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2011 LIABILITIES, CAPITAL AND SURPLUS - 003
95517 - Aetna Health Inc ME Corp
Quarter 3

Line Covered Current Period Uncovered Current Period Total Current Period Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 6,013,954 150,956 6,164,910 7,573,617
02 Accrued medical incentive pool and bonus amounts 0 0 0 0
03 Unpaid claims adjustment expenses 108,128 0 108,128 117,716
04 Aggregate health policy reserves 317,906 0 317,906 62,862
05 Aggregate life policy reserves 0 0 0 0
06 Property/casualty unearned premium reserve 0 0 0 0
07 Aggregate health claim reserves 52,280 0 52,280 73,359
08 Premiums received in advance 1,673,498 0 1,673,498 4,820
09 General expenses due or accrued 10,230 0 10,230 0
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 167,905 0 167,905 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 0 0 0 1,304,023
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) 145,214 0 145,214 145,487
24 Total liabilities (Lines 1 to 23) 8,489,115 150,956 8,640,071 9,281,884
25 Aggregate write-ins for special surplus funds     498,075 960,128
26 Common capital stock     1,000,000 1,000,000
27 Preferred capital stock     0 0
28 Gross paid in and contributed surplus     9,700,000 9,700,000
29 Surplus notes     0 0
30 Aggregate write-ins for other than special surplus funds     0 0
31 Unassigned funds (surplus)     4,035,103 3,270,971
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     15,233,178 14,931,099
34 Total liabilities, capital and surplus     23,873,249 24,212,983
Details of Write-Ins
2301 CMS Coverage Gap 144,519 0 144,519 145,487
2302 CMS Payable 695 0 695 0
2399   145,214 0 145,214 145,487
2501 Additional Deferred Tax Asset Admitted Amount     498,075 960,128
2599       498,075 960,128
3099       0 0

Last Updated: September 27, 2010