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2012 LIABILITIES, CAPITAL AND SURPLUS - 003
12151 - Arcadian Hlth Plan Inc

OLTPPROD Copyright 2013 National Association of Insurance Commissioners. All rights reserved. 03/06/2013
Line Covered Current Year Uncovered Current Year Total Current Year Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 40,925,656 3,154,364 44,080,020 40,984,393
02 Accrued medical incentive pool and bonus amounts 0 0 0 400,675
03 Unpaid claims adjustment expenses 291,851 0 291,851 1,081,716
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 389,199 0 389,199 1,389,674
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 446,047 0 446,047 0
09 General expenses due or accrued 17,045,924 0 17,045,924 8,348,324
10.1 Current federal and foreign income tax payable and interest thereon (including $86190 on realized capital gains (losses)) 720,856 0 720,856 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 28,520 0 28,520 183,576
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 2,387,922 0 2,387,922 0
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, $0 unauthorized reinsurers and ($0 certified reinsurers) 0 0 0 0
20 Reinsurance in unauthorized and certified ($0) 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 1,719,614 0 1,719,614 2,603,767
23 Aggregate write-ins for other liabilities (including $0 current) 1,344 0 1,344 0
24 Total liabilities (Lines 1 to 23) 63,956,933 3,154,364 67,111,297 54,992,125
25 Aggregate write-ins for special surplus funds     0 0
26 Common capital stock     600,000 600,000
27 Preferred capital stock     0 0
28 Gross paid in and contributed surplus     68,696,777 34,696,777
29 Surplus notes     0 0
30 Aggregate write-ins for other than special surplus funds     0 0
31 Unassigned funds (surplus)     4,359,903 3,160,876
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     73,656,680 38,457,653
34 Total liabilities, capital and surplus     140,767,977 93,449,778
Details of Write-Ins
2301 Medicare Risk Adjustment Premium Payable 1,344 0 1,344 0
2302   0 0 0 0
2303   0 0 0 0
2399   1,344 0 1,344 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: March 6, 2013