|
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 |
|
2,944 |
11,081 |
34,203 |
| 02 |
Net premium income (including $0 non-health premium
income) |
|
1,025,772 |
3,814,746 |
12,247,006 |
| 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 |
|
1,025,772 |
3,814,746 |
12,247,006 |
| 09 |
Hospital/medical benefits (hospital and medical) |
0 |
799,298 |
1,837,566 |
5,521,641 |
| 10 |
Other professional services (hospital and
medical) |
0 |
56,029 |
195,162 |
636,802 |
| 11 |
Outside referrals (hospital and medical) |
0 |
0 |
0 |
684 |
| 12 |
Emergency room and out-of-area (hospital and
medical) |
1,144 |
68,685 |
128,138 |
426,003 |
| 13 |
Prescription drugs (hospital and medical) |
0 |
128,083 |
404,070 |
1,376,944 |
| 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 |
-238,005 |
-78,453 |
223,816 |
| 16 |
Subtotal (hospital and medical) |
1,144 |
814,090 |
2,486,483 |
8,185,890 |
| 17 |
Net reinsurance recoveries (less) |
0 |
0 |
0 |
0 |
| 18 |
Total hospital and medical (less) |
1,144 |
814,090 |
2,486,483 |
8,185,890 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses, including $3544 cost
containment expenses (less) |
0 |
20,157 |
79,443 |
252,038 |
| 21 |
General administrative expenses (less) |
0 |
147,606 |
576,938 |
1,691,564 |
| 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 |
1,144 |
981,853 |
3,142,864 |
10,129,492 |
| 24 |
Net underwriting gain or (loss) |
|
43,919 |
671,882 |
2,117,514 |
| 25 |
Net investment income earned |
0 |
113,135 |
158,491 |
558,542 |
| 26 |
Net realized capital gains (losses) less capital
gains tax of $-18 |
0 |
-200 |
0 |
47,963 |
| 27 |
Net investment gains or (losses) |
0 |
112,935 |
158,491 |
606,505 |
| 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 |
68 |
| 30 |
Net income or (loss) after capital gains tax and
before all other federal income taxes |
|
156,854 |
830,373 |
2,724,090 |
| 31 |
Federal and foreign income taxes incurred |
|
30,284 |
132,352 |
742,923 |
| 32 |
Net income (loss) |
|
126,570 |
698,021 |
1,981,167 |
|
Details of Write-Ins |
| 0601 |
|
|
0 |
0 |
0 |
| 0699 |
|
|
0 |
0 |
0 |
| 0799 |
|
|
0 |
0 |
0 |
| 1499 |
|
0 |
0 |
0 |
0 |
| 2901 |
OTHER INCOME |
0 |
0 |
0 |
68 |
| 2999 |
|
0 |
0 |
0 |
68 |
2009 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
95447 -
Cigna Healthcare of ME Inc
Quarter 1 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year Ended December 31 |
| 33 |
Capital and surplus prior reporting year |
7,793,834 |
10,296,952 |
10,296,952 |
| 34 |
Net income or (loss) from Line 32 |
126,570 |
698,021 |
1,981,167 |
| 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 |
-9,006 |
-24,439 |
-117,247 |
| 39 |
Change in nonadmitted assets |
8,159 |
65,802 |
132,962 |
| 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 |
0 |
0 |
-4,500,000 |
| 47 |
Aggregate write-ins for gains or (losses) in
surplus |
0 |
0 |
0 |
| 48 |
Net change in capital and surplus |
125,723 |
739,384 |
-2,503,118 |
| 49 |
Capital and surplus end of reporting period |
7,919,557 |
11,036,337 |
7,793,834 |
|
Details of Write-Ins |
| 4799 |
|
0 |
0 |
0 |
|
|
