Babbitt Municipalities, Inc. v. Health Care Service Corp.

2016 IL App (1st) 152662, 64 N.E.3d 1178
CourtAppellate Court of Illinois
DecidedOctober 11, 2016
Docket1-15-2662
StatusUnpublished
Cited by25 cases

This text of 2016 IL App (1st) 152662 (Babbitt Municipalities, Inc. v. Health Care Service Corp.) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Babbitt Municipalities, Inc. v. Health Care Service Corp., 2016 IL App (1st) 152662, 64 N.E.3d 1178 (Ill. Ct. App. 2016).

Opinion

2016 IL App (1st) 152662

FIRST DIVISION

October 11, 2016

No. 1-15-2662

) BABBITT MUNICIPALITIES, INC., ) Appeal from the ) Circuit Court of Plaintiff-Appellant, ) Cook County, ) v. ) No. 14 CH 08460 ) HEALTH CARE SERVICE CORPORATION, ) Honorable an Illinois Mutual Legal Reserve Company, ) Neil H. Cohen, d/b/a Blue Cross Blue Shield of Illinois, ) Judge Presiding. ) Defendant-Appellee. ) )

JUSTICE MIKVA delivered the judgment of the court, with opinion. Presiding Justice Connors and Justice Harris concurred in the judgment and opinion.

OPINION

¶1 This is an appeal from the circuit court’s dismissal of claims for breach of contract and

declaratory judgment brought by plaintiff, Babbitt Municipalities, Inc. (Babbitt), against

defendant, Health Care Service Corporation (HCSC). Babbitt alleged that HCSC had a duty,

pursuant to its originating documents, to act as a not-for-profit company for the mutual benefit of

its policyholder-members. Babbitt alleged that HCSC breached this duty by accumulating a large

cash surplus, rather than spending any amount exceeding a reasonable reserve for the benefit of

its members. Concluding that Babbitt’s second amended complaint failed to cure the defects

identified in its prior pleadings, the circuit court dismissed Babbitt’s claims with prejudice

pursuant to section 2-615 of the Code of Civil Procedure (Code) (735 ILCS 2-615 (West 2014)).

The court determined that Babbitt did not adequately allege a specific contractual provision that 1-15-2662

HCSC breached, a concrete injury, an actual controversy based on HCSC’s present conduct, or

facts that, if proved, would rebut the presumption of good faith afforded by the business

judgment rule. For the more limited reasons that follow, we affirm the judgment of the circuit

court.

¶2 BACKGROUND

¶3 Defendant, Health Care Service Corporation (HCSC), is an Illinois mutual legal reserve

insurance company—a not-for-profit company owned by its policyholder-members—operating

as a licensee of Blue Cross and Blue Shield (BCBS). Plaintiff, Babbitt Municipalities, Inc.

(Babbitt), is one of HCSC’s policyholder-members.

¶4 HCSC’s “Amended and Restated Articles of Incorporation” (Articles) state that “[t]he

object for which [HCSC] is founded is to do all things necessary, proper or convenient for the

purpose of promoting, establishing, maintaining and operating a non-profit health care service

plan as authorized by the laws of the State of Illinois.” In accordance with this stated objective,

HCSC’s “Amended and Restated By-Laws” (Bylaws) set forth the companies “purposes”:

“(a) To do all things necessary, proper or convenient for

the purpose of promoting, establishing, maintaining and operating

a mutual health care insurance company as authorized by

applicable laws ***;

(b) To do all things necessary, proper or convenient for

the purpose of promoting, establishing, maintaining and operating

said mutual health care insurance company and any other business

activity reasonably complementary or supplementary to its

insurance business; and

1-15-2662

(c) To engage in any lawful act or activity in which a

mutual insurance company may engage under applicable laws.”

¶5 HCSC’s Bylaws also state that the company “shall operate on a not-for-profit basis for

the mutual benefit of its Members” and “[n]o person or entity shall receive, directly or indirectly,

any profits from [HCSC].” The Bylaws further provide, however, that “[c]ompensation for

services performed or reimbursement for reasonable expenses shall not be considered profit.”

Compensation of the company’s officers is “fixed from time to time by the Board of Directors,”

and compensation of all other executives is determined by the president and CEO pursuant to

compensation policies approved by the board’s compensation committee.

¶6 Babbitt filed three successive complaints in this matter, asserting claims for both breach

of contract and declaratory judgment based on the above provisions. Babbitt’s initial complaint

relied on slightly different legal theories and is not at issue in this appeal. The allegations

summarized here are those contained in Babbitt’s second amended complaint for declaratory

judgment, as well as allegations from its first amended complaint that were incorporated by

reference in its claim for breach of contract, which Babbitt preserved for review.

¶7 Babbitt alleged that HCSC failed to live up to its stated purpose of operating as a not-for­

profit company for the benefit of its members, and in fact acted contrary to this goal, by

“stockpiling (rather than using) profits.” In support of this allegation, Babbitt cited HCSC’s

financial statements indicating that the company’s combined net income from operations for the

years 2009 through 2013 totaled over $4 billion. According to Babbitt, HCSC “branch[ed] out

and conduct[ed] activities separate and apart from its mission” by, for example, generating

“enormous fees” for the administration of its members’ health care benefits and using its “ever­

increasing accumulation of profits” to “expand its business operation without corresponding

mutual benefit to its members.” Babbitt alleged that, by the end of 2013, HCSC had accumulated

$10.29 billion.

¶8 Babbitt further alleged that the surplus earnings retained by HCSC were excessive when

compared with certain fiscal benchmarks. Babbitt alleged, for example, that “under an

exceedingly conservative standard previously used by [BCBS] Plans[,] there was no need to set

aside profits equal to more than three months [sic] worth of expenses, as that amount would

cover nearly any conceivable financial contingency.” According to Babbitt, HCSC historically

kept a surplus of about twice that amount. Babbitt also alleged that a comparison of HCSC’s

assets in relation to the amount and type of risk it faced resulted in “Risk Based Capital levels

*** three times higher than internal BCBS standards, four times higher than Federal Affordable

Care Act and leading actuarial suggested guidelines, and over ten times higher than minimum

regulatory standards” (emphasis in original), the latter of which are used to determine when

control of a company should be ceded to regulators.

¶9 Babbitt additionally alleged that HCSC’s reserves were excessive when compared with

those held by other nonprofit companies like California Blue, which recently pledged to cap its

net income at 2% of revenue, and Wellmark, Inc., a plan operating in Iowa and South Dakota,

which recently “announced a corporate philosophy and goal of zero profit for the mutual benefit

of its policyholder-owners.”

¶ 10 According to Babbitt, HCSC’s executives stood to gain from the company’s retention of

surplus earnings. Babbitt noted, for example, that HCSC’s CEO Patricia Hall received total

compensation of $16 million in 2012 (including $14.9 million in bonuses) and $11.2 million in

2013 (including $10 million in bonuses). Between 2011 and 2013, Babbitt alleged that “the top

ten executives at HCSC ha[d] earned nearly 96 million in bonus money.” Babbitt further alleged

that HCSC “established a corporate structure with a primary profit motive” and incentivized the

accumulation of excess profit by tying its executives’ compensation to “membership growth and

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2016 IL App (1st) 152662, 64 N.E.3d 1178, Counsel Stack Legal Research, https://law.counselstack.com/opinion/babbitt-municipalities-inc-v-health-care-service-corp-illappct-2016.