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2012 LIABILITIES, CAPITAL AND SURPLUS - 003
12545 - Martins Point Generations LLC
Quarter 1

OLTPPROD Copyright 2012 National Association of Insurance Commissioners. All rights reserved. 11/20/2012
Line Quarter Number Covered Current Period Uncovered Current Period Total Current Period Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 1 11,272,877 0 11,272,877 11,085,843
02 Accrued medical incentive pool and bonus amounts 1 250,000 0 250,000 175,000
03 Unpaid claims adjustment expenses 1 283,484 0 283,484 251,921
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 1 0 0 0 0
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 0 0 0 0
08 Premiums received in advance 1 9,398,781 0 9,398,781 264,636
09 General expenses due or accrued 1 374,284 0 374,284 789,721
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 1 0 0 0 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 0 0 0 0
13 Remittances and items not allocated 1 0 0 0 0
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 1 224,828 0 224,828 388,144
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 0 0 0 0
23 Aggregate write-ins for other liabilities (including $0 current) 1 0 0 0 0
24 Total liabilities (Lines 1 to 23) 1 21,804,254 0 21,804,254 12,955,265
25 Aggregate write-ins for special surplus funds 1     0 0
26 Common capital stock 1     0 0
27 Preferred capital stock 1     0 0
28 Gross paid in and contributed surplus 1     31,700,000 30,500,000
29 Surplus notes 1     0 0
30 Aggregate write-ins for other than special surplus funds 1     0 0
31 Unassigned funds (surplus) 1     -24,006,700 -21,089,224
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     7,693,300 9,410,776
34 Total liabilities, capital and surplus 1     29,497,554 22,366,041
Details of Write-Ins
2301   1 0 0 0 0
2302   1 0 0 0 0
2303   1 0 0 0 0
2399   1 0 0 0 0
2501   1     0 0
2502   1     0 0
2503   1     0 0
2599   1     0 0
3001   1     0 0
3002   1     0 0
3003   1     0 0
3099   1     0 0

Last Updated: November 20, 2012