|
Line |
Covered Current Year |
Uncovered Current Year |
Total Current Year |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
80,496,273 |
417,513 |
80,913,786 |
88,208,434 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
3,010,043 |
0 |
3,010,043 |
3,056,105 |
| 04 |
Aggregate health policy reserves |
47,950,468 |
0 |
47,950,468 |
41,381,155 |
| 05 |
Aggregate life policy reserves |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserves |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
0 |
0 |
0 |
0 |
| 08 |
Premiums received in advance |
18,914,598 |
0 |
18,914,598 |
13,571,773 |
| 09 |
General expenses due or accrued |
7,779,186 |
0 |
7,779,186 |
9,629,987 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains
(losses)) |
1,645,696 |
0 |
1,645,696 |
189,200 |
| 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 |
334,595 |
0 |
334,595 |
607,319 |
| 13 |
Remittances and items not allocated |
5,114,532 |
0 |
5,114,532 |
10,369,251 |
| 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 |
33,196,348 |
0 |
33,196,348 |
26,467,541 |
| 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 |
5,401,419 |
0 |
5,401,419 |
7,973,523 |
| 21 |
Aggregate write-ins for other liabilities (including
$5209570 current) |
18,899,879 |
0 |
18,899,879 |
4,284,185 |
| 22 |
Total liabilities (Lines 1 to 21) |
222,743,037 |
417,513 |
223,160,550 |
205,738,473 |
| 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) |
|
|
104,819,662 |
128,905,678 |
| 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 |
|
|
227,972,562 |
252,058,578 |
| 32 |
Total liabilities, capital and surplus |
|
|
451,133,112 |
457,797,051 |
|
Details of Write-Ins |
| 2101 |
FEP Special Advance |
13,558,427 |
0 |
13,558,427 |
0 |
| 2102 |
Other Liabilities |
2,703,994 |
0 |
2,703,994 |
4,101,926 |
| 2103 |
Accounts Payable - ITS |
2,637,458 |
0 |
2,637,458 |
182,259 |
| 2199 |
|
18,899,879 |
0 |
18,899,879 |
4,284,185 |
| 2399 |
|
|
|
0 |
0 |
| 2899 |
|
|
|
0 |
0 | |
