ANNUAL STATEMENT FOR THE YEAR 2017 OF THE Wilton Reassurance Life Company of New York ASSETS

ASSETS Assets Current Year Nonadmitted Assets Net Admitted Assets (Cols. - ) Prior Year Net Admitted Assets. Bonds (Schedule D) 79,09,856 79,09,856 88,8,8. Stocks (Schedule D):. Preferred stocks,55,88,55,88,05,988. Common stocks 80 80 58,9. Mortgage loans on real estate (Schedule B):. First liens 0 0. Other than first liens 0 0. Real estate (Schedule A):. Properties occupied by the company (less $ encumbrances) 0 0. Properties held for the production of income (less $ encumbrances) 0 0. Properties held for sale (less $ encumbrances) 0 0 5. Cash ($,89,790, Schedule E - Part ), cash equivalents ($,99,89, Schedule E - Part ) and short-term investments ($ 0, Schedule DA),8,686,8,686,805,0 6. Contract loans (including $ premium notes),88, 69,8,7,005,805,756 7. Derivatives (Schedule DB) 0 0 8. Other invested assets (Schedule BA) 0,95,858 0,95,858,77,7 9. Receivables for securities 7,7 9,,50 87,78 0. Securities lending reinvested collateral assets (Schedule DL) 0 0. Aggregate write-ins for invested assets 0 0 0 0. Subtotals, cash and invested assets (Lines to ) 86,766,0 8,9 86,7,68 88,98,9. Title plants less $ charged off (for Title insurers only) 0 0. Investment income due and accrued 6,8,567 6,8,567 7,6,57 5. Premiums and considerations: 5. Uncollected premiums and agents' balances in the course of collection 55,869 8,9 57,78 756,085 5. Deferred premiums and agents' balances and installments booked but deferred and not yet due (including $ earned but unbilled premiums) 867,978 867,978,0,7 5. Accrued retrospective premiums ($ ) and 6. Reinsurance: contracts subject to redetermination ($ ) 0 0 6. Amounts recoverable from reinsurers,6,05,80,68, 6,806,599 6. Funds held by or deposited with reinsured companies 0 0 6. Other amounts receivable under reinsurance contracts,978,76,978,76 8,66 7. Amounts receivable relating to uninsured plans 0 0 8. Current federal and foreign income tax recoverable and interest thereon 0 0 8. Net deferred tax asset,09, 9,,67,075,8,75,90 9. Guaranty funds receivable or on deposit 900,000 900,000 900,000 0. Electronic data processing equipment and software 0 0. Furniture and equipment, including health care delivery assets ($ ) 0 0. Net adjustment in assets and liabilities due to foreign exchange rates 0 0. Receivables from parent, subsidiaries and affiliates 0 0. Health care ($ ) and other amounts receivable 0 0 5. Aggregate write-ins for other than invested assets,7,90 796,50 98,06,006,55 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5) 905,58,5 0,70,67 895,067, 90,56,5 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 69,0 69,0 605,0 8. Total (Lines 6 and 7) 906,9,59 0,70,67 895,758,88 905,,578 0. 0. 0. DETAILS OF WRITE-INS 98. Summary of remaining write-ins for Line from overflow page 0 0 0 0 99. Totals (Lines 0 thru 0 plus 98)(Line above) 0 0 0 0 50. Prepaid Reinsurance - NYSID allowed under Circ Letter 98,06 0 98,06,006,55 50. Expenses Paid in Advance 796,50 796,50 0 0 50. 598. Summary of remaining write-ins for Line 5 from overflow page 0 0 0 0 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above),7,90 796,50 98,06,006,55

LIABILITIES, SURPLUS AND OTHER FUNDS Current Year Prior Year. Aggregate reserve for life contracts $ 75,98,09 (Exh. 5, Line 9999999) less $ included in Line 6. (including $ 7,68,06 Modco Reserve) 75,98,09 7,680,55. Aggregate reserve for accident and health contracts (including $ 0 Modco Reserve) 5,06 6,65. Liability for deposit-type contracts (Exhibit 7, Line, Col. ) (including $ Modco Reserve),086,,96,6. Contract claims:. Life (Exhibit 8, Part, Line., Col. less sum of Cols. 9, 0 and ) 0,85,55,9,8. Accident and health (Exhibit 8, Part, Line., sum of Cols. 9, 0 and ) 8,9,7 5. Policyholders dividends $ and coupons $ due and unpaid (Exhibit, Line 0) 0 0 6. Provision for policyholders dividends and coupons payable in following calendar year - estimated amounts: 6. Dividends apportioned for payment (including $ Modco) 6. Dividends not yet apportioned (including $ Modco) 6. Coupons and similar benefits (including $ Modco) 7. Amount provisionally held for deferred dividend policies not included in Line 6 8. Premiums and annuity considerations for life and accident and health contracts received in advance less $ discount; including $ 65 accident and health premiums (Exhibit, Part, Col., sum of lines and ) 5,56 5,780 9. Contract liabilities not included elsewhere: 9. Surrender values on canceled contracts 7,565 8,68 9. Provision for experience rating refunds, including the liability of $ accident and health experience rating refunds of which $ is for medical loss ratio rebate per the Public Health Service Act 0 9. Other amounts payable on reinsurance, including $ assumed and $ 6, ceded 6,,00 9. Interest maintenance reserve (IMR, Line 6) 9,8,095,06,95 0. Commissions to agents due or accrued-life and annuity contracts $ 65,0 accident and health $ and deposit-type contract funds $ 65,0 8,0. Commissions and expense allowances payable on reinsurance assumed (,058) (56,6). General expenses due or accrued (Exhibit, Line, Col. 6),79,8,6,660. Transfers to Separate Accounts due or accrued (net) (including $ accrued for expense allowances recognized in reserves, net of reinsured allowances) 0. Taxes, licenses and fees due or accrued, excluding federal income taxes (Exhibit, Line 9, Col. 5) 85,95 96,8 5. Current federal and foreign income taxes, including $ 56,6 on realized capital gains (losses),59,0,0,59 5. Net deferred tax liability 0 6. Unearned investment income 69,8 77,00 7. Amounts withheld or retained by company as agent or trustee (7,00) 6,6 8. Amounts held for agents' account, including $ 58,85 agents' credit balances 58,85 9,86 9. Remittances and items not allocated,807,7,6,0 0. Net adjustment in assets and liabilities due to foreign exchange rates 0. Liability for benefits for employees and agents if not included above 0. Borrowed money $ and interest thereon $ 0. Dividends to stockholders declared and unpaid 0. Miscellaneous liabilities:.0 Asset valuation reserve (AVR, Line 6, Col. 7) 6,5,90 5,087,76.0 Reinsurance in unauthorized and certified ($ 0 ) companies 9,8,8,5,955.0 Funds held under reinsurance treaties with unauthorized and certified ($ ) reinsurers 7,5,88 7,0,5.0 Payable to parent, subsidiaries and affiliates 6,59 5,678.05 Drafts outstanding 0.06 Liability for amounts held under uninsured plans 0.07 Funds held under coinsurance 0.08 Derivatives 0 0.09 Payable for securities.0 Payable for securities lending 0. Capital notes $ and interest thereon $ 0 5. Aggregate write-ins for liabilities,5,,59,86 6. Total liabilities excluding Separate Accounts business (Lines to 5) 80,00,6 808,78,76 7. From Separate Accounts Statement 69,08 605,0 8. Total liabilities (Lines 6 and 7) 80,89,5 808,88,750 9. Common capital stock,50,500,50,500 0. Preferred capital stock. Aggregate write-ins for other than special surplus funds 0 0. Surplus notes 0. Gross paid in and contributed surplus (Page, Line, Col. plus Page, Line 5., Col. ) 7,56,8 7,56,8. Aggregate write-ins for special surplus funds 0 0 5. Unassigned funds (surplus) 8,88,8,08,977 6. Less treasury stock, at cost: 6. shares common (value included in Line 9 $ ) 6. shares preferred (value included in Line 0 $ ) 7. Surplus (Total Lines ++++5-6) (including $ in Separate Accounts Statement) 90,6,76 9,755,5 8. Totals of Lines 9, 0 and 7 (Page, Line 55) 9,866,976 96,57,85 9. Totals of Lines 8 and 8 (Page, Line 8, Col. ) 895,758,88 905,,575 DETAILS OF WRITE-INS 50. Abandoned property 66,8 9,6 50. Payable to NACOLAH 50,70 50,70 50. Contingency reserve,075 00,000 598. Summary of remaining write-ins for Line 5 from overflow page,06 5,58 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above),5,,59,86 0. 0. 0. 98. Summary of remaining write-ins for Line from overflow page 0 0 99. Totals (Lines 0 thru 0 plus 98)(Line above) 0 0 0. 0. 0. 98. Summary of remaining write-ins for Line from overflow page 0 0 99. Totals (Lines 0 thru 0 plus 98)(Line above) 0 0

SUMMARY OF OPERATIONS Current Year Prior Year. Premiums and annuity considerations for life and accident and health contracts (Exhibit, Part, Line 0., Col., less Col. ),,90 8,0,. Considerations for supplementary contracts with life contingencies 9,85,8,8. Net investment income (Exhibit of Net Investment Income, Line 7),7,7,589,. Amortization of Interest Maintenance Reserve (IMR, Line 5),975,906,0,76 5. Separate Accounts net gain from operations excluding unrealized gains or losses 0 6. Commissions and expense allowances on reinsurance ceded (Exhibit, Part, Line 6., Col. ),75,87,788,58 7. Reserve adjustments on reinsurance ceded (70,88) (0,8) 8. Miscellaneous Income: 8. Income from fees associated with investment management, administration and contract guarantees from Separate Accounts 7,5 7,008 8. Charges and fees for deposit-type contracts 0 0 8. Aggregate write-ins for miscellaneous income (8,8) (7,70) 9. Total (Lines to 8.) 6,08,56 66,666,99 0. Death benefits 9,9,8,050,70. Matured endowments (excluding guaranteed annual pure endowments) 8,988 0,95. Annuity benefits (Exhibit 8, Part, Line 6., Cols. + 8) 7,,99 9,66,70. Disability benefits and benefits under accident and health contracts 98,799 50,59. Coupons, guaranteed annual pure endowments and similar benefits 0 5. Surrender benefits and withdrawals for life contracts 0,80,78,,69 6. Group conversions 0 7. Interest and adjustments on contract or deposit-type contract funds (55,895) (8,78) 8. Payments on supplementary contracts with life contingencies,6,879,75,588 9. Increase in aggregate reserves for life and accident and health contracts (8,8,96),58,99 0. Totals (Lines 0 to 9) 0,08,589 7,887,00. Commissions on premiums, annuity considerations, and deposit-type contract funds (direct business only) (Exhibit, Part, Line, Col. ),0,76,7,77. Commissions and expense allowances on reinsurance assumed (Exhibit, Part, Line 6., Col. ) (68,55) (65,85). General insurance expenses (Exhibit, Line 0, Cols.,, and ),8,807 5,579,8. Insurance taxes, licenses and fees, excluding federal income taxes (Exhibit, Line 7, Cols. + + ) 899,755,,76 5. Increase in loading on deferred and uncollected premiums 0 6. Net transfers to or (from) Separate Accounts net of reinsurance (67) (,796) 7. Aggregate write-ins for deductions 7,906 (9,789) 8. Totals (Lines 0 to 7) 6,68,97 55,6,8 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8),55,66,0,7 0. Dividends to policyholders 0 0. Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0),55,66,0,7. Federal and foreign income taxes incurred (excluding tax on capital gains) 6,56,96 5,09,0. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) 8,098,66 6,00,96. Net realized capital gains (losses) (excluding gains (losses) transferred to the IMR) less capital gains tax of $ 8,70 (excluding taxes of $,65 transferred to the IMR) (87,587) (,5,07) 5. Net income (Line plus Line ) 7,8,077,85,809 CAPITAL AND SURPLUS ACCOUNT 6. Capital and surplus, December, prior year (Page, Line 8, Col. ) 96,57,85 90,770,8 7. Net income (Line 5) 7,8,077,85,809 8. Change in net unrealized capital gains (losses) less capital gains tax of $,85,05,5,065 5,7 9. Change in net unrealized foreign exchange capital gain (loss) 0. Change in net deferred income tax (6,867,9) 7,97,878. Change in nonadmitted assets 7,87,6 (7,9,5). Change in liability for reinsurance in unauthorized and certified companies (,60,6) (89,768). Change in reserve on account of change in valuation basis, (increase) or decrease 0 0. Change in asset valuation reserve (,058,66) 8,8 5. Change in treasury stock (Page, Lines 6. and 6., Col. minus Col. ) 0 0 6. Surplus (contributed to) withdrawn from Separate Accounts during period 7. Other changes in surplus in Separate Accounts Statement 8. Change in surplus notes 9. Cumulative effect of changes in accounting principles 50. Capital changes: 50. Paid in 50. Transferred from surplus (Stock Dividend) 50. Transferred to surplus 5. Surplus adjustment: 5. Paid in 0 0 5. Transferred to capital (Stock Dividend) 5. Transferred from capital 5. Change in surplus as a result of reinsurance 5. Dividends to stockholders (9,75,5) 5. Aggregate write-ins for gains and losses in surplus 0 0 5. Net change in capital and surplus for the year (Lines 7 through 5) (,90,89) 5,87,0 55. Capital and surplus, December, current year (Lines 6 + 5) (Page, Line 8) 9,866,976 96,57,85 DETAILS OF WRITE-INS 08.0. Prepaid Reinsurance - NYSID allowed under Circ Letter (78,0) (,88) 08.0. Miscellaneous Income 900 58 08.0. Modco Investment Income (,7) (,700) 08.98. Summary of remaining write-ins for Line 8. from overflow page 0 0 08.99. Totals (Lines 08.0 thru 08.0 plus 08.98)(Line 8. above) (8,8) (7,70) 70. Fines and Penalties 6,8 (9,789) 70. Contingency Reserve,075 0 70. 798. Summary of remaining write-ins for Line 7 from overflow page 0 0 799. Totals (Lines 70 thru 70 plus 798)(Line 7 above) 7,906 (9,789) 50. 50. 50. 598. Summary of remaining write-ins for Line 5 from overflow page 0 0 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 0 0

CASH FLOW Current Year Prior Year Cash from Operations. Premiums collected net of reinsurance,86,9 9,56,90. Net investment income 0,07,58 0,0,07. Miscellaneous income (,5,77),55,676. Total (Lines through ),7,00 6,8,685 5. Benefit and loss related payments 8,95,0 7,078,908 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts (67) (,796) 7. Commissions, expenses paid and aggregate write-ins for deductions 5,6,9 5,99,6 8. Dividends paid to policyholders 0 0 9. Federal and foreign income taxes paid (recovered) net of $,5,0 tax on capital gains (losses),0,8,079, 0. Total (Lines 5 through 9) 58,56,995 66,06,77. Net cash from operations (Line minus Line 0) (5,805,965) (,988,0) Cash from Investments. Proceeds from investments sold, matured or repaid:. Bonds,87,98,668,88. Stocks,779,555,98,90. Mortgage loans 0 0. Real estate 0 0.5 Other invested assets 0 0,66.6 Net gains or (losses) on cash, cash equivalents and short-term investments 0 0.7 Miscellaneous proceeds (86,) 756,5.8 Total investment proceeds (Lines. to.7) 6,08,9,7,867. Cost of investments acquired (long-term only):. Bonds 85,79,00 5,766,9. Stocks,99,0,86,6. Mortgage loans 0 0. Real estate 0 0.5 Other invested assets,09,76,76,66.6 Miscellaneous applications 0 0.7 Total investments acquired (Lines. to.6) 87,98,58,0,9. Net increase (decrease) in contract loans and premium notes (,07,9) (965,90) 5. Net cash from investments (Line.8 minus Line.7 minus Line ) 9,0,9,576,79 Cash from Financing and Miscellaneous Sources 6. Cash provided (applied): 6. Surplus notes, capital notes 0 0 6. Capital and paid in surplus, less treasury stock 0 0 6. Borrowed funds 0 0 6. Net deposits on deposit-type contracts and other insurance liabilities (860,0) (55,706) 6.5 Dividends to stockholders 9,75,5 0 6.6 Other cash provided (applied) (,9,9) (,,) 7. Net cash from financing and miscellaneous sources (Lines 6. to 6. minus Line 6.5 plus Line 6.6) (,68,057) (,767,08) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 8. Net change in cash, cash equivalents and short-term investments (Line, plus Lines 5 and 7),006,68 (,78,67) 9. Cash, cash equivalents and short-term investments: 9. Beginning of year,805,8 5,98,889 9. End of year (Line 8 plus Line 9.),8,686,805,8 Note: Supplemental disclosures of cash flow information for non-cash transactions: 5

6 ANALYSIS OF OPERATIONS BY LINES OF BUSINESS Ordinary 6 Group Accident and Health 5 7 8 9 0 Aggregate of All Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance (a) Annuities Group Credit (Group and Individual) Other Other Lines of Business. Premiums and annuity considerations for life and accident and health contracts,,90 0 9,505,70,69,9 0 5,88 0 7, 0,0. Considerations for supplementary contracts with life contingencies 9,85 9,85. Net investment income,7,6 0 8,7,6,8,6 5,57 0 8,969 0 0 0 0. Amortization of Interest Maintenance Reserve (IMR),975,906 0 00,8,59,686,5 0 0,7 0 0 0 0 5. Separate Accounts net gain from operations excluding unrealized gains or losses 0 6. Commissions and expense allowances on reinsurance ceded,75,87 0,75,9 8 0 0 0 0 0 0 7. Reserve adjustments on reinsurance ceded (70,88) (70,88) 8. Miscellaneous Income: 8. Fees associated with income from investment management, administration and contract guarantees from Separate Accounts 7,5 7,5 8. Charges and fees for deposit-type contracts 0 8. Aggregate write-ins for miscellaneous income (8,8) 0 (8,) 0 0 0 0 0 0 0 (50) 0 9. Totals (Lines to 8.) 6,08,56 0 0,,668 0,07,5 787,77 0 6,0 0,96 7, 0,5 0 0. Death benefits 9,9,8 9,9,8. Matured endowments (excluding guaranteed annual pure endowments) 8,988 8,988. Annuity benefits 7,,99 0 7,,99 0 0 0 0 0 0 0 0. Disability benefits and benefits under accident and health contracts 98,799 670,65 0 0 0 0 0 0,079 0 (8,9) 0. Coupons, guaranteed annual pure endowments and similar benefits 0 0 0 0 0 0 0 0 0 0 0 5. Surrender benefits and withdrawals for life contracts 0,80,78,,00 6,69,8 0 0 0 0 0 0 0 0 6. Group conversions 0 0 0 0 0 0 0 0 0 0 0 7. Interest and adjustments on contract or deposit-type contract funds (55,895) 0 0 (55,895) 0 0 0 0 0 0 0 8. Payments on supplementary contracts with life contingencies,6,879 0 0,6,879 0 0 0 0 0 0 0 9. Increase in aggregate reserves for life and accident and health contracts (8,8,96) (9,6,6) 575,90 58, 0 0 0 (,075) 0 (68) 0 0. Totals (Lines 0 to 9) 0,08,589 0,968,999,500,60 9,7 0 0 0 9,00 0 (8,0) 0. Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only),0,76 0,00,5 6,55 0 0 0 0 0 700 0. Commissions and expense allowances on reinsurance assumed (68,55) 0 (68,55) 0 0 0 0 0 0 0 0. General insurance expenses,8,805 0 98,876,799,79 59,9 0,5 0 0 0 0. Insurance taxes, licenses and fees, excluding federal income taxes 899,75 0 9,85 607,90 0 0 0 0 0 0 5. Increase in loading on deferred and uncollected premiums 0 0 0 0 0 0 0 0 0 0 0 0 6. Net transfers to or (from) Separate Accounts net of reinsurance (67) 0 (67) 0 0 0 0 0 0 0 0 0 7. Aggregate write-ins for deductions 7,906 0,906 5,000 0 0 0 0 0 0 0 0 8. Totals (Lines 0 to 7) 6,68,9 0 7,000,6 9,069,5 98,0 0,5 9,00 0 (8,0) 0 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8),55,68 0,,06,00,07 (9,96) 0 6,078 7,0 8,0 0 8,75 0 0. Dividends to policyholders 0 0. Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0),55,68 0,,06,00,07 (9,96) 0 6,078 7,0 8,0 0 8,75 0. Federal income taxes incurred (excluding tax on capital gains) 6,56,96 0 5,79,0 7,69 (8,976) 0,69,786,59 0 67,60 0. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) 8,098,666 0 7,0,8 566, (09,987) 0,9 5,57,68 0 6,9 0 DETAILS OF WRITE-INS 08.0. Prepaid Reinsurance - NYSID allowed under Circ Letter (78,0) (78,0) 08.0. Miscellaneous Income 900 950 (50) 08.0. Modco Investment Income (,7) (,7) 08.98. Summary of remaining write-ins for Line 8. from overflow page 0 0 0 0 0 0 0 0 0 0 0 0 08.99. Totals (Lines 08.0 thru 08.0 plus 08.98) (Line 8. above) (8,8) 0 (8,) 0 0 0 0 0 0 0 (50) 0 70. Fines and Penalties 6,8,8 5,000 70. Contingency Reserve,075,075 70. 798. Summary of remaining write-ins for Line 7 from overflow page 0 0 0 0 0 0 0 0 0 0 0 0 799. Totals (Lines 70 thru 70 plus 798) (Line 7 above) 7,906 0,906 5,000 0 0 0 0 0 0 0 0 (a) Includes the following amounts for FEGLI/SGLI: Line, Line 0, Line 6, Line, Line

ANALYSIS OF INCREASE IN RESERVES DURING THE YEAR Ordinary 6 Group 5 7 Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance 8 Annuities Involving Life or Disability Contingencies (Reserves) (Net of Reinsurance Ceded). Reserve December, prior year 7,680,05 0 5,6,70 579,87,00 9,67,8 0,0 505,096. Tabular net premiums or considerations 5,66, 9,5,78,69,9,6,879 5,88. Present value of disability claims incurred 0 XXX. Tabular interest,9,989 6,57,769,6,5 8,9 8, 5. Tabular less actual reserve released 5,07,68 86,090 5,55,765 (78,8) (5,05) 6. Increase in reserve on account of change in valuation basis 0 7 6. Change in excess of VM-0 deterministic/stochastic reserve over net premium reserve 0 XXX 0 XXX XXX XXX XXX XXX 7. Other increases (net),697,60 (5,6,6) 6,959,067 8. Totals (Lines to 7) 797,0,957 0 65,68,9 6,006,88 0,7,996 0 0, 88,05 9. Tabular cost 9,66,770 9,60,506 XXX 6,6 0. Reserves released by death,57,06,57,06 XXX XXX XXX. Reserves released by other terminations (net),95,7 8,56,,89,56 677. Annuity, supplementary contract and disability payments involving life contingencies 9,9,8 670,65 7,,99,6,879. Net transfers to or (from) Separate Accounts 0. Total Deductions (Lines 9 to ) 6,0,650 0 9,967,8 0,6,5,6,879 0 6,9 0 5. Reserve December, current year 75,98,07 0 5,0,76 580,8,776 9,0,7 0,0 88,05

EXHIBIT OF NET INVESTMENT INCOME Collected During Year Earned During Year. U.S. Government bonds (a),95,878,86,897. Bonds exempt from U.S. tax (a). Other bonds (unaffiliated) (a) 0,8,5 0,0,688. Bonds of affiliates (a). Preferred stocks (unaffiliated) (b) 7,76 7,76. Preferred stocks of affiliates (b). Common stocks (unaffiliated) 5 5. Common stocks of affiliates. Mortgage loans (c). Real estate (d) 5 Contract loans,9,,9, 6 Cash, cash equivalents and short-term investments (e) 90,88 66,0 7 Derivative instruments (f) 8. Other invested assets 80,0 80,0 9. Aggregate write-ins for investment income 6,875 6,875 0. Total gross investment income,9,6,67,768. Investment expenses (g),,. Investment taxes, licenses and fees, excluding federal income taxes (g) 0. Interest expense (h). Depreciation on real estate and other invested assets (i) 0 5. Aggregate write-ins for deductions from investment income 67,0 6. Total deductions (Lines through 5),50,5 7. Net investment income (Line 0 minus Line 6),7,7 DETAILS OF WRITE-INS 090. Miscellaneous Investment Income 6,875 6,875 090. 090. 0998. Summary of remaining write-ins for Line 9 from overflow page 0 0 0999. Totals (Lines 090 thru 090 plus 0998) (Line 9, above) 6,875 6,875 50. Funds Withheld Interest Paid 67,0 50. 50. 598. Summary of remaining write-ins for Line 5 from overflow page 0 599. Totals (Lines 50 thru 50 plus 598) (Line 5, above) 67,0 (a) Includes $,,0 accrual of discount less $ 88,977 amortization of premium and less $ 9, paid for accrued interest on purchases. (b) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued dividends on purchases. (c) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued interest on purchases. (d) Includes $ for company s occupancy of its own buildings; and excludes $ interest on encumbrances. (e) Includes $ 5,698 accrual of discount less $ 0 amortization of premium and less $ 0 paid for accrued interest on purchases. (f) Includes $ accrual of discount less $ 0 amortization of premium. (g) Includes $ investment expenses and $ investment taxes, licenses and fees, excluding federal income taxes, attributable to segregated and Separate Accounts. (h) Includes $ interest on surplus notes and $ interest on capital notes. (i) Includes $ depreciation on real estate and $ depreciation on other invested assets. EXHIBIT OF CAPITAL GAINS (LOSSES) 5 Total Realized Capital Gain (Loss) (Columns + ) Change in Unrealized Capital Gain (Loss) Change in Unrealized Foreign Exchange Capital Gain (Loss) Realized Gain (Loss) On Sales or Maturity Other Realized Adjustments. U.S. Government bonds 0 0 0 0 0. Bonds exempt from U.S. tax 0. Other bonds (unaffiliated) 97,7 (8,96) 888,76 (,58) 0. Bonds of affiliates 0 0 0 0 0. Preferred stocks (unaffiliated) 90 0 90 0 0. Preferred stocks of affiliates 0 0 0 0 0. Common stocks (unaffiliated) (,578) 0 (,578) (7,) 0. Common stocks of affiliates 0 0 0 0 0. Mortgage loans 0 0 0 0. Real estate 0 0 0 5. Contract loans 0 6. Cash, cash equivalents and short-term investments 5 0 5 0 0 7. Derivative instruments 0 8. Other invested assets 0 0 5,,580 0 9. Aggregate write-ins for capital gains (losses) 0 0 0 0 0 0. Total capital gains (losses) 958,807 (8,96) 875,86 5,0,0 0 DETAILS OF WRITE-INS 090. 090. 090. 0998. Summary of remaining write-ins for Line 9 from overflow page 0 0 0 0 0 0999. Totals (Lines 090 thru 090 plus 0998) (Line 9, above) 0 0 0 0 0 8

9 EXHIBIT - PART - PREMIUMS AND ANNUITY CONSIDERATIONS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS Ordinary 5 Group Accident and Health 6 7 8 9 0 Aggregate of All Total Industrial Life Life Insurance Individual Annuities Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual) Other Other Lines of Business FIRST YEAR (other than single). Uncollected 0. Deferred and accrued 0. Deferred, accrued and uncollected:. Direct 0. Reinsurance assumed 0. Reinsurance ceded 0. Net (Line + Line ) 0 0 0 0 0 0 0 0 0 0 0. Advance 0 5. Line. - Line 0 0 0 0 0 0 0 0 0 0 0 6. Collected during year: 6. Direct 9,700 9,700 6. Reinsurance assumed,07,07 6. Reinsurance ceded 95,697 95,697 6. Net,07 0,07 0 0 0 0 0 0 0 0 7. Line 5 + Line 6.,07 0,07 0 0 0 0 0 0 0 0 8. Prior year (uncollected + deferred and accrued - advance) 0 0 0 0 0 0 0 0 0 0 0 9. First year premiums and considerations: 9. Direct 9,700 9,700 9. Reinsurance assumed,07,07 9. Reinsurance ceded 95,697 95,697 9. Net (Line 7 - Line 8),07 0,07 0 0 0 0 0 0 0 0 SINGLE 0. Single premiums and considerations: 0. Direct 0 0. Reinsurance assumed 0 0. Reinsurance ceded 0 0. Net 0 0 0 0 0 0 0 0 0 0 0 RENEWAL. Uncollected 5,055 5,6 (9). Deferred and accrued 867,978 867,978. Deferred, accrued and uncollected:. Direct,56,505,56,670 (65). Reinsurance assumed,0,75,0,75 0. Reinsurance ceded,55,07,55,8 6. Net (Line + Line ),0,0 0,0, 0 0 0 0 0 0 (9) 0. Advance 5,56 5,9 65 5. Line. - Line 975,677 0 976,0 0 0 0 0 0 0 (56) 0 6. Collected during year: 6. Direct 50,890,505 6,09,07,70,0 5,88 7, 6,0 6. Reinsurance assumed,06,79,06,79 6. Reinsurance ceded 7,9,08 7,66,550 0,750,78 6. Net,606,7 0 9,889,5,69,9 0 5,88 0 7, 0,0 0 7. Line 5 + Line 6. 5,58,98 0 0,865,8,69,9 0 5,88 0 7, 0,06 0 8. Prior year (uncollected + deferred and accrued - advance),0,7 0,0,088 0 0 0 0 0 0 (56) 0 9. Renewal premiums and considerations: 9. Direct 50,95,9 6,0,09,70,0 5,88 7, 6,0 9. Reinsurance assumed 86,9 86,9 9. Reinsurance ceded 7,58, 7,56,96 0,750,78 9. Net (Line 7 - Line 8),80,6 0 9,6,96,69,9 0 5,88 0 7, 0,0 0 TOTAL 0. Total premiums and annuity considerations: 0. Direct 5,00,09 0 6,98,79,70,0 0 5,88 0 7, 0 6,0 0 0. Reinsurance assumed 859,0 0 859,0 0 0 0 0 0 0 0 0 0. Reinsurance ceded 7,677, 0 7,55,6 0,750 0 0 0 0 0,78 0 0. Net (Lines 9. + 0. + 9.),,90 0 9,505,70,69,9 0 5,88 0 7, 0,0 0

0 DIVIDENDS AND COUPONS APPLIED (included in Part ) EXHIBIT - PART - DIVIDENDS AND COUPONS APPLIED, REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES AND COMMISSIONS INCURRED (Direct Business Only) Ordinary 5 Group Accident and Health 6 7 8 9 0 Total. To pay renewal premiums 0. All other 0 REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES INCURRED. First year (other than single): Industrial Life Life Insurance. Reinsurance ceded,59,59. Reinsurance assumed,90,90 Individual Annuities Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual) Other Aggregate of All Other Lines of Business. Net ceded less assumed (9,8) 0 (9,8) 0 0 0 0 0 0 0 0. Single:. Reinsurance ceded 0. Reinsurance assumed 0. Net ceded less assumed 0 0 0 0 0 0 0 0 0 0 0 5. Renewal: 5. Reinsurance ceded,7,5,7,9 8 5. Reinsurance assumed (00,5) (00,5) 5. Net ceded less assumed,0,770 0,0,89 8 0 0 0 0 0 0 0 6. Totals: 6. Reinsurance ceded (Page 6, Line 6),75,87 0,75,9 8 0 0 0 0 0 0 0 6. Reinsurance assumed (Page 6, Line ) (68,55) 0 (68,55) 0 0 0 0 0 0 0 0 6. Net ceded less assumed,0,89 0,0,008 8 0 0 0 0 0 0 0 COMMISSIONS INCURRED (direct business only) 7. First year (other than single),59,59 8. Single 0 9. Renewal,8, 990,96 6,55 700 0. Deposit-type contract funds 0. Totals (to agree with Page 6, Line ),0,76 0,00,5 6,55 0 0 0 0 0 700 0

EXHIBIT - GENERAL EXPENSES Insurance 5 6 Accident and Health Life Cost Containment All Other All Other Lines of Business Investment Total. Rent 99,8 99,8. Salaries and wages,786,865,786,865. Contributions for benefit plans for employees 8,00 8,00. Contributions for benefit plans for agents 0 0. Payments to employees under non-funded benefit plans 0 0. Payments to agents under non-funded benefit plans 0 0. Other employee welfare 0 0. Other agent welfare 0 0. Legal fees and expenses 7,60 7,60. Medical examination fees 0 0. Inspection report fees 0 0. Fees of public accountants and consulting actuaries 87, 87,.5 Expense of investigation and settlement of policy claims 6,55 6,55 5. Traveling expenses 90,590 90,590 5. Advertising 50 50 5. Postage, express, telegraph and telephone 5,76 5,76 5. Printing and stationery 9,759 9,759 5.5 Cost or depreciation of furniture and equipment 0 0 5.6 Rental of equipment 8,95 8,95 5.7 Cost or depreciation of EDP equipment and software 0,78 0,78 6. Books and periodicals 0 0 6. Bureau and association fees 96,06 96,06 6. Insurance, except on real estate,56,56 6. Miscellaneous losses 0 0 6.5 Collection and bank service charges 9,8 9,8 6.6 Sundry general expenses 76, 76, 6.7 Group service and administration fees 0 0 6.8 Reimbursements by uninsured plans 0 0 7. Agency expense allowance 0 0 7. Agents balances charged off (less $ recovered) 0 0 7. Agency conferences other than local meetings 0 0 9. Real estate expenses 0 0 9. Investment expenses not included elsewhere 0,,,, 9. Aggregate write-ins for expenses 0 0 0 0 0 0 0. General expenses incurred,8,807 0 0 0,, (a) 5,987,98. General expenses unpaid December, prior year,57,660 0,000,6,660. General expenses unpaid December, current year,, 507,07,79,8. Amounts receivable relating to uninsured plans, prior year 0. Amounts receivable relating to uninsured plans, current year 0 5. General expenses paid during year (Lines 0+--+),780,56 0 0 0 90,08,70,0 DETAILS OF WRITE-INS 09.0. 09.0. 09.0. 09.98. Summary of remaining write-ins for Line 9. from overflow page 0 0 0 0 0 0 09.99. Totals (Lines 09.0 thru 09.0 plus 09.98) (Line 9. above) 0 0 0 0 0 0 (a) Includes management fees of $ to affiliates and $ to non-affiliates. EXHIBIT - TAXES, LICENSES AND FEES (EXCLUDING FEDERAL INCOME TAXES) Insurance 5 Life Accident and Health All Other Lines of Business Investment Total. Real estate taxes 0 0. State insurance department licenses and fees 07,57 07,57. State taxes on premiums 60,98 60,98. Other state taxes, including $ for employee benefits,670,670 5. U.S. Social Security taxes 0 0 6. All other taxes 0 0 7. Taxes, licenses and fees incurred 899,755 0 0 0 899,755 8. Taxes, licenses and fees unpaid December, prior year 96,8 96,8 9. Taxes, licenses and fees unpaid December, current year 85,95 85,95 0. Taxes, licenses and fees paid during year (Lines 7 + 8-9) 909,98 0 0 0 909,98 EXHIBIT - DIVIDENDS OR REFUNDS. Applied to pay renewal premiums. Applied to shorten the endowment or premium-paying period. Applied to provide paid-up additions. Applied to provide paid-up annuities 5. Total Lines through 6. Paid in cash 7. Left on deposit 8. Aggregate write-ins for dividend or refund options 9. Total Lines 5 through 8 0. Amount due and unpaid. Provision for dividends or refunds payable in the following calendar year NONE. Terminal dividends. Provision for deferred dividend contracts. Amount provisionally held for deferred dividend contracts not included in Line 5. Total Lines 0 through 6. Total from prior year 7. Total dividends or refunds (Lines 9 + 5-6) DETAILS OF WRITE-INS 080. 080. 080. 0898. Summary of remaining write-ins for Line 8 from overflow page 0899. Totals (Lines 080 thru 080 plus 0898) (Line 8 above) Life Accident and Health

EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial Ordinary 5 Credit (Group and Individual) 6 Group 00000. CSO.50% NLP ANB IDB 957-96 80, 80, 00000. CSO.75% NLP ANB IDB 958-96 76,95 76,95 00000. CSO.00% NLP ANB IDB 957-96 7,07 7,07 00000. 58 CET.5% NLP ALB IDB 98-98 6,069 6,069 000005. 58 CET.50% CRVM ANB IDB 98-985 0,6 0,6 000006. 58 CET.00% NLP ANB IDB 96-985,79,79 000007. 58 CET.50% NJ ANB IDB 98-987 8,79 8,79 000008. 58 CET.50% NLP ALB IDB 97-98,57,57 000009. 58 CET.50% NLP ANB IDB 977-98 8,08 8,08 00000. 58 CET.00% NLP ALB IDB 979-980,90,90 0000. 58 CET.50% CRVM ALB IDB 98-98,08,08 0000. 58 CET.50% NJ ANB IDB 987-987 7,50 7,50 0000. 58 CET.50% NLP ALB IDB 98-987 7,78 7,78 0000. 58 CSO.5% CRVM ALB IDB 979-986 9,757 9,757 00005. 58 CSO.5% NLP ALB IDB 980-988,67,67 00006. 58 CSO.50% CRVM ANB IDB 98-986 97,7 97,7 00007. 58 CSO.50% NLP ANB IDB 970-980,80,80 00008. 58 CSO.00% NLP ALB IDB 977-980 7,70 7,70 00009. 58 CSO.00% NLP ANB IDB 96-987 5,9,9 5,9,9 00000. 58 CSO.50% CRVM ALB IDB 967-987 98,96 98,96 0000. 58 CSO.50% CRVM ANB IDB 98-98 9,50 9,50 0000. 58 CSO.50% MOD ANB IDB 979-985 7,9 7,9 0000. 58 CSO.50% NJ ANB IDB 980-987,6,6 0000. 58 CSO.50% NLP ALB IDB 979-987 5,55 5,55 00005. 58 CSO.50% NLP ANB IDB 969-987,599,,596,09,0 00006. 58 CSO.00% CRVM ALB CNF ISL 985-988,597,7,597,7 00007. 58 CSO.00% CRVM ALB IDB 978-00,07,6,07,6 00008. 58 CSO.00% CRVM ANB IDB ISL 98-986,79,75,79,75 00009. 58 CSO.00% NLP ALB IDB 980-980,78,78 00000. 58 CSO.00% NLP ANB IDB 98-986 5,7 5,7 0000. 58 CSO.50% CRVM ALB IDB 98-988 0,,59 0,,59 0000. 58 CSO.50% CRVM ANB IDB 98-000,, 0000. 58 CSO.50% CRVM ANB IDB ISL 98-988,,579,,579 0000. 58 CSO.50% NJ ANB IDB 98-988,787,787 00005. 58 CSO.50% NLP ANB IDB 98-000 90 90 00006. 80 CET.00% CRVM ALB CNF 000-000,89,89 00007. 80 CET.50% CRVM ALB 989-99,7,7 00008. 80 CET.50% CRVM ALB IDB 997-000 5,88 5,88 00009. 80 CET.50% CRVM ANB IDB 998-00 5,77 5,77 00000. 80 CET.50% NLP ANB IDB 988-99 6,6 6,6 0000. 80 CET 5.00% CRVM ANB IDB 989-99 9,60 9,60 0000. 80 CET 5.50% CRVM ANB IDB 988-99 6,057 6,057 0000. 80 CSO.00% CRVM ALB CNF 990-000 5,86 5,86 0000. 80 CSO.00% CRVM ALB CNF ISL 006-008,0,065,0,065 00005. 80 CSO.00% CRVM ANB CNF 006-007,6,5,6,5 00006. 80 CSO.00% CRVM ANB IDB 988-000 00007. 80 CSO.00% NLP ALB IDB 008-008 776 776 00008. 80 CSO.50% CRVM ALB 989-99 8,88 8,88 00009. 80 CSO.50% CRVM ALB CNF ISL 005-005 9,0 9,0 000050. 80 CSO.50% CRVM ALB IDB 99-996 5 5 00005. 80 CSO.50% CRVM ANB CNF 00-005 5,7,090 5,7,090 00005. 80 CSO.50% CRVM ANB IDB 99-0 905,56 905,56 00005. 80 CSO.50% CRVM ANB IDB ISL 988-005 06,979,07 06,979,07 00005. 80 CSO.50% NLP ANB IDB 988-007,087,087 000055. 80 CSO 5.00% CRVM ALB IDB 99-99 5, 5, 000056. 80 CSO 5.00% CRVM ALB IDB ISL 99-99 5,77 5,77 000057. 80 CSO 5.00% CRVM ANB IDB 987-995,600,97,600,97 000058. 80 CSO 5.00% CRVM ANB IDB ISL 985-99 06,69,77 06,69,77 000059. 80 CSO 5.00% NLP ALB IDB 988-99 6,6 6,6 000060. 80 CSO 5.00% NLP ANB IDB 99-995,80,80 00006. 80 CSO 5.50% CRVM ALB IDB 987-99 5,988 5,988 00006. 80 CSO 5.50% CRVM ALB IDB ISL 987-99 6,97,576 6,97,576 00006. 80 CSO 5.50% CRVM ANB IDB 988-00,7,99,7,99 00006. 80 CSO 5.50% CRVM ANB IDB ISL 990-99 9,75,09 9,75,09 000065. 80 CSO 5.50% NLP ANB IDB 987-99,59,59 000066. 80 CSO 6.00% CRVM ANB IDB 97-990 7,88 7,88 000067. 80 CSO 6.00% NLP ANB IDB 98-986,807,807 000068. 80 CSO S/U %/0/.5% CRVM ALB CNF ISL 996-00,00,8,00,8 000069. 80 CSO S/U.00% CRVM ALB CNF ISL 986-00,00,5,00,5 000070. 80 CSO S/U.00% CRVM ANB IDB 006-07 7,980 7,980 00007. 80 CSO S/U.00% CRVM ANB IDB ISL 996-009,08,6,08,6 00007. 80 CSO S/U.50% CRVM ALB 985-999,55,,55, 00007. 80 CSO S/U.50% CRVM ALB CNF ISL 988-00,676,8,676,8 00007. 80 CSO S/U.50% CRVM ALB IDB 9-005,597,55,597,55 000075. 80 CSO S/U.50% CRVM ALB IDB ISL 00-00,57,057,57,057 000076. 80 CSO S/U.50% CRVM ANB IDB 989-005 00,897,966 00,897,966 000077. 80 CSO S/U.50% CRVM ANB IDB ISL 998-005 58,50,80 58,50,80 000078. 80 CSO S/U 5.00% CRVM ALB IDB 989-99 8,856 8,856 000079. 80 CSO S/U 5.00% CRVM ANB IDB 99-999,688,688 000080. 80 CSO S/U 5.50% CRVM ALB IDB 987-99 6,670 6,670 00008. 80 CSO S/U 5.50% CRVM ANB IDB 987-995 7,999 7,999 00008. 80 CSO S/U 5.50% NLP ANB IDB 988-990 75 75 00008. 80 CSO S/U 6.00% CRVM ALB IDB 985-986,85,85 00008. 80 CSO S/U 6.00% CRVM ANB IDB 98-986,9,9 000085. 00 CSO.50% CRVM ANB CNF 0-07,9,9 000086. 00 CSO.50% CRVM ANB CNF ISL 0-07 65,68 65,68

EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial Ordinary 5 Credit (Group and Individual) 6 Group 000087. 00 CSO.50% CRVM ANB IDB 0-07 7,05 7,05 000088. 00 CSO.00% CRVM ANB CNF 00-0 56, 56, 000089. 00 CSO.00% CRVM ANB CNF ISL 0-0 7,7 7,7 000090. 00 CSO.00% CRVM ANB IDB 009-0 90,6 90,6 00009. 00 CSO S/U.50% CRVM ANB IDB 0-07 0,60 0,60 00009. 00 CSO S/U.00% CRVM ANB IDB 006-0 67,956 67,956 00009. 00 CSO S/U.50% CRVM ANB IDB 00-005,099,896,099,896 00009. Cash Value 959-009 5,68 5,68 000095. Factors 978-0 08,059 08,059 000096. Fund Value 985-000,99,98,99,98 000097. Unearned COI 98-0 9,70 9,70 000098. Unearned Premium 977-06 6,69 6,69 099997. Totals (Gross) 5,0,68 0 5,0,5 0,0 099998. Reinsurance ceded 8,97,90 8,97,90 099999. Life Insurance: Totals (Net) 0,087,58 0 0,08,055 0,0 00000. 7 SA Imm 985-990,8 XXX,8 XXX 00000. 7 GAM 6.00% Def 976-979 9,605 XXX 9,605 XXX 00000. 7 GAM 7.50% Def 980-98 8,585 XXX 8,585 XXX 00000. 7 IAM 0.00% Def 98-98 6,8, XXX 6,8, XXX 000005. 7 IAM 5.50% Def 980-98 7,6,0 XXX 7,6,0 XXX 000006. 7 IAM 6.00% Def 977-979 0,88,675 XXX 0,88,675 XXX 000007. 7 IAM 6.00% Imm 98-98,8,7 XXX,8,7 XXX 000008. 7 IAM 8.00% Def 98-98,66, XXX,6,687 XXX 9,65 000009. 7 IAM 8.5% Def 98-98,78,59 XXX,9,76 XXX 8,756 00000. 7 IAM 8.50% Def 98-98,65, XXX,65, XXX 0000. 7 IAM 8.75% Def 98-98 5,800,69 XXX 5,800,69 XXX 0000. 7 IAM 9.5% Def 98-98,070,0 XXX 968,80 XXX 0,00 0000. 8 GAM 5.75% Def 99-99 6,55 XXX 6,55 XXX 0000. 8 GAM 6.5% Def 99-99,768,97 XXX,768,97 XXX 00005. 8 GAM 6.50% Def 990-990,5,87 XXX,5,87 XXX 00006. 8 GAM 6.75% Def 99-99,80,75 XXX,80,75 XXX 00007. 8 GAM 7.00% Def 988-989,665,6 XXX,665,6 XXX 00008. 8 IAM 5.00% Def 998-999,8,88 XXX,8,88 XXX 00009. 8 IAM 5.5% Def 99-999,9,5 XXX,9,5 XXX 00000. 8 IAM 5.50% Def 99-997 00,96,66 XXX 00,96,66 XXX 0000. 8 IAM 5.75% Def 99-995,606,655 XXX,606,655 XXX 0000. 8 IAM 6.00% Def 99-995,8,699 XXX,8,699 XXX 0000. 8 IAM 6.00% Imm 985-999,056,09 XXX,056,09 XXX 0000. 8 IAM 6.5% Def 987-00 7,75,9 XXX 7,7,9 XXX 7,7 00005. 8 IAM 6.50% Def 987-00 55,06,05 XXX 55,06,05 XXX 00006. 8 IAM 6.50% Imm 99-99,656 XXX,656 XXX 00007. 8 IAM 6.75% Def 986-00 5,565,8 XXX 5,7,597 XXX 9,7 00008. 8 IAM 6.75% Imm 996-996, XXX, XXX 00009. 8 IAM 7.00% Def 988-989 0,750,689 XXX 0,750,689 XXX 00000. 8 IAM 7.00% Imm 99-99 97,67 XXX 97,67 XXX 0000. 8 IAM 7.5% Def 986-000 5,6,5 XXX 5,6,5 XXX 0000. 8 IAM 7.5% Imm 995-999 70,60 XXX 70,60 XXX 0000. 8 IAM 7.75% Imm 99-99 9,958 XXX 9,958 XXX 0000. 8 IAM 8.00% Def 985-985,9,099 XXX,7,85 XXX 99,8 00005. 8 IAM 8.00% Imm 986-99 0,590 XXX 0,590 XXX 00006. 8 IAM 8.5% Imm 988-99,0,600 XXX,0,600 XXX 00007. 8 IAM 8.50% Def 985-985 0,8,09 XXX 0,8,09 XXX 00008. 8 IAM 8.75% Imm 989-989 5,96 XXX 5,96 XXX 00009. A000.75% Def 0-0,78 XXX,78 XXX 00000. A000.75% Imm 07-07 7,785 XXX 7,785 XXX 0000. A000.00% Imm 0-06 75,97 XXX 75,97 XXX 0000. A000.50% Def 005-005 5,76 XXX 5,76 XXX 0000. A000.75% Def 00-00,598,66 XXX,598,66 XXX 0000. A000 5.00% Def 00-00 6,575, XXX 6,575, XXX 00005. A000 5.00% Imm 0-0 5,05 XXX 5,05 XXX 00006. A000 5.5% Imm 0-0,60 XXX,60 XXX 00007. A000 5.50% Def 00-00,5,87 XXX,5,87 XXX 00008. A000 5.75% Def 000-000,6,805 XXX,6,805 XXX 00009. A000 6.00% Imm 000-00,68 XXX,68 XXX 000050. A000 6.5% Imm 998-999 65,56 XXX 65,56 XXX 00005. A000 6.75% Imm 00-00 9,96 XXX 9,96 XXX 00005. A000 7.00% Imm 000-000 60,075 XXX 60,075 XXX 00005. A0.75% Def 05-05 50,56 XXX 50,56 XXX 00005. Account Value 99-000 76, XXX 76, XXX 000055. Fund Value 985-99 8,5 XXX 8,5 XXX 099997. Totals (Gross) 5,60,96 XXX 5,,9 XXX 88,05 099998. Reinsurance ceded,79, XXX,79, XXX 099999. Annuities: Totals (Net) 58,87,8 XXX 58,8,778 XXX 88,05 00000. 8 IAM 6.00% Imm 990-999 7,68 7,68 00000. 8 IAM 6.5% Imm 998-998,5,5 00000. 8 IAM 7.00% Imm 99-99 5,85 5,85 00000. 8 IAM 8.5% Imm 990-99,9,9 000005. 8 IAM 8.75% Imm 988-988 5,59 5,59 000006. A000.00% Imm 0-07,98,799,98,799 000007. A000.5% Imm 0-0 78,6 78,6 000008. A000.50% Imm 0-0 8,58 8,58 000009. A000 5.00% Imm 0-0 869,0 869,0 00000. A000 5.5% Imm 005-00,65,695,65,695 0000. A000 5.50% Imm 00-008,9,778,9,778 0000. A000 6.00% Imm 000-009 98,90 98,90 0000. A000 6.5% Imm 999-999 88,68 88,68 0000. A000 6.50% Imm 00-00,6,6 00005. A000 7.00% Imm 000-000 9,9 9,9 00006. A0.00% Imm 06-06 6,65 6,65 00007. A0.50% Imm 0-0 0,8 0,8 099997. Totals (Gross) 9,0,8 0 9,0,8 0 0 099998. Reinsurance ceded 0.

EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial Ordinary 5 Credit (Group and Individual) 6 Group 099999. SCWLC: Totals (Net) 9,0,8 0 9,0,8 0 0 00000. 59 ADB / 58 CSO.50% ALB 985-99,75,75 00000. 59 ADB / 58 CSO.50% ANB 977-000,67,67 00000. 59 ADB / 58 CSO.00% ALB 975-98 8 8 00000. 59 ADB / 58 CSO.00% ANB 96-997,59,59 000005. 59 ADB / 58 CSO.50% ANB 979-986 97 97 000006. 59 ADB / 58 CSO.50% ANB 98-987 000007. 59 ADB / 80 CSO.00% ANB 0-0 00 00 000008. 59 ADB / 80 CSO.50% ANB 988-005,6,6 000009. Unearned COI 98-006 6 6 00000. Unearned Premium 995-000 50 50 099997. Totals (Gross) 0,68 0 0,68 0 0 099998. Reinsurance ceded 5,00 5,00 099999. Accidental Death Benefits: Totals (Net) 5,578 0 5,578 0 0 050000. 5 DIS / 58 CSO.00% ALB 977-986,858,858 050000. 5 DIS / 58 CSO.00% ANB 960-0,697,59,697,59 050000. 5 DIS / 80 CSO.50% ALB 986-000,07,07 050000. 5 Dis Per., Ben 5.50% ALB 97-99,75,75 0500005. 85 CIDA / 80 CSO.50% ANB 990-008 7,5 7,5 0500006. Unearned COI 98-008 7,097 7,097 0599997. Totals (Gross),87, 0,87, 0 0 0599998. Reinsurance ceded,709,966,709,966 0599999. Disability-Active Lives: Totals (Net) 577,55 0 577,55 0 0 060000. 5 DIS / 58 CSO.00% ALB 986-986 6,5 6,5 060000. 5 DIS / 58 CSO.00% ANB 960-005,0,776,0,776 060000. 5 DIS / 80 CSO.00% ALB 997-997 75 75 060000. 5 DIS / 80 CSO.00% ANB 986-005,7,70,7,70 0600005. 5 DIS / 80 CSO.50% ALB 986-998 9,6 9,6 0600006. 5 Dis Per., Ben 5.50% ALB 97-99 7,58 7,58 0600007. 85 CIDA / 80 CSO.50% ANB 99-005,59,957,59,957 0699997. Totals (Gross) 6,655,867 0 6,655,867 0 0 0699998. Reinsurance ceded,85,90,85,90 0699999. Disability-Disabled Lives: Totals (Net),809,957 0,809,957 0 0 070000. Asset Adequacy Reserve 67,000,000 67,000,000 070000. Deficiency Reserve 0,06,0 0,06,0 070000. Immediate Payment of Claims 5,7 5,7 070000. Nondeduction of Deferred Premium,77,77 0700005. Refund of Premium on Death Reserve 667,90 667,90 0799997. Totals (Gross) 78,0,55 0 78,0,55 0 0 0799998. Reinsurance ceded,9,5,9,5 0799999. Miscellaneous Reserves: Totals (Net),79,0 0,79,0 0 0 9999999. Totals (Net) - Page, Line 75,98,09 0 7,707,07 0 9,8.

EXHIBIT 5 - INTERROGATORIES. Has the reporting entity ever issued both participating and non-participating contracts? Yes [ ] No [ X ]. If not, state which kind is issued.. Does the reporting entity at present issue both participating and non-participating contracts? Yes [ ] No [ X ]. If not, state which kind is issued.. Does the reporting entity at present issue or have in force contracts that contain non-guaranteed elements? Yes [ X ] No [ ] If so, attach a statement that contains the determination procedures, answers to the interrogatories and an actuarial opinion as described in the instructions.. Has the reporting entity any assessment or stipulated premium contracts in force? Yes [ ] No [ X ] If so, state:. Amount of insurance? $ 0. Amount of reserve? $ 0. Basis of reserve:. Basis of regular assessments:.5 Basis of special assessments:.6 Assessments collected during the year $ 0 5. If the contract loan interest rate guaranteed in any one or more of its currently issued contracts is less than 5%, not in advance, state the contract loan rate guarantees on any such contracts. 6. Does the reporting entity hold reserves for any annuity contracts that are less than the reserves that would be held on a standard basis? Yes [ ] No [ X ] 6. If so, state the amount of reserve on such contracts on the basis actually held: $ 0 6. That would have been held (on an exact or approximate basis) using the actual ages of the annuitants; the interest rate(s) used in 6.; and the same mortality basis used by the reporting entity for the valuation of comparable annuity benefits issued to standard lives. If the reporting entity has no comparable annuity benefits for standard lives to be valued, the mortality basis shall be the table most recently approved by the state of domicile for valuing individual annuity benefits: $ 0 Attach statement of methods employed in their valuation. 7. Does the reporting entity have any Synthetic GIC contracts or agreements in effect as of December of the current year? Yes [ ] No [ X ] 7. If yes, state the total dollar amount of assets covered by these contracts or agreements $ 0 7. Specify the basis (fair value, amortized cost, etc.) for determining the amount: 7. State the amount of reserves established for this business: $ 0 7. Identify where the reserves are reported in the blank: 8. Does the reporting entity have any Contingent Deferred Annuity contracts or agreements in effect as of December of the current year? Yes [ ] No [ X ] 8. If yes, state the total dollar amount of account value covered by these contracts or agreements: $ 0 8. State the amount of reserves established for this business: $ 0 8. Identify where the reserves are reported in the blank: 9. Does the reporting entity have any Guaranteed Lifetime Income Benefit contracts, agreements or riders in effect as of December of the current year? Yes [ ] No [ X ] 9. If yes, state the total dollar amount of any account value associated with these contracts, agreements or riders: $ 0 9. State the amount of reserves established for this business: $ 0 9. Identify where the reserves are reported in the blank: EXHIBIT 5A - CHANGES IN BASES OF VALUATION DURING THE YEAR Valuation Basis Description of Valuation Class Changed From Changed To Increase in Actuarial Reserve Due to Change 9999999 - Total (Column, only) NONE

EXHIBIT 6 - AGGREGATE RESERVES FOR ACCIDENT AND HEALTH CONTRACTS Other Individual Contracts Credit Accident 5 6 7 8 Total Group Accident and Health and Health (Group and Individual) Collectively Renewable Non-Cancelable Guaranteed Renewable Non-Renewable for Stated Reasons Only Other Accident Only ACTIVE LIFE RESERVE. Unearned premium reserves 6,65,58 0 6 0 9 0 0 6,8. Additional contract reserves (a) 7,0 6,98 0,068 0,670 0 0,67. Additional actuarial reserves-asset/liability analysis 0 0 0 0 0 0 0 0 0. Reserve for future contingent benefits 0 0 0 0 0 0 0 0 0 5. Reserve for rate credits 0 0 0 0 0 0 0 0 0 6. Aggregate write-ins for reserves 0 0 0 0 0 0 0 0 0 7. Totals (Gross) 9,95 9,5 0,9 0,699 0 0 65,9 8. Reinsurance ceded 66,58 5 0 0 0,9 0 0 65,09 9. Totals (Net) 5,06 9,67 0,9 0,05 0 0 0 CLAIM RESERVE 0. Present value of amounts not yet due on claims 6,807 6,807. Additional actuarial reserves-asset/liability analysis 0. Reserve for future contingent benefits 0. Aggregate write-ins for reserves 0 0 0 0 0 0 0 0 0. Totals (Gross) 6,807 0 0 0 0 0 0 0 6,807 5. Reinsurance ceded 6,807 6,807 6. Totals (Net) 0 0 0 0 0 0 0 0 0 7. TOTAL (Net) 5,06 9,67 0,9 0,05 0 0 0 8. TABULAR FUND INTEREST 9 96 0 9 0 7 0 0 0 DETAILS OF WRITE-INS 060. 060. 060. 0698. Summary of remaining write-ins for Line 6 from overflow page 0 0 0 0 0 0 0 0 0 0699. TOTALS (Lines 060 thru 060 plus 0698) (Line 6 above) 0 0 0 0 0 0 0 0 0 0. 0. 0. 98. Summary of remaining write-ins for Line from overflow page 0 0 0 0 0 0 0 0 0 99. TOTALS (Lines 0 thru 0 plus 98) (Line above) 0 0 0 0 0 0 0 0 0 (a) Attach statement as to valuation standard used in calculating this reserve, specifying reserve bases, interest rates and methods. 7 Hosp & Surg Table % Yr PT 958 CSO 7 Hosp & Surg Table 5.5% Yr PT 980 CSO 59 Acc Death Ben 5.5% Yr PT 980 CSO Outpatient Med (Co Exper) 5.5% Yr PT 980 CSO 7 Hosp & Surg Table % Yr PT 958 CSO 9 All Other

EXHIBIT 7 - DEPOSIT TYPE CONTRACTS Total Guaranteed Interest Contracts Annuities Certain Supplemental Contracts 5 Dividend Accumulations or Refunds 6 Premium and Other Deposit Funds. Balance at the beginning of the year before reinsurance,0,0 0,87,508 9,7,96 0 696. Deposits received during the year,677,5 6,067,05,7,0. Investment earnings credited to the account 767,50 09,96 557,59 5. Other net change in reserves (,6,087) (7,089) (8,998) 5. Fees and other charges assessed 0 6. Surrender charges 0 7. Net surrender or withdrawal payments,005,0 6,875,855,06,50 8. Other net transfers to or (from) Separate Accounts 0 0 0 0 5 9. Balance at the end of current year before reinsurance (Lines +++-5-6-7-8),5,67 0,698,57 8,65,50 0 550 0. Reinsurance balance at the beginning of the year (,8,656) 0 (,8,657) 0 0. Net change in reinsurance assumed 0. Net change in reinsurance ceded (6,70) (6,70). Reinsurance balance at the end of the year (Lines 0+-) (,67,86) 0 (,67,87) 0 0. Net balance at the end of current year after reinsurance (Lines 9 + ),086, 0,,60 8,65,5 0 550

. Due and unpaid:. In course of settlement:. Direct 0. Reinsurance assumed 0. Reinsurance ceded 0 EXHIBIT 8 - CLAIMS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS PART - Liability End of Current Year Ordinary 6 Group Accident and Health 5 7 8 9 0 Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual). Net 0 0 0 0 0 0 0 0 0 0 0. Resisted. Direct 0. Reinsurance assumed 0. Reinsurance ceded 0. Net 0 0 (b) 0 (b) 0 0 (b) 0 (b) 0 0 0 0 0 Other 6. Other. Direct 7,686,,0,06,8,07. Reinsurance assumed 99,99 99,99. Reinsurance ceded 9,98,796 9,67,0,765. Incurred but unreported:. Net 9,7,8 0 (b) 5,867,0 (b),50,07 0 (b) 0 (b) 0 0 (b) 0 (b) 0 (b) 0. Direct 7,68,885 7,609,9 7,859,08. Reinsurance assumed 00,0 00,0. Reinsurance ceded 6,8,7 6,8,7. Net,76,870 0 (b),77,97 (b) 0 0 (b) 0 (b) 0 0 (b) 7,859 (b) 0 (b),08. TOTALS. Direct 5,05,08 0,0,00,8,07 0 0 0 0 7,859 0,08. Reinsurance assumed,0,9 0,0,9 0 0 0 0 0 0 0 0. Reinsurance ceded 5,68, 0 5,69,8,765 0 0 0 0 0 0 0. Net 0,85,98 (a) 0 (a) 7,59,98,50,07 0 0 (a) 0 0 7,859 0,08 (a) Including matured endowments (but not guaranteed annual pure endowments) unpaid amounting to $ in Column, $ in Column and $ in Column 7. (b) Include only portion of disability and accident and health claim liabilities applicable to assumed "accrued" benefits. Reserves (including reinsurance assumed and net of reinsurance ceded) for unaccrued benefits for Ordinary Life Insurance $,809,957 Individual Annuities $, Credit Life (Group and Individual) $, and Group Life $, are included in Page, Line, (See Exhibit 5, Section on Disability Disabled Lives); and for Group Accident and Health $ Credit (Group and Individual) Accident and Health $, and Other Accident and Health $ are included in Page, Line (See Exhibit 6, Claim Reserve).