|
Line |
Covered Current Year |
Uncovered Current Year |
Total Current Year |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
0 |
0 |
0 |
0 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
0 |
0 |
0 |
0 |
| 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 |
0 |
0 |
0 |
0 |
| 09 |
General expenses due or accrued |
0 |
0 |
0 |
114 |
| 10.1 |
Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) |
0 |
585 |
585 |
1,098 |
| 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 |
0 |
1,146 |
1,146 |
1,681 |
| 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) |
0 |
1,731 |
1,731 |
2,893 |
| 25 |
Aggregate write-ins for special surplus funds |
|
|
0 |
0 |
| 26 |
Common capital stock |
|
|
1,000 |
1,000 |
| 27 |
Preferred capital stock |
|
|
0 |
0 |
| 28 |
Gross paid in and contributed surplus |
|
|
1,519,000 |
1,519,000 |
| 29 |
Surplus notes |
|
|
0 |
0 |
| 30 |
Aggregate write-ins for other than special surplus funds |
|
|
0 |
0 |
| 31 |
Unassigned funds (surplus) |
|
|
1,094 |
2,037 |
| 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 |
|
|
1,521,094 |
1,522,037 |
| 34 |
Total liabilities, capital and surplus |
|
|
1,522,825 |
1,524,930 |
|
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 |
