|
Line |
Uncovered Current Year to Date |
Total Current Year to Date |
Total Prior Year to Date |
Total Prior Year Ended December 31 |
| 01 |
Member months |
|
20,520 |
8,558 |
11,909 |
| 02 |
Net premium income (including $0 non-health premium
income) |
|
11,910,686 |
4,749,323 |
6,550,791 |
| 03 |
Change in unearned premium reserves and reserve for
rate credits |
|
0 |
0 |
0 |
| 04 |
Fee-for-service (net of $0 medical expenses) |
|
0 |
0 |
0 |
| 05 |
Risk revenue |
|
0 |
0 |
0 |
| 06 |
Aggregate write-ins for other health care related
revenues |
|
0 |
0 |
0 |
| 07 |
Aggregate write-ins for other non-health revenues |
|
0 |
0 |
0 |
| 08 |
Total revenues |
|
11,910,686 |
4,749,323 |
6,550,791 |
| 09 |
Hospital/medical benefits (hospital and medical) |
0 |
7,883,429 |
3,555,485 |
4,238,109 |
| 10 |
Other professional services (hospital and
medical) |
0 |
0 |
0 |
0 |
| 11 |
Outside referrals (hospital and medical) |
0 |
0 |
0 |
0 |
| 12 |
Emergency room and out-of-area (hospital and
medical) |
0 |
0 |
0 |
0 |
| 13 |
Prescription drugs (hospital and medical) |
0 |
1,456,873 |
548,180 |
738,203 |
| 14 |
Aggregate write-ins for other hospital and medical
(hospital and medical) |
0 |
0 |
0 |
0 |
| 15 |
Incentive pool, withhold adjustments and bonus
amounts (hospital and medical) |
0 |
0 |
0 |
0 |
| 16 |
Subtotal (hospital and medical) |
0 |
9,340,302 |
4,103,665 |
4,976,312 |
| 17 |
Net reinsurance recoveries (less) |
0 |
6,649 |
0 |
20,063 |
| 18 |
Total hospital and medical (less) |
0 |
9,333,653 |
4,103,665 |
4,956,249 |
| 19 |
Non-health claims (net) (less) |
0 |
0 |
0 |
0 |
| 20 |
Claims adjustment expenses, including $125354 cost
containment expenses (less) |
0 |
230,688 |
50,871 |
87,146 |
| 21 |
General administrative expenses (less) |
0 |
2,564,167 |
1,319,895 |
2,663,044 |
| 22 |
Increase in reserves for life and accident and
health contracts (including $0 increase in reserves for life only)
(less) |
0 |
0 |
0 |
0 |
| 23 |
Total underwriting deductions |
0 |
12,128,508 |
5,474,431 |
7,706,439 |
| 24 |
Net underwriting gain or (loss) |
|
-217,822 |
-725,108 |
-1,155,648 |
| 25 |
Net investment income earned |
0 |
24,525 |
64,660 |
82,340 |
| 26 |
Net realized capital gains (losses) less capital
gains tax of $0 |
0 |
0 |
0 |
0 |
| 27 |
Net investment gains or (losses) |
0 |
24,525 |
64,660 |
82,340 |
| 28 |
Net gain or (loss) from agents' or premium balances
charged off [(amount recovered $0 (amount charged off $0] |
0 |
0 |
0 |
0 |
| 29 |
Aggregate write-ins for other income or expenses |
0 |
0 |
0 |
0 |
| 30 |
Net income or (loss) after capital gains tax and
before all other federal income taxes |
|
-193,297 |
-660,448 |
-1,073,308 |
| 31 |
Federal and foreign income taxes incurred |
|
0 |
0 |
0 |
| 32 |
Net income (loss) |
|
-193,297 |
-660,448 |
-1,073,308 |
|
Details of Write-Ins |
| 0601 |
|
|
0 |
0 |
0 |
| 0602 |
|
|
0 |
0 |
0 |
| 0603 |
|
|
0 |
0 |
0 |
| 0699 |
|
|
0 |
0 |
0 |
| 0701 |
|
|
0 |
0 |
0 |
| 0702 |
|
|
0 |
0 |
0 |
| 0703 |
|
|
0 |
0 |
0 |
| 0799 |
|
|
0 |
0 |
0 |
| 1401 |
|
0 |
0 |
0 |
0 |
| 1402 |
|
0 |
0 |
0 |
0 |
| 1403 |
|
0 |
0 |
0 |
0 |
| 1499 |
|
0 |
0 |
0 |
0 |
| 2901 |
|
0 |
0 |
0 |
0 |
| 2902 |
|
0 |
0 |
0 |
0 |
| 2903 |
|
0 |
0 |
0 |
0 |
| 2999 |
|
0 |
0 |
0 |
0 |
2009 STATEMENT OF REVENUE AND EXPENSES (Continued) - 005
12545 -
Martins Point Generations LLC
Quarter 3 |
|
Line |
Current Year to Date |
Prior Year to Date |
Prior Year Ended December 31 |
| 33 |
Capital and surplus prior reporting year |
1,804,076 |
1,927,591 |
1,927,591 |
| 34 |
Net income or (loss) from Line 32 |
-193,297 |
-660,448 |
-1,073,308 |
| 35 |
Change in valuation basis of aggregate policy and
claim reserves |
0 |
0 |
0 |
| 36 |
Change in net unrealized capital gains (losses) less
capital gains tax of $0 |
0 |
0 |
0 |
| 37 |
Change in net unrealized foreign exchange capital
gain or (loss) |
0 |
0 |
0 |
| 38 |
Change in net deferred income tax |
0 |
0 |
0 |
| 39 |
Change in nonadmitted assets |
10,285 |
1,193 |
-26,414 |
| 40 |
Change in unauthorized reinsurance |
0 |
0 |
0 |
| 41 |
Change in treasury stock |
0 |
0 |
0 |
| 42 |
Change in surplus notes |
0 |
0 |
0 |
| 43 |
Cumulative effect of changes in accounting
principles |
0 |
0 |
0 |
| 44.1 |
Paid in (capital changes) |
0 |
1,000,000 |
1,000,000 |
| 44.2 |
Transferred from surplus (stock dividend) (capital
changes) |
0 |
0 |
0 |
| 44.3 |
Transferred to surplus (capital changes) |
0 |
0 |
0 |
| 45.1 |
Paid in (surplus adjustments) |
0 |
0 |
0 |
| 45.2 |
Transferred to capital (stock dividend) (surplus
adjustments) |
0 |
0 |
0 |
| 45.3 |
Transferred from capital (surplus adjustments) |
0 |
0 |
0 |
| 46 |
Dividends to stockholders |
0 |
0 |
0 |
| 47 |
Aggregate write-ins for gains or (losses) in
surplus |
0 |
-23,793 |
-23,793 |
| 48 |
Net change in capital and surplus |
-183,012 |
316,952 |
-123,515 |
| 49 |
Capital and surplus end of reporting period |
1,621,064 |
2,244,543 |
1,804,076 |
|
Details of Write-Ins |
| 4701 |
Correction of prior year understatement
of General Expenses Due and accrued |
0 |
-23,793 |
-23,793 |
| 4702 |
|
0 |
0 |
0 |
| 4703 |
|
0 |
0 |
0 |
| 4799 |
|
0 |
-23,793 |
-23,793 |
|
|
