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2012 LIABILITIES, CAPITAL AND SURPLUS - 003
13627 - SelectCare of ME Inc
Quarter 3

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) 3 0 0 0 0
02 Accrued medical incentive pool and bonus amounts 3 0 0 0 0
03 Unpaid claims adjustment expenses 3 0 0 0 0
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 3 0 0 0 0
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 0 0 0 0
09 General expenses due or accrued 3 0 0 0 0
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 3 0 918 918 585
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 0 1,992 1,992 1,146
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 0 0 0 0
24 Total liabilities (Lines 1 to 23) 3 0 2,910 2,910 1,731
25 Aggregate write-ins for special surplus funds 3     0 0
26 Common capital stock 3     1,000 1,000
27 Preferred capital stock 3     0 0
28 Gross paid in and contributed surplus 3     1,519,000 1,519,000
29 Surplus notes 3     0 0
30 Aggregate write-ins for other than special surplus funds 3     0 0
31 Unassigned funds (surplus) 3     1,713 1,094
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     1,521,713 1,521,094
34 Total liabilities, capital and surplus 3     1,524,623 1,522,825
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 20, 2012