| |
Line |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
95,470,502 |
325,094 |
95,795,596 |
93,523,130 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
2,709,388 |
0 |
2,709,388 |
3,241,745 |
| 04 |
Aggregate health policy reserves |
47,937,552 |
0 |
47,937,552 |
75,703,424 |
| 05 |
Aggregate life policy reserves |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserve |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
0 |
0 |
0 |
0 |
| 08 |
Premiums received in advance |
15,605,050 |
0 |
15,605,050 |
1,142,594 |
| 09 |
General expenses due or accrued |
14,366,516 |
0 |
14,366,516 |
31,534,108 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains (losses)) |
6,009 |
0 |
6,009 |
842,445 |
| 10.2 |
Net deferred tax liability |
0 |
0 |
0 |
0 |
| 11 |
Ceded reinsurance premiums payable |
0 |
0 |
0 |
0 |
| 12 |
Amounts withheld or retained for the account of others |
637,236 |
0 |
637,236 |
635,519 |
| 13 |
Remittances and items not allocated |
4,224,115 |
0 |
4,224,115 |
6,746,716 |
| 14 |
Borrowed money (including $0 current) and interest
thereon $0 (including $0 current) |
0 |
0 |
0 |
0 |
| 15 |
Amounts due to parent, subsidiaries and affiliates |
58,092,202 |
0 |
58,092,202 |
91,027,784 |
| 16 |
Payable for securities |
0 |
0 |
0 |
0 |
| 17 |
Funds held under reinsurance treaties with ($0
authorized reinsurers and $0 unauthorized reinsurers) |
0 |
0 |
0 |
0 |
| 18 |
Reinsurance in unauthorized companies |
0 |
0 |
0 |
0 |
| 19 |
Net adjustments in assets and liabilities due to foreign exchange rates |
0 |
0 |
0 |
0 |
| 20 |
Liability for amounts held under uninsured plans |
2,245,653 |
0 |
2,245,653 |
19,190,370 |
| 21 |
Aggregate write-ins for other liabilities (including $1572236 current) |
2,826,760 |
0 |
2,826,760 |
2,811,246 |
| 22 |
Total liabilities (Lines 1 to 21) |
244,120,983 |
325,094 |
244,446,077 |
326,399,081 |
| 23 |
Aggregate write-ins for special surplus funds |
|
|
0 |
0 |
| 24 |
Common capital stock |
|
|
2,500,000 |
2,500,000 |
| 25 |
Preferred capital stock |
|
|
0 |
0 |
| 26 |
Gross paid in and contributed surplus |
|
|
120,652,900 |
120,652,900 |
| 27 |
Surplus notes |
|
|
0 |
0 |
| 28 |
Aggregate write-ins for other than special surplus funds |
|
|
0 |
0 |
| 29 |
Unassigned funds (surplus) |
|
|
115,992,370 |
92,142,619 |
| 30.1 |
(1) shares common (value included in common capital
stock $0) (less treasury stock, at cost) |
|
|
0 |
0 |
| 30.2 |
(1) shares preferred (value included in preferred
capital stock $0) (less treasury stock, at cost) |
|
|
0 |
0 |
| 31 |
Total capital and surplus |
|
|
239,145,270 |
215,295,519 |
| 32 |
Total liabilities, capital and surplus |
|
|
483,591,347 |
541,694,600 |
|
Details of Write-Ins |
| 2101 |
Other Liabilities |
2,651,951 |
0 |
2,651,951 |
2,629,322 |
| 2102 |
Accounts Payable - ITS |
174,809 |
0 |
174,809 |
181,924 |
| 2199 |
|
2,826,760 |
0 |
2,826,760 |
2,811,246 |
| 2399 |
|
|
|
0 |
0 |
| 2899 |
|
|
|
0 |
0 | |
