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2013 LIABILITIES, CAPITAL AND SURPLUS - 003
12151 - Arcadian Hlth Plan Inc
Quarter 2

OLTPPROD Copyright 2013 National Association of Insurance Commissioners. All rights reserved. 08/20/2013
Line Quarter Number Covered Current Period Uncovered Current Period Total Current Period Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 2 23,760,919 1,616,270 25,377,189 44,080,020
02 Accrued medical incentive pool and bonus amounts 2 0 0 0 0
03 Unpaid claims adjustment expenses 2 184,325 0 184,325 291,851
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 2 880,543 0 880,543 389,199
05 Aggregate life policy reserves 2 0 0 0 0
06 Property/casualty unearned premium reserve 2 0 0 0 0
07 Aggregate health claim reserves 2 0 0 0 0
08 Premiums received in advance 2 214,800 0 214,800 446,047
09 General expenses due or accrued 2 7,117,498 0 7,117,498 17,045,924
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 2 0 0 0 4,873,640
10.2 Net deferred tax liability 2 0 0 0 0
11 Ceded reinsurance premiums payable 2 0 0 0 0
12 Amounts withheld or retained for the account of others 2 5,760 0 5,760 28,520
13 Remittances and items not allocated 2 30,029 0 30,029 0
14 Borrowed money (including $0 current) and interest thereon $0 (including $0 current) 2 0 0 0 0
15 Amounts due to parent, subsidiaries and affiliates 2 9,299,240 0 9,299,240 2,387,922
16 Derivatives 2 0 0 0 0
17 Payable for securities 2 0 0 0 0
18 Payable for securities lending 2 0 0 0 0
19 Funds held under reinsurance treaties with ($0 authorized reinsurers, $0 unauthorized reinsurers and $0 certified reinsurers) 2 0 0 0 0
20 Reinsurance in unauthorized and certified ($0) companies 2 0 0 0 0
21 Net adjustments in assets and liabilities due to foreign exchange rates 2 0 0 0 0
22 Liability for amounts held under uninsured plans 2 2,527,346 0 2,527,346 1,719,614
23 Aggregate write-ins for other liabilities (including $273995 current) 2 273,995 0 273,995 1,344
24 Total liabilities (Lines 1 to 23) 2 44,294,455 1,616,270 45,910,725 71,264,081
25 Aggregate write-ins for special surplus funds 2     0 0
26 Common capital stock 2     600,000 600,000
27 Preferred capital stock 2     0 0
28 Gross paid in and contributed surplus 2     68,696,777 68,696,777
29 Surplus notes 2     0 0
30 Aggregate write-ins for other than special surplus funds 2     0 0
31 Unassigned funds (surplus) 2     10,613,267 2,777,861
32.1 (1) shares common (value included in common capital stock $0) (less treasury stock, at cost) 2     0 0
32.2 (1) shares preferred (value included in preferred capital stock $0) (less treasury stock, at cost) 2     0 0
33 Total capital and surplus 2     79,910,044 72,074,638
34 Total liabilities, capital and surplus 2     125,820,769 143,338,719
Details of Write-Ins
2301 Medicare Risk Adjustment Premium Payable 2 273,995 0 273,995 1,344
2302   2 0 0 0 0
2303   2 0 0 0 0
2399   2 273,995 0 273,995 1,344
2501   2     0 0
2502   2     0 0
2503   2     0 0
2599   2     0 0
3001   2     0 0
3002   2     0 0
3003   2     0 0
3099   2     0 0

Last Updated: September 27, 2010