|
Line |
Uncovered Current Year to
Date |
Total Current Year to Date |
Total Prior Year to Date |
| 01 |
Member months |
|
29,664 |
49,122 |
| 02 |
Net premium income (including
$0 non-health premium income) |
|
9,844,464 |
15,171,765 |
| 03 |
Change in unearned premium
reserves and reserve for rate credits |
|
0 |
0 |
| 04 |
Fee-for-service (net of $0
medical expenses) |
|
0 |
0 |
| 05 |
Risk revenue |
|
0 |
0 |
| 06 |
Aggregate write-ins for other
health care related revenues |
|
0 |
0 |
| 07 |
Aggregate write-ins for other
non-health revenues |
|
0 |
0 |
| 08 |
Total revenues |
|
9,844,464 |
15,171,765 |
| 09 |
Hospital/medical benefits
(hospital and medical) |
134,453 |
6,792,839 |
10,256,892 |
| 10 |
Other professional services
(hospital and medical) |
11,927 |
598,228 |
858,350 |
| 11 |
Outside referrals (hospital
and medical) |
164,217 |
164,218 |
300,497 |
| 12 |
Emergency room and out-of-area
(hospital and medical) |
18,560 |
460,024 |
740,072 |
| 13 |
Prescription drugs (hospital
and medical) |
0 |
1,274,175 |
1,985,807 |
| 14 |
Aggregate write-ins for other
hospital and medical (hospital and medical) |
0 |
14,642 |
302,494 |
| 15 |
Incentive pool, withhold
adjustments and bonus amounts (hospital and medical) |
0 |
7,852 |
50,000 |
| 16 |
Subtotal (hospital and medical) |
329,157 |
9,311,978 |
14,494,112 |
| 17 |
Net reinsurance recoveries
(less) |
0 |
137,454 |
0 |
| 18 |
Total hospital and medical
(less) |
329,157 |
9,174,524 |
14,494,112 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses,
including $87282 cost containment expenses (less) |
0 |
246,149 |
357,990 |
| 21 |
General administrative expenses
(less) |
0 |
704,264 |
1,382,414 |
| 22 |
Increase in reserves for
life and accident and health contracts (including $0 increase
in reserves for life only) (less) |
0 |
-815,000 |
180,000 |
| 23 |
Total underwriting deductions |
329,157 |
9,309,937 |
16,414,516 |
| 24 |
Net underwriting gain or
(loss) |
|
534,527 |
-1,242,751 |
| 25 |
Net investment income earned |
0 |
189,114 |
242,653 |
| 26 |
Net realized capital gains
(losses) less capital gains tax of $7239 |
0 |
10,504 |
0 |
| 27 |
Net investment gains or (losses) |
0 |
199,618 |
242,653 |
| 28 |
Net gain or (loss) from agents'
or premium balances charged off [(amount recovered $0
(amount charged off $0] |
0 |
0 |
0 |
| 29 |
Aggregate write-ins for other
income or expenses |
0 |
0 |
0 |
| 30 |
Net income or (loss) after
capital gains tax and before all other federal income
taxes |
|
734,145 |
-1,000,098 |
| 31 |
Federal and foreign income
taxes incurred |
|
-117,623 |
-292,070 |
| 32 |
Net income (loss) |
|
851,768 |
-708,028 |
|
Details of Write-Ins |
| 0699 |
|
|
0 |
0 |
| 0799 |
|
|
0 |
0 |
| 1401 |
DIRIGO ASSESSMENT |
0 |
0 |
302,494 |
| 1402 |
OTHER MEDICAL EXPENSE |
0 |
14,642 |
0 |
| 1499 |
|
0 |
14,642 |
302,494 |
| 2999 |
|
0 |
0 |
0 |
2007 STATEMENT OF REVENUE AND EXPENSES
(Continued) - 005
95447 - Cigna Healthcare of ME Inc
Quarter 1 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year |
| 33 |
Capital and surplus
prior reporting year |
7,995,086 |
11,079,054 |
11,079,054 |
| 34 |
Net income or (loss)
from Line 32 |
851,768 |
-708,028 |
-232,555 |
| 35 |
Change in valuation
basis of aggregate policy and claim reserves |
0 |
0 |
0 |
| 36 |
Change in net unrealized
capital gains (losses) less capital gains tax
of $0 |
0 |
0 |
0 |
| 37 |
Change in net unrealized
foreign exchange capital gain or (loss) |
0 |
0 |
0 |
| 38 |
Change in net deferred
income tax |
-249,680 |
267,845 |
347,734 |
| 39 |
Change in nonadmitted
assets |
65,370 |
-97,783 |
521,930 |
| 40 |
Change in unauthorized
reinsurance |
0 |
0 |
0 |
| 41 |
Change in treasury
stock |
0 |
0 |
0 |
| 42 |
Change in surplus
notes |
0 |
0 |
0 |
| 43 |
Cumulative effect
of changes in accounting principles |
0 |
0 |
0 |
| 44.1 |
Paid in (capital
changes) |
0 |
0 |
0 |
| 44.2 |
Transferred from
surplus (stock dividend) (capital changes) |
0 |
0 |
0 |
| 44.3 |
Transferred to surplus
(capital changes) |
0 |
0 |
0 |
| 45.1 |
Paid in (surplus
adjustments) |
0 |
0 |
0 |
| 45.2 |
Transferred to capital
(stock dividend) (surplus adjustments) |
0 |
0 |
0 |
| 45.3 |
Transferred from
capital (surplus adjustments) |
0 |
0 |
-721,077 |
| 46 |
Dividends to stockholders |
0 |
0 |
-3,000,000 |
| 47 |
Aggregate write-ins
for gains or (losses) in surplus |
0 |
0 |
0 |
| 48 |
Net change in capital
and surplus |
667,458 |
-537,966 |
-3,083,968 |
| 49 |
Capital and surplus
end of reporting period |
8,662,544 |
10,541,088 |
7,995,086 |
|
Details of Write-Ins |
| 4701 |
|
0 |
0 |
0 |
| 4799 |
|
0 |
0 |
0 |
|
|
