|
Line |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
77,793,692 |
814,141 |
78,607,833 |
88,208,434 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
2,714,287 |
0 |
2,714,287 |
3,056,105 |
| 04 |
Aggregate health policy reserves |
43,078,507 |
0 |
43,078,507 |
41,381,155 |
| 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 |
21,467,614 |
0 |
21,467,614 |
13,571,773 |
| 09 |
General expenses due or accrued |
10,304,517 |
0 |
10,304,517 |
9,629,987 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains
(losses)) |
8,062,084 |
0 |
8,062,084 |
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 |
388,739 |
0 |
388,739 |
607,319 |
| 13 |
Remittances and items not allocated |
9,477,408 |
0 |
9,477,408 |
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 |
4,781,692 |
0 |
4,781,692 |
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 |
14,742,189 |
0 |
14,742,189 |
7,973,523 |
| 21 |
Aggregate write-ins for other liabilities (including
$2495680 current) |
3,688,551 |
0 |
3,688,551 |
4,284,185 |
| 22 |
Total liabilities (Lines 1 to 21) |
196,499,280 |
814,141 |
197,313,421 |
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) |
|
|
146,139,239 |
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 |
|
|
269,292,139 |
252,058,578 |
| 32 |
Total liabilities, capital and surplus |
|
|
466,605,560 |
457,797,051 |
|
Details of Write-Ins |
| 2101 |
Other Liabilities |
3,688,551 |
0 |
3,688,551 |
4,101,926 |
| 2102 |
Accounts Payable - ITS |
0 |
0 |
0 |
182,259 |
| 2199 |
|
3,688,551 |
0 |
3,688,551 |
4,284,185 |
| 2399 |
|
|
|
0 |
0 |
| 2899 |
|
|
|
0 |
0 | |
