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ANNUAL STATEMENT

FOR THE YEAR ENDING DECEMBER 31, 2012
OF THE CONDITION AND AFFAIRS OF THE

Select Care Of Maine, Inc.

 

NAIC Group Code..... 953, 953
(Current Period) (Prior Period)

NAIC Company Code..... 13627

Employer's ID Number..... 20-4156007

Organized under the Laws of Maine

State of Domicile or Port of Entry Maine

Country of Domicile United States

Licensed as Business Type: Health Maintenance Organization

Is HMO Federally Qualified? Yes [ ] No [ X ]

Incorporated/Organized..... November 30, 2005

Commenced Business..... April 2, 2009

Statutory Home Office 4888 Loop Central Drive, Suite 700, Houston, TX 77081
(Street and Number) (City or Town, State and Zip Code)

Main Administrative Office 4888 Loop Central Drive, Suite 700, Houston, TX 77081 713-965-9444
(Street and Number) (City or Town, State and Zip Code) (Area Code) (Telephone Number)

Mail Address 4888 Loop Central Drive, Suite 700, Houston, TX 77081
(Street and Number or P.O. Box) (City or Town, State and Zip Code)

Primary Location of Books and Records 4888 Loop Central Drive, Suite 700, Houston, TX 77081 713-770-1111
(Street and Number) (City or Town, State and Zip Code) (Area Code) (Telephone Number)

Internet Website Address www.universalamerican.com

Statutory Statement Contact Travis R. Christie 713-770-1111
(Name) (Area Code) (Telephone Number) (Extension)
tchristie@universalamerican.com 713-770-1241
(E-mail Address) (Fax Number)

OFFICERS
Theodore Marvin Carpenter, Jr., President & CEO
John Michael Squarok, Secretary, EVP, Secretary, Treasurer, CFO
Robert Arthur Waegelein, Exec. Vice-President
Scott Gerald Ellsworth, Vice-President

OTHER OFFICERS
Carol Lloyd Cochrane, Vice-President, Tax
Chung-Sing Sya, Vice-President & Chief Actuary
James Patrick McAleer, Vice-President
David Robert Monroe, Sr. Vice-President
Robert Michael Hayes, Vice-President
Steve Lamar Carlton, Asst Secretaryt
Paul David Jernigan, Asst Secretary

DIRECTORS OR TRUSTEES
Scott Gerald Ellsworth
Theodore Marvin Carpenter Jr.
John Michael Squarok
Robert Arthur Waegelein

State of........ TX
County of..... Harris

The officers of this reporting entity, being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement.

______________________________
Theodore Marvin Carpenter Jr.
President

______________________________
John Michael Squarok
Secretary, Treasurer, CFO

______________________________

 

Subscribed and sworn to before me
This ____ day of _________________

________________________________________

 

a. Is this an original filing? Yes [ X ] No [ ]
b. If no: 1. State the amendment number.....
2. Date filed.....
3. Number of pages attached.....

 

Last Updated: March 6, 2013