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2011 LIABILITIES, CAPITAL AND SURPLUS - 003
12545 - Martins Point Generations LLC

Line Covered Current Year Uncovered Current Year Total Current Year Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 11,085,843 0 11,085,843 10,298,378
02 Accrued medical incentive pool and bonus amounts 175,000 0 175,000 199,371
03 Unpaid claims adjustment expenses 251,921 0 251,921 196,841
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 0 0 0 0
05 Aggregate life policy reserves 0 0 0 0
06 Property/casualty unearned premium reserves 0 0 0 0
07 Aggregate health claim reserves 0 0 0 0
08 Premiums received in advance 264,636 0 264,636 138,169
09 General expenses due or accrued 789,721 0 789,721 143,919
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 0 0 0 0
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 0 0 0 0
13 Remittances and items not allocated 0 0 0 0
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 388,144 0 388,144 1,346,555
16 Derivatives 0 0 0 0
17 Payable for securities 0 0 0 0
18 Payable for securities lending 0 0 0 0
19 Funds held under reinsurance treaties with ($0 authorized reinsurers and $0 unauthorized reinsurers) 0 0 0 0
20 Reinsurance in unauthorized companies 0 0 0 0
21 Net adjustments in assets and liabilities due to foreign exchange rates 0 0 0 0
22 Liability for amounts held under uninsured plans 0 0 0 0
23 Aggregate write-ins for other liabilities (including $0 current) 0 0 0 0
24 Total liabilities (Lines 1 to 23) 12,955,265 0 12,955,265 12,323,233
25 Aggregate write-ins for special surplus funds     0 0
26 Common capital stock     0 0
27 Preferred capital stock     0 0
28 Gross paid in and contributed surplus     30,500,000 14,500,000
29 Surplus notes     0 0
30 Aggregate write-ins for other than special surplus funds     0 0
31 Unassigned funds (surplus)     -21,089,224 -9,242,208
32.1 (1) shares common (value included in common capital stock $0) (less treasury stock, at cost)     0 0
32.2 (1) shares preferred (value included in preferred capital stock $0) (less treasury stock, at cost)     0 0
33 Total capital and surplus     9,410,776 5,257,792
34 Total liabilities, capital and surplus     22,366,041 17,581,025
Details of Write-Ins
2301   0 0 0 0
2302   0 0 0 0
2303   0 0 0 0
2399   0 0 0 0
2501       0 0
2502       0 0
2503       0 0
2599       0 0
3001       0 0
3002       0 0
3003       0 0
3099       0 0

Last Updated: August 15, 2012