|
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 |
|
8,558 |
2,447 |
3,394 |
| 02 |
Net premium income (including $0 non-health premium income) |
|
4,749,323 |
1,408,274 |
1,874,853 |
| 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 |
|
4,749,323 |
1,408,274 |
1,874,853 |
| 09 |
Hospital/medical benefits (hospital and medical) |
0 |
3,555,485 |
1,155,053 |
1,581,457 |
| 10 |
Other professional services (hospital and medical) |
0 |
0 |
0 |
0 |
| 11 |
Outside referrals (hospital and medical) |
0 |
0 |
0 |
0 |
| 12 |
Emergency room and out-of-area (hospital and medical) |
0 |
0 |
0 |
0 |
| 13 |
Prescription drugs (hospital and medical) |
0 |
548,180 |
169,203 |
220,414 |
| 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 |
0 |
0 |
0 |
| 16 |
Subtotal (hospital and medical) |
0 |
4,103,665 |
1,324,256 |
1,801,871 |
| 17 |
Net reinsurance recoveries (less) |
0 |
0 |
0 |
0 |
| 18 |
Total hospital and medical (less) |
0 |
4,103,665 |
1,324,256 |
1,801,871 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses, including $18415 cost
containment expenses (less) |
0 |
50,871 |
56,249 |
63,014 |
| 21 |
General administrative expenses (less) |
0 |
1,319,895 |
937,956 |
1,583,465 |
| 22 |
Increase in reserves for life and accident and
health contracts (including $0 increase in reserves for life only) (less) |
0 |
0 |
0 |
0 |
| 23 |
Total underwriting deductions |
0 |
5,474,431 |
2,318,461 |
3,448,350 |
| 24 |
Net underwriting gain or (loss) |
|
-725,108 |
-910,187 |
-1,573,497 |
| 25 |
Net investment income earned |
0 |
64,660 |
101,192 |
134,963 |
| 26 |
Net realized capital gains (losses) less capital
gains tax of $0 |
0 |
0 |
0 |
0 |
| 27 |
Net investment gains or (losses) |
0 |
64,660 |
101,192 |
134,963 |
| 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 |
0 |
0 |
| 30 |
Net income or (loss) after capital gains tax and
before all other federal income taxes |
|
-660,448 |
-808,995 |
-1,438,534 |
| 31 |
Federal and foreign income taxes incurred |
|
0 |
0 |
0 |
| 32 |
Net income (loss) |
|
-660,448 |
-808,995 |
-1,438,534 |
|
Details of Write-Ins |
| 0601 |
|
|
0 |
0 |
0 |
| 0602 |
|
|
0 |
0 |
0 |
| 0603 |
|
|
0 |
0 |
0 |
| 0699 |
|
|
0 |
0 |
0 |
| 0701 |
|
|
0 |
0 |
0 |
| 0702 |
|
|
0 |
0 |
0 |
| 0703 |
|
|
0 |
0 |
0 |
| 0799 |
|
|
0 |
0 |
0 |
| 1401 |
|
0 |
0 |
0 |
0 |
| 1402 |
|
0 |
0 |
0 |
0 |
| 1403 |
|
0 |
0 |
0 |
0 |
| 1499 |
|
0 |
0 |
0 |
0 |
| 2901 |
|
0 |
0 |
0 |
0 |
| 2902 |
|
0 |
0 |
0 |
0 |
| 2903 |
|
0 |
0 |
0 |
0 |
| 2999 |
|
0 |
0 |
0 |
0 |
2008 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
12545 -
Martins Point Generations LLC
Quarter 3 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year Ended December 31 |
| 33 |
Capital and surplus prior reporting year |
1,927,591 |
2,369,289 |
2,369,289 |
| 34 |
Net income or (loss) from Line 32 |
-660,448 |
-808,995 |
-1,438,534 |
| 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 |
0 |
0 |
0 |
| 39 |
Change in nonadmitted assets |
1,193 |
0 |
-3,164 |
| 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) |
1,000,000 |
1,000,000 |
1,000,000 |
| 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 |
0 |
0 |
0 |
| 47 |
Aggregate write-ins for gains or (losses) in surplus |
-23,793 |
0 |
0 |
| 48 |
Net change in capital and surplus |
316,952 |
191,005 |
-441,698 |
| 49 |
Capital and surplus end of reporting period |
2,244,543 |
2,560,294 |
1,927,591 |
|
Details of Write-Ins |
| 4701 |
Correction of prior year understatement
of General Expenses Due and Accrued |
-23,793 |
0 |
0 |
| 4702 |
|
0 |
0 |
0 |
| 4703 |
|
0 |
0 |
0 |
| 4799 |
|
-23,793 |
0 |
0 |
|
|
