|
Line |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
85,099,141 |
733,149 |
85,832,290 |
78,058,597 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
2,737,231 |
0 |
2,737,231 |
2,711,186 |
| 04 |
Aggregate health policy reserves |
54,669,127 |
0 |
54,669,127 |
55,275,969 |
| 05 |
Aggregate life policy reserves |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserve |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
2,328,449 |
0 |
2,328,449 |
2,358,002 |
| 08 |
Premiums received in advance |
21,647,028 |
0 |
21,647,028 |
17,670,768 |
| 09 |
General expenses due or accrued |
10,122,133 |
0 |
10,122,133 |
9,001,474 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains
(losses)) |
5,516,446 |
0 |
5,516,446 |
219,572 |
| 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 |
290,502 |
0 |
290,502 |
290,502 |
| 13 |
Remittances and items not allocated |
4,422,583 |
0 |
4,422,583 |
8,461,460 |
| 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 |
4,813,127 |
0 |
4,813,127 |
11,343,519 |
| 16 |
Derivatives |
0 |
0 |
0 |
0 |
| 17 |
Payable for securities |
0 |
0 |
0 |
0 |
| 18 |
Funds held under reinsurance treaties with ($0
authorized reinsurers and $0 unauthorized reinsurers) |
0 |
0 |
0 |
0 |
| 19 |
Reinsurance in unauthorized companies |
0 |
0 |
0 |
0 |
| 20 |
Net adjustments in assets and liabilities due to
foreign exchange rates |
0 |
0 |
0 |
0 |
| 21 |
Liability for amounts held under uninsured plans |
8,314,207 |
0 |
8,314,207 |
9,795,601 |
| 22 |
Aggregate write-ins for other liabilities (including
$2553019 current) |
8,397,326 |
0 |
8,397,326 |
8,143,958 |
| 23 |
Total liabilities (Lines 1 to 22) |
208,357,300 |
733,149 |
209,090,449 |
203,330,608 |
| 24 |
Aggregate write-ins for special surplus funds |
|
|
0 |
0 |
| 25 |
Common capital stock |
|
|
2,500,000 |
2,500,000 |
| 26 |
Preferred capital stock |
|
|
0 |
0 |
| 27 |
Gross paid in and contributed surplus |
|
|
120,652,900 |
120,652,900 |
| 28 |
Surplus notes |
|
|
0 |
0 |
| 29 |
Aggregate write-ins for other than special surplus
funds |
|
|
0 |
0 |
| 30 |
Unassigned funds (surplus) |
|
|
96,796,952 |
86,353,405 |
| 31.1 |
(1) shares common (value included in common capital
stock $0) (less treasury stock, at cost) |
|
|
0 |
0 |
| 31.2 |
(1) shares preferred (value included in preferred
capital stock $0) (less treasury stock, at cost) |
|
|
0 |
0 |
| 32 |
Total capital and surplus |
|
|
219,949,852 |
209,506,305 |
| 33 |
Total liabilities, capital and surplus |
|
|
429,040,301 |
412,836,913 |
|
Details of Write-Ins |
| 2201 |
FEP SPECIAL ADVANCE |
4,900,054 |
0 |
4,900,054 |
4,900,054 |
| 2202 |
OTHER LIABILITIES |
2,635,341 |
0 |
2,635,341 |
2,483,025 |
| 2203 |
RETROACTIVITY LIABILITY |
861,931 |
0 |
861,931 |
760,879 |
| 2299 |
|
8,397,326 |
0 |
8,397,326 |
8,143,958 |
| 2499 |
|
|
|
0 |
0 |
| 2999 |
|
|
|
0 |
0 |
|
