|
Line |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
87,112,486 |
334,476 |
87,446,962 |
68,798,486 |
| 02 |
Accrued medical incentive pool and bonus amounts |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
2,277,427 |
0 |
2,277,427 |
2,160,209 |
| 04 |
Aggregate health policy reserves |
69,222,206 |
0 |
69,222,206 |
68,779,925 |
| 05 |
Aggregate life policy reserves |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserve |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
2,119,521 |
0 |
2,119,521 |
2,234,693 |
| 08 |
Premiums received in advance |
19,501,878 |
0 |
19,501,878 |
19,062,725 |
| 09 |
General expenses due or accrued |
6,761,325 |
0 |
6,761,325 |
8,450,084 |
| 10.1 |
Current federal and foreign income tax payable and
interest thereon (including $0 on realized capital gains
(losses)) |
1,300,682 |
0 |
1,300,682 |
1,454,442 |
| 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 |
309,113 |
0 |
309,113 |
361,452 |
| 13 |
Remittances and items not allocated |
5,947,352 |
0 |
5,947,352 |
4,562,050 |
| 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 |
2,473,411 |
0 |
2,473,411 |
30,225,876 |
| 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 |
11,928,176 |
0 |
11,928,176 |
6,585,123 |
| 23 |
Aggregate write-ins for other liabilities (including
$1536127 current) |
7,915,512 |
0 |
7,915,512 |
9,785,564 |
| 24 |
Total liabilities (Lines 1 to 23) |
216,869,089 |
334,476 |
217,203,565 |
222,460,629 |
| 25 |
Aggregate write-ins for special surplus funds |
|
|
0 |
0 |
| 26 |
Common capital stock |
|
|
2,500,000 |
2,500,000 |
| 27 |
Preferred capital stock |
|
|
0 |
0 |
| 28 |
Gross paid in and contributed surplus |
|
|
120,652,900 |
120,652,900 |
| 29 |
Surplus notes |
|
|
0 |
0 |
| 30 |
Aggregate write-ins for other than special surplus
funds |
|
|
0 |
0 |
| 31 |
Unassigned funds (surplus) |
|
|
134,641,525 |
106,028,537 |
| 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 |
|
|
257,794,425 |
229,181,437 |
| 34 |
Total liabilities, capital and surplus |
|
|
474,997,990 |
451,642,066 |
|
Details of Write-Ins |
| 2301 |
FEP SPECIAL ADVANCE |
5,251,254 |
0 |
5,251,254 |
7,240,551 |
| 2302 |
ESCHEAT LIABILITY |
1,108,561 |
0 |
1,108,561 |
1,023,931 |
| 2303 |
OTHER LIABILITIES |
892,649 |
0 |
892,649 |
791,495 |
| 2304 |
RETROACTIVITY LIABILITY |
663,048 |
0 |
663,048 |
729,587 |
| 2399 |
|
7,915,512 |
0 |
7,915,512 |
9,785,564 |
| 2599 |
|
|
|
0 |
0 |
| 3099 |
|
|
|
0 |
0 | |
