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2013 LIABILITIES, CAPITAL AND SURPLUS - 003
12151 - Arcadian Hlth Plan Inc
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 24,206,779 1,671,850 25,878,629 44,080,020
02 Accrued medical incentive pool and bonus amounts 3 0 0 0 0
03 Unpaid claims adjustment expenses 3 189,306 0 189,306 291,851
04 Aggregate health policy reserves, including the liability of $0 for medical loss ratio rebate per the Public Health Service Act 3 1,348,529 0 1,348,529 389,199
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 74,290 0 74,290 446,047
09 General expenses due or accrued 3 3,511,500 0 3,511,500 17,045,924
10.1 Current federal and foreign income tax payable and interest thereon (including $0 on realized capital gains (losses)) 3 0 0 0 4,873,640
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 6,018 0 6,018 28,520
13 Remittances and items not allocated 3 4,889 0 4,889 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 4,352,665 0 4,352,665 2,387,922
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 1,588,702 0 1,588,702 1,719,614
23 Aggregate write-ins for other liabilities (including $135344 current) 3 135,344 0 135,344 1,344
24 Total liabilities (Lines 1 to 23) 3 35,418,022 1,671,850 37,089,872 71,264,081
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     68,696,777 68,696,777
29 Surplus notes 3     0 0
30 Aggregate write-ins for other than special surplus funds 3     0 0
31 Unassigned funds (surplus) 3     7,455,734 2,777,861
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     76,752,511 72,074,638
34 Total liabilities, capital and surplus 3     113,842,383 143,338,719
Details of Write-Ins
2301 MEDICARE RISK ADJUSTMENT PREMIUM PAYABLE 3 135,344 0 135,344 1,344
2399   3 135,344 0 135,344 1,344
2599   3     0 0
3001   3     0 0
3099   3     0 0

Last Updated: November 19, 2013