UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

FORM 10-Q
(Mark One)
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31,June 30, 2017
 
Oror

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(D) OF THE SECURITIES EXCHANGE ACT OF 1934
 
For the transition period from           to

COMMISSION FILE NUMBER:  001-33865
 
Triple-S Management Corporation
 
Puerto Rico 66-0555678
(State or other jurisdiction of incorporation or organization) (I.R.S. Employer Identification No.)
   
1441 F.D. Roosevelt Avenue
San Juan, Puerto Rico 00920
(Address of principal executive offices) (Zip code)
 
(787) 749-4949
(Registrant’s telephone number, including area code)

Not applicable
(Former name, former address and former fiscal year, if changed since last report)

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.
   Yes   No
 
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).
Yes    No
 
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company, or an emerging growth company.  See the definitions of “large accelerated filer”,filer,” “accelerated filer”filer,”  “smaller reporting company,” and “smaller reporting“emerging growth company” in Rule 12b-2 of the Exchange Act.  (Check one):
 
Large accelerated filer  
Accelerated filer  
Non-accelerated filer  
Smaller reporting company  
Emerging growth company ☐
 

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). 
Yes   No
 
Indicate the number of shares outstanding of each of the issuer’sissuer's classes of common stock, as of the latest practicable date.
 
Title of each class
Outstanding at March 31,June 30, 2017
Common Stock Class A, $1.00 par value950,968
Common Stock Class B, $1.00 par value23,491,67023,494,170
 


Triple-S Management Corporation
FORM 10-Q
For the Quarter Ended March 31,June 30, 2017
 
Table of Contents

3
  
Item 1.3
   
Item 2.3031
   
 3031
 3031
 3132
 3234
 3234
 3335
 3538
 3741
�� 3842
 3944
   
Item 3.4146
   
Item 4.4146
   
4148
Item 1.48
   
Item 1A.Item 1.Legal Proceedings4148
   
Item 1A.Risk Factors41
Item 2.4249
   
Item 3.4249
   
Item 4.4249
   
Item 5.4249
   
Item 6.4249
   
4350
 
2

Part I – Financial Information
 
Item 1.
Financial Statements

Triple-S Management Corporation
Condensed Consolidated Balance Sheets (Unaudited)
(dollar amounts in thousands, except share data)

 
March 31,
2017
  
December 31,
2016
  
June 30,
2017
  
December 31,
2016
 
Assets            
Investments and cash:            
Securities available for sale, at fair value:            
Fixed maturities $1,153,545  $1,151,643  $1,196,161  $1,151,643 
Equity securities  277,149   270,349   287,820   270,349 
Securities held to maturity, at amortized cost:                
Fixed maturities  2,514   2,836   2,835   2,836 
Policy loans  8,546   8,564   8,716   8,564 
Cash and cash equivalents  218,884   103,428   172,526   103,428 
Total investments and cash  1,660,638   1,536,820   1,668,058   1,536,820 
Premiums and other receivables, net  292,837   286,365   320,548   286,365 
Deferred policy acquisition costs and value of business acquired  195,513   194,787   200,034   194,787 
Property and equipment, net  66,756   66,369   69,083   66,369 
Deferred tax asset  64,128   57,768   69,576   57,768 
Goodwill  25,397   25,397   25,397   25,397 
Other assets  53,186   51,493   52,672   51,493 
Total assets $2,358,455  $2,218,999  $2,405,368  $2,218,999 
Liabilities and Stockholders’ Equity        
Liabilities and Stockholders' Equity        
Claim liabilities $530,304  $487,943  $504,240  $487,943 
Liability for future policy benefits  326,162   321,232   331,427   321,232 
Unearned premiums  163,780   79,310   175,561   79,310 
Policyholder deposits  179,599   179,382   179,225   179,382 
Liability to Federal Employees’ Health Benefits and Federal Employees’ Programs  37,206   34,370 
Liability to Federal Employees' Health Benefits and Federal Employees' Programs  40,363   34,370 
Accounts payable and accrued liabilities  171,643   169,449   204,194   169,449 
Deferred tax liability  19,599   18,850   22,203   18,850 
Long-term borrowings  34,465   35,085   33,667   35,085 
Liability for pension benefits  30,472   30,892   30,496   30,892 
Total liabilities  1,493,230   1,356,513   1,521,376   1,356,513 
Stockholders’ equity:                
Triple-S Management Corporation stockholders’ equity        
Common stock Class A, $1 par value. Authorized 100,000,000 shares; issued and outstanding 950,968 at March 31, 2017 and December 31, 2016, respectively  951   951 
Common stock Class B, $1 par value. Authorized 100,000,000 shares; issued and outstanding 23,491,670 and 23,321,163 shares at March 31, 2017 and December 31, 2016, respectively  23,492   23,321 
Triple-S Management Corporation stockholders' equity        
Common stock Class A, $1 par value. Authorized 100,000,000 shares;issued and outstanding 950,968 at June 30, 2017and December 31, 2016, respectively
  951   951 
Common stock Class B, $1 par value. Authorized 100,000,000 shares; issued and outstanding 23,494,170 and 23,321,163 shares at June 30, 2017 and December 31, 2016, respectively
  23,494   23,321 
Additional paid-in capital  63,978   65,592   65,589   65,592 
Retained earnings  726,562   730,904   739,267   730,904 
Accumulated other comprehensive income  50,920   42,395   55,369   42,395 
Total Triple-S Management Corporation stockholders’ equity  865,903   863,163 
Total Triple-S Management Corporation stockholders' equity  884,670   863,163 
Non-controlling interest in consolidated subsidiary  (678)  (677)  (678)  (677)
Total stockholders’ equity  865,225   862,486 
Total liabilities and stockholders’ equity $2,358,455  $2,218,999 
Total stockholders' equity  883,992   862,486 
Total liabilities and stockholders' equity $2,405,368  $2,218,999 

See accompanying notes to unaudited condensed consolidated financial statements.
 
3

Triple-S Management Corporation
Condensed Consolidated Statements of Earnings (Unaudited)
(dollar amounts in thousands, except per share data)


 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Revenues:                  
Premiums earned, net $702,273  $738,534  $722,891  $729,049  $1,425,164  $1,467,583 
Administrative service fees  4,379   5,083   4,548   4,520   8,927   9,603 
Net investment income  12,016   11,358   12,698   12,875   24,714   24,233 
Other operating revenues  965   812   1,121   915   2,086   1,727 
Total operating revenues  719,633   755,787   741,258   747,359   1,460,891   1,503,146 
Net realized investment gains (losses):                
Total other-than-temporary impairment losses on securities  -   (1,434)  -   (1,434)
Net realized gains, excluding other-than-temporary impairment losses on securities  4,054   2,954   4,390   3,012 
Net realized investment gains on sale of securities  336   58   4,054   1,520   4,390   1,578 
Other income, net  2,525   875   587   3,859   3,112   4,734 
Total revenues  722,494   756,720   745,899   752,738   1,468,393   1,509,458 
Benefits and expenses:                        
Claims incurred  620,863   626,694   611,297   622,087   1,232,160   1,248,781 
Operating expenses  110,946   122,980   118,720   121,112   229,666   244,092 
Total operating costs  731,809   749,674   730,017   743,199   1,461,826   1,492,873 
Interest expense  1,686   1,882   1,721   1,954   3,407   3,836 
Total benefits and expenses  733,495   751,556   731,738   745,153   1,465,233   1,496,709 
(Loss) income before taxes  (11,001)  5,164 
Income taxes  (6,658)  1,709 
Net (loss) income  (4,343)  3,455 
Income before taxes  14,161   7,585   3,160   12,749 
Income tax expense (benefit)  1,456   3,707   (5,202)  5,416 
Net income  12,705   3,878   8,362   7,333 
Less: Net loss attributable to non-controlling interest  1   1   -   2   1   3 
Net (loss) income attributable to Triple-S Management Corporation $(4,342) $3,456 
Net income attributable to Triple-S Management Corporation $12,705  $3,880  $8,363  $7,336 
Earnings per share attributable to Triple-S Management Corporation                        
Basic net (loss) income per share $(0.18) $0.14 
Diluted net (loss) income per share $(0.18) $0.14 
Basic net income per share $0.52  $0.16  $0.35  $0.30 
Diluted net income per share $0.52  $0.16  $0.34  $0.30 

See accompanying notes to unaudited condensed consolidated financial statements.
 
4

Triple-S Management Corporation
Condensed Consolidated Statements of Comprehensive Income (Unaudited)
(dollar amounts in thousands)
 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Net (loss) income $(4,343) $3,455 
Net income $12,705  $3,878  $8,362  $7,333 
Other comprehensive (loss) income, net of tax:                        
Net unrealized change in fair value of available for sale securities, net of taxes  8,472   19,577   4,396   15,830   12,868   35,407 
Defined benefit pension plan:                        
Actuarial loss, net  53   722   53   507   106   1,229 
Prior service credit, net  -   (88)  -   (62)  -   (150)
Total other comprehensive income, net of tax  8,525   20,211   4,449   16,275   12,974   36,486 
Comprehensive income  4,182   23,666   17,154   20,153   21,336   43,819 
Comprehensive income attributable to non-controlling interest  1   1   -   2   1   3 
Comprehensive income attributable to Triple-S Management Corporation $4,183  $23,667  $17,154  $20,155  $21,337  $43,822 

See accompanying notes to unaudited condensed consolidated financial statements.
 
5

Triple-S Management Corporation
Condensed Consolidated Statements of Stockholders’ Equity (Unaudited)
(dollar amounts in thousands)

 2017  2016  2017  2016 
Balance at January 1 $863,163  $847,526  $863,163  $847,526 
Share-based compensation  (1,443)  1,421   170   2,649 
Stock issued upon the exercise of stock options  -   55 
Repurchase and retirement of common stock  -   (8,027)  -   (14,616)
Comprehensive income  4,183   23,667   21,337   43,822 
Total Triple-S Management Corporation stockholders’ equity  865,903   864,587 
Total Triple-S Management Corporation stockholders' equity  884,670   879,436 
Non-controlling interest in consolidated subsidiary  (678)  (671)  (678)  (673)
Balance at March 31 $865,225  $863,916 
Balance at June 30 $883,992  $878,763 

See accompanying notes to unaudited condensed consolidated financial statements.
 
6

Triple-S Management Corporation
Condensed Consolidated Statements of Cash Flows (Unaudited)
(Dollardollar amounts in thousands)

 
Three months ended
March 31,
  
Six months ended
June 30,
 
 2017  2016  2017  2016 
Cash flows from operating activities:            
Net (loss) income $(4,343) $3,455 
Net income $8,362   7,333 
Adjustments to reconcile net income to net cash provided by operating activities:                
Depreciation and amortization  2,990   3,700   6,454   7,300 
Net amortization of investments  2,356   1,936   4,787   3,981 
(Reductions) additions to the allowance for doubtful receivables  (3,209)  1,531 
Deferred tax benefit  (7,525)  (2,435)
Reductions to the allowance for doubtful receivables  (2,390)  (313)
Deferred tax (benefit) expense  (11,734)  4,301 
Net realized investment gain on sale of securities  (336)  (58)  (4,390)  (1,578)
Interest credited to policyholder deposits  991   1,195   2,144   2,436 
Share-based compensation  (1,443)  1,085   170   2,313 
(Increase) decrease in assets:                
Premium and other receivables, net  (3,263)  (35,687)  (25,078)  (63,589)
Deferred policy acquisition costs and value of business acquired  (822)  (685)  (5,621)  (3,562)
Deferred taxes  (265)  162   (280)  178 
Other assets  (37)  (26,485)  (1,229)  (31,425)
Increase (decrease) in liabilities:                
Claim liabilities  42,361   33,301   16,297   (9,901)
Liability for future policy benefits  4,930   17,395   10,195   19,961 
Unearned premiums  84,470   (4,387)  96,251   1,791 
Liability to Federal Employees’ Health Benefits and Federal Employees’ Programs  2,836   1,663 
Liability to Federal Employees' Health Benefits and Federal Employees' Programs
  5,993   (2,141)
Accounts payable and accrued liabilities  11,274   35,574   33,774   52,350 
Net cash provided by operating activities  130,965   31,260 
(Continued)        
Net cash provided by (used in) operating activities  133,705   (10,565)
(Continued)
 
7

Triple-S Management Corporation
Condensed Consolidated Statements of Cash Flows (Unaudited)
(Dollardollar amounts in thousands)


 
Three months ended
March 31,
  
Six months ended
June 30,
 
 2017  2016  2017  2016 
Cash flows from investing activities:            
Proceeds from investments sold or matured:            
Securities available for sale:            
Fixed maturities sold $26,023  $90,328  $88,141  $163,150 
Fixed maturities matured/called  5,001   699   8,938   14,301 
Equity securities sold  10,272   11,257   21,499   32,252 
Securities held to maturity:                
Fixed maturities matured/called  703   -   703   700 
Acquisition of investments:                
Securities available for sale:                
Fixed maturities  (33,738)  (118,039)  (141,116)  (150,005)
Equity securities  (5,482)  (92,956)  (20,424)  (136,104)
Securities held to maturity:                
Fixed maturities  (382)  -   (703)  (609)
Increase in other investments  (2,044)  (182)  (731)  (1,383)
Net change in policy loans  18   (231)  (152)  (400)
Net capital expenditures  (3,295)  (1,465)  (8,704)  (2,716)
Net cash used in investing activities  (2,924)  (110,589)  (52,549)  (80,814)
Cash flows from financing activities:                
Change in outstanding checks in excess of bank balances  (11,401)  1,916   (8,545)  4,074 
Repayments of long-term borrowings  (24,676)  (410)  (1,212)  (820)
Proceeds from long-term borrowings  24,266   - 
Repurchase and retirement of common stock  -   (8,027)  -   (14,560)
Proceeds from policyholder deposits  4,116   3,403   8,166   7,942 
Surrenders of policyholder deposits  (4,890)  (2,905)  (10,467)  (6,935)
Net cash used in financing activities  (12,585)  (6,023)  (12,058)  (10,299)
Net increase (decrease) in cash and cash equivalents  115,456   (85,352)  69,098   (101,678)
Cash and cash equivalents:                
Beginning of period  103,428   197,818   103,428   197,818 
End of period $218,884  $112,466  $172,526  $96,140 

See accompanying notes to unaudited condensed consolidated financial statements.
 
8

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
 
(1)Basis of Presentation

The accompanying condensed consolidated interim financial statements prepared by Triple-S Management Corporation and its subsidiaries are unaudited.  In this filing, the “Corporation”, the “Company”, “TSM”, “we”, “us” and “our” refer to Triple-S Management Corporation and its subsidiaries.  The condensed consolidated interim financial statements do not include all of the information and the footnotes required by accounting principles generally accepted in the U.S. (GAAP) for complete financial statements.  These condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements included in the Corporation’s Annual Report on Form 10-K for the year ended December 31, 2016.

In the opinion of management, all adjustments, consisting of a normal recurring nature necessary for a fair presentation of such condensed consolidated interim financial statements, have been included.  The results of operations for the three months and six months ended March 31,June 30, 2017 are not necessarily indicative of the results for the full year ending December 31, 2017.

(2)Recent Accounting Standards

On May 10, 2017, the Financial Accounting Standard Board (FASB) issued guidance to provide clarity and reduce both (1) diversity in practice and (2) cost and complexity when applying the guidance in Topic 718, Compensation-Stock Compensation, to a change in the terms and conditions of a share-based payment award.  The amendments in this update affect any entity that changes the terms or conditions of a share-based payment award.  This guidance indicates an entity should account for the effects of a modification unless the following criteria are met: (1) the fair value (or calculated value or intrinsic value, if such an alternative measurement method is used) of the modified award is the same as the fair value (or calculated value or intrinsic value, if such an alternative measurement method is used) of the original award immediately before the original award is modified. If the modification does not affect any of the inputs to the valuation technique that the entity uses to value the award, the entity is not required to estimate the value immediately before and after the modification, (2) the vesting conditions of the modified award are the same as the vesting conditions of the original award immediately before the original award is modified, and (3) the classification of the modified award as an equity or liability instrument is the same as the classification of the original award immediately before the original award is modified. For all companies, these amendments, which should be applied on a prospective basis, are effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years.  We are currently evaluating the impact the adoption of this guidance may have on the Company's consolidated financial statements.

On March 10, 2017, the FASB issued guidance to improve the presentation of defined benefit costs in the income statement.  In particular, the guidance requires that an employer report the service cost component in the same line item(s) as other compensation costs arising from services rendered by the pertinent employees during the period. The other components of net benefit cost are required to be presented in the income statement separately from the service cost component and outside a subtotal of income from operations, if one is presented.  Additionally, this guidance allows only the service cost component to be eligible for capitalization, when applicable (e.g., as a cost of internally manufactured inventory or a self-constructed asset).  For public companies, these amendments, which should be applied on a prospective basis, are effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years.  Since we do not present a subtotal of income from operations, the adoption of this guidance should not have a material impact on the presentation of the Company’s consolidated result of operations.
9

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
 
On January 26, 2017, the FASB issued guidance to simplify the manner in which an entity is required to evaluate goodwill for impairment by eliminating Step 2 from the goodwill impairment test.  Step 2 measures a goodwill impairment loss by comparing the implied fair value of a reporting unit’s goodwill with the carrying amount of that goodwill.  Instead, under the amendments in this guidance, an entity should (1) perform its annual or interim goodwill impairment test by comparing the fair value of a reporting unit with its carrying amount, and (2) recognize an impairment charge for the amount by which the carrying amount exceeds the reporting unit’s fair value, with the understanding that the loss recognized should not exceed the total amount of goodwill allocated to that reporting unit.  Additionally, this guidance removes the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails such qualitative test, to perform Step 2 of the goodwill impairment test.  For public companies, these amendments, which should be applied on a prospective basis, are effective for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years.  We are currently evaluating the impact the adoption of this guidance may have on the Company’sCompany's consolidated financial statements.

Other than the accounting pronouncement disclosed above, there were no other new accounting pronouncements issued during the three months and six months ended March 31,June 30, 2017 that could have a material impact on the Corporation’s financial position, operating results or financials statementfinancial statements disclosures.
9

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

(3)Investment in Securities

The amortized cost for debt securities and cost for equity securities, gross unrealized gains, gross unrealized losses, and estimated fair value for available-for-sale and held-to-maturity securities by major security type and class of security at March 31,June 30, 2017 and December 31, 2016, were as follows:

 March 31, 2017  June 30, 2017 
 
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities available for sale:                        
Fixed maturities:                        
Obligations of government-sponsored enterprises $41,485  $61  $-  $41,546  $40,358  $29  $(4) $40,383 
U.S. Treasury securities and obligations of U.S. government instrumentalities  72,723   169   (14)  72,878   79,932   180   (115)  79,997 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  18,248   857   (37)  19,068   11,719   445   (3)  12,161 
Municipal securities  651,091   34,191   (304)  684,978   682,576   34,459   (393)  716,642 
Corporate bonds  279,540   12,457   (367)  291,630   278,417   15,626   (89)  293,954 
Residential mortgage-backed securities  638   29   -   667   11,877   35   (3)  11,909 
Collateralized mortgage obligations  42,919   83   (224)  42,778   41,129   97   (111)  41,115 
Total fixed maturities  1,106,644   47,847   (946)  1,153,545   1,146,008   50,871   (718)  1,196,161 
Equity securities - Mutual funds  236,356   40,910   (117)  277,149 
Equity securities:                
Mutual funds  214,923   43,446   (6)  258,363 
Alternative investments  29,336   368   (247)  29,457 
Total equity maturites  244,259   43,814   (253)  287,820 
Total $1,343,000  $88,757  $(1,063) $1,430,694  $1,390,267  $94,685  $(971) $1,483,981 
 
10

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

  December 31, 2016 
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities available for sale:            
Fixed maturities:            
Obligations of government-sponsored enterprises $41,442  $87  $(15) $41,514 
U.S. Treasury securities and obligations of U.S.government instrumentalities  85,652   157   (9)  85,800 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  17,930   2,189   (68)  20,051 
Municipal securities  650,175   34,187   (559)  683,803 
Corporate bonds  263,351   12,182   (661)  274,872 
Residential mortgage-backed securities  684   34   -   718 
Collateralized mortgage obligations  45,069   58   (242)  44,885 
Total fixed maturities  1,104,303   48,894   (1,554)  1,151,643 
Equity securities - Mutual funds  240,699   30,101   (451)  270,349 
Total $1,345,002  $78,995  $(2,005) $1,421,992 
  December 31, 2016 
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities available for sale:            
Fixed maturities:            
Obligations of government-sponsored enterprises $41,442  $87  $(15) $41,514 
U.S. Treasury securities and obligations of U.S. government instrumentalities  85,652   157   (9)  85,800 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  17,930   2,189   (68)  20,051 
Municipal securities  650,175   34,187   (559)  683,803 
Corporate bonds  263,351   12,182   (661)  274,872 
Residential mortgage-backed securities  684   34   -   718 
Collateralized mortgage obligations  45,069   58   (242)  44,885 
Total fixed maturities  1,104,303   48,894   (1,554)  1,151,643 
Equity securities - Mutual funds  240,699   30,101   (451)  270,349 
Total $1,345,002  $78,995  $(2,005) $1,421,992 

 March 31, 2017  June 30, 2017 
 
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities held to maturity:                        
U.S. Treasury securities and obligations of U.S. government instrumentalities $619  $160  $-  $779 
U.S. Treasury securities and obligations of U.S.government instrumentalities $618  $166  $-  $784 
Residential mortgage-backed securities  191   18   -   209   191   2   -   193 
Certificates of deposit  1,704   -   -   1,704   2,026   -   -   2,026 
Total $2,514  $178  $-  $2,692  $2,835  $168  $-  $3,003 
 
11

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

  December 31, 2016 
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities held to maturity:            
U.S. Treasury securities and obligations of U.S.government instrumentalities $619  $158  $-  $777 
Residential mortgage-backed securities  191   18   -   209 
Certificates of deposit  2,026   -   -   2,026 
Total $2,836  $176  $-  $3,012 
  December 31, 2016 
  
Amortized
cost
  
Gross
unrealized
gains
  
Gross
unrealized
losses
  
Estimated
fair value
 
Securities held to maturity:            
U.S. Treasury securities and obligations of U.S. government instrumentalities $619  $158  $-  $777 
Residential mortgage-backed securities  191   18   -   209 
Certificates of deposit  2,026   -   -   2,026 
Total $2,836  $176  $-  $3,012 

Gross unrealized losses on investment securities and the estimated fair value of the related securities, aggregated by investment category and length of time that individual securities have been in a continuous unrealized loss position as of March 31,June 30, 2017 and December 31, 2016 were as follows:

 March 31, 2017  June 30, 2017 
 Less than 12 months  12 months or longer  Total  Less than 12 months  12 months or longer  Total 
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
 
                                                      
Securities available for sale                           
Securities available for sale:                           
Fixed maturities                                                      
Obligations of government-sponsored enterprises $6,495  $(4)  2  $-  $-   -  $6,495  $(4)  2 
U.S. Treasury securities and obligations of U.S. governmental instrumentalities $12,940  $(14)  1  $-  $-   -  $12,940  $(14)  1   41,408   (115)  5   -   -   -   41,408   (115)  5 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  12,704   (37)  6   -   -   -   12,704   (37)  6   7,939   (3)  5   -   -   -   7,939   (3)  5 
Municipal securities  64,518   (304)  9   -   -   -   64,518   (304)  9   90,575   (393)  12   -   -   -   90,575   (393)  12 
Corporate bonds  84,093   (367)  18   -   -   -   84,093   (367)  18   32,355   (89)  10   -   -   -   32,355   (89)  10 
Residential mortgage-backed securities  2,017   (3)  1   -   -   -   2,017   (3)  1 
Collateralized mortgage obligations  26,043   (222)  6   665   (2)  1   26,708   (224)  7   25,454   (108)  6   564   (3)  1   26,018   (111)  7 
Total fixed maturities  200,298   (944)  40   665   (2)  1   200,963   (946)  41   206,243   (715)  41   564   (3)  1   206,807   (718)  42 
Equity securities-Mutual funds  2,831   (49)  4   2,006   (68)  1   4,837   (117)  5 
Equity securities                                    
Mutual funds  1,994   (6)  1   -   -   -   1,994   (6)  1 
Alternative investments  4,983   (129)  7   2,431   (118)  1   7,414   (247)  8 
Total equity securities  6,977   (135)  8   2,431   (118)  1   9,408   (253)  9 
Total for securities available for sale $203,129  $(993)  44  $2,671  $(70)  2  $205,800  $(1,063)  46  $213,220  $(850)  49  $2,995  $(121)  2  $216,215  $(971)  51 
 
12

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 December 31, 2016  December 31, 2016 
 Less than 12 months  12 months or longer  Total  Less than 12 months  12 months or longer  Total 
 
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
  
Estimated
Fair Value
  
Gross
Unrealized
Loss
  
Number of
Securities
 
                                                      
Securites available for sale                           
Securities available for sale:                           
Fixed maturities                                                      
Obligations of government-sponsored enterprises $9,483  $(15)  1  $-  $-   -  $9,483  $(15)  1  $9,483  $(15)  1  $-  $-   -  $9,483  $(15)  1 
U.S. Treasury securities and obligations of U.S. governmental instrumentalities  12,937   (9)  1   -   -   -   12,937   (9)  1   12,937   (9)  1   -   -   -   12,937   (9)  1 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  7,758   (68)  5   -   -   -   7,758   (68)  5   7,758   (68)  5   -   -   -   7,758   (68)  5 
Municipal securities  84,252   (559)  13   -   -   -   84,252   (559)  13   84,252   (559)  13   -   -   -   84,252   (559)  13 
Corporate bonds  105,054   (661)  22   -   -   -   105,054   (661)  22   105,054   (661)  22   -   -   -   105,054   (661)  22 
Collateralized mortgage obligations  32,120   (239)  8   784   (3)  1   32,904   (242)  9   32,120   (239)  8   784   (3)  1   32,904   (242)  9 
Total fixed maturities  251,604   (1,551)  50   784   (3)  1   252,388   (1,554)  51   251,604   (1,551)  50   784   (3)  1   252,388   (1,554)  51 
Equity securities-Mutual funds  22,615   (451)  4   -   -   -   22,615   (451)  4   22,615   (451)  4   -   -   -   22,615   (451)  4 
Total for securities available for sale $274,219  $(2,002)  54  $784  $(3)  1  $275,003  $(2,005)  55  $274,219  $(2,002)  54  $784  $(3)  1  $275,003  $(2,005)  55 
The Corporation reviews the investment portfolios under the Corporation’s impairment review policy.  Given market conditions and the significant judgments involved, there is a continuing risk that declines in fair value may occur and material other-than-temporary impairments may be recorded in future periods.  The Corporation from time to time may sell investments as part of its asset/liability management process or to reposition its investment portfolio based on current and expected market conditions.

Obligations of Government-Sponsored Enterprises, Obligations of U.S. Government Instrumentalities and Municipal Securities:  The unrealized losses on the Corporation’s investments in obligations of Government-Sponsored Enterprises, U.S. Government Instrumentalities and Municipal Securities were mainly caused by fluctuations in interest rates and general market conditions.  The contractual terms of these investments do not permit the issuer to settle the securities at a price less than the par value of the investment.  In addition, these investmentspositions have investment grade ratings. Because the decline in fair value is attributable to changes in interest rates and not credit quality; because the Corporation does not intend to sell the investments and it is not more likely than not that the Corporation will not be required to sell the investments before recovery of their amortized cost basis, which may be maturity; and because the Corporation expects to collect all contractual cash flows, these investments are not considered other-than-temporarily impaired.

Obligations of the Commonwealth of Puerto Rico and its Instrumentalities: Our holdings in Puerto Rico municipals can be divided in (1) escrowed bonds with a fair value of $7,848$7,939 and a gross unrealized loss of $37,$3, and (2) senior lien bonds issued by the Puerto Rico Sales Tax Financing Corporation (Cofina) with a fair value of $11,220$4,222 and a gross unrealized gain of $857.$445.  As of March 31,June 30, 2017, investments in escrow bonds are not considered other-than-temporarily impaired based on the length of time the funds have been in a loss position, the decline in estimated fair value is principally attributable to changes in interest rates, and the fact that these bonds are backed by US Government securities, and therefore have an implicit AA+/Aaa rating. 

There was no impairment on Cofina positions during the three months and six months ended March 31,June 30, 2017 and 2016.
 
13

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

Corporate Bonds:  The unrealized losses of these bonds were principally caused by fluctuations in interest rates and general market conditions.  All corporate bonds with an unrealized loss have investment grade ratings.  Because the decline in estimated fair value is principally attributable to changes in interest rates; because the Company does not intend to sell the investments and it is not more likely than not that the Company will not be required to sell the investments before recovery of their amortized cost basis, which may be maturity; and because the Company expects to collect all contractual cash flows, these investments are not considered other-than-temporarily impaired.
13


Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
Residential Mortgage-Backed Securities and Collateralized mortgage obligationsMortgage Obligations: The unrealized losses on investments in residential mortgage-backed securities collateralized mortgage obligations (“CMOs”) were mostly caused by fluctuations in interest rates and credit spreads. The contractual cash flows of these securities, other than private CMOs, are guaranteed by a U.S. government-sponsored enterprise. Any loss in these securities is determined according to the seniority level of each tranche, with the least senior (or most junior), typically the unrated residual tranche, taking any initial loss. The investment grade credit rating of our securities reflects the seniority of the securities that the Corporation owns. The Corporation does not consider these investments other-than-temporarily impaired because the decline in fair value is attributable to changes in interest rates and not credit quality; the Corporation does not intend to sell the investments and it is more likely than not that the Corporation will not be required to sell the investments before recovery of their amortized cost basis, which may be maturity; and because the Corporation expects to collect all contractual cash flows.

Mutual Funds:Funds and Alternative Investments:  As of March 31,June 30, 2017, investments in mutual funds and alternative investments with unrealized losses are not considered other-than-temporarily impaired based on market conditions and the length of time the funds have been in a loss position.  There were no impairmentimpairments on mutual funds and alternative investments during the three months and six months ended March 31, 2017June 30, 2017.  During the three and 2016.six months ended June 30, 2016, we recorded an other-than-temporary impairment related to these mutual funds amounting to $1,434.

Maturities of investment securities classified as available for sale and held to maturity were as follows:

 March 31, 2017  June 30, 2017 
 
Amortized
cost
  
Estimated
fair value
  
Amortized
cost
  
Estimated
fair value
 
Securities available for sale:            
Due in one year or less $48,742  $48,946  $71,618  $71,772 
Due after one year through five years  322,122   325,519   324,426   327,707 
Due after five years through ten years  131,128   137,138   131,235   137,195 
Due after ten years  561,095   598,497   565,723   606,463 
Residential mortgage-backed securities  638   667   11,877   11,909 
Collateralized mortgage obligations  42,919   42,778   41,129   41,115 
 $1,106,644  $1,153,545  $1,146,008  $1,196,161 
Securities held to maturity:                
Due in one year or less $1,704  $1,704  $2,026  $2,026 
Due after ten years  619   779   618   784 
Residential mortgage-backed securities  191   209   191   193 
 $2,514  $2,692  $2,835  $3,003 

Expected maturities may differ from contractual maturities because some issuers have the right to call or prepay obligations with or without call or prepayment penalties.
 
14

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
Information regarding realized and unrealized gains and losses from investments is as follows:

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Realized gains (losses):                  
Fixed maturity securities:                  
Securities available for sale:                  
Gross gains from sales $17  $961  $384  $912  $401  $1,873 
Gross losses from sales  (119)  (1,359)  (517)  (103)  (636)  (1,462)
Total fixed maturity securities  (102)  (398)  (133)  809   (235)  411 
Equity securities:                        
Securities available for sale:                        
Gross gains from sales  438   587   4,189   2,525   4,627   3,112 
Gross losses from sales  -   (131)  (2)  (380)  (2)  (511)
Gross losses from other-than-temporary impairments  -   (1,434)  -   (1,434)
Total equity securities  438   456   4,187   711   4,625   1,167 
Net realized gains on securities available for sale $336  $58  $4,054  $1,520  $4,390  $1,578 
 
 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Changes in net unrealized gains (losses):                  
Recognized in accumulated other comprehensive income:                  
Fixed maturities – available for sale $(439) $22,589  $3,252  $18,739  $2,813  $41,328 
Equity securities – available for sale  11,143   6,769   2,768   2,908   13,911   9,677 
 $10,704  $29,358  $6,020  $21,647  $16,724  $51,005 
Not recognized in the consolidated financial statements:                        
Fixed maturities – held to maturity $2  $36  $(10) $27  $(8) $63 

The change in deferred tax liability on unrealized gains recognized in accumulated other comprehensive income during the threesix months ended March 31,June 30, 2017 and 2016 was $2,136$3,931 and $9,78115,598, respectively.
 
As of March 31,June 30, 2017 and December 31, 2016, no individual investment in securities exceeded 10% of stockholders’ equity.
 
15

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(4)Premiums and Other Receivables, Net
 
Premiums and other receivables, net were as follows:

 
March 31,
2017
  
December 31,
2016
  
June 30,
2017
  
December 31,
2016
 
Premium $100,691  $91,528  $107,058  $91,528 
Self-funded group receivables  50,643   57,728   51,646   57,728 
FEHBP  14,274   14,321   15,582   14,321 
Agent balances  27,468   25,495   40,340   25,495 
Accrued interest  11,338   13,668   13,839   13,668 
Reinsurance recoverable  54,854   58,295   55,772   58,295 
Unsettled sales  6,715   - 
Other  65,152   62,637   62,859   62,637 
  324,420   323,672   353,811   323,672 
Less allowance for doubtful receivables:                
Premium  23,584   27,320   23,949   27,320 
Other  7,999   9,987   9,314   9,987 
  31,583   37,307   33,263   37,307 
Total premium and other receivables, net $292,837  $286,365  $320,548  $286,365 

As of March 31,June 30, 2017 and December 31, 2016, the Company had premiums and other receivables of $51,533$63,565 and $57,750, respectively, from the Government of Puerto Rico, including its agencies, municipalities and public corporations.  The related allowance for doubtful receivables as of March 31,June 30, 2017 and December 31, 2016 were $14,050$14,853 and $18,812, respectively.
 
16

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)


(5)Fair Value Measurements
 
Our condensed consolidated balance sheets include the following financial instruments: securities available for sale, policy loans, policyholder deposits, and long-term borrowings.  We consider the carrying amounts of policy loans, policyholder deposits, and long-term borrowings to approximate their fair value due to the short period of time between the origination of these instruments and the expected realization or payment. Certain assets are measured at fair value on a recurring basis and are disclosed below. These assets are classified into one of three levels of a hierarchy defined by GAAP. For a description of the methods and assumptions that are used to estimate the fair value and determine the fair value hierarchy classification of each class of financial instrument, see the consolidated financial statements and notes thereto included in our 2016 Form 10-K.
 
The following tables summarize fair value measurements by level for assets measured at fair value on a recurring basis:
 
 March 31, 2017  June 30, 2017 
 Level 1  Level 2  Level 3  Total  Level 1  Level 2  Level 3  Total 
Securities available for sale:                        
Fixed maturity securities                        
Obligations of government-sponsored enterprises $-  $41,546  $-  $41,546  $-  $40,383  $-  $40,383 
U.S. Treasury securities and obligations of U.S government instrumentalities72,878-   -   72,878   79,997   -   -   79,997 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities-19,068   -   19,068   -   12,161   -   12,161 
Municipal securities  -   684,978   -   684,978   -   716,642   -   716,642 
Corporate bonds  -   291,630   -   291,630   -   293,954   -   293,954 
Residential agency mortgage-backed securities  -   667   -   667   -   11,909   -   11,909 
Collateralized mortgage obligations  -   42,778   -   42,778   -   41,115   -   41,115 
Total fixed maturities  72,878   1,080,667   -   1,153,545   79,997   1,116,164   -   1,196,161 
Equity securities - Mutual funds  174,593   78,803   23,753   277,149   173,957   84,406   -   258,363 
Alternative investments - measured at net asset value  -   -   -   29,457 
Total $247,471  $1,159,470  $23,753  $1,430,694  $253,954  $1,200,570  $-  $1,483,981 
  December 31, 2016 
  Level 1  Level 2  Level 3  Total 
Securities available for sale:            
Fixed maturity securities            
Obligations of government-sponsored enterprises $-  $41,514  $-  $41,514 
U.S. Treasury securities and obligations of U.S government instrumentalities  85,800   -   -   85,800 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  -   20,051   -   20,051 
Municipal securities  -   683,803   -   683,803 
Corporate bonds  -   274,872   -   274,872 
Residential agency mortgage-backed securities  -   718   -   718 
Collateralized mortgage obligations  -   44,885   -   44,885 
Total fixed maturities  85,800   1,065,843   -   1,151,643 
Equity securities - Mutual funds  166,595   76,222   27,532   270,349 
Total $252,395  $1,142,065  $27,532  $1,421,992 

Certain investments that are measured at fair value using the net asset value per share practical expedient have not been classified in the fair value hierarchy.  The fair value amount presented in this table is intended to facilitate the reconciliation of the fair value hierarchy to the amounts presented in the statement of financial position.
  December 31, 2016 
  Level 1  Level 2  Level 3  Total 
Securities available for sale:            
Fixed maturity securities            
Obligations of government-sponsored enterprises $-  $41,514  $-  $41,514 
U.S. Treasury securities and obligations of U.S government instrumentalities  85,800   -   -   85,800 
Obligations of the Commonwealth of Puerto Rico and its instrumentalities  -   20,051   -   20,051 
Municipal securities  -   683,803   -   683,803 
Corporate bonds  -   274,872   -   274,872 
Residential agency mortgage-backed securities  -   718   -   718 
Collateralized mortgage obligations  -   44,885   -   44,885 
Total fixed maturities  85,800   1,065,843   -   1,151,643 
Equity securities - Mutual funds  166,595   76,222   27,532   270,349 
Total $252,395  $1,142,065  $27,532  $1,421,992 
17

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

There were no transfers in and/or out of Level 3 and between Levels 1 and 2 during the three months and six months ended March 31,June 30, 2017 and 2016.  Level 3 securities are partnerships measured at fair value using the net asset value affected by changes in the fair market value of the investments held in these partnerships.
The alternative investments represent investments in partnerships which invest in several equity and private equity funds.  Portfolios are diversified by vintage year, stage, geography, business sectors and number of investments. These investments are not redeemable with the funds. Distributions from each fund are received as the underlying investments of the funds are liquidated. It is estimated that the underlying assets of the funds will be liquidated in the next 5 to 12 years. The fair values of the investments in this class have been estimated using the net asset value of the Company’s ownership interest in the partnerships. Total unfunded capital commitments for these positions as of June 30, 2017 amounted to $118,668.
 
1718

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
A reconciliation of the beginning and ending balances of assets measured at fair value on a recurring basis using significant unobservable inputs (Level 3) for the three months ended March 31 is as follows:

  
Fair Value Measurements
Using Significant
Unobservable Inputs (Level 3)
 
  2017  2016 
Beginning balance $27,532  $7,958 
Realized gains  119   151 
Unrealized in other accumulated comprehensive income  (64)  (649)
Purchases  5,260   8 
Capital distributions  (9,094)  (471)
Ending balance $23,753  $6,997 

A summary of the carrying value and fair value by level of financial instruments not recorded at fair value on our condensed consolidated balance sheets at March 31, 2017 and December 31, 2016 are as follows:
 
 March 31, 2017  June 30, 2017 
 
Carrying
Value
   Fair Value  Carrying  Fair Value 
Level 1  Level 2  Level 3  Total  Value  Level 1  Level 2  Level 3  Total 
Assets:                              
Policy loans $8,546  $-  $8,546  $-  $8,546  $8,716  $-  $8,716  $-  $8,716 
                                        
Liabilities:                                        
Policyholder deposits $179,599  $-  $179,599  $-  $179,599  $179,225  $-  $179,225  $-  $179,225 
Long-term borrowings:                                        
Loans payable to bank - variable  34,465   -   34,465   -   34,465   33,968   -   33,968   -   33,968 
Total long-term borrowings  34,465   -   34,465   -   34,465   33,968   -   33,968   -   33,968 
Total liabilities $214,064  $-  $214,064  $-  $214,064  $213,193  $-  $213,193  $-  $213,193 
 
 December 31, 2016  December 31, 2016 
 
Carrying
Value
   Fair Value  Carrying  Fair Value 
Level 1  Level 2  Level 3  Total  Value  Level 1  Level 2  Level 3  Total 
Assets:                              
Policy loans $8,564  $-  $8,564  $-  $8,564  $8,564  $-  $8,564  $-  $8,564 
                                        
Liabilities:                                        
Policyholder deposits $179,382  $-  $179,382  $-  $179,382  $179,382  $-  $179,382  $-  $179,382 
Long-term borrowings:                                        
Loans payable to bank - variable  11,187   -   11,187   -   11,187   11,187   -   11,187   -   11,187 
6.6% senior unsecured notes payable  24,000   -   24,000   -   24,000   24,000   -   24,000   -   24,000 
Total long-term borrowings  35,187   -   35,187   -   35,187   35,187   -   35,187   -   35,187 
Total liabilities $214,569  $-  $214,569  $-  $214,569  $214,569  $-  $214,569  $-  $214,569 
 
1819

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(6)Claim Liabilities
 
A reconciliation of the beginning and ending balances of claim liabilities is as follows:

 
Three months ended
March 31, 2017
  
Three months ended
June 30, 2017
  
Six months ended
June 30, 2017
 
 
Managed
Care
  
Other
Business
Segments *
  Consolidated  
Managed
Care
  
Other
Business
Segments *
  Consolidated  
Managed
Care
  
Other
Business
Segments *
  Consolidated 
                           
Claim liabilities at beginning of year $349,047  $138,896  $487,943  $393,525  $136,779  $530,304  $349,047  $138,896  $487,943 
Reinsurance recoverable on claim liabilities  -   (38,998)  (38,998)  -   (35,898)  (35,898)  -   (38,998)  (38,998)
Net claim liabilities at beginning of year  349,047   99,898   448,945   393,525   100,881   494,406   349,047   99,898   448,945 
Claims incurred                                    
Current period insured events  602,620   28,226   630,846   580,608   26,282   606,890   1,183,241   54,508   1,237,749 
Prior period insured events  (15,340)  (1,333)  (16,673)  (1,355)  (1,196)  (2,551)  (16,695)  (2,529)  (19,224)
Total  587,280   26,893   614,173   579,253   25,086   604,339   1,166,546   51,979   1,218,525 
Payments of losses and loss-adjustment expenses                                    
Current period insured events  350,450   7,965   358,415   576,135   14,944   591,079   926,585   22,917   949,502 
Prior period insured events  192,352   17,945   210,297   25,208   11,586   36,794   217,573   29,523   247,096 
Total  542,802   25,910   568,712   601,343   26,530   627,873   1,144,158   52,440   1,196,598 
Net claim liabilities at end of year  393,525   100,881   494,406   371,435   99,437   470,872   371,435   99,437   470,872 
Reinsurance recoverable on claim liabilities  -   35,898   35,898   -   33,368   33,368   -   33,368   33,368 
Claim liabilities at end of year $393,525  $136,779  $530,304  $371,435  $132,805  $504,240  $371,435  $132,805  $504,240 
19

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
  
Three months ended
June 30, 2016
  
Six months ended
June 30, 2016
 
  
Managed
Care
  
Other
Business
Segments *
  Consolidated  
Managed
Care
  
Other
Business
Segments *
  Consolidated 
                   
Claim liabilities at beginning of year $381,448  $143,618  $525,066  $348,297  $143,468  $491,765 
Reinsurance recoverable on claim liabilities  -   (39,871)  (39,871)  -   (40,714)  (40,714)
Net claim liabilities at beginning of year  381,448   103,747   485,195   348,297   102,754   451,051 
Claims incurred                        
Current period insured events  596,909   25,950   622,859   1,192,499   51,840   1,244,339 
Prior period insured events  (6,728)  (686)  (7,414)  (6,028)  (2,934)  (8,962)
Total  590,181   25,264   615,445   1,186,471   48,906   1,235,377 
Payments of losses and loss-adjustment expenses                        
Current period insured events  583,381   16,557   599,938   948,420   21,653   970,073 
Prior period insured events  46,743   10,204   56,947   244,843   27,757   272,600 
Total  630,124   26,761   656,885   1,193,263   49,410   1,242,673 
Net claim liabilities at end of year  341,505   102,250   443,755   341,505   102,250   443,755 
Reinsurance recoverable on claim liabilities  -   38,109   38,109   -   38,109   38,109 
Claim liabilities at end of year $341,505  $140,359  $481,864  $341,505  $140,359  $481,864 
 
  
Three months ended
March 31, 2016
 
  
Managed
Care
  
Other
Business
Segments *
  Consolidated 
          
Claim liabilities at beginning of year $348,297  $143,468  $491,765 
Reinsurance recoverable on claim liabilities  -   (40,714)  (40,714)
Net claim liabilities at beginning of year  348,297   102,754   451,051 
Claims incurred            
Current period insured events  614,754   25,890   640,644 
Prior period insured events  (18,464)  (2,248)  (20,712)
Total  596,290   23,642   619,932 
Payments of losses and loss-adjustment expenses            
Current period insured events  365,039   5,096   370,135 
Prior period insured events  198,100   17,553   215,653 
Total  563,139   22,649   585,788 
Net claim liabilities at end of year  381,448   103,747   485,195 
Reinsurance recoverable on claim liabilities  -   39,871   39,871 
Claim liabilities at end of year $381,448  $143,618  $525,066 

*Other Business Segments include the Life Insurance and Property and Casualty segments, as well as intersegment eliminations.

As a result of differences between actual amounts and estimates of insured events in prior years, the amounts included as incurred claims for prior period insured events differ from anticipated claims incurred.
 
20

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

The favorable developments in the claims incurred and loss-adjustment expenses for prior period insured events for the three months and six months ended March 31,June 30, 2017 and 2016 are due primarily to better than expected utilization trends.  Reinsurance recoverable on unpaid claims is reported as premium and other receivables, net in the accompanying consolidated financial statements.
 
The claims incurred disclosed in this table exclude the portion of the change in the liability for future policy benefits expense, which amounted to $6,690$6,945 and $6,762$13,635 during the three months and six months ended March 31,June 30, 2017, respectively.  The change in the liability for future policy benefits during the three months and six months ended June 30, 2016 amounted to $6,642 and $13,404, respectively.
 
20

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
The following is information about total incurred but not reported (IBNR) liabilities plus expected development on reported claims included in the liability for unpaid claims adjustment expenses for the Managed Care segment as of March 31,June 30, 2017.

Incurred
Year
 
Total of IBNR Liabilities Plus Expected
Development on Reported Claims
  
Total of IBNR Liabilities Plus Expected
Development on Reported Claims
 
2015  60,717   68,022 
2016  80,062   46,181 
2017  252,163   256,656 
21

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

(7)Long-Term Borrowings
 
A summary of the borrowings entered by the Company is as follows:

  
March 31,
2017
  
December 31,
2016
 
       
Senior unsecured notes payable of $60,000 issued on December 2005; due December 2020. Interest is payable monthly at a fixed rate of 6.60%. $-  $24,000 
Secured loan payable of $11,187, payable in monthly installments of $137 through October 1, 2023, plus interest at a rate reset periodically of 100 basis points over selected LIBOR maturity (which was 1.79% at March 31, 2017.)  10,777   11,187 
Secured loan payable of $20,150, payable in monthly installments of $84 through January 1, 2024, plus interest at a rate reset periodically of 275 basis points over selected LIBOR maturity (which was 3.77% at March 31, 2017.)  19,982   - 
Secured loan payable of $4,116, payable in monthly installments of $49 through January 1, 2024, plus interest at a rate reset periodically of 325 basis points over selected LIBOR maturity (which was 4.27% at March 31, 2017.)  4,018   - 
Total borrowings  34,777   35,187 
         
Less unamortized debt issuance costs  312   102 
  $34,465  $35,085 
  June 30,  December 31, 
  2017  2016 
       
Senior unsecured notes payable of $60,000 issued on December 2005; due December 2020. Interest is payable monthly at a fixed rate of 6.60%. $-  $24,000 
Secured loan payable of $11,187, payable in monthly installments of $137 through October 1, 2023, plus interest at a rate reset periodically of 100 basis points over selected LIBOR maturity (which was 2.00% at June 30, 2017.)  10,367   11,187 
Secured loan payable of $20,150, payable in monthly installments of $84 through January 1, 2024, plus interest at a rate reset periodically of 275 basis points over selected LIBOR maturity (which was 3.90% at June 30, 2017.)  19,730   - 
Secured loan payable of $4,116, payable in monthly installments of $49 through January 1, 2024, plus interest at a rate reset periodically of 325 basis points over selected LIBOR maturity (which was 4.40% at June 30, 2017.)  3,871   - 
         
Total borrowings  33,968   35,187 
         
Less: unamortized debt issuance costs  301   102 
  $33,667  $35,085 

On December 28, 2016, TSM entered into a $35,500 credit agreement with a commercial bank in Puerto Rico. The agreement consists of three term loans: (i) Term Loan A in the principal amount of $11,187, (ii) Term Loan B in the principal amount of $20,150 and (iii) Term Loan C in the principal amount of $4,116.  Term Loan A was used to refinance the outstanding balance of the previous $41,000 secured loan payable with the same commercial bank in Puerto Rico.  Proceeds from Term Loans B and C were received on January 11, 2017 and were used to prepay the outstanding principal amount plus accrued interest of the 6.6% Senior Unsecured Notes due January 2021 ($24,000), and fund a portion of a debt service reserve for the Loan (approximately $200).  Interest payable commenced on January 1, 2017, in the case of Term Loan A, and on February 1, 2017, in the case of Term Loan B and Term Loan C.  The Credit Agreement includes certain financial and non-financial covenants, including negative covenants imposing certain restrictions on the Corporation’s business.
 
21

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
On March 11, 2016 Triple-S Salud, Inc. (TSS) entered into a $30,000 revolving loan agreement with a commercial bank in Puerto Rico. This unused line of credit had an interest rate of LIBOR plus 220 basis points and contained certain financial and non-financial covenants that are customary for this type of facility. This revolving loan agreement matured on March 11, 2017, and was not renewed.
 
On April 18, 2017, Triple-S Advantage, Inc. (TSA) entered into a $10,000 revolving loan agreement with a commercial bank in Puerto Rico. This unused line of credit has an interest rate of 30-day LIBOR plus 25 basis points, matures on April 17, 2018, and includes certain financial and non-financial covenants that are customary for this type of facility.  As of June 30, 2017, there is no outstanding balance in this line of credit.
 
22

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

(8)Pension Plan
 
The components of net periodic benefit cost for the three months and six months ended March 31June 30 were as follows:

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Components of net periodic benefit cost:                  
Service cost $-  $1,250  $-  $878  $-  $2,128 
Interest cost  1,798   2,762   1,798   1,939   3,596   4,701 
Expected return on assets  (2,199)  (2,926)  (2,199)  (2,054)  (4,398)  (4,980)
Amortization of prior service benefit  -   (144)  -   (102)  -   (246)
Amortization of actuarial loss  86   1,183   86   831   172   2,014 
Settlement loss  631   -   631   - 
Net periodic benefit cost $(315) $2,125  $316  $1,492  $1  $3,617 

Effective January 31, 2017, the Company froze the pay and service components of amounts used to calculate pension benefits for active employees who participated in the pension plan. Therefore, as of the Effective Date, active employees in the pension plan will not accrue additional benefits for future service and eligible compensation received.
 
Employer Contributions:  The Corporation disclosed in its audited consolidated financial statements for the year ended December 31, 2016 that it expected to contribute $4,000 to the pension program in 2017.  As of March 31,June 30, 2017, the Corporation has not made contributions to the pension program.
 
2223

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(9)Comprehensive Income
 
The accumulated balances for each classification of other comprehensive income, net of tax, are as follows:

 
Three months ended
June 30,
  
Six months ended
June 30,
 
 
Three months ended
March 31,
  2017  2016  2017  2016 
 2017  2016             
            
Net Unrealized Gain on Securities Beginning Balance $62,371  $62,478  $70,843  $82,055  $62,371  $62,478 
Other comprehensive income before reclassifications  8,741   19,623   7,639   18,193   16,380   37,817 
Amounts reclassified from accumulated other comprehensive income  (269)  (46)  (3,243)  (2,363)  (3,512)  (2,410)
Net current period change  8,472   19,577   4,396   15,830   12,868   35,407 
Ending Balance  70,843   82,055   75,239   97,885   75,239   97,885 
Liability for Pension Benefits Beginning Balance  (19,976)  (36,855)  (19,923)  (36,221)  (19,976)  (36,855)
Amounts reclassified from accumulated other comprehensive income  53   634   53   445   106   1,079 
Ending Balance  (19,923)  (36,221)  (19,870)  (35,776)  (19,870)  (35,776)
Accumulated Other Comprehensive Income Beginning Balance  42,395   25,623   50,920   45,834   42,395   25,623 
Other comprehensive income before reclassifications  8,741   19,623   7,639   18,193   16,380   37,817 
Amounts reclassified from accumulated other comprehensive income  (216)  588   (3,190)  (1,918)  (3,406)  (1,331)
Net current period change  8,525   20,211   4,449   16,275   12,974   36,486 
Ending Balance $50,920  $45,834  $55,369  $62,109  $55,369  $62,109 


(10)Share-Based Compensation
Share-based compensation expense recorded during the three months and six months ended June 30, 2017 was $1,613 and $170, respectively. Share-based compensation expense recorded during the three months and six months ended June 30, 2016 was $1,228 and $2,313, respectively. The lower expense during the six months ended June 30, 2017 results from a decrease in the 2014 and 2015 grants expected performance shares payouts. There was no cash received from stock option exercises during the six months ended June 30, 2017 and 2016.
2324

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(10)Share-Based Compensation
Share-based compensation (benefit) expense recorded during the three months ended March 31, 2017 and 2016 was ($1,443) and $1,085, respectively.  The benefit recorded in the 2017 period results from a decrease in the 2014 and 2015 grants expected performance shares payouts.  There were no stock option exercises during the three months ended March 31, 2017 and 2016.
(11)Net Income Available to Stockholders and Net Income per Share
 
The following table sets forth the computation of basic and diluted earnings per share:

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Numerator for earnings per share:                  
Net (loss) income attributable to TSM available to stockholders $(4,342) $3,456 
Net income attributable to TSM available to stockholders $12,705  $3,880  $8,363  $7,336 
Denominator for basic earnings per share:                        
Weighted average of common shares  24,143,261   24,587,681   24,246,591   24,624,070   24,195,211   24,609,749 
Effect of dilutive securities  -   72,353   36,687   45,364   50,220   58,892 
Denominator for diluted earnings per share  24,143,261   24,660,034   24,283,278   24,669,434   24,245,431   24,668,641 
Basic net (loss) income per share attributable to TSM $(0.18) $0.14 
Diluted net (loss) income per share attributable to TSM $(0.18) $0.14 
Basic net income per share attributable to TSM $0.52  $0.16  $0.35  $0.30 
Diluted net income per share attributable to TSM $0.52  $0.16  $0.34  $0.30 

The Company generated a loss from continuing operations attributable to the Company’s common stockholders for the three months ended March 31, 2017, so the effect of dilutive securities is not considered because their effect would be antidilutive. If the Company had generated income from continuing operations during the three months ended March 31, 2017, the effect of restricted stock awards on the diluted shares calculation would have been an increase in shares of 59,284 shares.
(12)Contingencies
 
The following information supplements and amends, as applicable, the disclosures in Note 24 to the Consolidated Financial Statements of the Company’s 2016 Annual Report on Form 10-K.  Our business is subject to numerous laws and regulations promulgated by Federal, Puerto Rico, USVI, Costa Rica, BVI, and Anguilla governmental authorities. Compliance with these laws and regulations can be subject to government review and interpretation, as well as regulatory actions unknown and unasserted at this time. The Commissioner of Insurance of Puerto Rico, as well as other Federal, Puerto Rico, USVI, Costa Rica, BVI, and Anguilla government authorities, regularly make inquiries and conduct audits concerning the Company’sCompany's compliance with such laws and regulations. Penalties associated with violations of these laws and regulations may include significant fines and exclusion from participating in certain publicly funded programs and may require the Company to comply with corrective action plans or changes in our practices.
 
We are involved in various legal actions arising in the ordinary course of business. We are also defendants in various other litigations and proceedings, some of which are described below.  Where the Company believes that a loss is both probable and estimable, such amounts have been recorded.  Although we believe our estimates of such losses are reasonable, these estimates could change as a result of further developments in these matters. In other cases, it is at least reasonably possible that the Company may incur a loss related to one or more of the mentioned pending lawsuits or investigations, but the Company is unable to estimate the range of possible loss which may be ultimately realized, either individually or in the aggregate, upon their resolution.  The outcome of legal proceedings is inherently uncertain and pending matters for which accruals have not been established have not progressed sufficiently to enable us to estimate a range of possible loss, if any.  Given the inherent unpredictability of these matters, it is possible that an adverse outcome in one or more of these matters could have a material adverse effect on the consolidated financial condition, operating results and/or cash flows of the Company.
 
24

Table of Contents
Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)
Additionally, we may face various potential litigation claims that have not been asserted to date, including claims from persons purporting to have rights to acquire shares of the Company on favorable terms pursuant to agreements previously entered by our predecessor managed care subsidiary, Seguros de Servicios de Salud de Puerto Rico, Inc. (SSS), with physicians or dentists who joined our provider network to sell such new provider shares of SSS at a future date (Share Acquisition Agreements) or to have inherited such shares notwithstanding applicable transfer and ownership restrictions.
 
25

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

ASES Audits
The Company is subject to numerous audits in connection with the provision of services to private and governmental entities.  These audits may include numerous aspects of our business, including claim payment practices, contractual obligations, service delivery, third-party obligations, and business practices, among others.  Deficiencies in audits could have a material adverse effect on our reputation and business, including termination of contracts, significant increases in the cost of managing and remediating deficiencies, payment of contractual penal clauses, and others, any of which could have a material and adverse effect on our results of operations, financial position and cash flows.
 
On July 2, 2014, ASES notified TSS that the results of an audit conducted in connection with the government health plan contract for several periods between October 2005 toand September 2013, reflected an overpayment of premiums made to TSS pursuant to prior contracts with ASES in the amount of $7,900. The alleged overpayments were related to duplicated payments or payments made for deceased members, and ASES requested the reimbursement of the alleged overpayment. On January 16, 2015, TSS filed an injunction against ASES under the case Triple-S Salud, Inc. v. AdministracionAdministración de Seguros de Salud de Puerto Rico. TSS contends that ASES’ request for reimbursement has no merits on several grounds, including a 2011 settlement between both parties covering the majority of the amount claimed by ASES, and that ASES, under the terms of the contracts, was responsible for certifying the membership. TSS also amended its claim to include the Puerto Rico Health Department (PRHD), as it asserts the PRHD is an indispensable party for the resolution of this matter and to seek the payment of approximately $5,000, since the premiums paid to TSS should have been higher than what ASES actually paid given the additional risk assumed by TSS. The case was assigned to a Special Commissioner, who has received a joint expert report concerning the case. Onon March 17, 2017 the Special Commissioner issued a report recommending the court to dismiss the complaint in favor of TSS. On May 26, 2017, the court issued a partial judgement dismissing the complaint in favor of TSS with respect to the alleged overpayments for the period between October 2005 and September 2010, which represented approximately $7,400 of the total alleged claim. After this partial dismissal, the only remaining claim pending to be adjudicated is awaitingfor the alleged overpayments for the 2011-2013 period, which amounts to approximately $500. On July 27, 2017, ASES appealed the court’s decision in connection to the report issued by the Special Commissioner.partial judgement. TSS will oppose ASES’ appeal and will continue to conduct a vigorous defense of this matter.
 
2526

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(13)Segment Information
 
The operations of the Corporation are conducted principally through three business segments: Managed Care, Life Insurance, and Property and Casualty Insurance.  The Corporation evaluates performance based primarily on the operating revenues and operating income of each segment.  Operating revenues include premiums earned, net, administrative service fees, net investment income, and revenues derived from other segments.  Operating costs include claims incurred and operating expenses.  The Corporation calculates operating income or loss as operating revenues less operating costs.
 
The following tables summarize the operations by reportable segment for the three months ended March 31, 2017 and 2016:segment:

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Operating revenues:                  
Managed Care:                  
Premiums earned, net $640,147  $678,380  $661,365  $668,932  $1,301,512  $1,347,312 
Administrative service fees  4,379   5,083   4,548   4,520   8,927   9,603 
Intersegment premiums/service fees  1,534   1,485   1,631   1,652   3,165   3,137 
Net investment income  3,892   3,480   4,146   4,107   8,038   7,587 
Total managed care  649,952   688,428   671,690   679,211   1,321,642   1,367,639 
Life Insurance:                        
Premiums earned, net  40,298   38,966   39,858   38,591   80,156   77,557 
Intersegment premiums  191   137   111   202   302   339 
Net investment income  6,087   5,914   6,330   6,412   12,417   12,326 
Total life insurance  46,576   45,017   46,299   45,205   92,875   90,222 
Property and Casualty Insurance:                        
Premiums earned, net  21,548   21,188   21,668   21,526   43,216   42,714 
Intersegment premiums  153   153   154   154   307   307 
Net investment income  1,924   1,929   2,134   2,325   4,058   4,254 
Total property and casualty insurance  23,625   23,270   23,956   24,005   47,581   47,275 
Other segments: *                        
Intersegment service revenues  1,586   2,545   2,259   2,617   3,845   5,162 
Operating revenues from external sources  1,000   856   1,154   959   2,154   1,815 
Total other segments  2,586   3,401   3,413   3,576   5,999   6,977 
Total business segments  722,739   760,116   745,358   751,997   1,468,097   1,512,113 
TSM operating revenues from external sources  78   4   55   1   133   5 
Elimination of intersegment premiums/service fees  (1,598)  (1,775)  (1,896)  (2,008)  (3,494)  (3,783)
Elimination of intersegment service revenues  (1,586)  (2,545)  (2,259)  2,518   (3,845)  (27)
Other intersegment eliminations  -   (13)  -   (5,149)  -   (5,162)
Consolidated operating revenues $719,633  $755,787  $741,258  $747,359  $1,460,891  $1,503,146 

*Includes segments that are not required to be reported separately, primarily the data processing services organization and the health clinic.
 
2627

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
 2017  2016  2017  2016  2017  2016 
Operating income (loss):                  
Managed care $(18,582) $(641) $2,920  $(3,780) $(15,662) $(4,421)
Life insurance  3,935   5,598   4,990   5,054   8,925   10,652 
Property and casualty insurance  2,067   2,111   3,775   3,388   5,842   5,499 
Other segments *  143   (179)  1   (182)  144   (361)
Total business segments  (12,437)  6,889   11,686   4,480   (751)  11,369 
TSM operating revenues from external sources  78   4   55   1   133   5 
TSM unallocated operating expenses  (2,217)  (3,167)  (2,900)  (2,707)  (5,117)  (5,874)
Elimination of TSM intersegment charges  2,400   2,387   2,400   2,386   4,800   4,773 
Consolidated operating (loss) income  (12,176)  6,113 
Consolidated operating income (loss)  11,241   4,160   (935)  10,273 
Consolidated net realized investment gains  336   58   4,054   1,520   4,390   1,578 
Consolidated interest expense  (1,686)  (1,882)  (1,721)  (1,954)  (3,407)  (3,836)
Consolidated other income, net  2,525   875   587   3,859   3,112   4,734 
Consolidated (loss) income before taxes $(11,001) $5,164 
Consolidated income before taxes $14,161  $7,585  $3,160  $12,749 
                        
Depreciation and amortization expense:                        
Managed care $2,239  $2,934  $2,649  $2,839  $4,888  $5,773 
Life insurance  280   255   318   249   598   504 
Property and casualty insurance  114   161   138   150   252   311 
Other segments*  160   153   163   166   323   319 
Total business segments  2,793   3,503   3,268   3,404   6,061   6,907 
TSM depreciation expense  197   197   196   196   393   393 
Consolidated depreciation and amortization expense $2,990  $3,700  $3,464  $3,600  $6,454  $7,300 

*Includes segments that are not required to be reported separately, primarily the data processing services organization and the health clinic.
 
2728

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
 
March 31,
2017
  
December 31,
2016
  
June 30,
2017
  
December 31,
2016
 
Assets:            
Managed care $1,144,927  $1,013,872  $1,156,585  $1,013,872 
Life insurance  820,481   816,920   841,401   816,920 
Property and casualty insurance  347,282   349,159   377,020   349,159 
Other segments *  26,274   26,034   27,031   26,034 
Total business segments  2,338,964   2,205,985   2,402,037   2,205,985 
Unallocated amounts related to TSM:                
Cash, cash equivalents, and investments  22,531   17,033   9,889   17,033 
Property and equipment, net  22,228   22,380   22,130   22,380 
Other assets  21,337   21,646   20,842   21,646 
  66,096   61,059   52,861   61,059 
Elimination entries-intersegment receivables and others  (46,605)  (48,045)  (49,530)  (48,045)
Consolidated total assets $2,358,455  $2,218,999  $2,405,368  $2,218,999 

*Includes segments that are not required to be reported separately, primarily the data processing services organization and the health clinic.
 
2829

Triple-S Management Corporation
Notes to Condensed Consolidated Financial Statements
(dollar amounts in thousands, except per share data)
(unaudited)

 
(14)Subsequent Events
 
The Company evaluated subsequent events through the date the financial statements were issued.  No events, other than those described in these notes, have occurred that require adjustment or disclosure pursuant to current Accounting Standards Codification.
 
2930

Item 2.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
 
In this Management’s Discussion and Analysis of Financial Condition and Results of Operations (MD&A), the “Corporation”, the “Company”, “TSM”, “we”, “us” and “our” refers to Triple-S Management Corporation and its subsidiaries.  The MD&A included in this Quarterly Report on Form 10-Q is intended to update the reader on matters affecting the financial condition and results of operations for the three months and six months ended March 31,June 30, 2017.  Therefore, the following discussion should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Annual Report on Form 10-K filed with the United States Securities and Exchange Commission as of and for the year ended December 31, 2016 and the MD&A included therein, and our unaudited consolidated financial statements and accompanying notes as of and for the three months and six months ended March 31,June 30, 2017 included in this Quarterly Report on Form 10-Q.
 
Cautionary Statement Regarding Forward-Looking Information
 
This Quarterly Report on Form 10-Q and other of our publicly available documents may include statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, including, among other things: statements concerning our business and our financial condition and results of operations.  These statements are not historical, but instead represent our belief regarding future events, any of which, by their nature, are inherently uncertain and outside of our control.  These statements may address, among other things, future financial results, strategy for growth, and market position.  It is possible that our actual results and financial condition may differ, possibly materially, from the anticipated results and financial condition indicated in these forward-looking statements.  The factors that could cause actual results to differ from those in the forward-looking statements are discussed throughout this form.  We are not under any obligation to update or alter any forward-looking statement (and expressly disclaims any such obligations), whether as a result of new information, future events or otherwise.  Factors that may cause actual results to differ materially from those contemplated by such forward looking statements include, but are not limited to, rising healthcare costs, business conditions and competition in the different insurance segments, government action and other regulatory issues.
 
Overview
 
We are one of the most significant players in the managed care industry in Puerto Rico and have over 55 years of experience in this industry.  We offer a broad portfolio of managed care and related products in the Commercial, Medicaid and Medicare Advantage markets.  In the Commercial market we offer products to corporate accounts, U.S. federal government employees, local government employees, individual accounts and Medicare Supplement.  We also participate in the Government of Puerto Rico Health Insurance Plan (a government of Puerto Rico-funded managed care program for the medically indigent that is similar to the Medicaid program in the U.S.) (Medicaid), by administering the provision of health benefits in designated service regions in Puerto Rico.  See details of the Medicaid contract in Item 1A of Part I of our Annual Report on Form 10-K for the year ended December 31, 2016 under the sub-caption “We are dependent on a small number of government contracts to generate a significant amount of the revenues of our managed care business.
 
We have the exclusive right to use the Blue Cross Blue Shield (BCBS) name and mark throughout Puerto Rico, the U.S. Virgin Islands, Costa Rica, the British Virgin Islands and Anguilla.  As of March 31,June 30, 2017, we served approximately 1,016,0001,006,000 members across all regions of Puerto Rico.  For the threesix months ended March 31,June 30, 2017 and 2016, respectively, our managed care segment represented approximately 91% and 92% of our total consolidated premiums earned.  We also have significant positions in the life insurance and property and casualty insurance markets.
 
We participate in the managed care market through our subsidiaries, Triple-S Salud, Inc. (TSS) and, Triple-S Advantage, Inc. (TSA), and Triple-S Blue, Inc.Inc. I.I. (TSB).  TSS, TSA and TSB are Blue Cross Blue Shield Association (BCBSA) licensees, which provides us with exclusive use of the Blue Cross and Blue Shield name and mark throughout Puerto Rico, the U.S. Virgin Islands, Costa Rica, the British Virgin Islands, and Anguilla.
 
3031

We participate in the life insurance market through our subsidiary, Triple-S Vida, Inc., and in the property and casualty insurance market through our subsidiary, Triple-S Propiedad, Inc. (TSP).
 
Intersegment revenues and expenses are reported on a gross basis in each of the operating segments but eliminated in the consolidated results.  Except as otherwise indicated, the numbers for each segment presented in this Quarterly Report on Form 10-Q do not reflect intersegment eliminations.  These intersegment revenues and expenses affect the amounts reported on the financial statement line items for each segment, but are eliminated in consolidation and do not change net income.  See note 13 of the Condensed Consolidated Financial Statements included in Quarterly Report on Form 10-Q.
 
Our revenues primarily consist of premiums earned, net and administrative service fees.  These revenues are derived from the sale of managed care products in the Commercial market to employer groups, individuals and government-sponsored programs, principally Medicare and the Government of Puerto Rico Health Insurance Plan.  Premiums are derived from insurance contracts and administrative service fees are derived from self-funded contracts, under which we provide a range of services, including claims administration, billing and membership services, among others.  Revenues also include premiums earned from the sale of property and casualty and life insurance contracts, and investment income and revenues derived from other segments.  Substantially all of our earnings are generated in Puerto Rico.
 
Claims incurred include the payment of benefits and losses, mostly to physicians, hospitals and other service providers, and to policyholders.  Each segment’s results of operations depend to a significant extent on their ability to accurately predict and effectively manage claims.  A portion of the claims incurred for each period consists of claims reported but not paid during the period, as well as a management and actuarial estimate of claims incurred but not reported during the period.  Operating expenses consist primarily of compensation, commission payments to brokers and other overhead business expenses.
 
We use operating income as a measure of performance of the underwriting and investment functions of our segments.  We also use the loss ratio and the operating expense ratio as measures of performance.  The loss ratio is claims incurred divided by premiums earned, net, multiplied by 100.  The operating expense ratio is operating expenses divided by premiums earned; net and administrative service fees, multiplied by 100.
 
Recent Developments
 
Puerto Rico Economy

During the past decade, Puerto Rico has been facing economic and fiscal challenges and its economy has been contracting.  In response to the Commonwealth of Puerto Rico (the Commonwealth)“Commonwealth”) fiscal and economic crisis, on June 30, 2016, the U.S. Congress enacted the Puerto Rico Oversight, Management and Economic Stability Act (“PROMESA”), which, among other things, established a Federally-appointed oversight board (the “Oversight Board”) comprised of seven members with ample powers over the finances of the Commonwealth and its instrumentalities.  PROMESA also established a temporary stay on litigation to enforce rights or remedies related to financial liabilities of the Commonwealth, its instrumentalities and municipalities, which expired on May 1, 2017.  Finally, PROMESA established two separate mechanisms to restructure the debts of the Commonwealth, its public corporations and municipalities. The first mechanism permits modifications of financial indebtedness with the consent of a supermajority of affected financial creditors. The second mechanism, known as Title III, is a court-supervised debt-adjustment process, which is modeled after Chapter 9 of the U.S. Bankruptcy Code.
 
Pursuant to PROMESA, the Oversight Board required the Commonwealth to deliver a fiscal plan by January 15, 2017, which deadline was later extended until February 28, 2017.  In a letter dated January 18, 2017, the Oversight Board recommended to the Governor a series of measures for inclusion in the fiscal plan, including: (i) a $1.0 billion reduction in health care spending by fiscal year 2019, (ii) the elimination of budgetary subsidies to municipalities and (iii) significant reductions in payroll expenditures and pension and/or pension-related benefits.  On February 28, 2017, the Governor of Puerto Rico submitted a 10-year fiscal plan to the Oversight Board, for its review and approval.  After certain revisions, a final plan was approved by the Oversight Board on March 13, 2017, which includes spending reductions of $25.7 billion. The plan implies larger concessions from bondholders since there would be approximately $8 billion available for debt service payments over the next 10 years, compared to around $35 billion that is owed over that period.  The plan also proposes (i) certain significant changes to the Commonwealth’s healthcare delivery model in order to reduce expenses and (ii) the elimination of subsidies to the municipalities, many of which have contracts for the provision of healthcare or other insurance products with our subsidiaries. The plan, however, does not provide details about the proposed changes or the timeline for their implementation.  Also, it is uncertain if and how the elimination of municipal subsidies will affect municipal finances and their ability to continue to meet their contractual obligations.
The Oversight Board also required that certain Commonwealthand approved fiscal plans for several government instrumentalities, such as Government Development Bank for Puerto Rico,including the Puerto Rico Aqueduct and Sewer Authority, the Puerto Rico Electric Power Authority (“PREPA”), and the University of Puerto Rico prepareHighways and submit fiscal plans.  All such fiscal plans have been submitted and approved, other than the plan for the University of Puerto Rico, and include significant expenditure reductions across all types of expenses.  In the future, the Oversight Board may require other instrumentalities and municipalities to prepare and submit fiscal plans.Transportation Authority (“PRHTA”), among others.
On May 1, 2017, the temporary stay on litigation established by PROMESA expired. After the expiration of the temporary stay, several investors holding general obligation and sales and use tax-backed bonds filed lawsuits to enforce their rights and remedies related to the financial liabilities of the Commonwealth, its instrumentalities and municipalities. On May 3, 2017, after not reaching an agreement with its creditors, the Oversight Board filed an order seeking the protection of the provisions of Title III of PROMESA for the Commonwealth. On May 5, 2017,Subsequently, the Oversight Board also sought the protection offiled Title III of PROMESA forpetitions with respect to the Puerto Rico Sales Tax Financing Corporation (“COFINA” by its Spanish acronym), which issued the sales and use tax-backed bonds.bonds, the Employee Retirement System, PRHTA and PREPA. While the proceedings under Title III of PROMESA are ongoing, all enforcement and collection actions against the Commonwealth and COFINAthese instrumentalities by its creditors are stayed. As a result of this court-supervised debt-adjustment process, the principal and interest payments due on general obligation, and sales and use tax-backed bonds, and bonds from these government instrumentalities will likely be restructured and such restructuring could lead to significant additional losses on such holdings. Further, on May 30, 2017, pursuant to a court order under COFINA’s Title III proceeding, funds held by the trustee of the COFINA bonds have not been applied for the payment of such bonds pending the resolution of various legal disputes. On June 6, 2017, S&P downgraded COFINA to “D”. Although as of the date hereof, these entities are the only instrumentalities for which the Oversight Board has sought the restructuring authority provided by PROMESA, in the future, the Oversight Board may use the restructuring mechanisms of PROMESA for other instrumentalities of the Commonwealth, including it municipalities.
 
Although the Oversight Board has not sought the protection of Title III of PROMESA for the Puerto Rico Health Insurance Administration (“ASES” by its Spanish acronym), the instrumentality responsible for the administration of the Government’s health plan, ASES may be affected by the Commonwealth’s fiscal plan and the proceedings commenced for the Commonwealth under Title III of PROMESA because its state-based funding is solely dependent on appropriations from the Government’s general fund.  Notwithstanding the Government’s statement in recent legislation that its public policy includes guaranteeing the continuity of public services in essential areas such as health, security, education, social work and development, among others, it is uncertain how the Commonwealth’s Title III proceeding will affect ASES and the contracts administered by it.
 
If the liquidity of the Government of Puerto Rico, its agencies, municipalities and public corporations becomes significantly affected as a result of their inability to raise funding in the market or generate enough revenues, we may face credit losses in our premium and fees receivables from these and other government related entities.  As of March 31,June 30, 2017, the Company had premiums and other receivables of $51.5$63.6 million from the Government of Puerto Rico, including its agencies, municipalities and public corporations with a related allowance for doubtful receivables of $14.1$14.9 million.  We also hold several positions categorized as Obligations of the Commonwealth of Puerto Rico, including Cofina bonds,one COFINA bond, which are susceptible to the aforementioned recent developments in the economy, see note 3 to the unaudited consolidated financial statements included in this Quarterly Report on Form 10-Q.

Legislation

On July 23, 2017, the Commonwealth enacted Act 47-2017 (“Act 47”), which, among other things, imposes restrictions on utilization review (“UR”) processes related to hospitalizations and the ability of  managed care organizations (“MCO”s), to conduct internal review processes at any level of appeal. Act 47 also creates a statutory cause of action against MCOs for intervening with the “diagnostic and medical treatment of a patient” making them joint and severally liable in those cases in which the patient suffers damages as a direct or indirect result of such intervention. Act 47 orders the Puerto Rico Patient's Advocate Office and the Puerto Rico Health Insurance Administration (“ASES”), to adopt the necessary regulations to ensure compliance with the provisions of Act 47 within 60 days of its enactment. Act 47 specifically orders ASES to regulate UR according to the United States’ national standards. We are closely monitoring how Act 47 and its regulations will impact the Company.
 
Puerto Rico Government Health Reform Program
 
Current Medicaid premiums rates are effective untilOn June 30, 2017;2017, TSS agreed to extend its contract with ASES for the negotiationprovision of health services in the Metro North and West regions of the Puerto Rico Government’s health insurance program, which expired on June 30, 2017, for a three-month period beginning July 1, 2017 and ending September 30, 2017.  This extension is intended to ensure the continuity of services while the parties conclude negotiations for the renewal of the contract through the remainder of the Puerto Rico Government’s 2017-2018 fiscal year, which ends June 30, 2018.  Under the contract extension, ASES will increase its payment to TSS from a rate of $165.93 to $183.38 per member per month (PMPM) for the Metro North region and from $138.37 to $148.99 PMPM for the West region.  The new rates reflect cost and utilization trends for the 2016-2017 fiscal year and are subject to CMS approval, which is expected to occur during the 90 day extension period.  ASES will continue to pay current PMPM rates until CMS approves new PMPM rates, at which time ASES will pay the endcumulative difference between both rates.  Upon reaching an agreement on outstanding terms of the three year agreement, is ongoing.contract renewal, the new rates will also apply for the remainder of the 2017-2018 fiscal year. See Item 1A.   Risk Factors—Risks Related to Our Business – “We are dependent on a small number of government contracts to generate a significant amount of the revenues of our managed care business.’’ included in our Annual Report on Form 10-K for the year ended December 31, 2016.
Political and Regulatory Developments
CMS announced final benchmark rates for the 2018 Medicare Advantage plans.  The call letter included revenue adjustments reflecting the physician payment increases, maintaining the zero claims adjustment, and allowing certain Puerto Rico counties to qualify for double bonus status.  The impact of these updates result in a benchmark increase of about 4%. See Item 1A.   Risk Factors—Risks Related to the Regulation of our Industry – “The revised rate calculation system for Medicare Advantage, the payment system for the Medicare Part D and changes in the methodology and payment policies used by CMS to establish rates could reduce our profitability and the benefits we offer our beneficiaries’’ included in our Annual Report on Form 10-K for the year ended December 31, 2016.

Recent Accounting Standards
 
For a description of recent accounting standards, see note 2 to the unaudited consolidated financial statements included in this Quarterly Report on Form 10-Q.
 
Managed Care Membership
 
 As of March 31,  As of June 30, 
 2017  2016  2017  2016 
Managed care enrollment:            
Commercial 1
  505,848   544,846   498,393   528,902 
Medicare  121,352   119,224   121,240   116,215 
Medicaid  389,130   402,933   386,070   402,661 
Total  1,016,330   1,067,003   1,005,703   1,047,778 
Managed care enrollment by funding arrangement:                
Fully-insured  847,327   886,547   839,299   868,157 
Self-insured  169,003   180,456   166,404   179,621 
Total  1,016,330   1,067,003   1,005,703   1,047,778 

(1)Commercial membership includes corporate accounts, self-funded employers, individual accounts, Medicare Supplement, Federal government employees and local government employees.
 
Consolidated Operating Results

The following table sets forth the Corporation’s consolidated operating results.  Further details of the results of operations of each reportable segment are included in the analysis of operating results for the respective segments.

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
(dollar amounts in millions) 2017  2016  2017  2016  2017  2016 
Revenues:                  
Premiums earned, net $702.3  $738.5  $722.9  $729.1  $1,425.2  $1,467.6 
Administrative service fees  4.4   5.1   4.5   4.5   8.9   9.6 
Net investment income  12.0   11.4   12.7   12.9   24.7   24.2 
Other operating revenues  0.9   0.8   1.1   0.9   2.1   1.7 
Total operating revenues  719.6   755.8   741.2   747.4   1,460.9   1,503.1 
Net realized investment gains  0.3   -   4.1   1.5   4.4   1.6 
Other income, net  2.6   0.9   0.6   3.8   3.1   4.7 
Total revenues  722.5   756.7   745.9   752.7   1,468.4   1,509.4 
Benefits and expenses:                        
Claims incurred  620.9   626.7   611.3   622.1   1,232.2   1,248.8 
Operating expenses  110.9   123.0   118.7   121.1   229.6   244.1 
Total operating expenses  731.8   749.7   730.0   743.2   1,461.8   1,492.9 
Interest expense  1.7   1.9   1.7   1.9   3.4   3.8 
Total benefits and expenses  733.5   751.6   731.7   745.1   1,465.2   1,496.7 
(Loss) income before taxes  (11.0)  5.1 
Income taxes (benefit) / expense  (6.7)  1.7 
Net (loss) income attributable to TSM $(4.3) $3.4 
Income before taxes  14.2   7.6   3.2   12.7 
Income tax expense (benefit)  1.5   3.7   (5.2)  5.4 
Net income attributable to TSM  12.7   3.9   8.4   7.3 

Three Months Ended March 31,June 30, 2017 Compared to Three Months Ended March 31,June 30, 2016
 
Operating Revenues
 
Consolidated premiums earned, net for the three months ended March 31,June 30, 2017 decreased by $36.2$6.2 million, or 4.9%0.9%, to $702.3$722.9 million when compared to the three months ended March 31,June 30, 2016.  This decrease primarily reflects lower premiums in the Managed Care segment by $38.2$7.6 million mainly due to lower Medicare risk score revenue adjustments and lower membership in the segment’s Medicaid and Commercial businesses. These decreases were partially offset by higher Life Insurance premiums, and by the Medicaid profit sharing accrual recorded during the three months ended June 30, 2016.
Net Realized Investment Gains
Consolidated net realized investment gains are the result of sales of debt and equity securities classified as available for sale, following our asset/liability management and tax planning strategies.  The net realized gains for the period ending June 30, 2016 were partially offset by $1.4 million other-than-temporary impairments related to certain equity investments.
 
Other Income, Net
 
The $1.7$3.2 million increasedecrease in consolidated other income reflects the collection of interest charged for late payment related to the current Medicaid contract.contract during the three months ended June 30, 2016.
 
Claims Incurred
 
Consolidated claims incurred decreased by $5.8$10.8 million, or 0.9%1.7%, to $620.9$611.3 million during the three months ended March 31,June 30, 2017, when compared to the claims incurred during the three months ended March 31, 2016, mostly due to lower claims in the Managed Care segment.  The decrease in Managed Care claims primarily reflects lower claims incurred in the segment’s MedicaidCommercial and CommercialMedicaid businesses primarily driven by lower enrollment, better claim experience in the Commercial business, offset in part by higher pharmacy claims trends in the Medicare and Medicaid businesses, higher Part B drugs in the Medicare business, and enhanced benefits in the Medicare 2017 offerings.  This decrease was also offset by higher claims incurred in the Life Insurance segment.  The consolidated loss ratio increaseddecreased by 35070 basis points to 88.4%84.6%.
 
Operating Expenses
 
Consolidated operating expenses during the three months ended March 31,June 30, 2017 decreased by $12.1$2.4 million, or 9.8%2.0%, to $110.9 million as compared to the operating expenses during the three months ended March 31, 2016.$118.7 million. The lower operating expenses are mostly the result of the decrease in the Health Insurance Providers Fee (HIP fee) of $10.8$10.7 million due to the 2017 tax holiday, and lower personnel costs.offset by increase in general operating expenses totaling approximately $8.1 million.  For the three months ended March 31,June 30, 2017, the consolidated operating expense ratio decreased 8020 basis points to 15.7%16.3%.
Income Taxes
Consolidated income tax expense decreased by $2.2 million, to an expense of $1.5 million for the three months ended June 30, 2017.  The year over year change primarily results from the prior year reassessment done by the Property and Casualty segment of the tax rate used to measure several temporary differences, which increased the deferred tax rate from 20% to 39%, resulting in an increase to the 2016 deferred tax expense of $2.6 million.

Six Months Ended June 30, 2017 Compared to Six Months Ended June 30, 2016
Operating Revenues
Consolidated premiums earned, net for the six months ended June 30, 2017 decreased by $42.4 million, or 2.9%, to $1,425.2 million when compared to the six months ended June 30, 2016.  This decrease primarily reflects lower premiums in the Managed Care segment by $45.7 million mainly due to lower membership in the segment’s Medicaid and Commercial businesses.
Net Realized Investment Gains
Consolidated net realized investment gains are the result of sales of debt and equity securities classified as available for sale, following our asset/liability management and tax planning strategies.  The net realized gains for the period ended June 30, 2016 were partially offset by $1.4 million other-than-temporary impairments related to certain equity investments.
Other Income, Net
The $1.6 million decrease in consolidated other income reflects the collection of interest charged for late payment related to the current Medicaid contract during the six months ended June 30, 2016.
Claims Incurred
Consolidated claims incurred decreased by $16.6 million, or 1.3%, to $1,232.2 million during the six months ended June 30, 2017, mostly due to lower claims in the Managed Care segment.  The decrease in Managed Care claims primarily reflects lower claims incurred in the segment’s Commercial and Medicaid businesses primarily driven by lower enrollment, better claim experience in the Commercial business, offset in part by higher pharmacy claims trends in the Medicare and Medicaid businesses, and enhanced benefits in the Medicare 2017 offerings.  The consolidated loss ratio increased by 140 basis points to 86.5%.
Operating Expenses
Consolidated operating expenses during the six months ended June 30, 2017 decreased by $14.5 million, or 5.9%, to $229.6 million as compared to the operating expenses during the six months ended June 30, 2016.  The lower operating expenses and expense ratio are mostly the result of the decrease in the HIP Fee of $21.6 million due to the 2017 moratorium offset by increase in general operating expenses totaling approximately $6.7 million.  For the six months ended June 30, 2017, the consolidated operating expense ratio decreased 50 basis points to 16.0%.
 
Income Taxes
 
Consolidated income taxes decreased by $8.4$10.6 million, to a net benefit of $6.7$5.2 million for the threesix months ended March 31,June 30, 2017.  The year over year change in income taxes primarily results from a loss before taxes incurred in the 2017 period incurred in the Managed Care segment.
 
Managed Care Operating Results

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
(dollar amounts in millions) 2017  2016  2017  2016  2017  2016 
Operating revenues:                  
Medical premiums earned, net:                  
Commercial $205.1  $215.5  $203.3  $215.0  $408.4  $430.5 
Medicare  257.7   261.0   266.6   273.1   524.3   534.0 
Medicaid  177.7   202.2   191.8   181.2   369.5   383.4 
Medical premiums earned, net  640.5   678.7   661.7   669.3   1,302.2   1,347.9 
Administrative service fees  5.6   6.3   5.8   5.8   11.4   12.1 
Net investment income  3.9   3.5   4.1   4.1   8.0   7.6 
Total operating revenues  650.0   688.5   671.6   679.2   1,321.6   1,367.6 
Medical operating costs:                        
Medical claims incurred  587.3   596.3   579.2   590.2   1,166.5   1,186.5 
Medical operating expenses  81.3   92.8   89.5   92.8   170.8   185.5 
Total medical operating costs  668.6   689.1   668.7   683.0   1,337.3   1,372.0 
Medical operating loss $(18.6) $(0.6)
Medical operating income (loss) $2.9  $(3.8) $(15.7) $(4.4)
Additional data:                        
Member months enrollment:                        
Commercial:                        
Fully-insured  1,013,205   1,096,282   1,001,638   1,063,422   2,014,843   2,159,704 
Self-funded  507,167   543,026   501,500   540,221   1,008,667   1,083,247 
Total Commercial  1,520,372   1,639,308 
Medicare  363,727   364,427 
Medicaid  1,173,273   1,221,892 
Total Commercial member months  1,503,138   1,603,643   3,023,510   3,242,951 
                
Medicare member months  363,257   351,108   726,984   715,535 
                
Medicaid member months  1,169,090   1,206,345   2,342,363   2,428,237 
Total member months  3,057,372   3,225,627   3,035,485   3,161,096   6,092,857   6,386,723 
Medical loss ratio  91.7%  87.9%  87.5%  88.2%  89.6%  88.0%
Operating expense ratio  12.6%  13.5%  13.4%  13.7%  13.0%  13.6%

Three Months Ended March 31,June 30, 2017 Compared to Three Months Ended March 31,June 30, 2016
 
Medical Operating Revenues

Medical premiums earned for the three months ended March 31,June 30, 2017 decreased by $38.2$7.6 million, or 5.6%1.1%, to $640.5$661.7 million when compared to the medical premiums earned during the three months ended March 31,June 30, 2016.  This decrease is principally the result of the following:

Medical premiums generated by the Medicaid business amounted to $177.7 million, $24.5 million, or 12.1% lower when compared to the medical premiumsPremiums earned during the three months ended March 31, 2016.  Decrease primarily reflects lower fully-insured member months enrollment by approximately 48,600 lives and the 4% decrease in average premium rates that went into effect July 1, 2016. Also contributing to the lower premiums during this period are last year’s partial reversal of the accrued 2.5% excess profit of $3.6 million and to $2.6 million related to the suspension of the HIP fee pass-through as a result of the 2017 moratorium.
Medical premiums generated by the Commercial business decreased by $10.4$11.7 million, or 4.8%5.4%, to $205.1$203.3 million.  This fluctuation primarily reflects lower fully-insured member enrollment during the quarter of approximately 83,00061,800 member months and $3.5$3.6 million related to the suspension of the HIP fee pass-through; offset by an increase in average premium rates of approximately 5%.

Medical premiums generated
Premiums earned by the Medicare business decreased by $3.3$6.5 million, or 1.3%2.4%, to $257.7$266.6 million, primarily reflecting a lower risk score revenue adjustment in 2017 by $17.5 million, lower average premium rates due to a change in membership mix, with the current period presenting a higher concentration of non-dual individuals and groups and a reduction in the 2017 Medicare reimbursement rates.rates; offset in part by an increase in member month enrollment of approximately 12,000 lives.
 
Premiums earned by the Medicaid business amounted to $191.8 million, $10.6 million, or 5.8% higher than the same period last year.  Increase primarily reflects the $14.6 million profit sharing accrual that decreased premiums during the 2016 period and the $11.6 million premium collection related to our compliance with the contract’s incentive metrics. These increases were partially offset by lower fully-insured member months enrollment by approximately 37,000 lives, the 4% decrease in the average premium rates that went into effect July 1, 2016, and $2.6 million related to the suspension of the HIP fee pass-through as a result of the 2017 moratorium.

Medical Claims Incurred

Medical claims incurred during the three months ended March 31,June 30, 2017 decreased by $9.0$11.0 million, or 1.5%1.9%, to $587.3$579.2 million when compared to the three months ended March 31,June 30, 2016.  The medical loss ratio (MLR) of the segment increased 380decreased 70 basis points during the 2017 period, to 91.7%87.5%.  This fluctuation is primarily attributed to the net effect of the following:
The medical claims incurred in the Medicaid business decreased by $8.4 million, or 4.6%, during the 2017 period, mostly driven by lower enrollment offset by higher utilization. The MLR, at 97.8%, was 770 basis point higher than the same period last year.  The higher MLR primarily reflects increased pharmacy and outpatient claim trends and the lower premium rates that went into effect July 1, 2016.

The medical claims incurred of the Commercial business decreased by $7.6$28.2 million, or 4.3%14.7%, during the 2017 period mostly driven by lower enrollment. The MLR, at 83.5%80.6%, was 70860 basis point higherlower than the same monthquarter last year.  Adjusting for the effect of prior period reserve developments, the Commercial MLR would have been 83.3%83.1%, 240450 basis points lower than the adjusted MLR for last year primarily reflecting claim trends that are lower than our premium trends following the continuity of our underwriting discipline.

The medical claims incurred of the Medicare business increased by $7.0$5.9 million, or 3.0%2.5%, during the 2017 period and its MLR increased by 390430 basis points, to 94.0%90.9%.  Adjusting for the effect of prior period reserve developments in 2017 and 2016 and moving the risk score revenue adjustments to their corresponding period, the Medicare MLR would have been approximately 95.6%94.3% this quarter, about 280300 basis points higher than last year, primarily reflecting higher trends in Part B drugs, pharmacy benefits and the improvement of benefits in 2017 products taking advantage of the HIP fee moratorium.

The medical claims incurred in the Medicaid business increased by $11.3 million, or 7.0%, during the 2017 period and its MLR increased by 100 basis points, to 90.3%.    Adjusting for the effect of prior period reserve developments in 2017 and 2016, as well as for the impact of the profit sharing accrual and this year’s quality incentive premiums, the Medicaid MLR would have been approximately 96.0% this quarter, about 580 basis points higher than last year.  The higher MLR primarily reflects increased pharmacy and outpatient claim trends and the lower premium rates that went into effect July 1, 2016.

Medical Operating Expenses

Medical operating expenses for the three months ended June 30, 2017 decreased by $3.3 million, or 3.6%, to $89.5 million when compared to the three months ended June 30, 2016.  The operating expense ratio decreased by 30 basis points to 13.4% in 2017.  The lower operating expenses and expense ratio are mostly the result of the decrease in the HIP Fee of $10.7 million due to the 2017 moratorium offset by increase in personnel costs, general operating expenses of totaling approximately $6.9 million.
Six Months Ended June 30, 2017 Compared to Six Months Ended June 30, 2016

Medical Operating Revenues

Medical premiums earned for the six months ended June 30, 2017 decreased by $45.7 million, or 3.4%, to $1,302.2 million when compared to the medical premiums earned during the six months ended June 30, 2016.  This decrease is principally the result of the following:

Premiums earned by the Commercial business decreased by $22.1 million, or 5.1%, to $408.4 million.  This fluctuation primarily reflects lower fully-insured enrollment during the year of approximately 144,900 member months and $7.2 million related to the suspension of the HIP fee pass-through; offset by an increase in average premium rates of approximately 5%.

Premiums earned by the Medicaid business decreased by $13.9 million, or 3.6% to $369.5 million.  Decrease primarily reflects lower fully-insured member months enrollment by approximately 85,900 lives, and the 4.0% decrease in average premium rates that went into effect July 1, 2016.  Also contributing to the lower premiums during this period was a $5.3 million related to the suspension of the HIP fee pass-through as a result of the 2017 moratorium.  Decreases are partially offset by the impact of the profit sharing accrual in the 2016 period that decreased premiums by $10.6 million and by the $11.6 million premium collection related to our compliance with the contract’s quality incentive metrics.

Premiums earned by the Medicare business decreased by $9.7 million, or 1.8%, to $524.3 million.  Decrease primarily reflects lower risk score revenue by $20.9 million as well as lower average premium rates due to a reduction in the 2017 Medicare reimbursement rates.  These decreases were partially offset by an increase in member month enrollment of approximately 11,000 lives.

Medical Claims Incurred

Medical claims incurred during the six months ended June 30, 2017 decreased by $20.0 million, or 1.7%, to $1,166.5 million when compared to the six months ended June 30, 2016.  The MLR of the segment increased 160 basis points during the 2017 period, to 89.6%.  This fluctuation is primarily attributed to the net effect of the following:

The medical claims incurred of the Commercial business decreased by $35.8 million, or 9.6%, during the 2017 period mostly driven by lower enrollment. The MLR, at 82.1%, was 390 basis point lower than the same period last year.  Adjusting for the effect of prior period reserve developments, the Commercial MLR would have been 82.8%, 390 basis points lower than the adjusted MLR for last year primarily reflecting claim trends that are lower than our premium trends following the continuity of our underwriting discipline.

The medical claims incurred in the Medicaid business increased by $3.0 million, or 0.9%, during the 2017 period and its MLR increased by 420 basis points, to 93.9%.  Adjusting for the effect of prior period reserve developments in 2017 and 2016, as well as for the impact of the profit sharing accrual and this year’s quality incentive premiums, the Medicaid MLR would have been approximately 95.4% this quarter, about 620 basis points higher than last year.  The higher MLR primarily reflects increased pharmacy and outpatient claim trends and the lower premium rates that went into effect July 1, 2016.

The medical claims incurred of the Medicare business increased by $12.9 million, or 2.7%, during the 2017 period and its MLR increased by 410 basis points, to 92.4%.  Adjusting for the effect of prior period reserve developments in 2017 and 2016 and moving the risk score revenue adjustments to their corresponding period, the Medicare MLR would have been approximately 94.1% this quarter, about 210 basis points higher than last year, primarily reflecting higher trends in Part B drugs, pharmacy benefits and the improvement of benefits in 2017 products taking advantage of the HIP fee moratorium.
 
Medical Operating Expenses

Medical operating expenses for the threesix months ended March 31,June 30, 2017 decreased by $11.5$14.7 million, or 12.4 %,7.9%, to $81.3$170.8 million when compared to the threesix months ended March 31,June 30, 2016.  The operating expense ratio decreased by 9060 basis points to 12.6%13.0% in 2017.  The lower operating expenses and expense ratio are mostly the result of the decrease in the HIP Fee of $10.7$21.6 million due to the 2017 moratorium as well as lower personnel costs.offset by increase in general operating expenses of totaling approximately $6.7 million.
Life Insurance Operating Results

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
(dollar amounts in millions) 2017  2016  2017  2016  2017  2016 
Operating revenues:                  
Premiums earned, net:                  
Premiums earned $41.8  $39.8  $41.8  $39.7  $83.6  $79.5 
Assumed earned premiums  0.9   1.5   0.5   1.2   1.4   2.7 
Ceded premiums earned  (2.2)  (2.2)  (2.3)  (2.1)  (4.5)  (4.3)
Premiums earned, net  40.5   39.1   40.0   38.8   80.5   77.9 
Net investment income  6.1   5.9   6.3   6.4   12.4   12.3 
Total operating revenues  46.6   45.0   46.3   45.2   92.9   90.2 
Operating costs:                        
Policy benefits and claims incurred  23.7   21.4   21.9   21.9   45.6   43.4 
Underwriting and other expenses  19.0   18.0   19.4   18.2   38.4   36.2 
Total operating costs  42.7   39.4   41.3   40.1   84.0   79.6 
Operating income $3.9  $5.6  $5.0  $5.1  $8.9  $10.6 
Additional data:                        
Loss ratio  58.5%  54.7%  54.8%  56.4%  56.6%  55.7%
Operating expense ratio  46.9%  46.0%  48.5%  46.9%  47.7%  46.5%

Three Months Ended March 31,June 30, 2017 Compared to Three Months Ended March 31,June 30, 2016

Operating Revenues

Premiums earned, net increased by $1.4$1.2 million, or 3.6%3.1% to $40.5$40.0 million as the result of premium growth in the segment’s Individual Life and Cancer lines of business, as well as growth in the Costa Rica operations.

Policy Benefits and Claims Incurred
 
Policy benefits and claims incurred remained at $21.9 million, the same as the 2016 period, despite the higher volume of business during the year.  The loss ratio for the period decreased to 54.8% in 2017, or 160 basis points, reflecting the higher volume of premiums during this quarter.

Underwriting and Other Expenses

Increase in underwriting and other expenses of $1.2 million, or 6.6%, to $19.4 million mostly reflects higher commissions following the segment’s premium growth.  In addition, the segment has incurred in higher development and marketing expenses related to the expansion of the Costa Rica operations.  As a result, the segment’s operating expense ratio increased to 48.5%, or 160 basis points.
Six Months Ended June 30, 2017 Compared to Six Months Ended June 30, 2016

Operating Revenues

Premiums earned, net increased by $2.3$2.6 million, or 10.7%,3.3% to $23.7$80.5 million as the result of premium growth in the segment’s Individual Life and Cancer lines of business, as well as growth in the Costa Rica operations.

Policy Benefits and Claims Incurred

Policy benefits and claims incurred increased by $2.2 million, or 5.1% to $45.6 million, mostly as the result of the higher volume of business during the year, particularly in the Cancer and Individual Life and Cancer lines of business and higher number of claims paid.business.  The loss ratio for the period increased to 58.5%56.6% in 2017, or 38090 basis points, reflecting the higher volume in the Cancer line of business, which has a higher loss ratio, as well as to a higher claims experience in this particular line of business.

Underwriting and Other Expenses

Increase in underwriting and other expenses of $1.0$2.2 million, or 5.6%6.1%, to $19.0$38.4 million mostly reflects higher commissions following the segment’s premium growth mentioned above.  In addition, the segment has incurred in higher development and marketing expenses related to the expansion of the Costa Rica operations.  As a result, the segment’s operating expense ratio increased to 46.9%47.7%, 90or 120 basis points.
Property and Casualty Insurance Operating Results

 
Three months ended
March 31,
  
Three months ended
June 30,
  
Six months ended
June 30,
 
(dollar amounts in millions) 2017  2016 
(Dollar amounts in millions) 2017  2016  2017  2016 
Operating revenues:                  
Premiums earned, net:                  
Premiums written $27.4  $27.6  $46.4  $40.9  $73.8  $68.5 
Premiums ceded  (10.1)  (10.4)  (16.6)  (13.1)  (26.7)  (23.5)
Change in unearned premiums  4.4   4.1   (8.0)  (6.1)  (3.6)  (2.0)
Premiums earned, net  21.7   21.3   21.8   21.7   43.5   43.0 
Net investment income  1.9   1.9   2.1   2.3   4.1   4.3 
Total operating revenues  23.6   23.2   23.9   24.0   47.6   47.3 
Operating costs:                        
Claims incurred  10.6   9.7   10.9   10.8   21.5   20.6 
Underwriting and other expenses  10.9   11.4   9.3   9.8   20.3   21.2 
Total operating costs  21.5   21.1   20.2   20.6   41.8   41.8 
Operating income $2.1  $2.1  $3.7  $3.4  $5.8  $5.5 
Additional data:                        
Loss ratio  48.8%  45.5%  50.0%  49.8%  49.4%  47.9%
Operating expense ratio  50.2%  53.5%  42.7%  45.2%  46.7%  49.3%

Three Months Ended March 31,June 30, 2017 Compared to Three Months Ended March 31,June 30, 2016

Operating Revenues

Total premiums written decreasedincreased by $0.2$5.5 million, or 0.7%13.4%, to $27.4$46.4 million driven by lowerhigher sales of Commercial package products.products, particularly Commercial property products, mainly as a result of the acquisition of a large account during the 2017 period.

The premiums ceded to reinsurers decreasedincreased by $0.3$3.5 million, or 2.9%26.7%, mostly reflecting lowerhigher premiums written in Commercial insurance products.products during the three months ended June 30, 2017.

The change in unearned premiums presents an increase of $0.3$1.9 million mostly reflecting the segments lowerhigher premiums written in 2017 and lower cost.2017.
 
Claims Incurred

Claims incurred increased by $0.1 million, or 0.9%, to $10.9 million during the three months ended June 30, 2017.  The loss ratio increased by 20 basis points, to 50.0% during this period.

Underwriting and Other Expenses

Underwriting and other operating expenses decreased by $0.5 million, or 5.1%, to $9.3 million mostly due to a lower net commission expense during the three months ended June 30, 2017.  The operating expense ratio was 42.7%, 250 basis points lower than last year.

Six Months Ended June 30, 2017 Compared to Six Months Ended June 30, 2016

Operating Revenues

Total premiums written increased by $5.3 million, or 7.7%, to $73.8 million, driven by higher sales of Commercial property and Commercial liability products, mainly as a result of the acquisition of a large account, as well as to higher sales of Personal package products.

The premiums ceded to reinsurers increased by $3.2 million, or 13.6%, mostly reflecting higher premiums written in Commercial insurance products during the six months ended June 30, 2017.

The change in unearned premiums presents an increase of $1.6 million mostly reflecting the segments higher premiums written in 2017.

Claims Incurred

Claims incurred increased by $0.9 million, or 9.3%4.4%, to $10.6 million.$21.5 million during the six months ended June 30, 2017.  The loss ratio increased by 330150 basis points, to 48.8%49.4% during this period, primarily as a result of an unfavorable loss experience in the Commercial and Personal Auto lines of business.

Underwriting and Other Expenses

Underwriting and other operating expenses decreased by $0.5$0.9 million, or 4.4%4.2%, to $10.9$20.3 million mostly due to lower personnel costs.  The operating expense ratio was 50.2%46.7%, 330260 basis points lower than last year.
 
Liquidity and Capital Resources
 
Cash Flows
 
A summary of our major sources and uses of cash for the periods indicated is presented in the following table:

 
Three months ended
March 31,
  
Six months ended
June 30,
 
(dollar amounts in millions) 2017  2016  2017  2016 
Sources (uses) of cash:            
Cash provided by operating activities $131.0  $31.3 
Net proceeds (purchases) of investment securities  0.4   (108.9)
Cash provided by (used in) operating activities $133.7  $(10.6)
Net purchases of investment securities  (43.0)  (76.3)
Net capital expenditures  (3.3)  (1.5)  (8.7)  (2.7)
Proceeds from long-term borrowings  24.3   -   24.3   - 
Payments of long-term borrowings  (24.7)  (0.4)  (25.5)  (0.8)
Proceeds from policyholder deposits  4.1   3.4   8.2   7.9 
Surrenders of policyholder deposits  (4.9)  (2.9)  (10.5)  (6.9)
Repurchase and retirement of common stock  -   (8.0)  -   (14.6)
Other  (11.4)  1.6   (9.4)  2.3 
Net increase (decrease) in cash and cash equivalents $115.5  $(85.4) $69.1  $(101.7)

Cash flow from operating activities increased by $99.7$144.3 million for the threesix months ended March 31,June 30, 2017 as compared to the threesix months ended March 31,June 30, 2016, principally due to an increase in premium collections of $67.1$85.0 million, lower claims paid by $16.5$44.0 million and, a decrease in cash paid to suppliers and employees of $14.4$9.2 million, and lower incomes tax paid by $5.7 million.   The higher premium collections follow the collection in advance of the AprilJuly 2017 Medicare premiums from CMS.
Net proceeds from sales of investments securities primarily results from net cash flows received from the sales, maturities, and purchases of investment securities during the period following our asset/liability management strategy.

During the threesix months ended March 31,June 30, 2017, we received the remaining $24.3 million from a loan with a commercial bank in Puerto Rico related with a credit agreement entered into in December 2016.  These proceeds were used during the 2017 period to prepay the outstanding principal amount of $24.0 million of the 6.6% senior unsecured notes.  See note 7 to the unaudited condensed consolidated financial statements included in this quarterly report on Form 10-Q.

There were no repurchase and retirement of common stock during the threesix months ended March 31,June 30, 2017.

The fluctuation in the Other uses/sources of cash is attributed to changes in the amount of outstanding checks over bank balances.

Net capital expenditures increased by $6.0 million during the six months ended June 30, 2017 as compared to the six months ended June 30, 2016, principally due to initiatives related to information technology in the Managed Care segment.
 
Financing and Financing Capacity

We have several short-term facilities available to address timing differences between cash receipts and disbursements.  These short-term facilities are mostly in the form of arrangements to sell securities under repurchase agreements.  As of March 31,June 30, 2017, we had $60.0 million of available credit under these facilities.  There are no outstanding short-term borrowings under these facilities as of March 31,June 30, 2017.

On December 21, 2005, we issued and sold $60.0 million of our 6.6% senior unsecured notes originally due December 2020 (the 6.6% notes).  These unsecured notes were paid in full on January 11, 2017.

On December 28, 2016, TSM entered into a $35.5 million credit agreement with a commercial bank in Puerto Rico. The agreement consists of three term loans: (i) Term Loan A in the principal amount of $11.2 million, (ii) Term Loan B in the principal amount of $20.2 million and (iii) Term Loan C in the principal amount of $4.1 million. Term Loan A matures in October 2023 while the Term Loans B and C mature in January 2024.  Term Loan A was used to refinance the previous $41.0 million secured loan payable with the same commercial bank in Puerto Rico.  Proceeds from Term Loans B and C were received on January 11, 2017 and were used to prepay the outstanding principal amount plus accrued interest of the 6.6% senior unsecured notes due January 2021 ($24.0 million).  Pursuant to the credit agreement, interest is payable on the outstanding balance of the Loan at the following annual rate: (i) 1% over LIBOR for Term Loan A, (ii) 2.75% over LIBOR for Term Loan B, and (iii) 3.25% over LIBOR for Term Loan C.  The loan includes certain financial and non-financial covenants, which are customary for this type of facility, including but not limited to, restrictions on the granting of certain liens, limitations on acquisitions and limitations on changes in control and dividends.  Failure to meet these covenants may trigger the accelerated payment of the outstanding balance.  As of March 31,June 30, 2017 we are in compliance with these covenants.

On March 11, 2016 TSS entered into a $30.0 million revolving loan agreement with a commercial bank in Puerto Rico. This unused line of credit had an interest rate of LIBOR plus 220 basis points and includes certain financial and non-financial covenants that are customary for this type of facility. This revolving loan agreement matured on March 11, 2017, and was not renewed.

On April 18, 2017, TSA entered into a $10.0 million revolving loan agreement with a commercial bank in Puerto Rico. This unused line of credit has an interest rate of 30-day LIBOR plus 25 basis points, and contains certain financial and non-financial covenants that are customary for this type of facility.  As of June 30, 2017, there is no outstanding balance in this line of credit.

We anticipate that we will have sufficient liquidity to support our currently expected needs.

Further details regarding the senior unsecured notes and the credit agreements are incorporated by reference to “Item 7.—Management Discussion and Analysis of Financial Condition and Results of Operations” included in our Annual Report on Form 10-K for the year ended December 31, 2016.
 
Item 3.
Quantitative and Qualitative Disclosures about Market Risk

We are exposed to certain market risks that are inherent in our financial instruments, which arise from transactions entered into in the normal course of business.  We have exposure to market risk mostly in our investment activities.  For purposes of this disclosure, “market risk” is defined as the risk of loss resulting from changes in interest rates and equity prices.  No material changes have occurred in our exposure to financial market risks since December 31, 2016.  A discussion of our market risk is incorporated by reference to “Item 7A. Quantitative and Qualitative Disclosures about Market Risk” of our Annual Report on Form 10-K for the year ended December 31, 2016.

Item 4.
Controls and Procedures

Evaluation of Disclosure Controls and Procedures

In connection with the preparation of this Quarterly Report on Form 10-Q, management, under the supervision and with the participation of the chief executive officer and chief financial officer, conducted an evaluation of the effectiveness of the “disclosure controls and procedures” as of the end of this period (as such term is defined under Exchange Act Rule 13a-15(e)) of the Corporation and its subsidiaries. Disclosure controls and procedures are designed to ensure that information required to be disclosed in reports filed or submitted under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in Securities and Exchange Commission rules and forms and that such information is accumulated and communicated to management, including the chief executive officer and chief financial officer, to allow timely decisions regarding required disclosures. A control system, no matter how well conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the control system are met.  There are inherent limitations to the effectiveness of any system of disclosure controls and procedures, including the possibility that judgments in decision-making can be faulty, and breakdowns as a result of simple errors or mistake. Accordingly, even effective disclosure controls and procedures can only provide reasonable assurance of achieving their control objectives.  The design of any system of controls also is based in part upon certain assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions.
 
Based on thistheir evaluation ouras of June 30, 2017, the Company’s chief executive officer and chief financial officer have concluded that the Company’s disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) were not effective because of the material weakness in our internal control over financial reporting described below.  Notwithstanding the material weakness in our internal control over financial reporting as of March 31,June 30, 2017, which ismanagement has concluded that the end of the period covered byconsolidated financial statements included in this Quarterly Report on Form 10-Q present fairly, in all material respects, our disclosure controlsfinancial position, results of operations and cash flows for the periods presented.
Management’s Report on Internal Control Over Financial Reporting

Management is responsible for establishing and maintaining adequate internal control over financial reporting and for the assessment of the effectiveness of “internal control over financial reporting,” as defined under Exchange Act Rule 13a-15(f). The Company’s internal control over financial reporting is a process designed by, or under the supervision of, the Company’s chief executive officer and chief financial officer, and effected by the Company’s board of directors, management and other personnel, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of the Company’s consolidated financial statements for external purposes in accordance with generally accepted accounting principles (“GAAP”), and includes those policies and procedures are effectivethat:

·pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the Company;

·provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with GAAP and that receipts and expenditures of the Company are being made only in accordance with authorizations of management and directors of the Company; and
·provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use or disposition of the Company’s assets that could have a material effect on the consolidated financial statements.

46

A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable levelpossibility that a material misstatement of assurance.
There were no significantthe annual or interim financial statements will not be prevented or detected on a timely basis. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements.  Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in our disclosure controlsconditions, or that the degree of compliance with the policies or procedures may deteriorate.

Management, under the supervision and procedures, or in factors that could significantly affect internal controls, subsequent towith the dateparticipation of the chief executive officer and chief financial officer, assessed the effectiveness of the Company’s internal control over financial reporting as of June 30, 2017 based on criteria described in the “Internal Control—Integrated Framework” issued by the Committee of Sponsoring Organizations of the Treadway Commission (“COSO”) on May 14, 2013.  Based on that assessment and those criteria, management has concluded that the Company’s internal control over financial reporting was not effective as of June 30, 2017 to provide reasonable assurance regarding the reliability of financial reporting and the preparation of the Company’s consolidated financial statements for external reporting purposes in accordance with GAAP due to the material weakness described below.

As the result of an inspection from the Public Company Accounting Oversight Board, our independent registered public accounting firm requested that we re-evaluate certain internal controls related to the review process of the Managed Care claims paid data input in our incurred but not reported (“IBNR”) actuarial model. As the result of this re-evaluation, management agreed that controls were not appropriately designed to validate that the claims paid information in the lag triangles used in the IBNR actuarial models is reviewed with enough precision to ascertain data is accurately presented by incurred date.  This deficiency was determined to be a material weakness as of June 30, 2017. Management has concluded that the Company’s consolidated financial statements as of and for the three months and six months ended June 30, 2017, included in this Quarterly Report on Form 10-Q present fairly, in all material respects, our financial position, results of operations and cash flows for the periods presented.

Remediation Plan

The main factor contributing to the material weakness were changes in our actuarial department during 2016. As a consequence, the preventive control over the accuracy of the incurred date component of the Managed Care claims paid data within the claim lags ceased to be fully effective. Although we engage an external actuarial consulting firm to support our claims reserving process, we did not ask them to do detailed testing over the incurred date component in order to ascertain the preciseness of the lag triangles. Even though this control deficiency is considered a material weakness, management has concluded that the consolidated financial statements included in this Quarterly Report on Form 10-Q present fairly, in all material respects, our financial position, results of operations and cash flows for the periods presented.

Management has designed a remediation plan to correct the material weakness described above and improve the design of internal controls. The remedial activities put in place include the following:

·After hiring additional personnel in the actuarial department, effective 2017 we reinforced the review process over the accuracy of the claims paid data within the claim lags.

·In addition we strengthened the claims paid reconciliation process to include the incurred date component within the claim lags on a monthly and historical basis.

We have completed the evaluation referredaforementioned activities as of the date of this amendment and believe that we have strengthened the Company’s internal control over financial reporting addressing the identified material weakness. However, control weaknesses are not be considered remediated until new internal controls have been operational for a period of time, are tested, and management concludes that these controls are operating effectively. We will continue to above.monitor the effectiveness of these remediation measures and we will make any changes to the design of this plan and take such other actions that we deem appropriate given the circumstances.

Changes in Internal Controls Over Financial Reporting

NoOther than as described in the aforementioned remediation plan, no changes in our internal control over financial reporting (as such term is defined in Exchange Act Rule 13a-15(f)) occurred during the fiscal quarter ended March 31,June 30, 2017 that materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

Part II – Other Information

Item 1.
Legal Proceedings

For a description of legal proceedings that have experienced significant developments during this quarter, see note 13 to the unaudited condensed consolidated financial statements included in this quarterly report on Form 10-Q.

Item 1A.
Risk Factors
 
For a description of our risk factors see Item 1A of Part I of our Annual Report on Form 10-K for the year ended December 31, 2016.

The following text updates the disclosure included in Item 1A of Part I of our Annual Report on Form 10-K for the year ended December 31, 2016, under the sub-caption “The health care reform law and the implementation of that law could have a material adverse effect on our business, financial condition, cash flows, or results of operations.
 
On January 20, 2017, President Trump signed an Executive Order directing federal agencies with authorities and responsibilities under the ACAPatient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010 (ACA) to waive, defer, grant exemptions from, or delay the implementation of any provision of the ACA that would impose a fiscal or regulatory burden on states, individuals, healthcare providers, health insurers, or manufacturers of pharmaceuticals or medical devices. Further, in January 2017, Congress voted to adopt a budget resolution for fiscal year 2017, or the Budget Resolution, that authorizes the implementation of legislation that would repeal portions of the ACA. Following the passage of the Budget Resolution, on March 6, 2017, the U.S. House of Representatives introduced legislation known as the American Health Care Act (AHCA), which, if enacted, would amend or repeal significant portions of the ACA. Among other changes, the American Health Care ActAHCA would sunset the annual insurance industry assessment as of December 31, 2017, essentially eliminate the individual and employer mandates by eliminating penalties and providing retroactive relief for failing to maintain or provide minimum essential coverage, and permit insurers to charge individuals a 30% surcharge on premiums for failing to demonstrate continuous coverage. The American Health Care ActAHCA would also make significant changes to Medicaid by, among other things, making the ACA Medicaid expansion optional for states, repealing the ACA requirement that state Medicaid plans provide the same essential health benefits that are required by plans available through the exchanges, implementing a per capita cap on federal payments to states beginning in fiscal year 2020, and changing certain eligibility requirements.  On May 4, 2017, the U.S. House of Representatives approved the American Health Care ActAHCA to repeal portions of the ACA.

The American Health Care Act will now be considered byU.S. Senate spent several months developing its alternative to the AHCA, culminating in several votes on various substitute amendments during the last week of July 2017.  None of the Senate substitutes, including a skinny package that would have repealed coverage mandates but maintained subsidies, were able to pass in the U.S. Senate.   While it is uncertain when or if the provisions in the American Health Care ActAHCA will become law, or the extent to which any such changes may impact our business, it is clear that Congress is taking concrete steps to repeal and replace certain aspects of the ACA.
 
Item 2.
Unregistered Sales of Equity Securities and Use of Proceeds

Not applicable.

Item 3.
Defaults Upon Senior Securities

Not applicable.

Item 4.
Mine Safety Disclosures

Not applicable.

Item 5.
Other Information

Not applicable.

Item 6.
Exhibits

ExhibitsDescription
  
3(i)(c)Articles of Incorporation of Triple-S Management Corporation, incorporated by reference to Exhibit 3(i)(c) to TSM’s Quarterly Report on Form 10-Q for the quarter ended March 31, 2008 (File No. 001-33865).
  
AmendmentsAmendment to Article Tenth and Thirteenth of the Amended and Restated Articles of Incorporation of Triple-S Management Corporation.
Composite Amended and Restated Articles of Incorporation of Triple-S Management Corporation.
11Statement re computation of per share earnings; an exhibit describing the computation of the earnings per shareExtend Contract for the three months ended March 31, 2017 and 2016 has been omitted asProvision of Physical & Behavioral Health Services under the detail necessary to determine the computation of earnings per share can be clearly determined from the material contained in Part I of this Quarterly Report on Form 10-Q.Government Health Plan Program
  
Certification of the President and Chief Executive Officer required by Rule 13a-14(a)/15d-14(a).
  
Certification of the Executive Vice President and Chief Financial Officer required by Rule 13a-14(a)/15d-14(a).
  
Certification of the President and Chief Executive Officer required pursuant to 18 U.S.C Section 1350.
  
Certification of the Executive Vice President and Chief Financial Officer required pursuant to 18 U.S.C Section 1350.

All other exhibits for which provision is made in the applicable accounting regulation of the United States Securities and Exchange Commission are not required under the related instructions or are inapplicable, and therefore have been omitted.

*Filed herein.
 
SIGNATURES
 
Pursuant to the requirements of the United States Securities and Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

    Triple-S Management Corporation 
    Registrant 
      
Date:MayAugust 9, 2017 By:/s/ Roberto García-Rodríguez 
    Roberto García-Rodríguez 
    President and Chief Executive Officer
      
Date:MayAugust 9, 2017 By:/s/ Juan J. Román-Jiménez 
    Juan J. Román-Jiménez 
    Executive Vice President and Chief Financial Officer
 
 
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