|
Line |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
84,084,653 |
401,611 |
84,486,264 |
80,913,786 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
3,174,183 |
0 |
3,174,183 |
3,010,043 |
| 04 |
Aggregate health policy reserves |
50,490,184 |
0 |
50,490,184 |
47,950,468 |
| 05 |
Aggregate life policy reserves |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserve |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
90,997 |
0 |
90,997 |
0 |
| 08 |
Premiums received in advance |
19,791,013 |
0 |
19,791,013 |
18,914,598 |
| 09 |
General expenses due or accrued |
7,461,154 |
0 |
7,461,154 |
7,779,186 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains
(losses)) |
0 |
0 |
0 |
1,645,696 |
| 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 |
329,536 |
0 |
329,536 |
334,595 |
| 13 |
Remittances and items not allocated |
3,255,808 |
0 |
3,255,808 |
5,114,532 |
| 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 |
26,734,014 |
0 |
26,734,014 |
33,196,348 |
| 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 |
6,545,523 |
0 |
6,545,523 |
5,401,419 |
| 21 |
Aggregate write-ins for other liabilities (including
$5283870 current) |
13,813,905 |
0 |
13,813,905 |
18,899,879 |
| 22 |
Total liabilities (Lines 1 to 21) |
215,770,970 |
401,611 |
216,172,581 |
223,160,550 |
| 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) |
|
|
79,826,753 |
104,819,662 |
| 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 |
|
|
202,979,653 |
227,972,562 |
| 32 |
Total liabilities, capital and surplus |
|
|
419,152,234 |
451,133,112 |
|
Details of Write-Ins |
| 2101 |
FEP SPECIAL ADVANCE |
8,478,703 |
0 |
8,478,703 |
13,558,427 |
| 2102 |
OTHER LIABILITIES |
2,277,027 |
0 |
2,277,027 |
2,703,994 |
| 2103 |
ACCOUNTS PAYABLE - ITS |
3,058,175 |
0 |
3,058,175 |
2,637,458 |
| 2199 |
|
13,813,905 |
0 |
13,813,905 |
18,899,879 |
| 2399 |
|
|
|
0 |
0 |
| 2899 |
|
|
|
0 |
0 | |
