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2010 STATEMENT OF REVENUE AND EXPENSES - 004
13627 - SelectCare of ME Inc
Quarter 3

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   0 0 0
02 Net premium income (including $0 non-health premium income)   0 0 0
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   0 0 0
09 Hospital/medical benefits (hospital and medical) 0 0 0 0
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 0 0 0
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 0 0 0
17 Net reinsurance recoveries (less) 0 0 0 0
18 Total hospital and medical (less) 0 0 0 0
19 Non-health claims (net) (less) 0 0 0 0
20 Claims adjustment expenses, including $0 cost containment expenses (less) 0 0 0 0
21 General administrative expenses (less) 0 697 0 789
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 0 697 0 789
24 Net underwriting gain or (loss)   -697 0 -789
25 Net investment income earned 1,242 1,242 1,476 2,603
26 Net realized capital gains (losses) less capital gains tax of $0 0 0 0 0
27 Net investment gains or (losses) 1,242 1,242 1,476 2,603
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   545 1,476 1,814
31 Federal and foreign income taxes incurred   191 517 635
32 Net income (loss)   354 959 1,179
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

 

2010 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
13627 - SelectCare 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 1,521,179 0 0
34 Net income or (loss) from Line 32 354 960 1,179
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 0 0 0
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 1,000 1,000
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 1,519,000 1,519,000
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 0 0 0
48 Net change in capital and surplus 354 1,520,960 1,521,179
49 Capital and surplus end of reporting period 1,521,533 1,520,960 1,521,179
Details of Write-Ins
4701   0 0 0
4702   0 0 0
4703   0 0 0
4799   0 0 0

 

Last Updated: September 27, 2010