|
Line |
Quarter Number |
Covered Current Period |
Uncovered Current Period |
Total Current Period |
Total Prior Year |
| 01 |
Claims unpaid (less $0 reinsurance ceded) |
1 |
86,810,344 |
369,850 |
87,180,194 |
97,012,263 |
| 02 |
Accrued medical incentive pool and bonus amounts |
1 |
0 |
0 |
0 |
0 |
| 03 |
Unpaid claims adjustment expenses |
1 |
2,018,920 |
0 |
2,018,920 |
2,166,078 |
| 04 |
Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act |
1 |
75,548,653 |
0 |
75,548,653 |
76,119,089 |
| 05 |
Aggregate life policy reserves |
1 |
0 |
0 |
0 |
0 |
| 06 |
Property/casualty unearned premium reserve |
1 |
0 |
0 |
0 |
0 |
| 07 |
Aggregate health claim reserves |
1 |
1,886,222 |
0 |
1,886,222 |
1,899,266 |
| 08 |
Premiums received in advance |
1 |
18,196,048 |
0 |
18,196,048 |
18,973,909 |
| 09 |
General expenses due or accrued |
1 |
9,370,086 |
0 |
9,370,086 |
9,406,290 |
| 10.1 |
Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) |
1 |
5,804,470 |
0 |
5,804,470 |
0 |
| 10.2 |
Net deferred tax liability |
1 |
0 |
0 |
0 |
0 |
| 11 |
Ceded reinsurance premiums payable |
1 |
0 |
0 |
0 |
0 |
| 12 |
Amounts withheld or retained for the account of others |
1 |
543,229 |
0 |
543,229 |
438,057 |
| 13 |
Remittances and items not allocated |
1 |
4,422,575 |
0 |
4,422,575 |
3,926,224 |
| 14 |
Borrowed money (including $0 current) and interest thereon $0 (including $0 current) |
1 |
0 |
0 |
0 |
0 |
| 15 |
Amounts due to parent, subsidiaries and affiliates |
1 |
29,457,381 |
0 |
29,457,381 |
32,513,158 |
| 16 |
Derivatives |
1 |
0 |
0 |
0 |
0 |
| 17 |
Payable for securities |
1 |
0 |
0 |
0 |
0 |
| 18 |
Payable for securities lending |
1 |
0 |
0 |
0 |
0 |
| 19 |
Funds held under reinsurance treaties with ($0 authorized reinsurers and $0 unauthorized reinsurers) |
1 |
0 |
0 |
0 |
0 |
| 20 |
Reinsurance in unauthorized companies |
1 |
0 |
0 |
0 |
0 |
| 21 |
Net adjustments in assets and liabilities due to foreign exchange rates |
1 |
0 |
0 |
0 |
0 |
| 22 |
Liability for amounts held under uninsured plans |
1 |
10,961,521 |
0 |
10,961,521 |
6,747,057 |
| 23 |
Aggregate write-ins for other liabilities (including $762571 current) |
1 |
6,815,219 |
0 |
6,815,219 |
7,031,208 |
| 24 |
Total liabilities (Lines 1 to 23) |
1 |
251,834,668 |
369,850 |
252,204,518 |
256,232,599 |
| 25 |
Aggregate write-ins for special surplus funds |
1 |
|
|
0 |
0 |
| 26 |
Common capital stock |
1 |
|
|
2,500,000 |
2,500,000 |
| 27 |
Preferred capital stock |
1 |
|
|
0 |
0 |
| 28 |
Gross paid in and contributed surplus |
1 |
|
|
120,652,900 |
120,652,900 |
| 29 |
Surplus notes |
1 |
|
|
0 |
0 |
| 30 |
Aggregate write-ins for other than special surplus funds |
1 |
|
|
0 |
0 |
| 31 |
Unassigned funds (surplus) |
1 |
|
|
121,640,961 |
101,489,895 |
| 32.1 |
(1) shares common (value included in common capital stock $0) (less treasury stock, at cost) |
1 |
|
|
0 |
0 |
| 32.2 |
(1) shares preferred (value included in preferred capital stock $0) (less treasury stock, at cost) |
1 |
|
|
0 |
0 |
| 33 |
Total capital and surplus |
1 |
|
|
244,793,861 |
224,642,795 |
| 34 |
Total liabilities, capital and surplus |
1 |
|
|
496,998,379 |
480,875,394 |
|
Details of Write-Ins |
| 2301 |
FEP SPECIAL ADVANCE |
1 |
4,428,350 |
0 |
4,428,350 |
4,428,350 |
| 2302 |
OTHER LIABILITIES |
1 |
1,006,207 |
0 |
1,006,207 |
1,082,807 |
| 2303 |
ESCHEAT LIABILITY |
1 |
1,011,770 |
0 |
1,011,770 |
940,233 |
| 2304 |
RETROACTIVITY LIABILITY |
1 |
368,892 |
0 |
368,892 |
579,818 |
| 2399 |
|
1 |
6,815,219 |
0 |
6,815,219 |
7,031,208 |
| 2599 |
|
1 |
|
|
0 |
0 |
| 3099 |
|
1 |
|
|
0 |
0 |
|
