<%@ Page Language="vb" AutoEventWireup="false" CodeBehind="FedPaymentReporting.aspx.vb" Inherits="LHSurvey.FedPaymentReporting" %>

<%@ Register Src="wucNumber.ascx" TagName="wucnumber" TagPrefix="uc1" %>
<%@ Register Src="wucNumberWithMaxMin.ascx" TagName="wucNumberWithMaxMin" TagPrefix="uc2" %>
<%@ Register Src="wucCurrency.ascx" TagName="wucCurrency" TagPrefix="uc3" %>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" lang="en-us">
<head runat="server">
	<title>Federal Payment Reporting</title>
	<link href="style.css" type="text/css" rel="stylesheet" />

	<script type="text/javascript" language="javascript">

		function InitializeDirtyFlags() {
			//text box groups

			document.getElementById("hidFedPayNumFromFedGrp_Modified").value = 0;
			document.getElementById("hidFedPayNumLivesGrp_Modified").value = 0;
			document.getElementById("hidFedPayTotalDollarFedGrp_Modified").value = 0;
			document.getElementById("hidFedPayEstDollarFedGrp_Modified").value = 0;
		}

		function formatNumber(num) {
			//alert("test");
			num = num.toString().replace(/\$|\,/g, '');
			if (num == '') //exit if null
				return num;
			if (num.indexOf(".") >= 0) //exit if decimal
				return num;
			if (isNaN(num))	//exit if not a number
				return num;
			//num = "0";
			//sign = (num == (num = Math.abs(num)));
			num = Math.floor(num * 100 + 0.50000000001);
			cents = num % 100;
			num = Math.floor(num / 100).toString();

			for (var i = 0; i < Math.floor((num.length - (1 + i)) / 3) ; i++)
				num = num.substring(0, num.length - (4 * i + 3)) + ',' + num.substring(num.length - (4 * i + 3));
			//return (((sign)?'':'-') + '$' + num + '.' + cents);
			//return (((sign) ? '' : '-') + num);
			return num;
		}

		function SetFieldsAsDirty(object) {
			//alert("test2");
			var objectid = object.id;
			//alert("entered");

			if (objectid.indexOf("wucFedPayNumFromFedGrp") != -1) {
				document.getElementById("hidFedPayNumFromFedGrp_Modified").value = 1;
			}
			else if (objectid.indexOf("wucFedPayNumLivesGrp") != -1) {
				document.getElementById("hidFedPayNumLivesGrp_Modified").value = 1;
			}
			else if (objectid.indexOf("wucFedPayTotDollarFedGrp") != -1) {
				document.getElementById("hidFedPayTotalDollarFedGrp_Modified").value = 1;
			}
			else if (objectid.indexOf("wucFedPayEstDollarFedGrp_ReinsurancePymts") != -1) {
				document.getElementById("hidFedPayEstDollarFedGrp_Modified").value = 1;

			}
		}

		function SetAllFieldsDirty(groupName) {

			document.getElementById("hidFedPayNumFromFedGrp_Modified").value = 1;
			document.getElementById("hidFedPayNumLivesGrp_Modified").value = 1;
			document.getElementById("hidFedPayTotalDollarFedGrp_Modified").value = 1;
			document.getElementById("hidFedPayEstDollarFedGrp_Modified").value = 1;

		}


	</script>

	<style type="text/css">
		.auto-style1 {
			width: 200px;
		}

		.auto-style2 {
			color: #000000;
			font-size: 0.75em;
			font-family: Verdana, Arial,Helvetica;
			height: 30px;
			vertical-align: middle;
			width: 200px;
		}
	</style>

</head>
<body>
	<form id="Form1" style="padding-top:15px" method="post" runat="server">
		<input type="hidden" id="hidDataApplicableAdmnExp_modified" name="hidDataApplicableAdmnExp_modified" />
		<input type="hidden" id="hidDataApplicableOpenEnrl_modified" name="hidDataApplicableOpenEnrl_modified" />
		<input type="hidden" id="hidFedPayNumFromFedGrp_Modified" name="hidFedPayNumFromFedGrp_Modified" />
		<input type="hidden" id="hidFedPayEstDollarFedGrp_Modified" name="hidFedPayEstDollarFedGrp_Modified" />
		<input type="hidden" id="hidFedPayNumLivesGrp_Modified" name="hidFedPayNumLivesGrp_Modified" />
		<input type="hidden" id="hidFedPayTotalDollarFedGrp_Modified" name="hidFedPayTotalDollarFedGrp_Modified" />
		<input id="hidFederalPaymentRecordExist" type="hidden" name="hidFederalPaymentRecordExist" runat="server" />
        <div style="margin: 0 auto; border-spacing: 0px; padding: 0px; width: 80%;" class="FrmTable" align="center">
            <div class="FrmTitleBackGrnd" style="font-weight: bold; color: #000000;" align="left">
                Annual Report of Ohio Health Insurance Business (LHSurvey) - Detail Page
                          <a style="margin-left:1000px;" class="main" onmouseover="window.status='Context Sensitive Help';return true;" onmouseout="window.status='';return true;"
                              href="Instructions/Help.pdf" target="helpwindow">Help</a>
            </div>
            <div style="margin: 5px;">
                <table width="100%" border="0" class="FrmBackGrnd" role="presentation">
                    <tr valign="baseline">
                        <td width="17">
                            <img src="/images/frmBullet.gif" alt=""/>
                        </td>
                        <td width="484" height="20" class="FrmInfo">Data for <b>
                            <asp:Label ID="lblCompanyName" runat="server"></asp:Label></b>
                        </td>
                    </tr>
                    <tr valign="baseline">
                        <td width="17">
                            <img src="/images/frmBullet.gif" alt=""/>
                        </td>
                        <td height="20" class="FrmInfo">NAIC Number: <b>
                            <asp:Label ID="lblNaicNum" runat="server"></asp:Label></b>
                        </td>
                    </tr>
                    <tr valign="baseline">
                        <td width="17">
                            <img src="/images/frmBullet.gif" alt=""/>
                        </td>
                        <td height="20" class="FrmInfo">
                            <b>INFORMATION RELATED ONLY TO BUSINESS IN OHIO</b>
                        </td>
                    </tr>
                    <tr valign="baseline">
                        <td width="14">
                            <img src="/images/frmBullet.gif" alt=""/></td>
                        <td height="20" class="FrmInfo">
                            <b>REPORTING FOR THE PREVIOUS YEAR BEGINS MID-MARCH</b></td>
                    </tr>
                    <tr valign="baseline">
                        <td width="14">
                            <img src="/images/frmBullet.gif" alt=""/></td>
                        <td height="20" class="FrmInfo">
                            <b>CURRENTLY VIEWING FOR THE YEAR ENDING
															<asp:Label ID="lblPeriod" runat="server"></asp:Label></b></td>
                    </tr>
                    <tr valign="baseline">
                        <td colspan="2" height="20" class="FrmInfoBig">
                            <br />
                            *Each numeric field can accept up to 11 digits. Only numeric characters and commas are
                                                    allowed. Precede negative numbers with a minus sign -- parentheses are not allowed.
                                                    Decimals, alphabetic, and special characters (e.g., $, %, @) are also not allowed.<br />
                        </td>
                    </tr>
                    <tr>
                        <td class="FrmError" colspan="2">
                            <asp:ValidationSummary ID="vsError" runat="server" EnableViewState="False" Width="100%"
                                CssClass="FrmHintBig"></asp:ValidationSummary>
                        </td>
                    </tr>
                    <tr>
                        <td class="FrmError" colspan="2">
                            <div id="CodeBhindErrors">
                                <asp:Label ID="lblAdminExpMsg" runat="server" EnableViewState="False"></asp:Label>
                            </div>
                        </td>
                    </tr>
                    <tr>
                        <td colspan="2">
                            <asp:Label ID="lblDataEntryInstructions" CssClass="FrmHintBig" runat="server" Visible="false" />
                        </td>
                    </tr>
                </table>
                <table id="federalPaymentReportingtbl">
                    <tr>
                        <td colspan="6">&nbsp;<h3>Federal Payment Reporting Page: </h3>
                        </td>
                    </tr>
                    <tr>
                        <td class="style2"></td>
                        <th class="auto-style1">Federal Payment Reporting Page
                        </th>
                        <th>Number of Policies for which payments are received from the Federal Government
                        </th>
                        <th>Number of Lives Covered under such Policies
                        </th>
                        <th>Total Dollar Amount Received from the Federal Government for enrollees in Ohio
                        </th>
                        <th>Estimated Dollar Amount to be Received from the Federal Government for enrollees in Ohio
                        </th>
                    </tr>
                    <tr>
                        <td class="style2">33.
                        </td>
                        <td class="auto-style2">Cost Sharing Subsidy
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumFromFedGrp_CostSharSub" runat="server"
                                InvalidErrorMessage="Number of Policies for payments received from Federal Government & Cost Sharing Subsidy amount is not valid"
                                RequiredErrorMessage="FEI Group Gross Earned Premiums is required" Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumLivesGrp_CostSharSub" runat="server"
                                InvalidErrorMessage="Number of Lives Covered & Cost Sharing Subsidy amount is not valid"
                                RequiredErrorMessage="Non - FEI Group Gross Earned Premiums is required" Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayTotDollarFedGrp_CostSharSub" runat="server"
                                InvalidErrorMessage="Total Dollar Amount Received from Federal Government & Cost Sharing Subsidy amount is not valid"
                                RequiredErrorMessage="Individual Group (Open Enrollment) Gross Earned Premiums is required"
                                Required="false" />
                        </td>
                        <td></td>
                    </tr>
                    <tr>
                        <td class="style2">34.
                        </td>
                        <td class="auto-style2">Premium Tax Credit
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumFromFedGrp_PremTaxCredit" runat="server"
                                InvalidErrorMessage=" Number of Policies for payments received from Federal Government & Premium Tax Credit is not valid"
                                RequiredErrorMessage="Number of Policies for payments received from Federal Government & Premium Tax Credit is required"
                                Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumLivesGrp_PremTaxCredit" runat="server"
                                InvalidErrorMessage="Number of Lives Covered & Premium Tax Credit is not valid"
                                RequiredErrorMessage="Number of Policies for payments received from Federal Government & Premium Tax Credit is required"
                                Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayTotDollarFedGrp_PremTaxCredit" runat="server"
                                InvalidErrorMessage="Total Dollar Amount Received from Federal Government & Premium Tax Credit is not valid"
                                RequiredErrorMessage=" Total Dollar Amount Received from Federal Government & Premium Tax Credit is required"
                                Required="false" />
                        </td>
                        <td></td>
                    </tr>
                    <tr>
                        <td class="style2">35.
                        </td>
                        <td class="auto-style2">Reinsurance Payments
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumFromFedGrp_ReinsurancePymts" runat="server"
                                InvalidErrorMessage=" Number of Policies for payments received from Federal Government & Reinsurance Payments is not valid"
                                RequiredErrorMessage="Number of Policies for payments received from Federal Government & Reinsurance Payments is required"
                                Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayNumLivesGrp_ReinsurancePymts" runat="server"
                                InvalidErrorMessage="Number of Lives Covered & Premium Tax Credit is not valid"
                                RequiredErrorMessage="Number of Lives Covered & Reinsurance Payments is required"
                                Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayTotDollarFedGrp_ReinsurancePymts" runat="server"
                                InvalidErrorMessage="Total Dollar Amount Received from Federal Government & Reinsurance Payments is not valid"
                                RequiredErrorMessage="Total Dollar Amount Received from Federal Government & Reinsurance Payments is required"
                                Required="false" />
                        </td>
                        <td>
                            <uc2:wucNumberWithMaxMin ID="wucFedPayEstDollarFedGrp_ReinsurancePymts" runat="server"
                                InvalidErrorMessage="Estimated Dollar Amount received from Federal Government & Reinsurance Payments is not valid"
                                RequiredErrorMessage="Total Dollar Amount Received from Federal Government & Reinsurance Payments  is required"
                                Required="false" />
                        </td>
                    </tr>
                </table>
            </div>
            <div class="FrmHint" align="left" style="margin:2px;">
                <asp:Button ID="cmdSave" OnClick="cmdSave_Click" runat="server" Text="Save & Validate" OnClientClick="document.getElementById('CodeBhindErrors').innerHTML=''"></asp:Button>&nbsp;&nbsp;&nbsp;
            </div>
        </div>
	</form>
</body>
</html>
