

ALLEGHENY IMAGING OF MCCANDLESS

45% PA FEIN

WEST PENN CORPORATE MEDICAL SERVICES,

INC. PA FEIN

MEDICAL CENTER CLINIC, PC PA FEIN

OPTIMA IMAGING 20% PA FEIN

5148 LIBERTY AVENUE MEDICAL

ASSOCIATES, LP 50% PA FEIN

MCCANDLESS ENDOSCOPY

CENTER 50% PA FEIN

NORTH SHORE ENDOSCOPY

CENTER 50% PA FEIN

Physician Owner(s) Sole Shareholder

ALLEGHENY CLINIC PA

FEIN: 25-1838458

WEST PENN ALLEGHENY SURGERY CENTER

51% PA FEIN

PHYSICIAN LANDING

ZONE PA

FEIN 45-3913973

18%

49%

PETERS TOWNSHIP SURGERY CENTER,

LLC PA FEIN

CANONSBURG GENERAL HOSPITAL PA

FEIN: 25-1737079

CANONSBURG GENERAL HOSPITAL AMBULANCE

SERVICE FEIN: 23-2939715

LAKE ERIE MEDICAL GROUP PC^ PA

FEIN 45-3444157

PREMIER MEDICAL ASSOCIATES, PC^

PA FEIN 25-1742869

FORBES REGIONAL UROLOGIC 20% PA FEIN

ALLE- KISKI MEDICAL CENTER TRUST

FEIN: 20-5855753

7 HMI-000282

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download