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2012 LIABILITIES, CAPITAL AND SURPLUS - 003
95517 - Aetna Hlth Inc ME Corp
Quarter 3

OLTPPROD Copyright 2012 National Association of Insurance Commissioners. All rights reserved. 11/19/2012
Line Quarter Number Covered Current Period Uncovered Current Period Total Current Period Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 3 6,758,803 246,233 7,005,036 6,587,712
02 Accrued medical incentive pool and bonus amounts 3 278,402 0 278,402 0
03 Unpaid claims adjustment expenses 3 129,119 0 129,119 106,669
04 Aggregate health policy reserves, including the liability of $233236 for medical loss ratio rebate per the Public Health Service Act 3 598,654 0 598,654 173,857
05 Aggregate life policy reserves 3 0 0 0 0
06 Property/casualty unearned premium reserve 3 0 0 0 0
07 Aggregate health claim reserves 3 62,506 0 62,506 49,973
08 Premiums received in advance 3 8,330 0 8,330 13,085
09 General expenses due or accrued 3 10,110 0 10,110 6,087
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 3 564,846 0 564,846 0
10.2 Net deferred tax liability 3 0 0 0 0
11 Ceded reinsurance premiums payable 3 0 0 0 0
12 Amounts withheld or retained for the account of others 3 0 0 0 0
13 Remittances and items not allocated 3 0 0 0 0
14 Borrowed money (including $0 current) and interest thereon $0 (including $0 current) 3 0 0 0 0
15 Amounts due to parent, subsidiaries and affiliates 3 707,713 0 707,713 893,113
16 Derivatives 3 0 0 0 0
17 Payable for securities 3 0 0 0 0
18 Payable for securities lending 3 0 0 0 0
19 Funds held under reinsurance treaties with ($0 authorized reinsurers and $0 unauthorized reinsurers) 3 0 0 0 0
20 Reinsurance in unauthorized companies 3 0 0 0 0
21 Net adjustments in assets and liabilities due to foreign exchange rates 3 0 0 0 0
22 Liability for amounts held under uninsured plans 3 0 0 0 0
23 Aggregate write-ins for other liabilities (including $0 current) 3 337,760 0 337,760 188,064
24 Total liabilities (Lines 1 to 23) 3 9,456,243 246,233 9,702,476 8,018,560
25 Aggregate write-ins for special surplus funds 3     0 331,882
26 Common capital stock 3     1,000,000 1,000,000
27 Preferred capital stock 3     0 0
28 Gross paid in and contributed surplus 3     8,700,000 8,700,000
29 Surplus notes 3     0 0
30 Aggregate write-ins for other than special surplus funds 3     0 0
31 Unassigned funds (surplus) 3     4,333,193 1,340,048
32.1 (1) shares common (value included in common capital stock $0) (less treasury stock, at cost) 3     0 0
32.2 (1) shares preferred (value included in preferred capital stock $0) (less treasury stock, at cost) 3     0 0
33 Total capital and surplus 3     14,033,193 11,371,930
34 Total liabilities, capital and surplus 3     23,735,669 19,390,490
Details of Write-Ins
2301 CMS Payable 3 168,605 0 168,605 1,391
2302 CMS Coverage Gap 3 153,185 0 153,185 174,079
2303 Other Payable 3 15,970 0 15,970 0
2304 Medicare Part D Low Income Cost Share Payable 3 0 0 0 12,594
2399   3 337,760 0 337,760 188,064
2501 Additional Deferred Tax Asset Admitted Amount 3     0 331,882
2599   3     0 331,882
3099   3     0 0

Last Updated: November 19, 2012