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AGENCY CUSTOMER ID:
<br />LOC #:
<br />A� ADDITIONAL REMARKS SCHEDULE
<br />AGENCY
<br />HUB International Midwest Limited
<br />POLICY NUMBER
<br />CARRIER
<br />NAIC CODE
<br />EFFECTIVE DATE:
<br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
<br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
<br />ADDITIONAL NAMED INSUREDS INCLUDE:
<br />• CCS-CMGC Parent Holdings, LP
<br />• CCS-CMGC Intermediate Holdings2, Inc,
<br />• CCS-CMGC Intermediate Holdings, Inc,
<br />• Wellpath Holdings, Inc (fka CCS-CMGC Holdings, Inc.)
<br />• Wellpath Community Care, LLC
<br />• Wellpath CFMG, Inc. (fka CFMG Holdings Corp)
<br />• Wellpath Management, Inc. (fka Correctional Medical Group Companies, Inc, fka California Forensic Management Group, Inc.)
<br />• Southwest Correctional Medical Group, Inc,
<br />• Wellpath Group Holdings, LLC (fka Correct Care Solutions Group Holdings, LLC)
<br />• Wellpath Recovery Solutions of Alaska, Inc.
<br />• Jessamine Healthcare, Inc.
<br />• Wellpath LLC(fka CorrectCare Solutions, LLC (DE), fka Correct Care Solutions, LLC (KS)
<br />• League Medical Concepts, LLC (fka League Medical Concepts, LP, fka League Medical Concepts, LLC)
<br />• HCS Correctional Management, LLC (fka Health Cost Solutions, LLC changed 1114/2021)
<br />• Correct Care Holdings, LLC (fka GEO Care Holdings LLC)
<br />• Wellpath Recovery Solutions, LLC (fka Correct Care, LLC fka GEO Care, LLC)
<br />• Correct Care of South Carolina, LLC (fka GEO Care of South Carolina LLC)
<br />• Conmed Healthcare Management, LLC (fka Conmed Healthcare Management, Inc.)
<br />• Conmed, LLC (fka Conmed, Inc.)
<br />• Correctional Mental Health Services, LLC
<br />• Correctional Healthcare Holding Company, LLC (fka Jessamine -Peyton Purchaser, Inc, fka Correctional Healthcare Holdings Companu, Inc., fka Correctional
<br />Healthcare Holdings, Inc.)
<br />• CHC Companies, LLC (fka Correctional Healthcare Companies, Inc., fka CHC Companies, Inc.)
<br />• CHC Pharmacy Services, LLC
<br />• Physicians Network Association, Inc.
<br />• Correctional Healthcare Companies, LLC (fka Correctional Healthcare Companies, Inc., fka CHC Companies, Ltd.)
<br />• Healthcare Professional, LLC (fka Health Professionals, Ltd.)
<br />• Correct Cate Australia PTY, LLC (fka Gad Care Australia PTY, Ltd.)
<br />• Correct Care UK Limited
<br />• Wellpath Hospital Holdings Company, LLC
<br />• 901 45th Street West Palm Beach Florida Behavioral Health Hospital Company, LLC
<br />• Boynton Beach Florida Behavioral Health Hospital Company, LLC
<br />• Wellpath Community Care Centers of Virginia, LLC
<br />• Wellpath Community Care Holdings, LLC (DE)
<br />• Wellpath Community Care Management, LLC (DE)
<br />• Alpine Behavioral Health Hold Co, LLC (DE)
<br />• California Forensic Medical Group, Incorporated (fka CFMG Holdings Corp.)
<br />• California Health and Recovery Solutions, P.C. (fka California CCS, P.C.)
<br />• CCS-Kastre Nevada, P.C.
<br />• Emerald Healthcare Services, P.C.
<br />• Grand Prairie Healthcare Services, P.C. (several PCs merged into Grand Prairie)
<br />• Great Peak Dental, P.C.
<br />• Great Peak Healthcare Services, P.C.
<br />• Kansas Health and Recovery Solutions, Professional Corporation (fka Kansas CCS, Professional Corporation) q
<br />• Massachusetts Correctional Healthcare Services, P.C.
<br />• Midwest Center, P,C.
<br />• New Garden Healthcare Services, RC.
<br />• New York Correct Care Solutions Medical Services, P.C.
<br />• Old Empire Dental, P.C.
<br />• Old Empire Psychology, P.C.
<br />• Southeast Correctional Medical Group, LLC
<br />• Southwest Correctional Medical Group, PLLC
<br />• Stringfellow Correctional Dental, P.A.
<br />• Texas Health and Recovery Solutions, P.A. (fka Texas CCS, P.A.)
<br />• California Community Care Clinics, PC
<br />• Wellpath Community Care Centers of Indiana, P.C.
<br />• Wellpath Community Care Centers of Michigan, P.C.
<br />• Wellpath Community Care Centers of North Carolina, P.C.
<br />ACORD 101 (2008101) © 2008 A
<br />The ACORD name and logo are registered marks of ACORD
<br />REVIEIWED&APPROVEDfir
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