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2013 LIABILITIES, CAPITAL AND SURPLUS - 003
95517 - Aetna Hlth Inc ME Corp
Quarter 3

OLTPPROD Copyright 2013 National Association of Insurance Commissioners. All rights reserved. 11/19/2013
Line
Quarter Number
Covered Current Period
Uncovered Current Period
Total Current Period
Total Prior Year
01 Claims unpaid (less $0 reinsurance ceded) 3 9,050,475 339,006 9,389,481 7,427,685
02 Accrued medical incentive pool and bonus amounts 3 404,901 0 404,901 231,372
03 Unpaid claims adjustment expenses 3 164,347 0 164,347 147,635
04 Aggregate health policy reserves, including the liability of $250068 for medical loss ratio rebate per the Public Health Service Act 3 936,678 0 936,678 213,335
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 66,275 0 66,275 69,354
08 Premiums received in advance 3 12,218 0 12,218 6,914
09 General expenses due or accrued 3 26,566 0 26,566 14,201
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 3 327,642 0 327,642 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 0 0 0 4,556,051
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, $0 unauthorized reinsurers and $0 certified reinsurers) 3 0 0 0 0
20 Reinsurance in unauthorized and certified ($0) 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) 3 118,585 0 118,585 111,882
24 Total liabilities (Lines 1 to 23) 3 11,107,687 339,006 11,446,693 12,778,429
25 Aggregate write-ins for special surplus funds 3     0 0
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     4,681,173 5,118,026
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     14,381,173 14,818,026
34 Total liabilities, capital and surplus 3     25,827,866 27,596,455
Details of Write-Ins
2301 CMS Coverage Gap Discount 3 107,356 0 107,356 104,569
2302 Other Payable 3 8,498 0 8,498 6,848
2303 CMS Payable 3 2,731 0 2,731 0
2304 Pharmacy Manufacturer's Discount Payable 3 0 0 0 465
2399   3 118,585 0 118,585 111,882
2599   3     0 0
3099   3     0 0

Last Updated: November 19, 2013