Filetype Excel XLSX | Posted on 18 Aug 2022 | 3 years ago
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204x Filetype XLSX File size 0.06 MB Source: www.health.ny.gov
Sheet 1: Bal Sheet-Assets
| VBP INNOVATOR NAME | PERIOD ENDING | ||||
| Current Period | Current Period | Current Period | Previous Period | ||
| BALANCE SHEET - ASSETS | Assets | Nonadmitted Assets | Net Admitted Assets |
Net Admitted Assets As of 12/31 |
|
| 00400 | 00176 | 00401 | 00403 | 00404 | 00405 |
| CURRENT ASSETS | |||||
| Cash | 0001 | 0 | |||
| Short-Term Investments | 0002 | 0 | |||
| Premiums Receivable-net | 0003 | 0 | |||
| Interest Receivable | 0004 | 0 | |||
| NYS Medicaid Reinsurance Recovery Receivable | 0005 | 0 | |||
| Other Receivables - Net | 0006 | 0 | |||
| Prepaid Expenses | 0007 | 0 | |||
| Aggregate Write-Ins for Current Assets (list below) | 0008 | 0 | 0 | 0 | 0 |
| 0009 | 0 | ||||
| 0010 | 0 | ||||
| 0011 | 0 | ||||
| 0012 | 0 | ||||
| 0013 | 0 | ||||
| TOTAL CURRENT ASSETS | 0014 | 0 | 0 | 0 | 0 |
| OTHER ASSETS | |||||
| NYS Escrow Account Balance | 0015 | 0 | |||
| Amounts Due from Affiliates | 0016 | 0 | |||
| Loan Escrow | 0017 | 0 | |||
| Long-Term Investments | 0018 | 0 | |||
| Intangible Investments and Goodwill | 0019 | 0 | |||
| 0020 | 0 | ||||
| 0021 | 0 | ||||
| 0022 | 0 | ||||
| 0023 | 0 | ||||
| 0024 | 0 | ||||
| Other Restricted Assets | 0084 | 0 | |||
| Aggregate Write-Ins for Other Assets (list below) | 0026 | 0 | 0 | 0 | 0 |
| 0027 | 0 | ||||
| 0028 | 0 | ||||
| 0029 | 0 | ||||
| 0030 | 0 | ||||
| 0031 | 0 | ||||
| TOTAL OTHER ASSETS | 0032 | 0 | 0 | 0 | 0 |
| PROPERTY AND EQUIPMENT | |||||
| Land | 0033 | 0 | |||
| Building and Improvements | 0034 | 0 | |||
| Construction In Progress | 0035 | 0 | |||
| Furniture and Equipment | 0036 | 0 | |||
| Leasehold Improvments | 0025 | 0 | |||
| Aggregate Write-Ins for Other Equipment (list below) | 0037 | 0 | 0 | 0 | 0 |
| 0038 | 0 | ||||
| 0039 | 0 | ||||
| 0040 | 0 | ||||
| 0041 | 0 | ||||
| 0042 | 0 | ||||
| TOTAL PROPERTY AND EQUIPMENT | 0043 | 0 | 0 | 0 | 0 |
| TOTAL ASSETS | 0044 | 0 | 0 | 0 | 0 |
| 0 | 12/30/1899 | ||
| BALANCE SHEET - LIABILITIES | Current Period |
Previous Calendar Year as of 12/31 |
|
| 00400 | 00178 | 00401 | 00402 |
| Accounts Payable | 0045 | ||
| Claims Payable | 0046 | ||
| Accrued Inpatient Claims (Not Reported) | 0047 | ||
| Accrued Physician Claims (Not Reported) | 0048 | ||
| Accrued Referral Claims (Not Reported) | 0049 | ||
| Accrued Other Medical | 0050 | ||
| Accrued Medical Incentive Pool | 0051 | ||
| Unearned Premiums | 0052 | ||
| Loans and Notes Payable | 0053 | ||
| Aggregate Write-Ins for Current Liabilitied (List Below) | 0054 | 0 | 0 |
| 0055 | |||
| 0056 | |||
| 0057 | |||
| 0058 | |||
| 0059 | |||
| Medical Home (Non-Adirondack) Payable | 0085 | ||
| Adirondack Medical Home Payable | 0086 | ||
| TOTAL CURRENT LIABILITIES | 0060 | 0 | 0 |
| Loans and Notes | 0061 | ||
| Amounts Due to Affiliated | 0062 | ||
| Aggregate Write-Ins for Other Liabilities (list below) | 0063 | 0 | 0 |
| 0064 | |||
| 0065 | |||
| 0066 | |||
| 0067 | |||
| 0068 | |||
| TOTAL OTHER LIABILITIES | 0069 | 0 | 0 |
| TOTAL LIABILITIES | 0070 | 0 | 0 |
| Donated Capital | 0071 | ||
| Capital | 0072 | ||
| Paid In Surplus | 0073 | ||
| NYS Contingent Reserve Requirement | 0074 | ||
| Aggregate Write-Ins for Other Net Worth Items (list below) | 0075 | 0 | 0 |
| 0076 | |||
| 0077 | |||
| 0078 | |||
| 0079 | |||
| 0080 | |||
| Unassigned Surplus | 0081 | ||
| TOTAL NET WORTH | 0082 | 0 | 0 |
| TOTAL LIABILITIES AND NET WORTH | 0083 | 0 | 0 |
| 0 | 12/30/1899 | |
| NET WORTH RECONCILIATION | ||
| 00420 | 00179 | 00421 |
| Net Worth Last Year | 0001 | 0 |
| Total Net Income | 0002 | |
| Change in nonadmitted assets | 0003 | |
| Dividends to stockholders | 0004 | |
| Withdrawals of equity | 0005 | |
| Change in Net unrealized capital gains & losses less capital gains tax | 0020 | |
| Adjusted Net Worth | 0006 | 0 |
| Current Net Worth | 0007 | 0 |
| Difference | 0008 | 0 |
| Explanations: | ||
| 0009 | ||
| 0010 | ||
| 0011 | ||
| 0012 | ||
| 0013 | ||
| 0014 | ||
| 0015 | ||
| 0016 | ||
| 0017 | ||
| 0018 | ||
| Total Explanations | 0019 | 0 |
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