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2012 STATEMENT OF REVENUE AND EXPENSES - 004
13627 - SelectCare of ME Inc
Quarter 1

OLTPPROD Copyright 2012 National Association of Insurance Commissioners. All rights reserved. 11/20/2012
Line Quarter Number Uncovered Current Year to Date Total Current Year to Date Total Prior Year to Date Total Prior Year Ended December 31
01 Member months 1   0 0 0
02 Net premium income (including $0 non-health premium income) 1   0 0 0
03 Change in unearned premium reserves and reserve for rate credits 1   0 0 0
04 Fee-for-service (net of $0 medical expenses) 1   0 0 0
05 Risk revenue 1   0 0 0
06 Aggregate write-ins for other health care related revenues 1   0 0 0
07 Aggregate write-ins for other non-health revenues 1   0 0 0
08 Total revenues 1   0 0 0
09 Hospital/medical benefits (hospital and medical) 1 0 0 0 0
10 Other professional services (hospital and medical) 1 0 0 0 0
11 Outside referrals (hospital and medical) 1 0 0 0 0
12 Emergency room and out-of-area (hospital and medical) 1 0 0 0 0
13 Prescription drugs (hospital and medical) 1 0 0 0 0
14 Aggregate write-ins for other hospital and medical (hospital and medical) 1 0 0 0 0
15 Incentive pool, withhold adjustments and bonus amounts (hospital and medical) 1 0 0 0 0
16 Subtotal (hospital and medical) 1 0 0 0 0
17 Net reinsurance recoveries (less) 1 0 0 0 0
18 Total hospital and medical (less) 1 0 0 0 0
19 Non-health claims (net) (less) 1 0 0 0 0
20 Claims adjustment expenses, including $0 cost containment expenses (less) 1 0 0 46 0
21 General administrative expenses (less) 1 247 247 214 2,739
22 Increase in reserves for life and accident and health contracts (including $0 increase in reserves for life only) (less) 1 0 0 0 0
23 Total underwriting deductions 1 247 247 260 2,739
24 Net underwriting gain or (loss) 1   -247 -260 -2,739
25 Net investment income earned 1 385 385 253 1,283
26 Net realized capital gains (losses) less capital gains tax of $0 1 0 0 0 0
27 Net investment gains or (losses) 1 385 385 253 1,283
28 Net gain or (loss) from agents' or premium balances charged off [(amount recovered $0 (amount charged off $0] 1 0 0 0 0
29 Aggregate write-ins for other income or expenses 1 0 0 0 0
30 Net income or (loss) after capital gains tax and before all other federal income taxes 1   138 -7 -1,456
31 Federal and foreign income taxes incurred 1   48 0 -512
32 Net income (loss) 1   90 -7 -944
Details of Write-Ins
0601   1   0 0 0
0602   1   0 0 0
0603   1   0 0 0
0699   1   0 0 0
0701   1   0 0 0
0702   1   0 0 0
0703   1   0 0 0
0799   1   0 0 0
1401   1 0 0 0 0
1402   1 0 0 0 0
1403   1 0 0 0 0
1499   1 0 0 0 0
2901   1 0 0 0 0
2902   1 0 0 0 0
2903   1 0 0 0 0
2999   1 0 0 0 0

 

2012 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
13627 - SelectCare of ME Inc
Quarter 1

OLTPPROD Copyright 2012 National Association of Insurance Commissioners. All rights reserved. 11/20/2012
Line Quarter Number Current Year to Date Prior Year to Date Prior Year Ended December 31
33 Capital and surplus prior reporting year 1 1,521,094 1,522,037 1,522,037
34 Net income or (loss) from Line 32 1 90 -7 -944
35 Change in valuation basis of aggregate policy and claim reserves 1 0 0 0
36 Change in net unrealized capital gains (losses) less capital gains tax of $0 1 0 0 0
37 Change in net unrealized foreign exchange capital gain or (loss) 1 0 0 0
38 Change in net deferred income tax 1 -3 0 0
39 Change in nonadmitted assets 1 0 0 0
40 Change in unauthorized reinsurance 1 0 0 0
41 Change in treasury stock 1 0 0 0
42 Change in surplus notes 1 0 0 0
43 Cumulative effect of changes in accounting principles 1 0 0 0
44.1 Paid in (capital changes) 1 0 0 0
44.2 Transferred from surplus (stock dividend) (capital changes) 1 0 0 0
44.3 Transferred to surplus (capital changes) 1 0 0 0
45.1 Paid in (surplus adjustments) 1 0 0 0
45.2 Transferred to capital (stock dividend) (surplus adjustments) 1 0 0 0
45.3 Transferred from capital (surplus adjustments) 1 0 0 0
46 Dividends to stockholders 1 0 0 0
47 Aggregate write-ins for gains or (losses) in surplus 1 0 0 0
48 Net change in capital and surplus 1 87 -7 -944
49 Capital and surplus end of reporting period 1 1,521,181 1,522,030 1,521,094
Details of Write-Ins
4701   1 0 0 0
4702   1 0 0 0
4703   1 0 0 0
4799   1 0 0 0

 

Last Updated: November 20, 2012