Free Motion for Summary Judgment - District Court of Federal Claims - federal

,u"... M,uOL )1I11t11L"T FOR THE YEAR 1993 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

UNDERWRITING AND INVESTMENT EXHIBIT PART 1
I
2

3
4 5

6

Hel

line of luslness

01 rect
Re l nsurance

Ius Iness
Assu..ed

Reinsurance
Ceded
1 l 2 . 3) (Psrt IA) (Columns 6 . 1)

Written
Premiums
Decembe r 31

Pre.t ums
Unearned

Unearned

1

8
9

Pre.lums
Rate
and Retrospective

Rue..e for Credlii
Tota I Re..r.e for Unearned
Premiums

Prem I ums

(Colulls
December 31

Prey I ous Year
on Experience

Current 'ear
Returns Iised

Earned
(Columns
4 l 5 . 8)

1. Hospital.................................

2. Hed lca I ..................................

1,922,404,500
1,922,404,500
18,180,145

62,650,453
1,181,463

3. Dental...................................

62.650.453
i .181.463

250,513,042 250,513,042

1.931.934.192
250,849.304

2.051,125

4. Other....................................

145,549,014
145,549 ,014

2,183,838

2.238.189
66,610,105
X X X X X X

5. Totals ...................................

2,238.189
66.610,105
X X X X X X
X X X
X X X

145,494.123

2,918,526,616 2,918,526,616
82,422,308
X X X X X X

2,934,218,819
X X X X X X

6. Federal ('"10)'11 Health Benefits Program Premium ...............................................

16,590,222

7. Ballnca (Column 4, LIne 5 .Inui LIne 6) ........................................................

2,841,936,394

Case 1:05-cv-01030-LSM

(

'"

PART lA
UNEARNED PREMIUMS
1 2

Premiums In Force
Dece.ber 31

Amount of Premiums or

Current
I. Annui I preml ums ............................................... 2. Se"l.innull premiums... ..... .......... ........ ................

Yur

feu Unearned

Document 23-5

(r (f
3. Quarterl)' pre.lums ............................................
4. Monthl)' pre.luOl. ...................... ........................

5. Advinced pre..lums ...........................................,.
6. Totals ......... ......... ....................... ......... ......

66,610,105

Filed 02/15/2007

B-78

66.610.105

Page 1 of 45

c: u.

11

W

\D

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 2 of 45

Fa.. 13 AHNUAl STATEMENT FOR !"( YEAR 1993 OF !"( H(OI' ~(RVic£ ASSOCIATION OF PENNSTlVAHIA

UNDERWRITING ~~D INVESTMENT EXHIBl r

PART Z - CLAIMS PAID AND INCURRED - NET OF REINSURANCE
1

2

3

4

Clilials

Currnt Yeir
(Co 1 UI 4,

Unpaid

IncurTd
C14i.s Unpaid Previous Yeir
Z . 3 - 4)

5 Ch i..

Line of Business

Chies Paid
1,655.959,943

Part 2.)

(COI..s

i-

Hospi ta 1

......................._-......................__.
199,98,404
16,399,719

2. Meical
3. Dent.l 4. Other 5.

.................................................. ..........................-.........................

237,466,606

1,618,481,741
zi9 , 183,571

2zi,1l6.919
664.428,88
2,541,505,746

18,333,06
56,316,232
312,115,905

.........................-...................... Totals ...................-....-............-.....

71.393,013
287.781.136

679,505,665

2,517,170,977

v

PART ZA - CLAIMS UNPAID - NET OF REINSURANCE
1

Line of Business
1. Hospitai

Reported Chill in Process

Z

of AdjuSt.Rt

But Unreported

Estiuted Incurre

3

4

Chill

Total

Unpiid

2. Meical
3. Dental

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

19.638,442
Z,D99,019

180,349.962

199,98,40
16,399.719

........oO.......................................................oO......

14,300.700

4. Other
5.

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

128,395

71,264,618
265,915,280

71,393.013
281 ,781,136

Tota ls

21,865,85

PART 2B - DEFERRED MATERNIT BENEFITS - NET OF REINSURACE
1

Line-

of 8usine-ss

Currnt

liability

2

Liability
Prey; OU$

3

YeAr

Year

4 Cl_11in L i abi ty

1. Hospital

2. Melcai
3.

.................................................................................. ........................oO..........................................................

Othr ................................................oO.......................oO..oOoO.........
Totals ....... .... ..........oO.... ..... .......... ......... ....... .... .............

N

0

N

E

4.

PART 2C - ANALYSIS OF CLAIMS UNPAID - PREVIOUS YEAR - NET OF REINSURACE
Claill Un..id

C1al.. Paid During the Year

YeAr,

llelr 31 of Currt Year
1

llr 31 of Currt Viz.: Esti_ted liability
4
5

6

7

2
On Cla i.. Incurr
Prior to January

3

Of Claill Un..id

of Currt Tear an Clai.. Illrr

Illrr llelr

Total Claill

to
31

Line of Busines

On Clalii Incurr

1 of Cu..t Year

Ourin9 tie YHr
1,436,823,896
202,679,594

llelr 31 of

,"ious

THr

On Cla i.. Incurr

Durin9

ti YHr

(Ca1i-s

In Prior Tears 2 + 4)

£StiNted Clalii llr 31 of
Llabit ity OI

Uni d

Prei ous

Tear

1. Hospital......

2. Meical.......
3. Dental........
4. Other .........

219,136,047
18,437,3Z5

9,762,439
151,785

190,225,965

228,898,48
18,589,110 42,346,342

237 ,46,60

16,247,934

18,33.06
S6,316,23Z

35,84,244
273,421,616

628,58,640

6,498.09
16,412,32

64,894,915
271,368,814

5.

-

Totals ...

2,268,08,130

289,833,93

312,115,90

7

~q

B-79

U8540

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 3 of 45

fOnt lJ AINUAL STATOIENT fOR TNE TEAR 199J Of THE HEr '. SERVICE ASSOCIATION Of PENNSTLVAIlA

UNDERWRITING riND INVESTMENT EXHIB~ T

PART 3 ANALYSIS OF EXPENSES
IncuM'
Exøenses

Clai. Adjustit A.inistrative
L Coiis51OO$
2. Advertising
3. So.nis, bureaus and Associations ...............

2

J

Soliciting
7.89J,069

l

Investint

5

6

Total

7,89J,06

23l.Jll
ll .712
110, 92J ,692

2Jl,ici
J.125

1,801.26l
l4.477 .187

al4
126.410

1.819.545
160.108.174

4.. 5.1 ari es ..............................................................................
S. Eiloye ""lations and ""lfa,. .................

4.580.88

2l .840 .267

11.742,IJ6
515.26J

1.0lJ.l65
11 ,842

21,3l5

J7,641,21J

6. Insurance, exept on r-al estate ......._.........
7. Travel and travel it.. ........................

28.168

38
2.890

555,65

".

1.040,734

2.443.837

228.38

J.715.8lJ

8. Rent and r"t itess, including

occupancy 0 fits ow bu i 1 d i "gs. 1 ess

S 3,405,669 for Corporation's

.
9,J7J.067
16.917.809

S reei Yed under sub 1 eise

1,52l.l62
16.!1 ,807

110.476

6.731 20.479

11 ,014.736

g. Equipent ......................................
10. Printing and stationery ..........uuu............

15J.764
178.150
144 ,876

J4,060.859
11 .100 ,60J

5.559.Jll
23.6J6.125
222,105

5,959.26J

3.279
975
79

11. Postage. t. I ephone and t.legraph.
exchange and express .................. ...............................
12. L.gal

2.623,9l9
1.Z8 .J16

26.405,925

1,504,50
8.311.J95

13. ..diting. actuarial and consulting

services ................ .....................................................

2.955,512

l ,758,l41

26.88

570,556

14. Taxes, licenses end fees:
(a) Stat. and loc.1 insuranc. tu.s ............

(b) Insuranc deøartnt 1 icenses
and fees ...........................................

12.193

12.793

(c) Payroll ta.s ..............................

9.616.965

3.l32,338

J7J .695

10.168

13.l3J.I66

(d) Otter (excluding federal in~ and

....1 .state) ...............................

(.) Total tiies lic..ses and f..s (i+b+c+d) ....

9.616,965

3.445.1Jl

373.695

10.168

13.445.95

is. Real estate exses ...........................
16. Re.1 .state t&s ..............................

2.249.192
675.413

2.2l9.19
675.ll3

17. Rei-iul'_ts by uninsure accident
and heltt plans ...............................

18. Aggrete writ..lns for otter e_us .........

(43.633.126)
161.495.311

27 .044.196

27.550,203 42.299.418

ci.J3l.023)
2.354.320

9.627,250
330.969.672

19. Total _ses incurr...... ..... .............
ZOo Geeral exnses unpaid:

124.8Z .593

(.) Ge.ral _s.. unpaid Oec_r 31.
p....ious year ..............................

15.050.947

46. 40 ,189

16.722.007

83.137

79.014.28
78.714,19
331.269.753

(b) Gen.ral expe..s uniiid OK_r 31.

cu..t yer ...............................

14.107,618
162.438.670

47.58.195

16.125.278

897.50
2.295.949

ii. Exses paid (Line 19 .. Lln. 20& - Lin. 20b) ..

123.63.98

42,lI.147

l£TAILS Of WRITE-INS AGEGATED AT LINE 18 fOR OTHER EXPElES
181. Claill In...stlgatlon Exns. ................. :80. Prof.sslon.1 Relations ....................... :803. CP .. ............... ........................ .8. Nosp. Pllf Svc. Chg. .........................

58.408
102 ,783
59.237 ,166

53

1

294.664

2J.S51

(12)

420._
155.00.42
(25J,010)
(112,177 .43)

58.492

(253,010)

.8. S_ry of ..inlng wrte-ins ................. Go...t .................. for line 18 .8.
hi 0""rf_ page ...........................
(P.rt 3. Line 18) ............................

(85,209.98) (17.56,490) (43,633,12)

(25.83,04)
(15.65 .110)

68,238,607

27.526,652

(1,13.40)
(198.60)

(33 42a.20
9,62 .z

1l. Totls (Line 181 ttrogh 180 plus 189)

27.04,19

V.550,203

(1,33,023)

-

latio of upe of soliciting subscMbers .n a..inistrathe exses to net ,..i.. wrtten:
Acul 1

Le.l Li-lt
1.5 It

(_) ir ., ..Udd.. l-t. ..l... I. Pv 1. eel. c U.. ii .. .. .. .i I. c..l U_ S

It It It

1'1 oWol....h. ia:

__ PI l, .. J, COL. Z , J . l, Lt.. ii .. .. " .. 1. c.. l, U.. S

9.9 It
11.4 It

Ie) T_I _

_ .. .. .. J. (01. '. u.. ii .. .. l, .. L Co. t. u. S

8

qO

B-80

US541

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 4 of 45

DEFENDANT'S EXHIBIT 5

B-81

Case 1:05-cv-01030-LSM

Document 23-5 PENNSYLVANIA

Filed 02/15/2007FO..U Page 5 of 45

ANNUAL STATEMENT
OF THE

MEDICAL SERVICE ASSOCIATION
OF PENNSYLVANIA

of 1800 CENTER STREE~ CAMP HILL
In the State of

PENNSYLVANIA

)

\,

TO THE

Insurance COlnlTissloner
OF THE

'" '"

t-

~

COMMONWEALTH OF PENNSYLVANIA

FOR THE YEAR ENDED

DECEMBER 31.1994
elU INS 5E1vn Co.

NAS TEN.

\
/

HOSPITAL. MEDICAL AND DENTAL SEVICE OR INDEMNIT

COPORATIONS

,~

1994
~"
B-82

USI024

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 6 of 45

HOSPITAL. MEDICAL AND DENTAL SERVICE OR INDEMITY CORPORATIONS
11m 111111111 II111 I 111111 11m 11m 11111

ImJS41n91l100

ANNUAL STATEMENT
For the Year Ended December 31, 1994

OF THE CONDITION AND AFFAIRS OF THE

MEDICAL SERVICE ASSOCIATION OF PENI
NAIC Group Code: 812

NAIC Comany Code: 54771

Emloyer's

Organized under the Laws of the State of Pennsylvania

INSURANCE DEPARTMENT OF THE STATE OF PENNSYLVANIA PURSUANT TO THE LAWS THEREOF
Incorprated: 09/05/1939
Statutory Hoo Office: 1BOO Center Street
Main Adiinistrative Office: 1800 Center Street

Conn,
Camp Hill. PA

Camp Hill. PA 17089
Mail Address: 1800 Center Street

(77)63-3151
Camp Hill. PA 17089

PriMary Location of Boks and Records: 1800 Center Stret

Camp Hill. PA 17089
Annual Statemnt Contact Person and Phone N..ber: Nanette P. Kline

(7171763-3151 (7171730-1845

OFFICERS
Prsident &ld t.E.O.: Samel David Ross, Jr. Secretary: Carrie Joy Pecht, Esquire'
Treasurer: Donald Leroy Fi sher

Vice Presidents
John Stewart Brouse - Chief Operating, Officer Hershel Bemard Donald - Third Vice-, Chainin Gilbert Anthony Friday, Jr. H.D. - Chainin of, the Board Robert Eugene Patterson
Everett Franklin Bryant George Frederi ck Grode Ralph John Stalter, H.D. - Firs Joseph Anthony Ricci, H.D.

Tlis Charles s-rs Warrn Gerge Webber - Second Vice-, Chainnn

Daniel Henry Thoms

Marian Warnr Wright'
DIRECTORS OR TRUSTEES

Walter Frederic Froh, Esquire'

William H. Alexander Dor;. G. Bartuska, H.D. Joseph B. Bloo, Jr., M.D.
A. J. Chialastri ,D.O. S. (Reti red, 4/6/94)

Richard D. Baltz, H.D.

J . Robert Ba..

Walter o'Alessio
Walter J. Oealtrey Judith R. Diehl

John A. Carpnter, Esqui re John H. Dacott, D.M.o. , Frank DeFazio
Carlo J. DiMarco, H.o.

The DIRECTORS OR TRUSTEES listing is continued on the following page.

State of Pennsylvania

County of Curland ss
S-I Død "'S. Jr. Pri.it, Ci, ~ r.t Se.. II i- 'it_ Seor ".1 00. of ti iolCA SECE ASIATC

di -l .. of tl Ui li... cili officm of . Slid ~1t.., -i tW ..aci t1irt-flrst di of ..t1is _i sl sa lMt SlW ~lt... fr -l c1.. fni IIUeo or c1lllS ... tl IS ..h stm -i tIt lIS. .11 "lil

..1.. -l ..I_tlao u.l ciii. -- or ",i.. to is . 1111 -l _ stll-t 01 ill tl IS -l ¡;eiltl.. -i I.. IS of . ttlrl-first 4a of .. list, a4 of Its I.. -i -iGl _ for tl ,. .. .. tI 4Ii.. -i Nw ..

l.

),

~

_1 stli-t losao -i _tlii prlCci -i pn _Is..t to th _t tll: (1) sll 1..11 dlffõ or, (2) .iffem Ii reii lOt ",Iil to _tlii pnCl -i pr. oaiii to th bet of tllr ¡if_i... i-i.. -i beli.f. r

SetI

L:i¿~
f:l

S.."or ".1 00

, 1995

Is this an original fi1n~

If no: ii l state the ii date filed ;; i nuir of p4¡

:r~1

B-83

U81025

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 7 of 45

Fa.. 13 ANNUAL STATEMrNT FOR THr HAI 1994 OF THr HEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

DIRECTORS OR TRUSTEES (Continued)
Hershe 1 Bernard Donald
Gilbert A. Friday, Jr., H.D. W;ii;&l E. Hall, 0.0.5. Peter Hannn Hillyer, H.D. Angelo S. Monaco, D.P.H. Samuel David Ross, Jr. (Ex Officio)
Robert W. Ford, H.D.

Robert L. Grolund

Stephen J. Herceg, H.D. Charles R. HeCrae, H.D. Edward J. Resnick, H.D.

Thos J. Roher, M.D.
Gloria J. Schucolsky

Susan F. Sordon I
Ralph John Stalter, H.D.

Paul L Strickler

John H. Wil ds
Shi rley V. Young

Warren George Webber

i.

)
1.1 3pÇ
B-84

U51026

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 8 of 45

Fann \3 ANNUAL STATEMENT FOR THE YEAR 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA
I miiiiiii~ 11m 11m 11m 11~1 1m II!

_m9411l

ACTUARIAL STATEMENT

ï"

- .,.../

') ~

1.2

3'3"

B-85

US1027

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 9 of 45

Fo"" 13 ANNUAL STATEMENT FOR THE TEAR 1394 OF THE HEDICAl SERVICE ASSOCIATION OF PENNSYlVAIIA

ASSETS
1. Bonds:la).. ." .. ..... .,. ....... ............. ............ ... .............. 2. Stocks: la)

2. i Pr~ferred stocks _.
2 2 Commn stocks

........ ..-...... ............- .." _. ........._-

.. ._ ._._ .... .0 ......................... .................
encumbrances . . - - . . . . . . - . - . . - - . . . - . . . . . . . - - . . . . . . . -

J. Mortgage loans on rea 1 es ta te . . .. . . . .. . . . .. .. .......................... .. .....

4.

Real estate, less S.

S. Collateral loans .. _."

.. ........-_.. .....-_.. ...__......... ......-...........-_.-

6.1 Cash on hand and on deposit ., ... ..... ............. ..........................................

6.2 Short-teri investments .......... .-_... ...,..- ............... .............-_.....
7. Aggregate ",rite-ins for invested assets p --...... _. .. - ... _.......... .. - - _.. _..........--

7A. Subtotals, cash and invested assets, (lines i to 7) 0__'_ .... ......-.. ..... -. .....

8. Uncollected premiums ., ............. .... ........ ..... .. ...............

9. A:nunts receivable r~lati"9 to unins.ured accident and health plans .....
10. Funds held by or deposited with reinsured companies ..... ............. ... ...... ........ ..

11. Rein'sunnce recoverables on loss and loss adjustment paymnts........... .. ..... ........

12. Federal income tax recoverable ...... ........ .. ..... .......... .. ..... ......
13. Interest and other investment incolTe due and accrued ...................... .. .. ....

14. Receivable from parent. subsidiaries and affiliates ... ........ ... .. ....... .... ..

15.

£1ectronic data processing equipment

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

lB.
19.

Aggregate write-ins for other than invested assets........ ............ .... ..............
Totals (lines 7A through IB)

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

DETAILS Of WRITE-liS
070\. Oeferred Compensation lrust Fund

.,... .. ........ .. ................. ..................

0702. 0703.

......... .. ... .. ..... .. ........... ........... .... ................ ..' ...........

............. ....... ..... .,. ..................... .............. .......... .........

0798. Sumary of remaining write-ins for line 7 fro.. overflow page .............. ........ ....... 0799. Totals (Unes 0701 thru 0703 plus 079S)(llne 07 above) ................. .............. ........

lBO\. Accounts Rece i vable-Agent Plans

................. .., ................. ..... ...........

1802. Accounts Receivable-Federal Employee Program .......................... ................. .......

1803. Accounts Receivable-Governl8nt Contracts .............. ............... ..................
1698. SU1ry of remaining write-ins for Line 18 fro overflow page. .,..... --........ H" ............
IB99. Totals (lines 1801 thru lB03 plus IB9)(line 18 above) ..........................................

la) State basis of valuation. Bonds are valued at allrtlzes cost. COIn stocks are .alued at iirket va.

)
'"
2

::~1

B-86

U81028

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 10 of 45

FoMl 13 ANNUAL STATEMENT FOR THE TEAR 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

LIABI LITI ES,

RESERVES & OTHER FUNDS -

1. ClailD unpaid (Part 2A. Line Sf Colull 4)(Inc1udes provision for retroctive cost adjustllnts
S................) ....................... ....... ..................... ............................ ..

2. Provision for deferred iitemity benefits (Part 28. Line 4, Column 2) ............................ 03. Unpaid claims adjustment expenses (Part 3, Line 20B, CalUM 2) ................................... ..

4. Unearned preiui (Part i, Column 8) ............................................................. ..

5. Unearned investmnt incom (Part 4. line 9, Column.) ............................................ ..

6. a. Taxes, licenses and fees due or accrued (excluding federal incom taxes) .................... .. b. Federal inc," taxes (excluding deferre taxes) ............................................. ..

c. Other expenses due or accrud...... ..... -......... ... .......- ......... _. _........ _.....-.... ..
7. P..ill depsits ..de by applicants rejected or not as yet accepted as Ilrs or subscribers .... ..
8. Borro iiney S................ and interest thereon $.. .............. ............... ........... .. 9. AIunts withheld or retained for account of others .............................--................ ..
10. Liabil ity for allunts held under uninsured accident and health plans............................. .. 11. Funds held by corporation under reinsurance treaties ............................................. ..

12a. Unearned preiUl on reinsurance in unauthorized comnies I................ .....................
lZb. Reinsurance on paid loss..s S................ and on unpaid reported losses S................

and on incurrd but not reported losses S................ recoverable tro unauthorized
comanies S................ ..................................... .............................. ...

lZc. Paid and unpaid allocated loss adjustiint expenses recoverable fl' unauthorized

coinies S...... ..........
lZd. Less funds held or retained by corpration for account of such unauthorized

coonies as per Schedule S, Part Z, COL"" 6 S................
13. Provision for unauthorized reinsurance (Lines 124 + 12b + 12c - 12d) .............................
14. Aggreate write-ins for other liabilities ....... ...... .... .................. ............. ........
15. Total liabilities ............... ....... .............. .......... .... ............ ...... ...... ...... ..

RESERVES AID SPECIAL FUNDS:
16. Statutory reserve ................................................................................
17. Surplus Notes. ............ ....... .......... ........... ........................ ...................

lB. Aggregate write-ins for reserves and special funds ... ......................... ......... ..........
19. Unassigned funds ....... .......... ...... ...... ...... ... ......... .-... ............................. .:

ZO. Total reserves and unassigned funds (Page 4, Line ZO) ............................................

ZI. Totals (Lines 15 plus ZO) ...................................................................
DETAILS OF WR-Ill
1401. Provision for Exprienu Rating Refunds
140. Acunts Payable ..... .................. ....... ........... ...... ........................... ......

1403. Checlc Issued in Excess of Funds on Oeposit .....................................................

1498. S_ry of reining write-ins for Line 14 fro overflow page................................... .:
1499. Totals (Lines 1401 thru 1403 plus 1498)(Line 14 above)

ieo1. Reserve for Deferre Hatemity Benefits.............. ...........................................
~
1.Z. Reserve for Contingencies...... ...... ................ ......... .......... .............. ..........

1803.
189. S_ry of ..ining write-ins for Line lB fl' overfow page ................................... .:
1899. Totals (Lines 1801 thru 1803 plus 189)(Line 18 above) ..........................................

,

)
I

3

1~ß

B-87

USI029

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 11 of 45

Fonn 13 ANNUAL STATEMENT FOR THE YEAR 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

UNDERWRITING AND INVESTMENT EXHIBIT
UNDERWRITING INCOME
1. Preiums eamed (Part 1, Line 5, Column g) ........................................................
2. l!. Claiiis incurred (Part 2, Line 5, Coluin 5) net of reinsurance (S................) ..............

-

b. Increase (decrease) in provision for deferred maternity benefits (Part 28, line 4, CalulI 4) .. ..
3. Expenses incurred (Part 3. Line 19. Column 2+3+4):
l!. Clai.. adjustint ........................................................................... _.. ..
b. Administrative......................... _........... _......... _.. .............................. " c. Soliciting.. __....... _................. _............. _._...................................... ..

4. Reinsurance allowances - expnse and exprience refund....... ..._..... ._.......H....... _.... -.... _
5. Total unde,.iting deductions (Lines 2 through 4) .................................................
6. Net underwriting gain or (loss) (Line 1 .inus Line 5) ............................_.....-_........- ..

INVESTMENT INCOME
7. Net fnvesi-nt incom earned (Part 4.Co1 8,line 14)
e. Net ..alized capital gains or (losses) (Part 4A,Col 6,Line 10) .................................... .. g. Net in.estllnt gain or (loss) (Line 7 plus Line e) ................................................ ..

OTHER INCOME
10. Agg..gate write-ins for other incom...................... ........................... .......... ... ..

11. Net gain or (loss) befo.. federal incoll taxes (Lines 6 + 9 + 10) ................................. ..
12. Federal incOl taxes incurred..................... _....... _... ....... .-................. _.. .~.... ..
13. Net gain or (loss)(to Line 15)(Line 11 minus Line 1Z) .............................................. ..

RESERVES AND UNASSIGNED FUNDS
14. Rese..es and unassigned funds Decenir 31, p...ious year (Page 4,Col 2,Line 20)

GAINS AND (LOSSES)
15. Net gain or (loss) (fro. Line 13) ................................................................. ..
16. Net un..alized capital gains or (losses) (Part ....Col 6,Line 11) .................................. ..

17. Change in non-ad1itted assets (Exibit Z, Line 6, Col. 3) ......................................... ..

18. Aggregate wrte-ins for changes to reserves and unassigned funds.................................. .. 19. ciange in ..se..es and unassigned funds for the year (Lines 15 throh ie) ........................ ..

ZOo Rese..es and unassigned funds Oeceir 31, cur..nt year (Line 14 plus Line 19) .................... ..

DETAILS OF WRITE-Ill

1001. Miscellaneus 111 and Exnse-/et

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

100.
1003.

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

109. Siiry of ..ining write-ins for Line'10 fro o.erflow page ................................... .:
109. Totals (Lines 1001 thru 1003 plus l09)(Line 10 abo.e) ..........................................

181. Pror Period Adustint - post..tlrent Helth Benefits ........................................

180.

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

18. ................................................................................................................................
189. S-ry of ..inlng write-ins for Line ie fro o.erfow page ................................... .:
18. Totals (Lines 181 "tru 1803 plus 189)(Line 18 above) ..........................................

/ ) ..

4

31f

B-88

U51030

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 12 of 45

Fo"" 13 ANNUAL STATEMENT FOR THE YEAR 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

CASH FLOW
1.
Pre;uias collected net of reinsurance

f-

2. Claill end claims adjustmnt expenses

......................................-_..........__.....-....__.....__.....................-_....................""-

3.

Underiiting expenses paid.............. _....... _....................................... _........

4. 5.

Other underwiting incom (expenses) ... _... _..... - _........ _. -.... - - _.. _.. -. _.... _.... _......... - Cash fro undeniriting (Line I - Line 2 - Line 3 + Line 4) .......................................

6.
7.

Investllnt incom (net of investment expenses) _... - _... - _... -. _.......... _.... _.... _.... - _... - _..

Other incom (expenses)

.........................-.........-_...__..............-.................

,

8.
9.
10.

Federal incom taxes (paid) recovered............................................................
Net cash fro operations (Line 5'" Line 6'" Line 7 .. line 8) ......................................

Proeeds fro investments sold. utured or repaid:
10.1 Bonds................................................................... .................... 10.2 Stocks........ ..............................................................................

10.3 Mortgage loans..............................................................................
10.4 Real estate ............. ...... ........... .......... ................ ..... ....... .......... ...

10.5 Collateral loans ........................................................ ....................

10.6 Other invested assets....................................................................... 10.7 Net gains or (losses) on cash and short-term investJnts ....................................
10.8 Miscellaneous proeeds.............. ................. ............ _.......................... -

10.9 Total investaint proceeds (Unes 10.1 thru 10.8) ............................................

11. Other cash provided:

11.1 Net transfers fro afnHates
11.3 Capital paid in

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

11.2 Borrod funds received............. ................ .................................. ......

11.4 Surplus paid in

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

11.5 Ot.her sources ................................................................................

11.6 Total other cash provided (Unes 11.1 thru 11.5) ............................................-

12. Total (Une 9 + Line 10.9 + Line 11.6) ...........................................................

13. Cost of investints acquire (long-teni 'only):
13.1 Bonds .......................................................................................
13.2 Stocks........ ..................................... ..................... ....................

13.3 Mortgage loans................................................................ ..............

13.4 Real estate.................................................................................
13.5 Collateral loans .......... ........ .................. .................. ......................

13.6 Other invested assets ...... ....................... ..........................................
13.7 Miscellaneous applications. ...................................................... .... ....... .:

13.8 Total investint acquire (Lines 13.1 thru 13.7) ............................................

14. Other cash appHed:
14.1 Net transfers to affil iates

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

14.2 Borro funds repaid .......................................................................
14.3 other applications ....... ......... ....... ............ ........................ ...............

14.4 Total other cash applied (Lines 14.1 thru 14.3) ............................................. .:

15. Total (Line 13.8 + Line 14.4)

........................................................................
RECONCILIATION

16. Net change in cash and short-te.. investints (Line 12 ainus Une 15) ............................

17. Cash and short-teni investints:

/

17.1 Beginning of year.... ...... .................................................................

.,)

17.2 End of year (Line 16 + Line 17.1) ...........................................................

5.

310

B-89

USI03I

'\"--'

It "

Form 13 ANNUAL STATEMENT FOR THE VÉAR 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

UNDERWRITING AND INVESTMENT EXHIBIT PART 1
1

2

3

4

5

6 Unea rned
1

8
Total Reserve

9
Preml ums

Reserve for

Net
Pre~1 ums

Unearned
Preml ums
Prem! ums December 31

Written
(Columns
1 + 2 . 3) (Part lA)

Rate Credits and Retrospect he
Returns Based

for Unearned
Preml ums (Columns 6 + 7)

Earned
(Columns
4 + 5 - 8)

Current
Year
on Experf ence

line of BusIness

DIrect Business
Rei nsurance Assumed

Rei nsurance Ceded
December 31 Prevfous Vear

Case 1:05-cv-01030-LSM

................. ................. ................. ................. ................. ................. .....64,293,781 2. Medl ca 1 .................................. .. 1,933,312,181 ..... 14,352,719 ................. .. 1,947,664,960 ..... 62,650,453 ...... 1,951,469 3. Dental .. ................................. .... 271,438,38 ...... 1,071,110 ................. .... 278,515,498 .. .... 1,781,463 4. Other .................................... .... 788,369,508 ................. ................. .... 188,369,508 ...... 2 ,238, 189 ...... 1,984,560 .....68,229,810 5; Totals ................................... .. 2,999,120,011 ..... 15,429,889 ................. .. 3,014,549,966 ..... 66,670,105
..... X X X ..... ..... X X X..... ..... X X X ..... ..... X X X.....

1. Hospital .................................

................. ................. ................. ................. ..... 64,293,781 .. 1,946,021,632 ................. ...... 1,951,469 ....278,345,492 ,................ ...... 1,984,560 ....788,623,137 ......,.......... ..... 68,229,810 .. 3,012,990,261
..... X X X.....

6. Federal Employee Health eeneflts Progrem Premium............................................... ..... 94,722,103

.....XXX.....
.....XXX.....
..... X X X.....

..... X X X .....

1. ealance (Column 4, Line 5 minus Line 6) ........................................................ .. 2,919,827,863

.....XXX.....

~

..

3: -1

PART lA
In

UNEARNED PREMIUMS
2

Document 23-5

Prem! ums

Force
December 31

Amount of
Preml ums or

Current Year
1. Annual preml ums ...............................................
2. SemI -innual premi ums ..........................................

Fees Unearned

Filed 02/15/2007

B-90

3. Quirterly premiums............................................
4. Monthly premIums ..............................................

................. ................. ................. ..........,.,....

.,'..,........... ................. ................. ...........,.....
-~ ~~~ ~.~

Page 13 of 45

c: ui

f-

o W

N

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 14 of 45

Fol" 13 ANNUAL STATEMT FOR THE YEAR 199 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

UNDERWRITING AND INVESTMENT EX

PART 2 - CLAIMS PAID AND INCURRED - NET OF REINSURAN
1

2

Chill

3

Unpaid

Current Year
(CoJu.n 4,

Line of Business

Claill Paid

Part

Clai.
Prey;

2A)

i.
3. 4. 5.

Hospital

~.........................-......-..........

.................. .................. ........... 187,461,439 ...... 17,98,913 ...... 42,379,237 ..... .247,826,589 - . .....
J

2. Meical

............................................. .., 1,58,973,553 Oental ............................................... ..... 234,469,54 Other ............................................... ..... 748,027,331 TotaJs ......................................... ... 2,571,470,432
,. '.
~./ . '-c.- :¡' ;.

....0.

......
.......l

PART 2A - CLAIMS UNPAID - NET OF REINSURANCE
1

2

Reported Claims in Process

E,

I'

........................................ ........... .., . . . . ~ . .. .., ... ..... ....... ..... .. .. 13,819,210 2. Meical . ~ . . . . . . . ~ . . . ............................ ...... ., ...... .......... . .. .. .... ...... 2,817,813 3. Oental . . . . . . . . . . .. .. . .. ~ . . . .. . . . . . . ... ................ .... ..... ........ 253,750 4. Other ..................... ............................ ....... .. .., . . . . . . . . . . . . . . ~ . . .. . . . . . ~ . . . . ~ . . . .. .. . ~ . . 16,B90,773 Totals ....... . .. .. .. ~ .. . . .. . ~ .. .. . . . . ~ . 5.
i.
Hospital

line of Business

of Adjustlfnt

But I

.....
... ..

...... ......
...~.

PART 2B - DEFERRED MATERNITY BENEFITS - NET OF REINSUI
1

line of

Bus i ness

Current Year

liability

2

P...

L

i.
3.
L L

Hospital

. . . ~ . . ~ ~ .. .. . .. ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . ~ . . ~ . . . . . ~

2. Medical

. ,

4.

........... ........................................................... ...... Other ............................................... . . . .. . . . ~ . . . . Totals ........... ......................................................

N

0

i
1

PART 2C - ANLYSIS OF CLAIMS UNPAID - PREVIOUS YEAR - NET OF Clalii Unpid Oeeier 31 of Currnt Tot Year, Viz.: Esti..ted Liabil ity Clal.. Paid Durin9 the Year
Deceir 31 of Currnt Year
4
On Claill Unpaid

Ine

2

On Clai.. Prior to January
Line of Business

Incurr

3
On Clai.. Incurrd

5
On Clai..

1 of Curnt Year

Ourin9

the Year

Oeceor 31 of P..vlous Year

Incur..d
~e Year

on Ch

of c.
in F

Dee

Ourl n9

(Coll

1. Hospital

....... ..................... ..................... ......................
178,712,774 .. . 1,410,260,779

.................. ......
....... 178,38,738 ......

2. Meical

r
.I

3. Dental 4. 5.

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

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

9,078,701
154 ,262

16,649,392

.....
...

217,820,156

...........
......~

).

Other........ . ........
Totals . ..

31,815,5I~

..... 716,211,812

4,66,230
13,901,193

227,177,68

2,344,292,747

...... 17,831,651 ...... ...... 37,711,007 ...... ..... 233,925,39 .....

7

~34v

B-91

USl033

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 15 of 45

Fa", 13 ANNUAL STATEMENT FOR THE YEA 1994 OF THE MEDICAL SERVICE ASSOCIATION OF PENNSYLVANIA

UNDERWRITING AND INVESTMENT EXI

PART 3 ANALYSIS OF EXPENSE
Claim Adjustment Administrative

2 3
.... ....

I ncurred Exnses

Solicitin9
.... 11,413,078 ..

4

1. Coissions
2. Advertisin9
....... 858,264

3. Boards, bureaus and associations ............... ........ 13,431 4. Salaries ....................................... ... 114,280,206

."." 1,749,699
52,066,553
14,104,059

5. Eiloyee relations and welfare ................. ....30,744,264
6. Insurance, except on real estate ............... ........49,210
7. Travel and travel items ........................ .....1,037,334
8. Rent and rent items. including S................ for Corpration's occupancy of its ow buildings, less S.... ............ received under sublease

....... 514,325 ..... 2,503,371
1,065,093

......... 9,636 ..... 5,248,446 ..... 1,315,98 ....t... 14,125 ....... 316,952
...._..

.. ., .. .. ..

.....9,156,635 ....-

9. Equipont ...................................... .... 15,606,165
10. Printing and stationery............ _........... ..... 5.562.087
11. Postage, telephone and tele9raph, exchange and express............... ............ .... 23,725,669

.... 21,002,885 ..... 4,993,399

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

314,08 .. 251,930 .,

633,84 ..
427,450

12. Leal.......................................... .......335,595
13. Auditing, actuarial and consulting services. ............ ............ ........ ...... .. ... 2,434.253

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

3,740,336 1,511,349

................
193,322

.. .. ..

8,478,968

14. Taxes. licenses and fees: a. State and locl insurance
b.

taxes
... .... 136,286

Insurance departllnt 1 icenses and fees.............................. _....

c.
d.

Payroll taxes

....................-......... .....
fees (a+b-l+d)

9,86,029

..... .....

3,892,979

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

419,99 ..

Other (excludin9 federa 1 incom and

rel

estate)

............................... ................ ................ ................
.... .....
9,860,029

..

e. Total taxes

1 i censes and

4,029,265

419,99 ..

15. Real estate expenses...........................
16. Real estate taxes... ...........................

17. Rehiburseints by uninsured accident and health plans ...............................
18. Aggreate write-ins for other expenses ......... ... (21,845,107) .... 40,30,313

19. Total exnses incurr........................
20. General expenses unpaid:

190,959,771 ... 156,925,879

30,141,597 .. 50,700,448 ..

a.
b.

Geeral exnses unpa i d Decemer 31.

.............................. .... General exnses unpaid Deemr 31, currnt year ................................ ....
previous year

14,107,618
13,934,331

.... ....
...

47,58,795
53,332,726
151,176,946

..,. .... ....

16,125,278
17,229,474

.. ..

2L. Exnses pa i d (Line 19 + Line 20a
DETAILS OF warn-iis

-

Line 20b)

.. . ..

191,133,058

49,596,252

..

1801. Clalas Investl9atlon Exnse ................. ........53,964 ............76 ...........114 ., 180. Professional Relations ....................... ....... 100,535 ....... 681,232 ........ 41,387 ..
1803. CPO ......................................... ...... (516,68) ....... .... ..... ...... .......... ..

1898. sury of rein;n9 write-ins for Line 18
fi- overfow page ..... ......................

.. . (21,48,923)

18.

latah (Line 1801 thru 1803 +
169) (Line 18 above) ........................

...

(21,845,107)

.... ....

39 ,627 ,005

40,30,313

.... ....

30,100,09 ..
30,141,597

..

Ratio of expese of soliciting subscribers and adiinistrative expenses to net pl'ii- written:

Actul
.. ~ of solldtiog si..: r.hg Pog a, ,or 3, U.. 21, CDl_ 4 to 'og " Po 1, U.. 5, CDl_ C
11

.. Mnalstat~ EJ: l' 'og a, ,or 3, CDl_ Z + 3 + 5, U.. 21 to 'og " Po 1, CDl_ 4, U.. 5
c. lG141 Ei:
r.hg 'og a, ,or 3, CDI_ 6, Uæ n to 'ig 6, 'ar 1, CDl_ 4, U.. 5

1:

8

.? l¡~

B-92

US1034

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 16 of 45

DEFENDANT'S EXHIBIT 6

B-93

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 17 of 45

United States

of America

Departn ient of the Treasury Internê.l Revenue Service
Date: March 8, 2006

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: Form 4340 Certificate of Assessments, and Payments, consisting of 25 page(s), of taxpayer(s) named herein in res~iect to the taxes specified, is a true and complete

transcript for the period(s) stated, and all assessments, credits, and refunds relating thereto as
disclosed by the records of this office as of the date of this certification are shown therein.
HIGHMARK INC, 120 Fifth Ave., Ste 922, Pittsburgh, PA 15222 for Tax Period(s) 199112, '199212, 199312,199412 and 199512 Form 1120. .

I N WITNESS WHEREOF, I. h'ave¡ hereunto set Ily hand,
and caused the seal

of this offce to be affxed, on the day
f the Treasury:

¡ md year first above written.

-_._--....

/J$!Jgg~;;,\ . ---- -*. - ""./- ,". .--

,(A II l /
M 'NAGER

:~
B-94

VPJ'UL .R OK!
~ ~CO NG ONTROUSER~CES OPÊÄATION
PIIlLAOELPHIA SUBMISSION

PROCESSING CENT~R

Catë:log Number 19002E

ikonn 2'866 (RéV: 09-1997)

US34

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007 ~

Page 18 of 45

- - - - - - - - - - -- - - - - --- -- - - - - -- -- ---- - - - --- - - --- - - --- --- - - - - - - - - - - - - - - - - -- - - - -- - -- - - --- - - -- - - - - --

---------------------------------------------------------------------------------------------------HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23 - 1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1991
EXPLANATION OF TRASACTIONS
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

== = = = = == = = = = = = = ============ = = = == = ========= === == = ======="======== = ====== = = ===== === == = === = = === = = = = = = = =

NET TAXABLE INCOME

970,402.00
09/22/1992 RETURN FILED AND TAX ASSESSED

28311-270-43202-2 199243 '

30,256,011.00

11/02/1992

04/15/1991 ESTIMATED TAX/FEDERAL TAX DEPOSIT
06/18/1991 ESTIMATED TAX/FEDERAL TAX DEPOSIT
DEPOSIT

3,000,000.00

3,500,000.00
9,500,000.00
396,192.50

09/16/1991 ESTIMATED TAX/FEDERAL TAX

04/15/1991 OVERPAID CREDIT FROM PRIOR TAX PERIOD

12/16/1991 ESTIMATED TAX/FEDERAL TAX DEPOSIT

11,000,000.00
.00

01/27/1992 RECEIVED POA/TIA
03/16/1992 ESTIMATED TAX/FEDERAL TAX DEPOSIT

4,400,000.00

03/18/1992 INITIAL INSTALLMENT PAYMENT

04/20/1992 EXTENSION OF

TIME TO ~ILE

09151992
ESTlMATEIl;TAX PENALTY

170,034.00
199243

11/02/1992

\
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Pase: 1 Form 4j40(Rev. 03-2000)

B-95

U835

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 19 of 45

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23 - 1294 723

U _ S _ CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC _ 1991
ASSESSMENT,
PAYMENT,

ASSESSMENT

DATE

DATE (23C, RAC 006 ) - - - -"- -- - - - - ----- -- -- -- -- -- -- ------------ - - - -- -- -- - - - -----~ ~---~ - -- -- ------ - - -- ------ ---- - -- --- - - - -- - - - - - - - - - -- -- -- -- - - - - --------- -- -- --- - ---- - - - - -- -- -- - - -- - -- - - - -- --~ - - EXPLANATION OF TRANSACTIONS

OTHER DEBITS
( REVERSAL)

CREDIT (REVERSAL)

11/0~/1992

OVERPAYMENT CREDIT TRANSFERRED

(1,231.35)
(321.45)
14.36
(1,368.,594 _ 70)

01 198912

11/02/1992 11/02/1992 04/15/1992

OVERPAYMENT CREDIT TRANSFERRED

01 198912

INTEREST DUE TAXPAYER

OVERPAYMENT CREDIT ELECT

TRANSFERRED TO NEXT TAX PERIOD

11/02/1992

REFUND

(14 _ 36)

01/13/1997 01/13/1997

REMOVED POA/TIA

_ 00

RECEIVED POA/TIA
LATE FILING PENALTY

.00
_ 00

ADDITIONAL TAX ASSESSED BY
EXAMINATION

.00

02/14/2000

28347-424-10000-0
12/31/1999 AMENDED RETURN FILED

29977-440-01284 -0
LATE FILING PENALTY
_ 00

04/12/2004 04/12/2004

ADDITIONAL TAX ASSESSED BY
E.I NAT I

_ 00

ON

28347-483~70006-4

- - -- - - - - - - - - - - - - - ~- - - - - -,- - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - -~ - - - - - - - - - - - - - - - - - - - - - - --

Form 4340 (Rev. Ö3-2000)

Page: 2

B-96

U836

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 20 of 45

¡' : : : _ : : : - - _ - - : - ~~~~;;; ~~~~ : ;; : ~~ ~~ ~~~~~~ : : ;~ ~~~N~~, _ ~~ - ;T~~R _ ~ ;~~;;; ED - MA ~~E~~ : : _ _ - : _ _ - : _ _ : : : - - - _
HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EINlSSN: 23-1294723

U. S .

- -- - - --- - -- - - --- - ---- ---- - - - -- - -- - - - -- ---- --- - --- - - - - - - - - ~ - - - - - --~ - - - - - - - - - ---- - - - - - - - - - - - - -- - - - - - --

FORM: 1120 TAX PERIOD: DEC. 1991

CORPORATION INCOME TAX RETURN

I certify that the foregoing transcript of the taxpayer named above in respect to the taxes specified is a true and complete transcript for the period stated, and all assessments, abatements, credits, refunds, and advance or unidentified payments, and the assessed balance

set forth
- - - - - - - - - - - - - -- -- - - - -- - -- - - _.:- - - - - - --

Signature of Certifying Officer:
Print Name: Paul L. Czarnecki

Title: Accounting Control/Services Operation Manager
Delegation Order: 11

Location: Internal Revenue Service Philadelphia, PA

Account Status Date: 03/08/2006

-------- --- --- --- ------ -- ----- ------ ---- --- -- - --- - ---------- - --- -- - - - - - - -- -- - ---- - -- --- - -- - -~ - - ----

,/

- - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - ~ - - - - - - - - - - - _.- - Page: 4 Form 4340(Rev. 03-2000)

B-97

US37

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 21 of 45

-- - ------ ----------- ---- ----- - ---------------------- - --------- -------- - ------- -- --- - ------- - -- - - - - -- - - ~--- -----~~ ---- - --- -- - ~ - - - - ~ - ~--- - --- - - - - - -- ----- -- --- -- --------- - - ------ - - ~ -- - -- - ~-- - - - - - - - ~ - - -HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
PO BOX 890089 CAMP HILL, PA 17089

EIN/SSN: 23 - 1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1991
EXPLANATION OF TRASACTIONS
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

== = == = = ========== = = = == = = = == == === = == == = = === = = = == = = == == = = = = = = = ========== ==== = ===== ======= ===== == = = = = =

01/23/2006 LEGAL SUIT PENDING

.00

- - - - --- - - ----------- --- - - - - ~ - - - - - -- -~ - -- --- - -- - - -- - - - -- - - - -- --- -- - --- - ~ -- --- ---- - - ------ -- ---- - - - --

ASSESSED ITEMS 8ALANCE DUE

.00

"

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -~ - - - - - --

Form 4340 (Rev. 03 - 2000)

Page: 3

B-98

U538

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 22 of 45

- - - - --- - -- -- -- ---- - -- -- - --------------- --- - ----------- ------ ------------ -- -------- ---- -- - - --~- - - - - -- ~ - -- - - --- - - - - - - - - - - - - - - - - - - - - ----- - - -- - - - ------ ----------- - --- --- -- - --- - -- -- --- - - - - - - - - - - - - - -HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23 -1294723

U _ S _ CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1992
EXPLANATION OF TRASACTIONS
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

~ = = = = = = = = = = = = = = = == = = = = = = = = = = == ===== ==== ==== == ======== = === ==== ======== ===== == ====== = == === == === = == = = =

NET TAXABLE INCOME

19,286,983.00
09/21/1993 RETURN FILED AND TAX ASSESSED

40,715,744.00
2,800,000.00

02/21/1994

28311-268-47200-3 199406
04/15/1992 ESTIMATED TAX/FEDERAL TAX DEPOSIT

06/15/1992 ESTIMATED TAX/FEDERAL TAX DEPOSIT

8,000,000.00
8,100,000.00
1,368,594.70
16,000,000.00

09/15/1992 ESTIMATED TAX/FEDERAL TAX DEPOSIT

04/15/1992 OVERPAID CREDIT FROM PRIOR TAX PERIOD

12/15/1992 ESTIMATED TAX/FEDERAL TAX DEPOSIT

03/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT

6,000,000.00

03/18/1993 INITIAL INSTALLMENT PAYMENT
'"

04/26/1993 EXTENSION OF TIME TO FILE

09151993
ESTIMATED TAX PENALTY

3,482.00
199406

02/21/1994

04/15/1993 OVERPAYMENT CREDIT ELECT TRASFERRED TO NEXT TAX PERIOD

(1,549,368.70) .

- - - --- - -- - - --- -- - - - -- --- - -- -- - ------ -------- ----------------------- ~-- ------------------------ - - --Form 4340(Rev. 03-2000)
Page: 1

. .

. .,' . .
B-99

(:/

U839

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 23 of 45

- - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
HIGHMARK Il-C

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1992
ASSESSMENT, PAYMENT, ASSESSMENT

DATE EXPLANATION OF TRANSACTIONS OTHER DEBITS CREDIT DATE (23C, (REVERSAL) (REVERSAL) RAC 006 )

== = = == = = == = = = ==== == = == = == == == =====~== == = = == == ==== === = = ===== == = == = ==== = = = = == = = = === = ==== ===== == = = = = = =

ESTIMATED TAX PENALTY _ 00 04/04/1994
.00 .00 .00
.00

ADDITIONAL TAX ASSESSED

04/04/1994 04/25/1994

28354 -470- 15043-4
ESTIMATED TAX PENALTY

ADDITIONAL TAX ASSESSED

04/25/1994

28354-496-18046-4
03/28/1995 RECEIVED POA/TIA
05/31/1996 ASSESSMENT STATUTE EXTENDED TO

06301997
01/13/1997 REMOVED POA/TIA

.00
_ 00

01/13/1997 RECEIVED POA/TIA

04/03/1997
04/21/1998

ASSESSMENT STATUTE EXTENDED TO

06301998
ASSESSMENT STATUTE EXTENDED TO

06301999

02/23/1999 12/01/1999
i
r'

¡ASSESSMENT STATUTE EXTENDED TO

06302000
ASSESSMENT STATUTE EXTENDED TO

04302001
LATE FILING PENALTY

.00

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - --- - - - - - - - - -- ~ - - - - - - - - - - - - -- - Page: 2 Form 4340 (Rev. 03-2000)
".

B-100

U540

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 24 of 45

-- - - - -- - - -- --- --------------- -- - ------------------- --- -- -- -- -- ----------- - --- --- -- - - ---- ---- --- - - - -CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - .. HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1992
DATE

EXPLANATION OF TRASACTIONS

ASSESSMENT, OTHER DEBITS (REVERSAL)

PAYMENT,

ASSESSMENT

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

== ~ = ~ = == ~ === = ====== =========== = = ========= = == ==== == = = = = = === = ==== === === ===== === ===== ======== == == = = = = =

ADDITIONAL TAX ASSESSED BY
EXAMINATION

.00

02/14/2000

28347-424-10001-0
12/31/1999 AMENDED RETURN FILED

29977-440-01285-0
01/25/2001 ASSESSMENT STATUTE EXTENDED TO

12312001

09/06/2001
08/20/2002
07/25/2003 07/25/2003 03/15/1994

ASSESSMENT STATUTE EXTENDED TO

12312002
ASSESSMENT STATUTE EXTENDED TO

12312003
ASSESSMENT STATUTE EXTENDED TO

12312004
ASSESSMENT STATUTE EXTENDED TO

06302004
OVERPAID CREDIT APPLIED

311,428.00

04/19/2004 CROSS REFERENCE DATA 23-1294723 02 199312
03/15/1995 OVERPAID CREDIT A~PLIED

267,329.25

04/19/2004 CROSS R~FERENCE DATA

23 -1294723 02 199412
04/15/2004 QUICK ASSESSMENT

559,276.00
. .00

29351 - 106 -13000-4
LATE FILING PENALTY

04/15/2004

Form 4340 (Rev. 03-2000)

- - - - - --~ - - - - - - - - - - - - - - - - - ~- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Page: 3

. .

B-101

US41

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 25 of 45

- - ------- ---------------- ---- -------- ---------------- ------------- -------- ------- - - - - - - - - - - - -- - --- - - - - - - -- - ----- -- ---- -- - --------------------- ---- ------- ----- -- - -- - - -- - -- - --- - - -- - - - - - - - - - -HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

PO BOX 890089

EIN/SSN: 23-1294723

CAMP HILL, PA i 7089

u. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1992
EXPLANATION OF TRASACTIONS
RESTRICTED INTEREST ASSESSED
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

DATE

CREDIT (REVERSAL)

ASSESSMENT DATE ( 2 3 C .

RAC 006 )

== = = = = = == = = = == = === ======= ==== = ======= = == = = = == == == === == = = === == = = = === == = ===== == = = = == = = = = = == = = = = = = = = = =

19,480.55

04/15/2004

200417
05/10/2004 OVERPAYMENT CLEARED
LATE FILING PENALTY
(_ 70)

.00 .00

07/19/2004

ADDITIONAL TAX ASSESSED BY
EXAMINATION

07/19/2004

29347-583-10003-4
LATE FILING PENALTY

.00

08/23/2004

ADDITIONAL TAX ASSESSED BY
EXAMINATION

.00

08/23/2004

28347-618-70001-4
01/23/2004 LEGAL SUIT PENDING
. 01/31/1994 TAXPAYER DELINQUENCY NOTICE

.00
.00 .00

04/15/2004 STATUTORY NOTICE OF BALANCE DUE

.00 ASSESSED ITEMS BALACE DUE -, - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - _.- -.- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form 4340 (Rev. 03-2000)

..

Page: 4

B-102

US42

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 26 of 45

I -- --- - --- ------ ----------- --------------- - --- -- ------ --- --- --- - - - - -- - -- - - - - --- - - - - - - - - -- ----- --CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1992

I certify that the foregoing transcript of the taxpayer named above in respect to the taxes specified is a true and complete transcript for the period stated, and all assessments, abatements, credits, refunds, and advance or unidentified payments, and the assessed balance relating thereto, as disclosed by the rec rds o~ this office as of the date of this

certification, are shown therein. I fUDthe c ~y at the oth~~specified matters set forth
in this transcript appear in the official re ~ u the Internai/~evenue Service.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - , - .' - /1- _ _ _ _ _ _ _ _ _ _ _ /1- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
/

Signature of Certifying OfficerÆ :
Print Name: Paul L. Czarnecki

. ~
/!

Title: Accounting Control/Services Operation Manager
Delegation Order: 11

Location: Internal Revenue Service Philadelphia, PA

Account Status Date: 03/08/200.6

r

- - - -- -- ------ - - -- - - - - - - -- -- - - - - - - -- - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - -- - -- - --- - ---- -- -- - -- - --Form 4340(Rev. a)-2000) Page: 5

B-103

U843

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 27 of 45

- -- ----- - ------- - - ----- - - - --- - -- ------------ ---- - --------- - -- - ------- ------- ---- - - - - - - - - ---- -- - - - - -HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC _ 1993
ASSESSMENT,
PAYMENT,

ASSESSMENT

DATE

RAC 006 ) ( REVERSAL) = = = = = = = = ======= === = = = = = = = = = = = == = = === = = = = = == = = = = ==== = == = ====== === === ==== ====== = ==== = = = === ====== == = = =

EXPLANATION OF TRANSACTIONS

OTHER DEBITS

CREDIT (REVERSAL)

DATE (23C,

NET TAXABLE INCOME
198,866, .608.00

09/15/1994 RETURN FILED AND TAX ASSESSED

41,867,883.00

.10/17/1994

28311-260-49601-4 199440
.04/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT

10,500,000.00

06/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT
04/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT 09/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT 12/15/1993 ESTIMATED TAX/FEDERAL TAX DEPOSIT

7,000,000.00
40,980.00

9,200,000.00
13,000,000.00

04/15/1993 OVERPAID CREDIT FROM PRIOR TAX PERIOD
03/15/1994 ESTIMATED TAX/FEDERAL TAX DEPOSIT
. 03/18/1994 INITIAL INSTALLMENT PAYMENT

1,549,368.70

600,000.00

05/02/1994 EXTENSION OF TIME TO FILE

09151994
ESTIMATED TAX PENALTY

10,401.00
199440

10117/1993

Form 4340 (Rev. 03-2000) Page: i
B-104

~ - - - - -- - --- - - - - -- - - - - - - - - - - - - - - -- - -- -- --- - - -- - - - - -- - -- -- -------------- - --- ------- --- ----- - -~---- ---

U544

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 28 of 45

- - ---- - -- - - -- - -- - -- -- ---------------- ----- ----------------------- -- - --- ----------- --- ---- - -- - ---- - ~CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

HIGHMARK INC

PO BOX 890089

EIN/SSN: 23-1294723

CAMP HILL, PA i 7089

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1993
EXPLANATION OF TRANSACTIONS
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

= = == = = = = = = = = = = == == = == = = = = ===== === = === == == = = === = ========= == ==== == ===== = = ===== ==== === = === == == == = = == = =

04/15/1994 OVERPAYMENT CREDIT ELECT TRANSFERRED TO NEXT TAX PERIOD

(12,064.70)

03/28/1995 RfCEIVED POA/TIA 01/13/1997 REMOVED POA/TIA 01/13/1997 RECEIVED POA/TIA

.00 .00

.00

04/03/1997
04/21/1998

ASSESSMENT STATUTE EXTENDED TO

06301998
ASSESSMENT STATUTE EXTENDED TO

06301999
ASSESSMENT STATUTE EXTENDED TO

02/23/1999 12/01/1999

06302000
ASSESSMENT STATUTE EXTENDED TO

04302001
LATE FILING PENALTY

.00 .00

02/14/2000 02/14/2000

ADDITIONAL. TAX ASSESSED BY
EXAMINATION

28347-424-1000200
12/31/1999 AMENDED RETURN FILED

29977-440-01287~0
01/25/2001 ASSESSMENT STATUTE EXTENDED TO

12312001
09/06/2001 ASSESSMENT STATUTE EXTENDED TO

12312002

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - 7 - - - - - ~ - - - - - - - ~ - - - - ~ - - - - - - - - ~ - ~ ~ - - - - - - - - - - - - ~ - - - - - - Page:. 2 Form 4340(Rev. 03-2000)

í j?

B-105

U545

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 29 of 45

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1993
EXPLANATION OF TRASACTIONS
ASSESSMENT STATUTE EXTENDED TO

DATE

~ = = == = = = == ======== = = === = ==== = == ==== == = = = == = = = == = ==== ==== = === == == == === = == ===== ==== = = = == ===== ==== = = = =

ASSESSMENT, OTHER DEBITS (REVERSAL)

PAYMENT,

ASSESSMENT

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

08/20/2002
07/25/2003 07/25/2003

12312003
ASSESSMENT STATUTE EXTENDED TO

12312004
ASSESSMENT STATUTE EXTENDED TO

06302004
LATE FILING PENALTY

.00

04/12/2004

04/12/2004 INTEREST DUE TAXPAYER
04/12/2004 PRIOR TAX ABATED BY EXAMINATION
,-

28347 -4 83 -70007-4
03/15/1994 CREDIT TRASFERRED
04/19/2004 CROSS REFERENCE DATA 23-1294723 02 199212

(311,428.00)

(311,428.00)

01/23/2006 LEGAL SUIT PENDING

.00

ASSESSED ITEMS

BALANCE DUE

.00

r

- - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - - - --- - - - - - - - - - ~ - - - - - - - - - - - - Form 4340(Rev. 03-2000) Page: 3

B-106

U546

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 30 of 45

- - -- -- -- ---------------------------------- -- ----- ------ - --- - -- -- -- - - --- - - - -- -- - - - ---- - - -- - -- - ---------------------- ------------------------- --- - -- --- ----- - - ---- - -- ---- - - -HIGHMARK INC

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

PO BOX 890089 CAMP HILL,PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

-- --- --- --- - - - - - -- - ------- - - -- - -- ------- - - - ------- - ---------- ------- - - - -- --- - -- ---- -- - --- - -- - -~ - - - --

FORM: 1120 TAX PERIOD: DEC. 1993

I certify that the foregoing transcript of the taxpayer named above in respect to the taxes specified is a true and complete transcript for the period stated, and all assessments, abatements, credits, refunds, and advance or unidentified payments, and the assessed balance relating thereto, as disclosed by the rec ds of this office as of the date of this certification, are shown therein. I further cert '~a the other / pecified matters set forth

in this transcript appear in the offic~al eco t e Internal evenue Service.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~(~ - -. - - - - - - - - - ~/- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

.

Signature of Certifying Officer: ~
Print Name: Paul L. Czarnecki

/¡j

Title: Accounting Control/Services Operation Manager
Delegation Order: 11

Location: Internal Revenue Servic~ Philadelphia, PA

Account Status Date: 03/08/2006

-- - - - -- - - - - -- - - - --- -- - - - - - - - - - - - -- -- - - -- - - - ---- ----- - -- - --- - -- - - - - - --- - - - - - - - - - - - - - - -- - - - - - - - - - - - --

- - ~- - - - - - - - - - - - _.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form 4340(Rev. 03-2000)
Page: 4

B-107

U847

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 31 of 45

-- -- --- - - -------- - - -- ------- -- --------------------- --- ---------- ---- --- - - - - - -- - --- -- -- - - -- -CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -"- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1994
EXPLANATION OF TRASACTIONS
ASSESSMENT, OTHER DEBITS (REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT
(REVERSAL)

DATE (23C, RAe 006 )

== ==== = = = === == = = = == = === == = == == = = = == == ========== == ====== = === ====== = = = = === = = = = ==== == = === = = = = = = = = = = = = =

NET TAXABLE INCOME

167,613,309.00
09/19/2005 RETURN FILED AND TAX .ASSESSED

35,780,069.00

01/01/1996

2 8 3 1 1 - 2 6 6 - 4 9 0 O~ - 5 1 9 9 5 5 1 \
04/15/1994 ESTIMATED TAX/FEDERAL TAX DEPOSIT

10,500,000.00

06/15/1994 ESTIMATED TAX/FEDERAL TAX DEPOSIT

10,500,000.00

09/15/1994 ESTIMATED TAX/FEDERAL TAX DEPOSIT

3,000,000.00
12,064.70

04/15/1994 OVERPAID CREDIT FROM PRIOR TAX PERIOD

12/15/1994 ESTIMATED TAX/FEDERAL TAX DEPOSIT

4,000,000.00
.00
i

03/28/1995 RECEIVED POA/TIA
r

03/17/1995 INITIAL INSTALLMENT PAYMENT

05/D1/1995 EXTENSION OF TIME TO FILE

09151995
)

03/17/1995 INITIAL INSTALLMENT PAYMENT

.03/15/1995 ESTIMATED TAX/FEDERAL TAX DEPOSIT

7,900,.000.00

-- -- --- - ---- ------- --------- - - ----------- ------~ ----- --~--- - - - - ----- -- -- - - - - - - - - --- - -- ---- - - - - - - - -Form 4340(Rev. 03~200D)
Page: 1

B-108

US48

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 32 of 45

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1994
EXPLANATION OF TRANSACTIONS
ASSESSMENT, OTHER DEBITS
( REVERSAL)
PAYMENT,

ASSESSMENT

DATE

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

04/15/1995 OVERPAYMENT CREDIT ELECT TRANSFERRED TO NEXT TAX PERIOD

(131,995.70)

ESTIMATED TAX PENALTY

234,568.90
199605
. 00

02/12/1996

ADDITIONAL TAX ASSESSED

02/12/1996

28354-419-15091-6
02/12/1996 ESTIMATED TAX PENALTY ABATED
ADDITIONAL TAX ASSESSED

(234,568.90)
_ 00

02/26/1996

28354 -436 -15053-6
01/13/1997 REMOVED POA/TIA
. 00

01/13/1997 RECEIVED POA/TIA

.00

04/21/1998 02/23/1999

ASSESSMENT STATUTE EXTENDED TO

06301999
ASSESSMENT STATUTE EXTENDED TO

06302000

12/01/1999

ASSESSMENT STATUTE EXTENDED TO

04302001
LATE FILING PENALTY
BY

. 00

02/14/2000 02/14/2000

ADDITIONAL TAX ASSESSED

_ 00

EXAMINATION

28347-424-10003-0
12/31/1999 AMENDED RETURN FILED

Form 4340(Rev. 03-2000)

Page: 2

,I

B-109

U549

Case 1:05-cv-01030-LSM

Document 23-5

Filed 02/15/2007

Page 33 of 45

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

HIGHMARK INC

PO BOX 890089
CAMP HILL, PA 17089

EIN/SSN: 23-1294723

U. S. CORPORATION INCOME TAX RETURN

FORM: 1120 TAX PERIOD: DEC. 1994
DATE

EXPLANATION OF TRASACTIONS
ASSESSMENT STATUTE EXTENDED TO

- ~ - - -- - -- -- - - ---- - --- - - - - --- - - - - - ------ ---- -- ---- --- - - ------------------ - -- - - - - - - - ------- -- -- -- -- -- -- -- ---- -- ----- ------- --- - ----- - --- - -- -- ----- - -- - - -- -- -- -- -- -- -- - ------- - - - - - - -- --- -- - -- - --

ASSESSMENT, OTHER DEBITS (REVERSAL)

PAYMENT,

ASSESSMENT

CREDIT (REVERSAL)

DATE (23C, RAC 006 )

01/25/2001 09/06/2001 08/20/2002
07/25/2003

12312001
ASSESSMENT STATUTE EXTENDED TO

12312002
ASSESSMENT STATUTE EXTENDED TO

12312003
ASSESSMENT STATUTE EXTENDED TO

12312004

07/25/2003

ASSESSMENT STATUTE EXTENDED TO

06302004
LATE FILING PENALTY
04 r12/2004 INTEREST DUE TAXPAYER

.00

04/12/2004

04/12/2004 PRIOR TAX ABATED BY EXAMINATION

(272,685.00)

28347-483-70008-4
03/15/1995 CREDIT TRANSFERRED

(267,3