|
Line |
Uncovered Current Year to Date |
Total Current Year to Date |
Total Prior Year to Date |
Total Prior Year Ended December 31 |
| 01 |
Member months |
|
28,804 |
75,903 |
92,725 |
| 02 |
Net premium income (including $0 non-health premium income) |
|
10,027,958 |
24,808,708 |
30,255,117 |
| 03 |
Change in unearned premium reserves and reserve for rate credits |
|
0 |
0 |
0 |
| 04 |
Fee-for-service (net of $0 medical expenses) |
|
0 |
0 |
0 |
| 05 |
Risk revenue |
|
0 |
0 |
0 |
| 06 |
Aggregate write-ins for other health care related revenues |
|
0 |
0 |
0 |
| 07 |
Aggregate write-ins for other non-health revenues |
|
0 |
0 |
0 |
| 08 |
Total revenues |
|
10,027,958 |
24,808,708 |
30,255,117 |
| 09 |
Hospital/medical benefits (hospital and medical) |
0 |
4,323,687 |
14,777,926 |
17,762,273 |
| 10 |
Other professional services (hospital and medical) |
0 |
515,435 |
1,497,583 |
1,805,834 |
| 11 |
Outside referrals (hospital and medical) |
649 |
649 |
274,998 |
271,316 |
| 12 |
Emergency room and out-of-area (hospital and medical) |
20,996 |
331,811 |
1,079,210 |
1,294,927 |
| 13 |
Prescription drugs (hospital and medical) |
0 |
1,116,819 |
3,102,145 |
3,849,634 |
| 14 |
Aggregate write-ins for other hospital and medical
(hospital and medical) |
0 |
0 |
0 |
0 |
| 15 |
Incentive pool, withhold adjustments and bonus
amounts (hospital and medical) |
0 |
170,781 |
125,000 |
258,864 |
| 16 |
Subtotal (hospital and medical) |
21,645 |
6,459,182 |
20,856,862 |
25,242,848 |
| 17 |
Net reinsurance recoveries (less) |
0 |
0 |
126,552 |
126,745 |
| 18 |
Total hospital and medical (less) |
21,645 |
6,459,182 |
20,730,310 |
25,116,103 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses, including $66337 cost
containment expenses (less) |
0 |
197,514 |
679,340 |
903,659 |
| 21 |
General administrative expenses (less) |
0 |
1,351,281 |
2,479,617 |
3,350,723 |
| 22 |
Increase in reserves for life and accident and
health contracts (including $0 increase in reserves for life only) (less) |
0 |
0 |
-815,000 |
-815,000 |
| 23 |
Total underwriting deductions |
21,645 |
8,007,977 |
23,074,267 |
28,555,485 |
| 24 |
Net underwriting gain or (loss) |
|
2,019,981 |
1,734,441 |
1,699,632 |
| 25 |
Net investment income earned |
0 |
439,517 |
545,892 |
721,079 |
| 26 |
Net realized capital gains (losses) less capital
gains tax of $32952 |
0 |
47,812 |
34,016 |
34,013 |
| 27 |
Net investment gains or (losses) |
0 |
487,329 |
579,908 |
755,092 |
| 28 |
Net gain or (loss) from agents' or premium balances
charged off [(amount recovered $0 (amount charged off $0] |
0 |
0 |
0 |
0 |
| 29 |
Aggregate write-ins for other income or expenses |
0 |
0 |
2,217 |
2,217 |
| 30 |
Net income or (loss) after capital gains tax and
before all other federal income taxes |
|
2,507,310 |
2,316,566 |
2,456,941 |
| 31 |
Federal and foreign income taxes incurred |
|
612,424 |
398,148 |
323,889 |
| 32 |
Net income (loss) |
|
1,894,886 |
1,918,418 |
2,133,052 |
|
Details of Write-Ins |
| 0601 |
|
|
0 |
0 |
0 |
| 0699 |
|
|
0 |
0 |
0 |
| 0799 |
|
|
0 |
0 |
0 |
| 1401 |
OTHER MEDICAL EXPENSES |
0 |
0 |
0 |
0 |
| 1499 |
|
0 |
0 |
0 |
0 |
| 2901 |
OTHER INCOME |
0 |
0 |
2,217 |
2,217 |
| 2999 |
|
0 |
0 |
2,217 |
2,217 |
2008 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
95447 - Cigna Healthcare of ME Inc
Quarter 3 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year Ended December 31 |
| 33 |
Capital and surplus prior reporting year |
10,296,951 |
7,995,086 |
7,995,086 |
| 34 |
Net income or (loss) from Line 32 |
1,894,886 |
1,918,418 |
2,133,052 |
| 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 |
-57,906 |
-421,991 |
-487,267 |
| 39 |
Change in nonadmitted assets |
171,383 |
738,063 |
736,915 |
| 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 |
0 |
| 46 |
Dividends to stockholders |
-4,500,000 |
0 |
0 |
| 47 |
Aggregate write-ins for gains or (losses) in surplus |
0 |
-238,789 |
-80,834 |
| 48 |
Net change in capital and surplus |
-2,491,637 |
1,995,701 |
2,301,866 |
| 49 |
Capital and surplus end of reporting period |
7,805,314 |
9,990,787 |
10,296,952 |
|
Details of Write-Ins |
| 4701 |
PRIOR YEAR STATE DEFERRED TAX
ADJUSTMENT |
0 |
-238,789 |
-80,834 |
| 4799 |
|
0 |
-238,789 |
-80,834 |
|
|
