|
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 |
|
7,058 |
28,804 |
34,203 |
| 02 |
Net premium income (including $0 non-health premium
income) |
|
2,494,353 |
10,027,958 |
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 |
|
2,494,353 |
10,027,958 |
12,247,006 |
| 09 |
Hospital/medical benefits (hospital and medical) |
0 |
1,123,762 |
4,323,687 |
5,521,641 |
| 10 |
Other professional services (hospital and
medical) |
0 |
130,954 |
515,435 |
636,802 |
| 11 |
Outside referrals (hospital and medical) |
34 |
34 |
649 |
684 |
| 12 |
Emergency room and out-of-area (hospital and
medical) |
4,117 |
126,170 |
331,811 |
426,003 |
| 13 |
Prescription drugs (hospital and medical) |
0 |
282,292 |
1,116,819 |
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 |
-250,006 |
170,781 |
223,816 |
| 16 |
Subtotal (hospital and medical) |
4,151 |
1,413,206 |
6,459,182 |
8,185,890 |
| 17 |
Net reinsurance recoveries (less) |
0 |
0 |
0 |
0 |
| 18 |
Total hospital and medical (less) |
4,151 |
1,413,206 |
6,459,182 |
8,185,890 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses, including $8434 cost
containment expenses (less) |
0 |
47,217 |
197,514 |
252,038 |
| 21 |
General administrative expenses (less) |
0 |
391,750 |
1,351,281 |
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 |
4,151 |
1,852,173 |
8,007,977 |
10,129,492 |
| 24 |
Net underwriting gain or (loss) |
|
642,180 |
2,019,981 |
2,117,514 |
| 25 |
Net investment income earned |
0 |
330,921 |
439,517 |
558,542 |
| 26 |
Net realized capital gains (losses) less capital
gains tax of $-7 |
0 |
-185 |
47,812 |
47,963 |
| 27 |
Net investment gains or (losses) |
0 |
330,736 |
487,329 |
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 |
|
972,916 |
2,507,310 |
2,724,090 |
| 31 |
Federal and foreign income taxes incurred |
|
195,413 |
612,424 |
742,923 |
| 32 |
Net income (loss) |
|
777,503 |
1,894,886 |
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 3 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year Ended December 31 |
| 33 |
Capital and surplus prior reporting year |
7,793,834 |
10,296,951 |
10,296,952 |
| 34 |
Net income or (loss) from Line 32 |
777,503 |
1,894,886 |
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 |
-12,009 |
-57,906 |
-117,247 |
| 39 |
Change in nonadmitted assets |
-5 |
171,383 |
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 |
-4,500,000 |
-4,500,000 |
| 47 |
Aggregate write-ins for gains or (losses) in
surplus |
0 |
0 |
0 |
| 48 |
Net change in capital and surplus |
765,489 |
-2,491,637 |
-2,503,118 |
| 49 |
Capital and surplus end of reporting period |
8,559,323 |
7,805,314 |
7,793,834 |
|
Details of Write-Ins |
| 4701 |
PRIOR YEAR STATE DEFERRED TAX
ADJUSTMENT |
0 |
0 |
0 |
| 4799 |
|
0 |
0 |
0 |
|
|
