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2012 STATEMENT OF REVENUE AND EXPENSES - 004
13627 - SelectCare of ME Inc
Quarter 3

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 3   0 0 0
02 Net premium income (including $0 non-health premium income) 3   0 0 0
03 Change in unearned premium reserves and reserve for rate credits 3   0 0 0
04 Fee-for-service (net of $0 medical expenses) 3   0 0 0
05 Risk revenue 3   0 0 0
06 Aggregate write-ins for other health care related revenues 3   0 0 0
07 Aggregate write-ins for other non-health revenues 3   0 0 0
08 Total revenues 3   0 0 0
09 Hospital/medical benefits (hospital and medical) 3 0 0 0 0
10 Other professional services (hospital and medical) 3 0 0 0 0
11 Outside referrals (hospital and medical) 3 0 0 0 0
12 Emergency room and out-of-area (hospital and medical) 3 0 0 0 0
13 Prescription drugs (hospital and medical) 3 0 0 0 0
14 Aggregate write-ins for other hospital and medical (hospital and medical) 3 0 0 0 0
15 Incentive pool, withhold adjustments and bonus amounts (hospital and medical) 3 0 0 0 0
16 Subtotal (hospital and medical) 3 0 0 0 0
17 Net reinsurance recoveries (less) 3 0 0 0 0
18 Total hospital and medical (less) 3 0 0 0 0
19 Non-health claims (net) (less) 3 0 0 0 0
20 Claims adjustment expenses, including $0 cost containment expenses (less) 3 0 0 0 0
21 General administrative expenses (less) 3 247 247 2,739 2,739
22 Increase in reserves for life and accident and health contracts (including $0 increase in reserves for life only) (less) 3 0 0 0 0
23 Total underwriting deductions 3 247 247 2,739 2,739
24 Net underwriting gain or (loss) 3   -247 -2,739 -2,739
25 Net investment income earned 3 1,199 1,199 905 1,283
26 Net realized capital gains (losses) less capital gains tax of $0 3 0 0 0 0
27 Net investment gains or (losses) 3 1,199 1,199 905 1,283
28 Net gain or (loss) from agents' or premium balances charged off [(amount recovered $0 (amount charged off $0] 3 0 0 0 0
29 Aggregate write-ins for other income or expenses 3 0 0 0 0
30 Net income or (loss) after capital gains tax and before all other federal income taxes 3   952 -1,834 -1,456
31 Federal and foreign income taxes incurred 3   333 642 -512
32 Net income (loss) 3   619 -2,476 -944
Details of Write-Ins
0601   3   0 0 0
0602   3   0 0 0
0603   3   0 0 0
0699   3   0 0 0
0701   3   0 0 0
0702   3   0 0 0
0703   3   0 0 0
0799   3   0 0 0
1401   3 0 0 0 0
1402   3 0 0 0 0
1403   3 0 0 0 0
1499   3 0 0 0 0
2901   3 0 0 0 0
2902   3 0 0 0 0
2903   3 0 0 0 0
2999   3 0 0 0 0

 

2012 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
13627 - SelectCare of ME Inc
Quarter 3

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 3 1,521,094 1,522,037 1,522,037
34 Net income or (loss) from Line 32 3 619 -2,476 -944
35 Change in valuation basis of aggregate policy and claim reserves 3 0 0 0
36 Change in net unrealized capital gains (losses) less capital gains tax of $0 3 0 0 0
37 Change in net unrealized foreign exchange capital gain or (loss) 3 0 0 0
38 Change in net deferred income tax 3 0 0 0
39 Change in nonadmitted assets 3 0 0 0
40 Change in unauthorized reinsurance 3 0 0 0
41 Change in treasury stock 3 0 0 0
42 Change in surplus notes 3 0 0 0
43 Cumulative effect of changes in accounting principles 3 0 0 0
44.1 Paid in (capital changes) 3 0 0 0
44.2 Transferred from surplus (stock dividend) (capital changes) 3 0 0 0
44.3 Transferred to surplus (capital changes) 3 0 0 0
45.1 Paid in (surplus adjustments) 3 0 0 0
45.2 Transferred to capital (stock dividend) (surplus adjustments) 3 0 0 0
45.3 Transferred from capital (surplus adjustments) 3 0 0 0
46 Dividends to stockholders 3 0 0 0
47 Aggregate write-ins for gains or (losses) in surplus 3 0 0 0
48 Net change in capital and surplus 3 619 -2,476 -944
49 Capital and surplus end of reporting period 3 1,521,713 1,519,561 1,521,094
Details of Write-Ins
4701   3 0 0 0
4702   3 0 0 0
4703   3 0 0 0
4799   3 0 0 0

 

Last Updated: November 20, 2012