LIFE AND ACCIDENT AND HEALTH

Transcription

1 201 FOR THE YEAR ENDED DECEMBER 1, 201 LIFE AND ACCIDENT AND HEALTH 201

2 Schedule A - Part 1 - Real Estate Owned Schedule A - Part 2 - Real Estate Acquired and Additions Made Schedule A - Part - Real Estate Disposed E01, E02, E0

3 E04 SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or % % & % % % ' ' % ' '

4 E04.1 SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or % % % & & &

5 E04.2 SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or % & & & & & & &

6 E04. SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or % % && && && '

7 E04.4 SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or % % % % %% % % Mortgages in good standing - Commercial mortgages-all other XXX Mortgages in good standing XXX Restructured Mortgages XXX Mortgages with overdue interest over 90 days XXX

8 SCHEDULE B - PART 1 Showing All Mortgage Loans OWNED December 1 of Current Year 1 2 Location Change in /Recorded Book Loan Number Code City State Loan Type Acquired Rate of Value/Recorded Unrealized Increase (Decrease) Current Year s (Amortization)/ Accretion Current Year s Other-Than- Temporary Impairment Recognized Capitalized Deferred and Other Foreign Change in Value of Land and Buildings of Last Appraisal or Mortgages in the process of foreclosure XXX s XXX General Interrogatory: 1. Mortgages in good standing unpaid taxes interest due and unpaid. 2. Restructured mortgages unpaid taxes interest due and unpaid.. Mortgages with overdue interest over 90 days not in process of foreclosure unpaid taxes interest due and unpaid. 4. Mortgages in process of foreclosure unpaid taxes interest due and unpaid. E04.5

9 E05 SCHEDULE B - PART 2 Showing All Mortgage Loans ACQUIRED AND ADDITIONS MADE During the Current Year 1 Location Additional Loan Number City State Loan Type Acquired Rate of Actual Cost at Time of Acquisition Made After Acquisition Value of Land and Buildings % Mortgages in good standing - Commercial mortgages-all other Mortgages in good standing Restructured Mortgages Mortgages with overdue interest over 90 days Mortgages in the process of foreclosure s

10 E06 SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized % Mortgages closed by repayment & % & & & %' & %' & %' & & & & & % % % % % %()*+),*-)./01 % %% ' '

11 E06.1 SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized % & & & & & ' % % % % % % % % % % % %

12 E06.2 SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized % & %

13 E06. SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized % % && && &&

14 E06.4 SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized

15 SCHEDULE B - PART Showing All Mortgage Loans DISPOSED, Transferred or Repaid During the Current Year 1 Location Change in /Recorded / Recorded Current / Recorded Loan Number City State Loan Type Acquired Prior Year Unrealized Increase (Decrease) Current Year s (Amortization) /Accretion Year s Other- Than- Temporary Impairment Recognized Capitalized Deferred and Other Change in ( ) Foreign Change in on Consideration Foreign Realized Mortgages with partial repayments % % Mortgages disposed s E06.5

16 Schedule BA - Part 1 - Other Long-Term Invested Assets Owned Schedule BA - Part 2 - Other Long-Term Invested Assets Acquired and Additions Made Schedule BA - Part - Other Long-Term Invested Assets Disposed, Transferred or Repaid E07, E08, E09

17 E10 SCHEDULE D - PART 1 Showing All Long-Term BONDS Owned December 1 of Current Year 1 2 Codes 6 7 Fair Value Change in Book/Adjusted Carrying Value s Foreign F Current o Year's Change r Rate Current Other- in e Used to Book/ Unrealized Year's Than- Book/ Admitted i Obtain Adjusted (Amortization) Temporary Adjusted Effective Amount Amount g Bond NAIC Actual Fair Fair Par Carrying Increase/ Impairment Carrying Rate Rate When Due and Received n Char Des. Cost Value Value Value Value (Decrease) Accretion Recognized Value of of Paid During Year Acquired C o d e CUSIP Identification Description Subtotal - Bonds - U.S. Governments - Issuer Obligations XXX XXX XXX XXX XXX XXX U.S. Government Bonds XXX XXX XXX XXX XXX XXX All Other Government Bonds XXX XXX XXX XXX XXX XXX U.S. States, Territories and Possessions Bonds XXX XXX XXX XXX XXX XXX U.S. Political Subdivisions Bonds XXX XXX XXX XXX XXX XXX % Subtotal - Bonds - U.S. Special Revenues - Issuer Obligations XXX XXX XXX XXX XXX XXX U.S. Special Revenues Bonds XXX XXX XXX XXX XXX XXX &%' ( ) & %' & * * % + ),% % ' %%( %' % ),% % ) - %& ) % ) % ) % ' ) %- ) ) * ),% - * ) %. ) % )+. ' ) ) & ) ( * ) ) * * * * ) * ' ) +),% ' ) ) %% +),% % % ) * * % ' ) % '* ) ' ) % '%' ) % & ( ) ' ) ' )/ % '% & * ) ' ( ) *) ) % Stated Contractual Maturity

18 E10.1 SCHEDULE D - PART 1 Showing All Long-Term BONDS Owned December 1 of Current Year 1 2 Codes 6 7 Fair Value Change in Book/Adjusted Carrying Value s Foreign F Current o Year's Change r Rate Current Other- in e Used to Book/ Unrealized Year's Than- Book/ Admitted i Obtain Adjusted (Amortization) Temporary Adjusted Effective Amount Amount g Bond NAIC Actual Fair Fair Par Carrying Increase/ Impairment Carrying Rate Rate When Due and Received n Char Des. Cost Value Value Value Value (Decrease) Accretion Recognized Value of of Paid During Year Acquired C o d e CUSIP Identification Description %%%& ' % (( ( ()% * % (( % ( ++ + ' ()%%%%(% % (( (+ + %+&%&%% ( &%)%, ( ( %%% & ( + -%%(% ( + (% ( ( ++& & &&, %)%%&(. ( ++ % + &+% + ( % ( & %+ +,( ' %(( ' (% )+ )* ) %%(% ' %%+ (+ %%+ (%% +%( '&% -%%(% + ()) (%( ( ( % ( %%& /% ( (+ %( % ' &%( -, (+ (.( ( *% ) (++& + % ((+, (% %(, % + Stated Contractual Maturity

19 E10.2 SCHEDULE D - PART 1 Showing All Long-Term BONDS Owned December 1 of Current Year 1 2 Codes 6 7 Fair Value Change in Book/Adjusted Carrying Value s Foreign F Current o Year's Change r Rate Current Other- in e Used to Book/ Unrealized Year's Than- Book/ Admitted i Obtain Adjusted (Amortization) Temporary Adjusted Effective Amount Amount g Bond NAIC Actual Fair Fair Par Carrying Increase/ Impairment Carrying Rate Rate When Due and Received n Char Des. Cost Value Value Value Value (Decrease) Accretion Recognized Value of of Paid During Year Acquired C o d e CUSIP Identification Description % & ' % ' & & & ' ' & ( % & ) & ) ' % ' ) & & *' +& )%' ) ' Subtotal - Bonds - Industrial and Miscellaneous (Unaffiliated) - Issuer Obligations XXX XXX XXX XXX XXX XXX % Subtotal - Bonds - Industrial and Miscellaneous (Unaffiliated) - Other Loan-Backed and Structured Securities XXX XXX XXX XXX XXX XXX Industrial and Miscellaneous (Unaffiliated) Bonds XXX XXX XXX XXX XXX XXX Hybrid Securities XXX XXX XXX XXX XXX XXX Parent, Subsidiaries and Affiliates Bonds XXX XXX XXX XXX XXX XXX Issuer Obligations XXX XXX XXX XXX XXX XXX Residential Mortgage-Backed Securities XXX XXX XXX XXX XXX XXX Commercial Mortgage-Backed Securities XXX XXX XXX XXX XXX XXX Other Loan-Backed and Structured Securities XXX XXX XXX XXX XXX XXX Bonds XXX XXX XXX XXX XXX XXX Stated Contractual Maturity

20 Schedule D - Part 2 - Section 1 - Preferred Stocks Owned Schedule D - Part 2 - Section 2 - Common Stocks Owned E11, E12

21 E1 1 2 SCHEDULE D - PART Showing All Long-Term Bonds and Stocks ACQUIRED During Current Year Paid for and Dividends CUSIP Identification Description Foreign Acquired Name of Vendor Number of Shares of Stock Actual Cost Par Value Subtotal - Bonds - U.S. Governments %&&' ( ) ) * + ) ( & + + & + ) ) + %&&' ( & *, Subtotal - Bonds - Industrial and Miscellaneous (Unaffiliated) Bonds - Part Bonds - Part Bonds Preferred Stocks - Part XXX Preferred Stocks - Part 5 XXX Preferred Stocks XXX Common Stocks - Part XXX Common Stocks - Part 5 XXX Common Stocks XXX Preferred and Common Stocks XXX s XXX

22 E14 SCHEDULE D - PART 4 Showing All Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year Change In Book/Adjusted Carrying Value CUSIP Identification Description Foreign Name of Purchaser Number of Shares of Stock Consideration Par Value Actual Cost Prior Year Book/ Adjusted Carrying Value Unrealized Increase/ Decrease Current Year's (Amortization)/ Accretion Current Year's Other- Than- Temporary Impairment Recognized Change in Book/ Adjusted Carrying Value ( ) Foreign Change in Book/ Adjusted Carrying Value Book/ Adjusted Carrying Value at Foreign Realized (Loss) on Bond / Stock Dividends Received During Year Stated Contractual Maturity Subtotal - Bonds - U.S. Governments XXX &' % % ( ) % * % % &' + ) &' +, + % % + % ( % % %. % % ( % Subtotal - Bonds - Industrial and Miscellaneous (Unaffiliated) XXX Bonds - Part 4 XXX Bonds - Part 5 XXX Bonds XXX Preferred Stocks - Part 4 XXX XXX Preferred Stocks - Part 5 XXX XXX Preferred Stocks XXX XXX Common Stocks - Part 4 XXX XXX Common Stocks - Part 5 XXX XXX Common Stocks XXX XXX Preferred and Common Stocks XXX XXX s XXX XXX

23 Schedule D - Part 5 - Long Term Bonds and Stocks Acquired and Fully Disposed Of Schedule D-Part 6-Section 1- of Shares of Subsidiary, Controlled or Affiliated Companies Schedule D - Part 6 - Section 2 Schedule DA - Part 1 - Short-Term s Owned Schedule DB - Part A - Section 1 - Options, Caps, Floors, Collars, Swaps and Forwards Open Schedule DB - Part A - Section 2 - Options, Caps, Floors, Collars, Swaps and Forwards Terminated Schedule DB - Part B - Section 1 - Futures Contracts Open Schedule DB - Part B - Section 1B - Brokers with whom cash deposits have been made Schedule DB - Part B - Section 2 - Futures Contracts Terminated Schedule DB - Part D - Section 1 - Counterparty Exposure for Derivative Instruments Open Schedule DB - Part D-Section 2 - Collateral for Derivative Instruments Open - Pledged By Schedule DB - Part D-Section 2 - Collateral for Derivative Instruments Open - Pledged To Schedule DL - Part 1 - Reinvested Collateral Assets Owned Schedule DL - Part 2 - Reinvested Collateral Assets Owned E15, E16, E17, E18, E19, E20, E21, E22, E2, E24, E25

24 1 SCHEDULE E - PART 1 - CASH 2 4 Amount of Received During Year 5 Amount of December 1 of Current Year Rate of Depository Code Balance * XXX XXX % &'() XXX *''+ &'(),, XXX Deposits in... 1 depositories which do not exceed the allowable limit in any one depository (See instructions) - open depositories XXX XXX XXX s - Open Depositories XXX XXX,, XXX Deposits in... 0 depositories which do not exceed the allowable limit in any one depository (See instructions) - suspended depositories XXX XXX XXX s - Suspended Depositories XXX XXX XXX Cash on Deposit XXX XXX,, XXX Cash in Company's Office XXX XXX XXX XXX XXX Cash XXX XXX,, XXX 6 7 TOTALS OF DEPOSITORY BALANCES ON THE LAST DAY OF EACH MONTH DURING THE CURRENT YEAR 1. January, 4. April 7. July, 10. October - 2. February May 8. August November,--,. March, 6. June 9. September December,, E26

25 SCHEDULE E - PART 2 - CASH EQUIVALENTS 1 Description Show s Owned December 1 of Current Year 2 4 Code Acquired Rate of 5 Maturity 6 Book/Adjusted Carrying Value 7 Amount of Due and 8 Amount Received During Year E27 NONE Cash Equivalents

26 States, Etc. SCHEDULE E - PART - SPECIAL DEPOSITS 1 2 Type of Deposit Purpose of Deposit Deposits For the Benefit of All Policyholders 4 Book/Adjusted Carrying Value Fair Value All Other Special Deposits 5 6 Book/Adjusted Carrying Value Fair Value 1. Alabama AL 2. Alaska AK. Arizona AZ 4. Arkansas AR 5. California CA 6. Colorado CO 7. Connecticut CT 8. Delaware DE 9. District of Columbia DC 10. Florida FL 11. Georgia GA 12. Hawaii HI 1. Idaho ID 14. Illinois IL 15. Indiana IN 16. Iowa IA 17. Kansas KS 18. Kentucky KY 19. Louisiana LA 20. Maine ME 21. Maryland MD 22. Massachusetts MA 2. Michigan MI 24. Minnesota MN 25. Mississippi MS 26. Missouri MO 27. Montana MT 28. Nebraska NE 29. Nevada NV 0. New Hampshire NH 1. New Jersey NJ 2. New Mexico NM. New York NY 4. North Carolina NC 5. North Dakota ND 6. Ohio OH 7. Oklahoma OK 8. Oregon OR 9. Pennsylvania PA 40. Rhode Island RI 41. South Carolina SC 42. South Dakota SD 4. Tennessee TN 44. Texas TX 45. Utah UT 46. Vermont VT 47. Virginia VA 48. Washington WA 49. West Virginia WV 50. Wisconsin WI 51. Wyoming WY 52. American Samoa AS 5. Guam GU 54. Puerto Rico PR 55. U.S. Virgin Islands VI 56. Northern Mariana Islands MP 57. Canada CAN 58. Aggregate Alien and Other OT XXX XXX 59. Subtotal XXX XXX DETAILS OF WRITE-INS Summary of remaining write-ins for Line 58 from overflow page XXX XXX s (Lines 5801 thru 580 plus 5898)(Line 58 above) XXX XXX E28

27 ANNUAL STATEMENT BLANK ALPHABETICAL INDEX Analysis of Increase in Reserves During The Year 7 Analysis of Operations By Lines of Business 6 Asset Reserve Default Component 0 Asset Reserve Equity 2 Asset Reserve Replications (Synthetic) Assets 5 Asset Reserve 29 Assets 2 Cash Flow 5 Exhibit 1 - Part 1 - Premiums and Annuity Considerations for Life and Accident and Health Contracts 9 Exhibit 1 - Part 2 - Dividends and Coupons Applied, Reinsurance Commissions and Expense 10 Exhibit 2 - General Expenses 11 Exhibit - Taxes, Licenses and Fees ( Federal Income Taxes) 11 Exhibit 4 - Dividends or Refunds 11 Exhibit 5 - Aggregate Reserve for Life Contracts 12 Exhibit 5 - Interrogatories 1 Exhibit 5A - Changes in Bases of During The Year 1 Exhibit 6 - Aggregate Reserves for Accident and Health Contracts 14 Exhibit 7 - Deposit-Type Contracts 15 Exhibit 8 - Claims for Life and Accident and Health Contracts - Part 1 16 Exhibit 8 - Claims for Life and Accident and Health Contracts - Part 2 17 Exhibit of Capital s (Losses) 8 Exhibit of Life Insurance 25 Exhibit of Net Income 8 Exhibit of Nonadmitted Assets 18 Exhibit of Number of Policies, Contracts, Certificates, Income Payable and Account Values 27 Five-Year Historical Data 22 Form for Calculating the Maintenance Reserve (IMR) 28 General Interrogatories 20 Jurat Page 1 Liabilities, Surplus and Other Funds Life Insurance (State Page) 24 Notes To Financial Statements 19 Overflow Page For Write-ins 55 Schedule A - Part 1 E01 Schedule A - Part 2 E02 Schedule A - Part E0 Schedule A - Verification Between Years SI02 Schedule B - Part 1 E04 Schedule B - Part 2 E05 Schedule B - Part E06 Schedule B - Verification Between Years SI02 Schedule BA - Part 1 E07 Schedule BA - Part 2 E08 Schedule BA - Part E09 Schedule BA - Verification Between Years SI0 Schedule D - Part 1 E10 Schedule D - Part 1A - Section 1 SI05 Schedule D - Part 1A - Section 2 SI08 Schedule D - Part 2 - Section 1 E11 Schedule D - Part 2 - Section 2 E12 Schedule D - Part E1 Schedule D - Part 4 E14 Schedule D - Part 5 E15 Schedule D - Part 6 - Section 1 E16 Schedule D - Part 6 - Section 2 E16 Schedule D - Summary By Country SI04 Schedule D - Verification Between Years SI0 Schedule DA - Part 1 E17 Schedule DA - Verification Between Years SI10 Index 1

28 ANNUAL STATEMENT BLANK (Continued) Schedule DB - Part A - Section 1 E18 Schedule DB - Part A - Section 2 E19 Schedule DB - Part A - Verification Between Years SI11 Schedule DB - Part B - Section 1 E20 Schedule DB - Part B - Section 2 E21 Schedule DB - Part B - Verification Between Years SI11 Schedule DB - Part C - Section 1 SI12 Schedule DB - Part C - Section 2 SI1 Schedule DB - Part D - Section 1 E22 Schedule DB - Part D - Section 2 E2 Schedule DB - Verification SI14 Schedule DL - Part 1 E24 Schedule DL - Part 2 E25 Schedule E - Part 1 - Cash E26 Schedule E - Part 2 - Cash Equivalents E27 Schedule E - Part - Special Deposits E28 Schedule E - Verification Between Years SI15 Schedule F 6 Schedule H - Accident and Health Exhibit - Part 1 7 Schedule H - Part 2, Part and Part 4 8 Schedule H - Part 5 - Health Claims 9 Schedule S - Part 1 - Section 1 40 Schedule S - Part 1 - Section 2 41 Schedule S - Part 2 42 Schedule S - Part - Section 1 4 Schedule S - Part - Section 2 44 Schedule S - Part 4 45 Schedule S - Part 5 46 Schedule S - Part 6 47 Schedule S - Part 7 48 Schedule T - Part 2 Interstate Compact 50 Schedule T - Premiums and Annuity Considerations 49 Schedule Y - Information Concerning Activities of Insurer Members of a Holding Company Group 51 Schedule Y - Part 1A - Detail of Insurance Holding Company System 52 Schedule Y - Part 2 - Summary of Insurer s Transactions With Any Affiliates 5 Summary Schedule SI01 Summary of Operations 4 Supplemental Exhibits and Schedules Interrogatories 54 Index 1.1