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2012 LIABILITIES, CAPITAL AND SURPLUS - 003
12151 - Arcadian Hlth Plan Inc
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 44,217,024 2,126,096 46,343,120 40,984,393
02 Accrued medical incentive pool and bonus amounts 3 0 0 0 400,675
03 Unpaid claims adjustment expenses 3 256,226 0 256,226 1,081,716
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 3 2,007,899 0 2,007,899 1,389,674
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 0 0 0 0
08 Premiums received in advance 3 137,180 0 137,180 0
09 General expenses due or accrued 3 14,835,759 0 14,835,759 8,348,324
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 3 0 0 0 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 59,896 0 59,896 183,576
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 0 0 0 0
16 Derivatives 3 0 0 0 0
17 Payable for securities 3 248,973 0 248,973 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 4,275,975 0 4,275,975 2,603,767
23 Aggregate write-ins for other liabilities (including $0 current) 3 0 0 0 0
24 Total liabilities (Lines 1 to 23) 3 66,038,932 2,126,096 68,165,028 54,992,125
25 Aggregate write-ins for special surplus funds 3     0 0
26 Common capital stock 3     600,000 600,000
27 Preferred capital stock 3     0 0
28 Gross paid in and contributed surplus 3     48,696,777 34,696,777
29 Surplus notes 3     0 0
30 Aggregate write-ins for other than special surplus funds 3     0 0
31 Unassigned funds (surplus) 3     3,111,187 3,160,876
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     52,407,964 38,457,653
34 Total liabilities, capital and surplus 3     120,572,992 93,449,778
Details of Write-Ins
2301   3 0 0 0 0
2302   3 0 0 0 0
2303   3 0 0 0 0
2399   3 0 0 0 0
2501   3     0 0
2502   3     0 0
2503   3     0 0
2599   3     0 0
3001   3     0 0
3002   3     0 0
3003   3     0 0
3099   3     0 0

Last Updated: November 19, 2012