Gulf Coast Health Care - Redacted HWM

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FW: HHS Office of Consumer Ltr (Sent Registered)

From: felicianom@gtlaw.com Sent: Wednesday, December 01, 2010 12:14 PM To: HHS HealthInsurance (HHS) Cc: tioakim@gulfcoasthealthcare.com; sirusr@gtlaw.com Subject: (R)egistered: FW: HHS Office of Consumer Ltr Attachments: [Untitled].pdf

This is a Registered E-mail message from felicianom@gtlaw.com. The attached is being sent on behalf of Richard A. Sirus. Regards,

Greenberg Traurig

federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to

From: LDAP-CHI [mailto:ldap-chi@gtlaw.com] Sent: Wednesday, December 01, 2010 10:58 AM To: Feliciano, Marisol (Secy-Chi-Tx) Subject: HHS Office of Consumer Ltr Please open the attached document. This document was digitally sent to you using an HP Digital Sending device.

<<RegistrationData.txt>>
-----Original Message----For more information about the RPost Registered E-mail service visit http://www.rpost.com
GULF CHC:000001

file:////co-adshare/...%20Health%20Care,%20LLC/(R)egistered%20FW%20HHS%20Office%20of%20Consumer%20Ltr.htm[11/15/2011 10:41:41 AM]

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Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S.

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PLEASE CONSIDER THE ENVIRONMENT BEFORE PRINTING THIS EMAIL

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Marisol Feliciano Assistant to Richard A. Sirus, Michelle C. Kauppila, William H. Mayer and Richard M. Cutshall Greenberg Traurig, LLP | 77 West Wacker Drive | Suite 3100 | Chicago, IL 60601 Tel 312.364.1624 | Fax 312.456.8435 felicianom@gtlaw.com | www.gtlaw.com

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%2012.18.10.htm[11/15/2011 10:43:13 AM]

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GULF CHC:000289

Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (b)(6) (Blackberry)

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file:////co-adshare/...OI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Correspondence%2012.22.10.htm[11/15/2011 10:43:19 AM]

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GULF CHC:000290

From: sirusr@gtlaw.com Sent: Wednesday, December 22, 2010 10:56 AM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); ioakimt@gtlaw.com Subject: RE: Your application on behalf of Gulf Coast

Ms. Andrews, following is the information you requested. Please contact me with any further questions. Rich Sirus


(b)(4)

Single Employee+Child Employee+Spouse Family

Option 3

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com.

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you.
GULF CHC:000291

file:////co-adshare/...n/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%2012.22.10.htm[11/15/2011 10:43:25 AM]

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In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

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From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, December 22, 2010 9:25 AM To: Andrews, Jane (HHS/OCIIO); Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

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Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (Blackberry) (b)(6)

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file:////co-adshare/...n/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%2012.22.10.htm[11/15/2011 10:43:25 AM]

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From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

GULF CHC:000292

From: sirusr@gtlaw.com Sent: Wednesday, December 22, 2010 10:44 AM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast 1. This is a self insured product.
Rich Sirus

Ms. Andrews, sorry for the delay in answering, and the fact that you have to be working on Saturday!

2. This is not a Taft-Hartley fund.

federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com.

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Co m

Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

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From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Saturday, December 18, 2010 12:58 PM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

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the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution

file:////co-adshare/...20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%20(2)%2012.22.10.htm[11/15/2011 10:43:30 AM]

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Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S.

GULF CHC:000293

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk)
GULF CHC:000294

file:////co-adshare/...rres/DFOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%2012.22.10.htm[11/15/2011 10:43:36 AM]

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

pl

In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

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From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:25 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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I apologize for asking one more question, but this is an application that another reviewer, who is out of the office on leave, reviewed and prepared. I am also not clear on the annual limits for the three options. It is an overall annual limit on the 3 plans, and if so, how much, or is it specific annual limits on certain essential benefits? Thanks. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:30 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

(b)(6)

(Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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file:////co-adshare/...rres/DFOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%2012.22.10.htm[11/15/2011 10:43:36 AM]

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GULF CHC:000295

From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you.
GULF CHC:000296

file:////co-adshare/...sing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Additional%20info%20request%2012.22.10.htm[11/15/2011 10:43:41 AM]

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

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From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

co m

In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:25 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (b)(6) (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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GULF CHC:000297

file:////co-adshare/...sing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Additional%20info%20request%2012.22.10.htm[11/15/2011 10:43:41 AM]

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I do still need the annual limits request that was in a separate e-mail this morning. I made three separate requests. Thanks. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 11:49 AM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Wednesday, December 22, 2010 10:56 AM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); ioakimt@gtlaw.com Subject: RE: Your application on behalf of Gulf Coast

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(b)(4)

Single Employee+Child Employee+Spouse Family

Option 1Option 2Option 3


Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com.

From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, December 22, 2010 9:25 AM To: Andrews, Jane (HHS/OCIIO); Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you.
GULF CHC:000298

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%2012.22.10.htm[11/15/2011 10:43:47 AM]

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promoting, marketing or recommending to another party any matters addressed herein.

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Ms. Andrews, following is the information you requested. Please contact me with any further questions. Rich Sirus

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Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (b)(6) (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW:


GULF CHC:000299

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%2012.22.10.htm[11/15/2011 10:43:47 AM]

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From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

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From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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GULF CHC:000300

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%2012.22.10.htm[11/15/2011 10:43:47 AM]

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From: sirusr@gtlaw.com Sent: Wednesday, December 22, 2010 3:29 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); tioakim@gulfcoasthealthcare.com Subject: RE: Your application on behalf of Gulf Coast

Ms. Andrews, Gulf Coast is requesting a waiver for both the overall ann and those f (b)(4) page 3 of the Exhibit A summary you can see that the annual limits are for Option 1 (b)(4) The first few pages of each Option SPD provided indicates the specific l essential be result in higher costs and financial burdens for employees. Please contact me with any further questions.

nefits. If you check for Options 2 and 3. ing any of these will Rich Sirus

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not promoting, marketing or recommending to another party any matters addressed herein.

The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply postmaster@gtlaw.com.

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:25 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you. Jane W. Andrews OCIIO
GULF CHC:000301

file:////co-adshare/...20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%20(3)%2012.22.10.htm[11/15/2011 10:43:52 AM]

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I apologize for asking one more question, but this is an application that another reviewer, who is out of the office on leave, reviewed and prepared. I am also not clear on the annual limits for the three options. It is an overall annual limit on the 3 plans, and if so, how much, or is it specific annual limits on certain essential benefits? Thanks. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

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From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, December 22, 2010 9:30 AM To: Andrews, Jane (HHS/OCIIO); Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast

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email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to

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intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2)

7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast

Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government
GULF CHC:000302

file:////co-adshare/...20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%20(3)%2012.22.10.htm[11/15/2011 10:43:52 AM]

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (Blackberry) (b)(6)

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use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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GULF CHC:000303

file:////co-adshare/...20Coast%20Health%20Care,%20LLC/Request%20for%20info%20response%20(3)%2012.22.10.htm[11/15/2011 10:43:52 AM]

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Ive got them. Thanks. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 3:58 PM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'tioakim@gulfcoasthealthcare.com' Subject: RE: Your application on behalf of Gulf Coast

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Wednesday, December 22, 2010 3:29 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); tioakim@gulfcoasthealthcare.com Subject: RE: Your application on behalf of Gulf Coast

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com.

From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Wednesday, December 22, 2010 9:30 AM To: Andrews, Jane (HHS/OCIIO); Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast I apologize for asking one more question, but this is an application that another reviewer, who is out of the office on leave, reviewed and prepared. I am also not clear on the annual limits for the three options. It is an overall annual limit on the 3 plans, and if so, how much, or is it specific annual limits on certain essential benefits? Thanks. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814
GULF CHC:000304

file:////co-adshare/...FOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Correspodence%2012.22.10.htm[11/15/2011 10:43:57 AM]

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or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply

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The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of

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Ms. Andrews, Gulf Coast is requesting a waiver for both the overall annual limits and those for essential benefits. If you check (b)(4) page 3 of the Exhibit A summary you can see that the annual limits are (b)(4) for Option 1 and for Options 2 and 3. essential benefits. Increasing any of these will The first few pages of each Option SPD provided indicates the specific result in higher costs and financial burdens for employees. Please contact me with any further questions. Rich Sirus

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301-492-4122 (desk) (Blackberry) (b)(6)

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:25 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); 'ioakimt@gtlaw.com' Subject: RE: Your application on behalf of Gulf Coast In addition, your application did not specify the number of enrollees in each of the 3 options. Could you please provide the number of enrollees in Option 1, broken down by employee tier (e.g. single,double, etc.) Option 2, and Option 3. Is there a way I could get all this information by close of business today? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

From: Andrews, Jane (HHS/OCIIO) Sent: Wednesday, December 22, 2010 10:06 AM To: Andrews, Jane (HHS/OCIIO); 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Your application on behalf of Gulf Coast

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: Andrews, Jane (HHS/OCIIO) Sent: Saturday, December 18, 2010 1:58 PM To: 'Sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: Your application on behalf of Gulf Coast
GULF CHC:000305

file:////co-adshare/...FOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Correspodence%2012.22.10.htm[11/15/2011 10:43:57 AM]

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Mr. Sirus can you please respond to the below e-mail so I can complete this application? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

file:////co-adshare/...FOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Correspodence%2012.22.10.htm[11/15/2011 10:43:57 AM]

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Mr. Sirus I am in receipt of your application for a waiver of annual limits on behalf of Gulf Coast. Could you please answer the following question so we can complete our review of this applicant? Is this a self-insured or fully insured product? Also, it does not appear to be a Taft Hartley plan. Please confirm. If it is a Taft Hartley plan, can you please tell me the effective date of the collective bargaining agreement and its expiration date? Thank you. Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

GULF CHC:000306

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Thursday, January 06, 2011 7:54 AM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence
Mr. Sirus, I sincerely apologize for the confusion. In my haste to get the approvals and denials out as close to the first of the year as possible I neglected to specify exactly which plans the approval letter referred to and which plans the denial letter referred to. The Gulf Plans that the denial letter refers to are as follows: Anthem Option 2 Anthem Option 3 The Gulf Plans that the approval letter refers to are as follows: Anthem Option 1 I have saved this letter, as well as the denial and approval letter, in Gulf Coasts file so there will be no confusion in the future. Please let me know if you have any further questions. Sincerely,

Importance: High

alexandra.botwinick@hhs.gov

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Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com. From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Monday, January 03, 2011 9:48 AM
GULF CHC:000307

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Approval%20clarification%201.6.11.htm[11/15/2011 10:44:03 AM]

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Ms. Botwinick, you have confused us with your most recent correspondence regarding our client'swaiver request. We received the attached approval last week. Your most recent correspondence is a denial. Please contact me to discuss. Richard Sirus, 312476-5006

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From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Tuesday, January 04, 2011 11:57 AM To: Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011

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Alexandra Botwinick Office of Oversight HHS/OCIIO

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To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Subject: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Importance: High

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GULF CHC:000308

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

file:////co-adshare/...Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Approval%20clarification%201.6.11.htm[11/15/2011 10:44:03 AM]

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Good Morning, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Gulf Coast Health Care. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,

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GULF CHC:000309

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GULF CHC:000310

From: sirusr@gtlaw.com Sent: Tuesday, January 04, 2011 11:44 AM To: Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 12-29-2010 Follow Up Flag: Follow up Flag Status: Red

Ms. Botwinick, on behalf of our client, thank you for the waiver grant. We appreciate the waiver and your attention to this matter. Richard Sirus

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not promoting, marketing or recommending to another party any matters addressed herein.

The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply postmaster@gtlaw.com.

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

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Sincerely,

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Please confirm receipt of this letter by replying to this e-mail.

Please let me know if I can be of further assistance.

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Good Afternoon,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Gulf Coast Health Care. HHS has reviewed your application and made its determination. Please see the attached letter.

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From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Wednesday, December 29, 2010 3:56 PM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Subject: Gulf Coast Health Care Waiver of the Annual Limits Requirements 12-29-2010 Importance: High

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email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to

file:////co-adshare/...0Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Approval%20confirmation%201.4.11.htm[11/15/2011 10:44:21 AM]

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intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2)

GULF CHC:000311

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Wednesday, December 29, 2010 4:56 PM To: sirusr@gtlaw.com Subject: Gulf Coast Health Care Waiver of the Annual Limits Requirements 12-29-2010 Importance: High Follow Up Flag: Follow up Flag Status: Green Attachments: Dec 1 Letter .pdf Good Afternoon,

Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Gulf Coast Health Care. HHS has reviewed your application and made its determination. Please see the attached letter.

Please let me know if I can be of further assistance.


Sincerely,

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Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

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Alexandra Botwinick

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GULF CHC:000312

Please confirm receipt of this letter by replying to this e-mail.

file:////co-adshare/...rres/DFOI%20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Approval%2012.29.10.htm[11/15/2011 10:44:26 AM]

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GULF CHC:000313

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GULF CHC:000314

From: sirusr@gtlaw.com Sent: Monday, January 10, 2011 1:53 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

Ms. Botwinick, I have not heard back from you regarding my request for a discussion about the waiver denial on Options 2 and 3. The denial came as a surprise and will cause the sponsor and plan partcipantsgreat difficultyand expense. Please contact me at your earliest convenience. Rich Sirus

alexandra.botwinick@hhs.gov

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Alexandra Botwinick Office of Oversight HHS/OCIIO

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Mr. Sirus, I sincerely apologize for the confusion. In my haste to get the approvals and denials out as close to the first of the year as possible I neglected to specify exactly which plans the approval letter referred to and which plans the denial letter referred to. The Gulf Plans that the denial letter refers to are as follows: Anthem Option 2 Anthem Option 3 The Gulf Plans that the approval letter refers to are as follows: Anthem Option 1 I have saved this letter, as well as the denial and approval letter, in Gulf Coasts file so there will be no confusion in the future. Please let me know if you have any further questions. Sincerely,

From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Tuesday, January 04, 2011 11:57 AM To: Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011

Ms. Botwinick, you have confused us with your most recent correspondence regarding our client'swaiver request. We received the attached approval last week. Your most recent correspondence is a denial. Please contact me to discuss. Richard Sirus, 312476-5006

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein.
GULF CHC:000315

file:////co-adshare/.../Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20on%20approval%20&%20denial%201.10.11.htm[11/15/2011 10:44:37 AM]

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From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Thursday, January 06, 2011 6:54 AM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence Importance: High

The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com. From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Monday, January 03, 2011 9:48 AM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Subject: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Importance: High

alexandra.botwinick@hhs.gov

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Alexandra Botwinick Office of Oversight HHS/OCIIO

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Good Morning, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Gulf Coast Health Care. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,

file:////co-adshare/.../Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20on%20approval%20&%20denial%201.10.11.htm[11/15/2011 10:44:37 AM]

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GULF CHC:000316

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Monday, January 10, 2011 2:11 PM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); Andrews, Jane (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence Importance: High
Mr. Sirus, I apologize for not having gotten back to you sooner. With the influx of applications with a January 1 st effective date you can

From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Monday, January 10, 2011 1:53 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Thursday, January 06, 2011 6:54 AM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence Importance: High Mr. Sirus, I sincerely apologize for the confusion. In my haste to get the approvals and denials out as close to the first of the year as possible I neglected to specify exactly which plans the approval letter referred to and which plans the denial letter referred to. The Gulf Plans that the denial letter refers to are as follows: Anthem Option 2 Anthem Option 3
GULF CHC:000317

file:////co-adshare/...20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20response%201.10.11.htm[11/15/2011 10:44:43 AM]

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Ms. Botwinick, I have not heard back from you regarding my request for a discussion about the waiver denial on Options 2 and 3. The denial came as a surprise and will cause the sponsor and plan partcipantsgreat difficultyand expense. Please contact me at your earliest convenience. Rich Sirus

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Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

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imagine how swamped we have been and our primary goal was to get people our decision by the 1 st of the year if not soon after. I understand your desire to have a discussion concerning the plans that were denied and the best person for you to call would be Jane Andrews at 301-492-4122. She will be able to assist you in the appeals process. Please let me know if you are unable to reach her or if you have any further questions. One again, I do apologize for my delayed response. Sincerely,

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The Gulf Plans that the approval letter refers to are as follows: Anthem Option 1 I have saved this letter, as well as the denial and approval letter, in Gulf Coasts file so there will be no confusion in the future. Please let me know if you have any further questions. Sincerely,

Ms. Botwinick, you have confused us with your most recent correspondence regarding our client'swaiver request. We received the attached approval last week. Your most recent correspondence is a denial. Please contact me to discuss. Richard Sirus, 312476-5006

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com. promoting, marketing or recommending to another party any matters addressed herein.

Good Morning, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Gulf Coast Health Care. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,

Alexandra Botwinick

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From: Botwinick, Alexandra (HHS/OCIIO) [mailto:Alexandra.Botwinick@hhs.gov] Sent: Monday, January 03, 2011 9:48 AM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Subject: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Importance: High

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From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Tuesday, January 04, 2011 11:57 AM To: Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011

file:////co-adshare/...20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20response%201.10.11.htm[11/15/2011 10:44:43 AM]

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GULF CHC:000318

Alexandra Botwinick Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

Office of Oversight HHS/OCIIO

alexandra.botwinick@hhs.gov

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GULF CHC:000319

file:////co-adshare/...20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20response%201.10.11.htm[11/15/2011 10:44:43 AM]

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From: Andrews, Jane (HHS/OCIIO) Sent: Monday, January 10, 2011 5:58 PM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence Alex Botwinick referred your e-mail below to me. If you wish to set up a phone call to discuss a reconsideration of the denial of a waiver of annual limit requirements, I can help with that; however, the applicant should draft a letter
to the same e-mail or post-office stop as the original address, with a cc to me. The letter should set out supplemental information not included in the original letter explaining why the denial of the waiver determination will result in either: i. A significant increase in premiums, or ii. A significant decrease in access to benefits. Upon receipt of that letter, I can arrange a phone call with a manager as soon as feasible. Thank you.
Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

Jane Andrews

Ms. Botwinick, I have not heard back from you regarding my request for a discussion about the waiver denial on Options 2 and 3. The denial came as a surprise and will cause the sponsor and plan partcipantsgreat difficultyand expense. Please contact me at your earliest convenience. Rich Sirus

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From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Monday, January 10, 2011 1:53 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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GULF CHC:000320

file:////co-adshare/...0Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%201.10.11.htm[11/15/2011 10:44:48 AM]

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From: sirusr@gtlaw.com Sent: Friday, January 21, 2011 12:32 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence
Ms. Andrews, we have been working with Gulf Coast to obtain the supplemental information to request a reconsideration of the denial of the annual limit waiver. We hope to have this information in the next two weeks. Can you tell me whether there is any time limit or deadline for the request? Also, can you advise what the client should do in the interim while the reconsideration is pending? Your assistance is greatly appreciated. Please contact me with any questions. Rich Sirus

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not promoting, marketing or recommending to another party any matters addressed herein.

The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply postmaster@gtlaw.com.

Alex Botwinick referred your e-mail below to me. If you wish to set up a phone call to discuss a reconsideration of the denial of a waiver of annual limit requirements, I can help with that; however, the applicant should draft a letter
to the same e-mail or post-office stop as the original address, with a cc to me. The letter should set out supplemental information not included in the original letter explaining why the denial of the waiver determination will result in either: i. A significant increase in premiums, or ii. A significant decrease in access to benefits. Upon receipt of that letter, I can arrange a phone call with a manager as soon as feasible. Thank you.
Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (Blackberry) (b)(6)

Jane Andrews

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
GULF CHC:000321

file:////co-adshare/...20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%201.21.11.htm[11/15/2011 10:44:53 AM]

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From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Monday, January 10, 2011 4:58 PM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

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email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to

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intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2)

Unauthorized disclosure may result in prosecution to the full extent of the law.
From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Monday, January 10, 2011 1:53 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

Ms. Botwinick, I have not heard back from you regarding my request for a discussion about the waiver denial on Options 2 and 3. The denial came as a surprise and will cause the sponsor and plan partcipantsgreat difficultyand expense. Please contact me at your earliest convenience. Rich Sirus

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GULF CHC:000322

file:////co-adshare/...20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Request%20for%20info%201.21.11.htm[11/15/2011 10:44:53 AM]

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Are you asking what they should do in the interim because their effective date has come and gone? Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 301-492-4122 (desk) (b)(6) (Blackberry)

From: Andrews, Jane (HHS/OCIIO) Sent: Friday, January 21, 2011 1:55 PM To: 'sirusr@gtlaw.com' Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Friday, January 21, 2011 12:32 PM To: Andrews, Jane (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

Tax Advice Disclosure: To ensure compliance with requirements imposed by the IRS under Circular 230, we inform you that any U.S. federal tax advice contained in this communication (including any attachments), unless otherwise specifically stated, was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties under the Internal Revenue Code or (2) promoting, marketing or recommending to another party any matters addressed herein. the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution email and destroy all copies of the original message. To reply to our email administrator directly, please send an email to postmaster@gtlaw.com.

From: Andrews, Jane (HHS/OCIIO) [mailto:Jane.Andrews@hhs.gov] Sent: Monday, January 10, 2011 4:58 PM To: Sirus, Richard A. (Shld-Chi-Corp-ERISA-Tax) Cc: Habit, Sandra (HHS/OCIIO); Botwinick, Alexandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

Alex Botwinick referred your e-mail below to me. If you wish to set up a phone call to discuss a reconsideration of the denial of a waiver of annual limit requirements, I can help with that; however, the applicant should draft a letter
to the same e-mail or post-office stop as the original address, with a cc to me. The letter should set out supplemental information not included in the original letter explaining why the denial of the waiver determination will result in either: i. A significant increase in premiums, or
GULF CHC:000323

file:////co-adshare/...20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20response%201.21.11.htm[11/15/2011 10:44:57 AM]

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or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply

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The information contained in this transmission may contain privileged and confidential information. It is intended only for the use of

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Ms. Andrews, we have been working with Gulf Coast to obtain the supplemental information to request a reconsideration of the denial of the annual limit waiver. We hope to have this information in the next two weeks. Can you tell me whether there is any time limit or deadline for the request? Also, can you advise what the client should do in the interim while the reconsideration is pending? Your assistance is greatly appreciated. Please contact me with any questions. Rich Sirus

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ii. A significant decrease in access to benefits.

Upon receipt of that letter, I can arrange a phone call with a manager as soon as feasible. Thank you.

Jane Andrews

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Ms. Botwinick, I have not heard back from you regarding my request for a discussion about the waiver denial on Options 2 and 3. The denial came as a surprise and will cause the sponsor and plan partcipantsgreat difficultyand expense. Please contact me at your earliest convenience. Rich Sirus

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From: sirusr@gtlaw.com [mailto:sirusr@gtlaw.com] Sent: Monday, January 10, 2011 1:53 PM To: Botwinick, Alexandra (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Gulf Coast Health Care Waiver of the Annual Limits Requirements 1-3-2011 Correspondence

ra do .

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

file:////co-adshare/...20Processing%20Team/Brandon/Gulf%20Coast%20Health%20Care,%20LLC/Question%20response%201.21.11.htm[11/15/2011 10:44:57 AM]

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Jane W. Andrews OCIIO 7501 Wisconsin Ave Bethesda, MD 20814 (desk) (b)(6) (Blackberry)

GULF CHC:000324

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