ANNUAL STATEMENT OF THE Of Montpelier in the state of VT to the Insurance Department of the state of For the Year Ended December 31, 2015 2015 LIFE AND ACCIDENT AND HEALTH
ASSETS 2 Current Year Prior Year 1 2 3 4 Net Admitted Nonadmitted Assets Net Assets Assets (Cols. 1-2) Admitted Assets 1. Bonds (Schedule D)......5,260,982,599...0...5,260,982,599...5,389,989,117 2. Stocks (Schedule D): 2.1 Preferred stocks......10,000,000...0...10,000,000...0 2.2 Common stocks......836,248,764...0...836,248,764...774,556,147 3. Mortgage loans on real estate (Schedule B): 3.1 First liens......551,901,903...0...551,901,903...522,440,017 3.2 Other than first liens......0...0...0...0 4. Real estate (Schedule A): 4.1 Properties occupied by the company (less...0 encumbrances)......52,725,460...0...52,725,460...53,707,384 4.2 Properties held for the production of income (less...0 encumbrances)......20,821,306...0...20,821,306...24,919,196 4.3 Properties held for sale (less...0 encumbrances)......6,750,608...0...6,750,608...7,880,608 5. Cash (...11,923,928, Schedule E-Part 1), cash equivalents (...0, Schedule E-Part 2) and short-term investments (...113,500,000, Schedule DA)......125,423,928...0...125,423,928...91,237,544 6. Contract loans (including...0 premium notes)......533,874,512...0...533,874,512...546,739,136 7. Derivatives (Schedule DB)......19,819,404...0...19,819,404...31,564,127 8. Other invested assets (Schedule BA)......374,854,166...0...374,854,166...376,240,001 9. Receivables for securities......0...0...0...11,844 10. Securities lending reinvested collateral assets (Schedule DL)......0...0...0...0 11. Aggregate write-ins for invested assets......1,702,744...0...1,702,744...1,167,485 12. Subtotals, cash and invested assets (Lines 1 to 11)......7,795,105,393...0...7,795,105,393...7,820,452,606 13. Title plants less...0 charged off (for Title insurers only)......0...0...0...0 14. Investment income due and accrued......74,015,862...0...74,015,862...74,325,801 15. Premiums and considerations: 15.1 Uncollected premiums and agents' balances in the course of collection......10,587,671...2,097...10,585,574...15,910,399 15.2 Deferred premiums, agents' balances and installments booked but deferred and not yet due (including...0 earned but unbilled premiums)......30,444,576...0...30,444,576...41,961,392 15.3 Accrued retrospective premiums (...0) and contracts subject to redetermination (...0)......0...0...0...0 16. Reinsurance: 16.1 Amounts recoverable from reinsurers......2,546,149...0...2,546,149...1,862,259 16.2 Funds held by or deposited with reinsured companies......0...0...0...0 16.3 Other amounts receivable under reinsurance contracts......0...0...0...0 17. Amounts receivable relating to uninsured plans......0...0...0...0 18.1 Current federal and foreign income tax recoverable and interest thereon......32,497,803...0...32,497,803...42,420,692 18.2 Net deferred tax asset......147,984,021...16,745,902...131,238,119...142,598,544 19. Guaranty funds receivable or on deposit......1,611,997...0...1,611,997...1,010,695 20. Electronic data processing equipment and software......121,158,127...115,318,741...5,839,386...3,869,182 21. Furniture and equipment, including health care delivery assets (...0)......6,188,884...6,188,884...0...0 22. Net adjustment in assets and liabilities due to foreign exchange rates......0...0...0...0 23. Receivables from parent, subsidiaries and affiliates......18,909,903...0...18,909,903...3,200,556 24. Health care (...0) and other amounts receivable......4,504,005...4,504,005...0...0 25. Aggregate write-ins for other than invested assets......330,767,663...5,544,082...325,223,581...284,606,226 26. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25)......8,576,322,055...148,303,711...8,428,018,343...8,432,218,353 27. From Separate Accounts, Segregated Accounts and Protected Cell Accounts......720,709,837...0...720,709,837...777,726,412 28. TOTALS (Lines 26 and 27)......9,297,031,892...148,303,711...9,148,728,181...9,209,944,765 DETAILS OF WRITE-INS 1101. Other real estate deposits......1,702,744...0...1,702,744...1,167,485 1102.......0...0...0...0 1103.......0...0...0...0 1198. Summary of remaining write-ins for Line 11 from overflow page......0...0...0...0 1199. Totals (Lines 1101 thru 1103 plus 1198) (Line 11 above)......1,702,744...0...1,702,744...1,167,485 2501. Corporate owned life insurance......255,718,587...0...255,718,587...233,092,602 2502. Note receivable from NLVF......33,623,247...0...33,623,247...33,623,247 2503. Cash value of deferred compensation life insurance policies......13,514,030...0...13,514,030...14,119,199 2598. Summary of remaining write-ins for Line 25 from overflow page......27,911,799...5,544,082...22,367,717...3,771,178 2599. Totals (Lines 2501 thru 2503 plus 2598) (Line 25 above)......330,767,663...5,544,082...325,223,581...284,606,226
LIABILITIES, SURPLUS AND OTHER FUNDS 1 2 Current Year Prior Year 1. Aggregate reserve for life contracts...2,649,605,912 (Exhibit 5, Line 9999999) less...0 included in Line 6.3 (including...19,257,319 Modco Reserve)......2,649,605,912...5,605,424,597 2. Aggregate reserve for accident and health contracts (including...398,739,791 Modco Reserve)......505,560,350...513,719,444 3. Liability for deposit-type contracts (Exhibit 7, Line 14, Col. 1) (including...0 Modco Reserve)......162,665,300...287,216,544 4. Contract claims: 4.1 Life (Exhibit 8, Part 1, Line 4.4, Col. 1 less sum of Cols. 9, 10 and 11)......10,242,977...35,366,504 4.2 Accident and health (Exhibit 8, Part 1, Line 4.4, sum of Cols. 9, 10 and 11)......1,484,068...1,638,497 5. Policyholders' dividends...1,808,036 and coupons...0 due and unpaid (Exhibit 4, Line 10)......1,808,036...2,850,292 6. Provision for policyholders' dividends and coupons payable in following calendar year - estimated amounts: 6.1 Dividends apportioned for payment (including...0 Modco)......13,168,825...75,624,898 6.2 Dividends not yet apportioned (including...0 Modco)......0...0 6.3 Coupons and similar benefits (including...0 Modco)......0...0 7. Amount provisionally held for deferred dividend policies not included in Line 6......0...0 8. Premiums and annuity considerations for life and accident and health contracts received in advance less...0 discount; including...161,680 accident and health premiums (Exhibit 1, Part 1, Col. 1, sum of Lines 4 and 14)......1,046,908...2,113,660 9. Contract liabilities not included elsewhere: 9.1 Surrender values on canceled contracts......0...0 9.2 Provision for experience rating refunds, including the liability of...0 accident and health experience rating refunds of which...0 is for medical loss ratio rebate per the Public Health Service Act......0...0 9.3 Other amounts payable on reinsurance, including...0 assumed and...0 ceded......0...0 9.4 Interest Maintenance Reserve (IMR, Line 6)......30,202,316...73,513,352 10. Commissions to agents due or accrued - life and annuity contracts...0, accident and health...42,724 and deposit-type contract funds...0......7,388,016...6,895,146 11. Commissions and expense allowances payable on reinsurance assumed......0...0 12. General expenses due or accrued (Exhibit 2, Line 12, Col. 6)......49,486,264...42,575,923 13. Transfers to Separate Accounts due or accrued (net) (including...0 accrued for expense allowances recognized in reserves, net of reinsured allowances)......(1,958,836)...(3,349,538) 14. Taxes, licenses and fees due or accrued, excluding federal income taxes (Exhibit 3, Line 9, Col. 5)......1,609,429...2,151,863 15.1 Current federal and foreign income taxes, including...0 on realized capital gains (losses)......0...0 15.2 Net deferred tax liability......0...0 16. Unearned investment income......345,244...25,881 17. Amounts withheld or retained by company as agent or trustee......(232,112)...800,490 18. Amounts held for agents' account, including...0 agents' credit balances......599...219 19. Remittances and items not allocated......20,572,075...24,029,420 20. Net adjustment in assets and liabilities due to foreign exchange rates......0...0 21. Liability for benefits for employees and agents if not included above......73,834,539...74,722,197 22. Borrowed money...0 and interest thereon...0......0...0 23. Dividends to stockholders declared and unpaid......0...0 24. Miscellaneous liabilities: 24.01 Asset valuation reserve (AVR Line 16, Col. 7)......78,770,838...84,842,163 24.02 Reinsurance in unauthorized and certified (...0) companies......0...0 24.03 Funds held under reinsurance treaties with unauthorized and certified (...0) reinsurers......0...0 24.04 Payable to parent, subsidiaries and affiliates......25,288,826...0 24.05 Drafts outstanding......0...0 24.06 Liability for amounts held under uninsured plans......0...0 24.07 Funds held under coinsurance......2,941,283,061...0 24.08 Derivatives......3,785,277...7,588,814 24.09 Payable for securities......516,353...88,486 24.10 Payable for securities lending......0...0 24.11 Capital notes...0 and interest thereon...0......0...0 25. Aggregate write-ins for liabilities......79,625,567...59,281,844 26. Total liabilities excluding Separate Accounts business (Lines 1 to 25)......6,656,099,833...6,897,120,695 27. From Separate Accounts Statement......714,621,444...771,668,635 28. Total liabilities (Line 26 and 27)......7,370,721,277...7,668,789,330 29. Common capital stock......2,500,000...2,500,000 30. Preferred capital stock......0...0 31. Aggregate write-ins for other than special surplus funds......0...0 32. Surplus notes......190,330,000...200,000,000 33. Gross paid in and contributed surplus (Page 3, Line 33, Col. 2 plus Page 4, Line 51.1, Col. 1)......351,091,928...194,091,928 34. Aggregate write-ins for special surplus funds......6,763,061...6,741,115 35. Unassigned funds (surplus)......1,227,321,915...1,137,822,392 36. Less treasury stock, at cost: 36.1...0.000 shares common (value included in Line 29...0)......0...0 36.2...0.000 shares preferred (value included in Line 30...0)......0...0 37. Surplus (Total Lines 31 + 32 + 33 + 34 + 35-36) (including...6,088,394 in Separate Accounts Statement)......1,775,506,904...1,538,655,435 38. Totals of Lines 29, 30 and 37 (Page 4, Line 55)......1,778,006,904...1,541,155,435 39. Totals of Lines 28 and 38 (Page 2, Line 28, Col. 3)......9,148,728,181...9,209,944,765 DETAILS OF WRITE-INS 2501. Liability for pension and postretirement unfunded benefits......29,593,743...34,129,326 2502. Low income housing tax credits......15,869,908...2,791,084 2503. Reinsurance reserve adjustment......5,709,278...12,024,533 2598. Summary of remaining write-ins for Line 25 from overflow page......28,452,638...10,336,901 2599. Totals (Lines 2501 thru 2503 plus 2598) (Line 25 above)......79,625,567...59,281,844 3101.......0...0 3102.......0...0 3103.......0...0 3198. Summary of remaining write-ins for Line 31 from overflow page......0...0 3199. Totals (Lines 3101 thru 3103 plus 3198) (Line 31 above)......0...0 3401. Separate account annuity mortality fluctuation fund......6,088,394...6,057,777 3402. Permanent surplus (Guaranty Fund)......500,000...500,000 3403. Separate account special contingency fund......174,667...183,338 3498. Summary of remaining write-ins for Line 34 from overflow page......0...0 3499. Totals (Lines 3401 thru 3403 plus 3498) (Line 34 above)......6,763,061...6,741,115 3
SUMMARY OF OPERATIONS 1 2 Current Year Prior Year 1. Premiums and annuity considerations for life and accident and health contracts (Exhibit 1, Part 1, Line 20.4, Col. 1, less Col. 11)...(2,918,970,314)...411,816,955 2. Considerations for supplementary contracts with life contingencies......1,023,679...1,631,884 3. Net investment income (Exhibit of Net Investment Income, Line 17)......326,613,374...395,163,979 4. Amortization of Interest Maintenance Reserve (IMR) (Line 5)......5,961,182...5,086,858 5. Separate Accounts net gain from operations excluding unrealized gains or losses......520,989...1,895,920 6. Commissions and expense allowances on reinsurance ceded (Exhibit 1, Part 2, Line 26.1, Col. 1)......57,911,691...11,487,308 7. Reserve adjustments on reinsurance ceded......(7,006,188)...(9,082,039) 8. Miscellaneous Income: 8.1 Income from fees associated with investment management, administration and contract guarantees from Separate Accounts...21,231,595...22,286,769 8.2 Charges and fees for deposit-type contracts......0...0 8.3 Aggregate write-ins for miscellaneous income......2,094,021...(1,785,181) 9. Totals (Lines 1 to 8.3)......(2,510,619,971)...838,502,453 10. Death benefits......91,187,335...214,163,632 11. Matured endowments (excluding guaranteed annual pure endowments)......4,757,513...5,528,771 12. Annuity benefits (Exhibit 8, Part 2, Line 6.4, Cols. 4 + 8)......37,256,211...42,411,800 13. Disability benefits and benefits under accident and health contracts......20,427,356...21,472,801 14. Coupons, guaranteed annual pure endowments and similar benefits......0...0 15. Surrender benefits and withdrawals for life contracts......187,065,785...282,894,062 16. Group conversions......0...0 17. Interest and adjustments on contract or deposit-type contract funds......(90,922,545)...9,804,796 18. Payments on supplementary contracts with life contingencies......4,031,990...4,168,626 19. Increase in aggregate reserves for life and accident and health contracts......(2,963,961,433)...(12,350,186) 20. Totals (Lines 10 to 19)......(2,710,157,788)...568,094,302 21. Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only) (Exhibit 1, Part 2, Line 31, Col. 1)......53,102,284...48,913,774 22. Commissions and expense allowances on reinsurance assumed (Exhibit 1, Part 2, Line 26.2, Col. 1)......1,159...1,707 23. General insurance expenses (Exhibit 2, Line 10, Columns 1, 2, 3 and 4)......166,438,179...173,574,469 24. Insurance taxes, licenses and fees, excluding federal income taxes (Exhibit 3, Line 7, Cols. 1 + 2 + 3)......10,826,730...12,537,269 25. Increase in loading on deferred and uncollected premiums......(2,728,826)...(237,448) 26. Net transfers to or (from) Separate Accounts net of reinsurance......(26,830,814)...(22,966,937) 27. Aggregate write-ins for deductions......37,103,150...2,963,103 28. Totals (Lines 20 to 27)......(2,472,245,925)...782,880,239 29. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 28)......(38,374,046)...55,622,213 30. Dividends to policyholders......(23,176,300)...73,816,878 31. Net gain from operations after dividends to policyholders and before federal income taxes (Line 29 minus Line 30)......(15,197,745)...(18,194,665) 32. Federal and foreign income taxes incurred (excluding tax on capital gains)......(53,511,509)...(50,381,003) 33. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line 31 minus Line 32)......38,313,764...32,186,338 34. Net realized capital gains (losses) (excluding gains (losses) transferred to the IMR) less capital gains tax of...13,171,155 (excluding taxes of...1,273,151 transferred to the IMR)......(26,304,961)...(13,107,389) 35. Net income (Line 33 plus Line 34)......12,008,803...19,078,949 CAPITAL AND SURPLUS ACCOUNT 36. Capital and surplus, December 31, prior year (Page 3, Line 38, Col. 2)......1,541,155,435...1,413,144,257 37. Net income (Line 35)......12,008,803...19,078,949 38. Change in net unrealized capital gains (losses) less capital gains tax of...0......16,934,729...61,657,715 39. Change in net unrealized foreign exchange capital gain (loss)......0...0 40. Change in net deferred income tax......(9,962,088)...7,102,947 41. Change in nonadmitted assets......(26,967,410)...(9,421,089) 42. Change in liability for reinsurance in unauthorized and certified companies......0...0 43. Change in reserve on account of change in valuation basis, (increase) or decrease......0...0 44. Change in asset valuation reserve......6,071,325...(3,197,412) 45. Change in treasury stock, (Page 3, Lines 36.1 and 36.2 Col. 2 minus Col. 1)......0...0 46. Surplus (contributed to) withdrawn from Separate Accounts during period......0...0 47. Other changes in surplus in Separate Accounts Statement......(490,372)...(1,383,274) 48. Change in surplus notes......(9,670,000)...0 49. Cumulative effect of changes in accounting principles......0...0 50. Capital changes: 50.1 Paid in......0...0 50.2 Transferred from surplus (Stock Dividend)......0...0 50.3 Transferred to surplus......0...0 51. Surplus adjustment: 51.1 Paid in......157,000,000...67,115,572 51.2 Transferred to capital (Stock Dividend)......0...0 51.3 Transferred from capital......0...0 51.4 Change in surplus as a result of reinsurance......0...0 52. Dividends to stockholders......0...0 53. Aggregate write-ins for gains and losses in surplus......91,926,482...(12,942,230) 54. Net change in capital and surplus for the year (Lines 37 through 53)......236,851,470...128,011,178 55. Capital and surplus, December 31, current year (Lines 36 + 54) (Page 3, Line 38)......1,778,006,904...1,541,155,435 DETAILS OF WRITE-INS 08.301. Miscellaneous income......22,253,364...20,386,100 08.302. Change in corporate owned life insurance......8,979,441...8,341,615 08.303. MODCO interest......(29,138,785)...(30,512,896) 08.398. Summary of remaining write-ins for Line 8.3 from overflow page......0...0 08.399. Totals (Lines 08.301 thru 08.303 plus 08.398) (Line 8.3 above)......2,094,021...(1,785,181) 2701. Funds withheld expense......73,777,578...0 2702. Change in agents deferred comp......3,031,281...2,967,787 2703. Fines and penalties......22,315...0 2798. Summary of remaining write-ins for Line 27 from overflow page......(39,728,023)...(4,684) 2799. Totals (Lines 2701 thru 2703 plus 2798) (Line 27 above)......37,103,150...2,963,103 5301. Ceding commission......87,390,899...0 5302. Change in liability for pension and postretirement unfunded benefits......4,535,583...(12,942,230) 5303.......0...0 5398. Summary of remaining write-ins for Line 53 from overflow page......0...0 5399. Totals (Lines 5301 thru 5303 plus 5398) (Line 53 above)......91,926,482...(12,942,230) 4
CASH FROM OPERATIONS CASH FLOW 1 2 Current Year Prior Year 1. Premiums collected net of reinsurance......408,213,970...416,135,269 2. Net investment income......351,457,999...408,595,432 3. Miscellaneous income......161,622,018...23,491,120 4. Total (Lines 1 through 3)......921,293,987...848,221,820 5. Benefit and loss related payments......503,157,896...584,291,007 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts......(28,221,517)...(24,212,491) 7. Commissions, expenses paid and aggregate write-ins for deductions......224,805,580...217,096,279 8. Dividends paid to policyholders......74,362,029...80,513,537 9. Federal and foreign income taxes paid (recovered) net of...13,171,155 tax on capital gains (losses)......(48,990,092)...(49,518,390) 10. Total (Lines 5 through 9)......725,113,896...808,169,942 11. Net cash from operations (Line 4 minus Line 10)......196,180,091...40,051,878 CASH FROM INVESTMENTS 12. Proceeds from investments sold, matured or repaid: 12.1 Bonds......650,465,161...988,720,218 12.2 Stocks......9,304,429...10,466,961 12.3 Mortgage loans......80,618,744...99,564,674 12.4 Real estate......6,584,605...475,000 12.5 Other invested assets......101,897,496...64,616,278 12.6 Net gains or (losses) on cash, cash equivalents and short-term investments......14...0 12.7 Miscellaneous proceeds......439,711...0 12.8 Total investment proceeds (Lines 12.1 to 12.7)......849,310,161...1,163,843,131 13. Cost of investments acquired (long-term only): 13.1 Bonds......792,085,259...975,412,542 13.2 Stocks......30,400,714...7,413,199 13.3 Mortgage loans......112,350,000...18,157,697 13.4 Real estate......1,671,016...2,593,862 13.5 Other invested assets......106,075,443...127,892,638 13.6 Miscellaneous applications......9,579,757...5,678,775 13.7 Total investments acquired (Lines 13.1 to 13.6)......1,052,162,189...1,137,148,713 14. Net increase (decrease) in contract loans and premium notes......(12,864,624)...(12,783,870) 15. Net cash from investments (Line 12.8 minus Lines 13.7 minus Line 14)......(189,987,405)...39,478,288 16. Cash provided (applied): CASH FROM FINANCING AND MISCELLANEOUS SOURCES 16.1 Surplus notes, capital notes......(15,079,113)...0 16.2 Capital and paid in surplus, less treasury stock......109,000,000...0 16.3 Borrowed funds......0...0 16.4 Net deposits on deposit-type contracts and other insurance liabilities......(27,308,299)...(404,907) 16.5 Dividends to stockholders......0...0 16.6 Other cash provided (applied)......(38,618,890)...(50,616,085) 17. Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6)......27,993,697...(51,020,992) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 18. Net change in cash, cash equivalents and short-term investments (Line 11 plus Line 15 plus Line 17)......34,186,384...28,509,175 19. Cash, cash equivalents and short-term investments: 19.1 Beginning of year......91,237,544...62,728,369 19.2 End of year (Line 18 plus Line 19.1)......125,423,928...91,237,544 Note: Supplemental disclosures of cash flow information for non-cash transactions: 20.0001 Affiliated noncash reinsurance transaction - Operating......3,124,001,480...0 20.0002 Capital Contribution to subsidiary, LSW - cash settled in February - Operating......(18,000,000)...0 20.0003 Real estate acquired in satisfaction of debt - Investing......2,301,912...0 20.0004 Bonds transferred to affiliate as part of initial reinsurance transaction - Investing......(279,961,439)...0 20.0005 Capital Contribution from parent, NLVF - cash settled in February - Financing......18,000,000...0 20.0006 Affiliated noncash reinsurance transaction - Financing......(2,844,040,041)...0 20.0007 Surplus note acquired from parent as a capital contribution - Financing......30,000,000...0 5
6 Annual Statement for the year 2015 of the ANALYSIS OF OPERATIONS BY LINES OF BUSINESS 1 2 Ordinary 6 Group Accident and Health 12 3 4 5 Credit Life 7 8 9 10 11 Aggregate of Industrial Life Individual Supplementary (Group and Life Credit (Group All Other Lines Total Life Insurance Annuities Contracts Individual) Insurance(a) Annuities Group and Individual) Other of Business 1. Premiums and annuity considerations for life and accident and health contracts.....(2,918,970,314)...0 (2,870,754,450)...(69,850,757)...0...0...0...16,668,733...0...0...4,966,160...0 2. Considerations for supplementary contracts with life contingencies......1,023,679...0...0...0...1,023,679...0...0...0...0...0...0...0 3. Net investment income......326,613,374...0...235,161,629...40,500,058...8,165,334...0...0...6,532,267...0...0...36,254,085...0 4. Amortization of Interest Maintenance Reserve (IMR)......5,961,182...0...4,292,051...739,187...149,030...0...0...119,224...0...0...661,691...0 5. Separate Accounts net gain from operations excluding unrealized gains or losses......520,989...0...0...520,989...0...0...0...0...0...0...0...0 6. Commissions and expense allowances on reinsurance ceded......57,911,691...0...53,098,233...(12,320)...0...0...0...0...0...0...4,825,779...0 7. Reserve adjustments on reinsurance ceded......(7,006,188)...0...11,106...(636,251)...0...0...0...0...0...0...(6,381,043)...0 8. Miscellaneous Income: 8.1 Fees associated with income from investment management, administration and contract guarantees from S/A......21,231,595...0...18,372,172...2,859,424...0...0...0...0...0...0...0...0 8.2 Charges and fees for deposit-type contracts......0...0...0...0...0...0...0...0...0...0...0...0 8.3 Aggregate write-ins for miscellaneous income......2,094,021...0...23,973,781...2,781,695...556,334...0...0...445,067...0...0...(25,662,857)...0 9. Totals (Lines 1 to 8.3).....(2,510,619,971)...0 (2,535,845,478)...(23,097,976)...9,894,377...0...0...23,765,292...0...0...14,663,815...0 10. Death benefits......91,187,335...0...91,187,335...0...0...0...0...0...0...0...0...0 11. Matured endowments (excluding guaranteed annual pure endowments)......4,757,513...0...4,757,513...0...0...0...0...0...0...0...0...0 12. Annuity benefits......37,256,212...0...0...23,973,655...0...0...0...13,282,557...0...0...0...0 13. Disability benefits and benefits under accident and health contracts......20,427,356...0...6,157,695...0...0...0...0...0...0...0...14,269,662...0 14. Coupons, guaranteed annual pure endowments and similar benefits......0...0...0...0...0...0...0...0...0...0...0...0 15. Surrender benefits and withdrawals for life contracts......187,065,784...0...115,333,050...71,420,472...0...0...0...312,262...0...0...0...0 16. Group conversions......0...0...0...0...0...0...0...0...0...0...0...0 17. Interest and adjustments on contract or deposit-type contract funds......(90,922,545)...0...(94,608,772)...3,686,227...0...0...0...0...0...0...0...0 18. Payments on supplementary contracts with life contingencies......4,031,990...0...0...0...4,031,990...0...0...0...0...0...0...0 19. Increase in aggregate reserves for life and accident and health contracts.....(2,963,961,433)...0 (2,847,116,382)...(113,977,892)...(1,829,852)...0...0...7,121,787...0...0...(8,159,094)...0 20. Totals (Lines 10 to 19).....(2,710,157,788)...0 (2,724,289,561)...(14,897,538)...2,202,138...0...0...20,716,606...0...0...6,110,568...0 21. Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only)......53,102,284...0...51,004,254...1,302,653...0...0...0...4,666...0...0...790,711...0 22. Commissions and expense allowances on reinsurance assumed......1,159...0...1,159...0...0...0...0...0...0...0...0...0 23. General insurance expenses......166,438,179...0...156,113,108...54,292...5,574,904...0...0...4,459,923...0...0...235,952...0 24. Insurance taxes, licenses and fees, excluding federal income taxes......10,826,730...0...10,356,650...259,083...0...0...0...(61,826)...0...0...272,823...0 25. Increase in loading on deferred and uncollected premiums......(2,728,826)...0...(2,728,826)...0...0...0...0...0...0...0...0...0 26. Net transfers to or (from) Separate Accounts net of reinsurance......(26,830,814)...0...(2,267,832)...(23,812,982)...0...0...0...(750,000)...0...0...0...0 27. Aggregate write-ins for deductions......37,103,150...0...35,282,969...1,820,181...0...0...0...0...0...0...0...0 28. Totals (Lines 20 to 27).....(2,472,245,925)...0 (2,476,528,078)...(35,274,312)...7,777,042...0...0...24,369,369...0...0...7,410,054...0 29. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 28)......(38,374,046)...0...(59,317,400)...12,176,336...2,117,335...0...0...(604,078)...0...0...7,253,761...0 30. Dividends to policyholders......(23,176,300)...0...(23,264,910)...28,509...60,101...0...0...0...0...0...0...0 31. Net gain from operations after dividends to policyholders and before federal income taxes (Line 29 minus Line 30)......(15,197,745)...0...(36,052,490)...12,147,828...2,057,234...0...0...(604,078)...0...0...7,253,761...0 32. Federal income taxes incurred (excluding tax on capital gains)......(53,511,509)...0...(60,810,670)...4,251,740...720,032...0...0...(211,427)...0...0...2,538,816...0 33. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line 31 minus Line 32)......38,313,764...0...24,758,180...7,896,088...1,337,202...0...0...(392,651)...0...0...4,714,944...0 DETAILS OF WRITE-INS 08.301. Miscellaneous income......22,253,364...0...16,022,422...2,759,417...556,334...0...0...445,067...0...0...2,470,123...0 08.302. Change in COLI......8,979,441...0...8,979,441...0...0...0...0...0...0...0...0...0 08.303. MODCO interest......(29,138,785)...0...(1,028,082)...22,278...0...0...0...0...0...0...(28,132,980)...0 08.398. Summary of remaining write-ins for Line 8.3 from overflow page......0...0...0...0...0...0...0...0...0...0...0...0 08.399. Total (Lines 08.301 thru 08.303 plus 08.398) (Line 8.3 above)......2,094,021...0...23,973,781...2,781,695...556,334...0...0...445,067...0...0...(25,662,857)...0 2701. IMR transferred to reinsurer......(39,714,276)...0...(39,572,341)...(141,935)...0...0...0...0...0...0...0...0 2702. Changes in agents deferred comp......3,031,281...0...3,031,281...0...0...0...0...0...0...0...0...0 2703. Fines and penalties......22,315...0...22,315...0...0...0...0...0...0...0...0...0 2798. Summary of remaining write-ins for Line 27 from overflow page......73,763,831...0...71,801,714...1,962,117...0...0...0...0...0...0...0...0 2799. Total (Lines 2701 thru 2703 plus 2798) (Line 27 above)......37,103,150...0...35,282,969...1,820,181...0...0...0...0...0...0...0...0 (a) Includes the following amounts for FEGLI/SGLI: Line 1...0 Line 10...0 Line 16...0 Line 23...0 Line 24...0.
Involving Life or Disability Contingencies (Reserves) (Net of Reinsurance Ceded) ANALYSIS OF INCREASE IN RESERVES DURING THE YEAR 1 2 Ordinary 6 Group 3 4 5 Credit Life 7 8 Industrial Supplementary (Group and Total Life Life Insurance Individual Annuities Contracts Individual) Life Insurance Annuities 1. Reserve December 31, prior year......5,605,424,597...0...4,678,433,833...793,610,423...30,947,698...0...0...102,432,644 2. Tabular net premiums or considerations......314,220,552...0...273,373,425...24,338,203...1,019,467...0...0...15,489,457 3. Present value of disability claims incurred......0...0 -... -......XXX......0...0...0 4. Tabular interest......168,403,479...0...133,154,862...29,771,422...3,821,993...0...0...1,655,202 5. Tabular less actual reserve released......(2,915,545)...0 -......(450,895)...(2,464,650)...0...0...0 6. Increase in reserve on account of change in valuation basis......0...0 -... -......0...0...0...0 7. Other increases (net)......(2,998,570,699)...0...(2,907,427,595)...(91,143,637)...0...0...0...533 8. Totals (Lines 1 to 7)......3,086,562,384...0...2,177,534,525...756,125,516...33,324,508...0...0...119,577,836 7 9. Tabular cost......146,312,304...0...146,312,304...0...xxx......0...0...0 10. Reserves released by death......40,492,483...0...40,492,483...xxx......xxx......0...0...xxx... 11. Reserves released by other terminations (net)......252,661,974...0...159,678,166...93,707,246...0...0...0...(723,438) 12. Annuity, supplementary contract, and disability payments involving life contingencies......23,860,718...0...0...6,371,501...4,206,660...0...0...13,282,557 13. Net transfers to or (from) Separate Accounts......(26,371,007)...0...(249,531)...(23,585,762)...0...0...0...(2,535,714) 14. Total deductions (Lines 9 to 13)......436,956,472...0...346,233,422...76,492,985...4,206,660...0...0...10,023,405 15. Reserve December 31, current year......2,649,605,912...0...1,831,301,103...679,632,531...29,117,848...0...0...109,554,431
EXHIBIT OF NET INVESTMENT INCOME 1 2 Collected Earned During Year During Year 1. U.S. government bonds... (a)...11,513,353...11,295,769 1.1 Bonds exempt from U.S. tax... (a)...0...0 1.2 Other bonds (unaffiliated)... (a)...272,182,477...271,802,133 1.3 Bonds of affiliates... (a)...491,508...491,508 2.1 Preferred stocks (unaffiliated)... (b)...0...0 2.11 Preferred stocks of affiliates... (b)...0...0 2.2 Common stocks (unaffiliated)......1,491,271...1,491,271 2.21 Common stocks of affiliates......0...0 3. Mortgage loans... (c)...33,818,042...33,818,042 4. Real estate... (d)...14,331,877...14,331,877 5. Contract loans......29,233,518...28,669,589 6. Cash, cash equivalents and short-term investments... (e)...14,426...14,495 7. Derivative instruments... (f)...(9,134,307)...(10,331,349) 8. Other invested assets......27,987,057...28,818,322 9. Aggregate write-ins for investment income......389,599...389,599 10. Total gross investment income......382,318,821...380,791,256 11. Investment expenses... (g)...15,587,090 12. Investment taxes, licenses and fees, excluding federal income taxes... (g)...2,382,948 13. Interest expense... (h)...21,000,000 14. Depreciation on real estate and other invested assets... (i)...15,207,846 15. Aggregate write-ins for deductions from investment income......0 16. Total deductions (Lines 11 through 15)......54,177,884 17. Net investment income (Line 10 minus Line 16)......326,613,372 DETAILS OF WRITE-INS 0901. Investment services between affiliates......168,999...168,999 0902. Miscellaneous investment income......220,600...220,600 0903.......0...0 0998. Summary of remaining write-ins for Line 9 from overflow page......0...0 0999. Totals (Lines 0901 thru 0903 plus 0998) (Line 9 above)......389,599...389,599 1501.......0 1502.......0 1503.......0 1598. Summary of remaining write-ins for Line 15 from overflow page......0 1599. Totals (Lines 1501 thru 1503 plus 1598) (Line 15 above)......0 (a) Includes...16,585,642 accrual of discount less...11,334,066 amortization of premium and less...3,936,685 paid for accrued interest on purchases. (b) Includes...0 accrual of discount less...0 amortization of premium and less...0 paid for accrued dividends on purchases. (c) Includes...0 accrual of discount less...0 amortization of premium and less...0 paid for accrued interest on purchases. (d) Includes...5,955,438 for company's occupancy of its own buildings; and excludes...0 interest on encumbrances. (e) Includes...0 accrual of discount less...0 amortization of premium and less...0 paid for accrued interest on purchases. (f) Includes...0 accrual of discount less...0 amortization of premium. (g) Includes...0 investment expenses and...0 investment taxes, licenses and fees, excluding federal income taxes, attributable to Segregated and Separate Accounts. (h) Includes...21,000,000 interest on surplus notes and...0 interest on capital notes. (i) Includes...3,144,169 depreciation on real estate and...12,063,677 depreciation on other invested assets. EXHIBIT OF CAPITAL GAINS (LOSSES) 1 2 3 4 5 Realized Change in Gain (Loss) Other Total Realized Change in Unrealized on Sales Realized Capital Gain (Loss) Unrealized Foreign Exchange or Maturity Adjustments (Columns 1 + 2) Capital Gain (Loss) Capital Gain (Loss) 1. U.S. government bonds......0...0...0...0...0 1.1 Bonds exempt from U.S. tax......0...0...0...0...0 1.2 Other bonds (unaffiliated)......5,689,194...(7,219,298)...(1,530,104)...5,613,326...0 1.3 Bonds of affiliates......0...0...0...0...0 2.1 Preferred stocks (unaffiliated)......0...0...0...0...0 2.11 Preferred stocks of affiliates......0...0...0...0...0 2.2 Common stocks (unaffiliated)......(36,714)...0...(36,714)...(1,276,986)...0 2.21 Common stocks of affiliates......0...0...0...33,910,032...0 3. Mortgage loans......(45,999)...0...(45,999)...0...0 4. Real estate......675,605...(1,130,000)...(454,395)...0...0 5. Contract loans......0...0...0...0...0 6. Cash, cash equivalents and short-term investments......14...0...14...0...0 7. Derivative instruments......0...0...0...0...0 8. Other invested assets......(330,044)...(1,689,893)...(2,019,937)...(21,311,642)...0 9. Aggregate write-ins for capital gains (losses)......(5,409,113)...0...(5,409,113)...0...0 10. Total capital gains (losses)......542,943...(10,039,191)...(9,496,248)...16,934,730...0 DETAILS OF WRITE-INS 0901. Loss on Redemption of Surplus Notes......(5,409,113)...0...(5,409,113)...0...0 0902.......0...0...0...0...0 0903.......0...0...0...0...0 0998. Summary of remaining write-ins for Line 9 from overflow page.....0...0...0...0...0 0999. Totals (Lines 0901 thru 0903 plus 0998) (Line 9 above)......(5,409,113)...0...(5,409,113)...0...0 8
9 Annual Statement for the year 2015 of the EXHIBIT 1 - PART 1 - PREMIUMS AND ANNUITY CONSIDERATIONS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS 1 2 Ordinary 5 Group Accident and Health 11 3 4 Credit Life 6 7 8 9 10 Aggregate of Industrial Individual (Group and Credit All Other Lines Total Life Life Insurance Annuities Individual) Life Insurance Annuities Group (Group & Individual) Other of Business FIRST YEAR (other than single) 1. Uncollected......1,078,547...0...1,078,252...0...0...0...0...0...0...295...0 2. Deferred and accrued......3,781,372...0...3,781,372...0...0...0...0...0...0...0...0 3. Deferred, accrued and uncollected: 3.1 Direct......4,861,099...0...4,859,623...0...0...0...0...0...0...1,476...0 3.2 Reinsurance assumed......0...0...0...0...0...0...0...0...0...0...0 3.3 Reinsurance ceded......1,181...0...0...0...0...0...0...0...0...1,181...0 3.4 Net (Line 1 + Line 2)......4,859,919...0...4,859,623...0...0...0...0...0...0...295...0 4. Advance......52,756...0...52,756...0...0...0...0...0...0...0...0 5. Line 3.4 - Line 4......4,807,162...0...4,806,867...0...0...0...0...0...0...295...0 6. Collected during year: 6.1 Direct......45,134,541...0...41,101,457...3,821,730...0...0...0...0...0...211,354...0 6.2 Reinsurance assumed......(113)...0...(113)...0...0...0...0...0...0...0...0 6.3 Reinsurance ceded......798,022...0...624,174...4,804...0...0...0...0...0...169,044...0 6.4 Net......44,336,406...0...40,477,170...3,816,926...0...0...0...0...0...42,310...0 7. Line 5 + Line 6.4......49,143,569...0...45,284,037...3,816,926...0...0...0...0...0...42,605...0 8. Prior year (uncollected + deferred and accrued - advance).....3,814,118...0...3,813,283...0...0...0...0...0...0...835...0 9. First year premiums and considerations: 9.1 Direct......46,125,427...0...42,095,042...3,821,730...0...0...0...0...0...208,655...0 9.2 Reinsurance assumed......(113)...0...(113)...0...0...0...0...0...0...0...0 9.3 Reinsurance ceded......795,863...0...624,174...4,804...0...0...0...0...0...166,885...0 9.4 Net (Line 7 - Line 8)......45,329,451...0...41,470,755...3,816,926...0...0...0...0...0...41,770...0 SINGLE 10. Single premiums and considerations: 10.1 Direct......92,124,267...0...85,583,362...6,447,587...0...0...93,318...0...0...0...0 10.2 Reinsurance assumed......0...0...0...0...0...0...0...0...0...0...0 10.3 Reinsurance ceded......27,977,259...0...27,977,201...57...0...0...0...0...0...0...0 10.4 Net......64,147,008...0...57,606,161...6,447,530...0...0...93,318...0...0...0...0 RENEWAL 11. Uncollected......10,606,248...0...10,478,850...0...0...0...0...0...0...127,398...0 12. Deferred and accrued......22,726,290...0...22,726,290...0...0...0...0...0...0...0...0 13. Deferred, accrued and uncollected: 13.1 Direct......51,916,688...0...51,332,615...0...0...0...0...0...0...584,073...0 13.2 Reinsurance assumed......23,560...0...23,560...0...0...0...0...0...0...0...0 13.3 Reinsurance ceded......18,607,710...0...18,151,035...0...0...0...0...0...0...456,675...0 13.4 Net (Line 11 + Line 12)......33,332,539...0...33,205,140...0...0...0...0...0...0...127,398...0 14. Advance......994,152...0...832,472...0...0...0...0...0...0...161,680...0 15. Line 13.4 - Line 14......32,338,387...0...32,372,668...0...0...0...0...0...0...(34,281)...0 16. Collected during year: 16.1 Direct......349,021,498...0...292,280,155...15,170,452...0...0...16,575,415...0...0...24,995,476...0 16.2 Reinsurance assumed......1,049,437...0...1,049,437...0...0...0...0...0...0...0...0 16.3 Reinsurance ceded......3,359,020,944...0...3,243,649,212...95,285,665...0...0...0...0...0...20,086,067...0 16.4 Net......(3,008,950,008)...0...(2,950,319,620)...(80,115,213)...0...0...16,575,415...0...0...4,909,409...0 17. Line 15 + Line 16.4......(2,976,611,622)...0...(2,917,946,952)...(80,115,213)...0...0...16,575,415...0...0...4,875,127...0 18. Prior year (uncollected + deferred and accrued - advance).....51,835,151...0...51,884,414...0...0...0...0...0...0...(49,263)...0 19. Renewal premiums and considerations: 19.1 Direct......346,745,409...0...289,938,334...15,170,452...0...0...16,575,415...0...0...25,061,208...0 19.2 Reinsurance assumed......1,072,997...0...1,072,997...0...0...0...0...0...0...0...0 19.3 Reinsurance ceded......3,376,265,180...0...3,260,842,697...95,285,665...0...0...0...0...0...20,136,818...0 19.4 Net (Line 17 - Line 18)......(3,028,446,773)...0...(2,969,831,365)...(80,115,213)...0...0...16,575,415...0...0...4,924,390...0 TOTAL 20. Total premiums and annuity considerations: 20.1 Direct......484,995,103...0...417,616,737...25,439,769...0...0...16,668,733...0...0...25,269,863...0 20.2 Reinsurance assumed......1,072,884...0...1,072,884...0...0...0...0...0...0...0...0 20.3 Reinsurance ceded......3,405,038,301...0...3,289,444,072...95,290,526...0...0...0...0...0...20,303,703...0 20.4 Net (Lines 9.4 + 10.4 + 19.4)......(2,918,970,314)...0...(2,870,754,450)...(69,850,757)...0...0...16,668,733...0...0...4,966,160...0
DIVIDENDS AND COUPONS APPLIED (included in Part 1) EXHIBIT 1 - PART 2 - DIVIDENDS AND COUPONS APPLIED, REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES AND COMMISSIONS INCURRED (direct business only) 1 2 Ordinary 5 Group Accident and Health 11 3 4 Credit Life 6 7 8 9 10 Aggregate of Industrial Individual (Group and Credit All Other Lines Total Life Life Insurance Annuities Individual) Life Insurance Annuities Group (Group & Individual) Other of Business 21. To pay renewal premiums......8,968,847...0...8,968,847...0...0...0...0...0...0...0...0 22. All other......15,833,921...0...15,469,705...364,216...0...0...0...0...0...0...0 REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES INCURRED 23. First year (other than single): 23.1 Reinsurance ceded......210,497...0...27,362...0...0...0...0...0...0...183,135...0 23.2 Reinsurance assumed......0...0...0...0...0...0...0...0...0...0...0 23.3 Net ceded less assumed......210,497...0...27,362...0...0...0...0...0...0...183,135...0 24. Single: 24.1 Reinsurance ceded......0...0...0...0...0...0...0...0...0...0...0 10 24.2 Reinsurance assumed......0...0...0...0...0...0...0...0...0...0...0 24.3 Net ceded less assumed......0...0...0...0...0...0...0...0...0...0...0 25. Renewal: 25.1 Reinsurance ceded......57,701,194...0...53,070,871...(12,320)...0...0...0...0...0...4,642,643...0 25.2 Reinsurance assumed......1,159...0...1,159...0...0...0...0...0...0...0...0 25.3 Net ceded less assumed......57,700,035...0...53,069,712...(12,320)...0...0...0...0...0...4,642,643...0 26. Totals: 26.1 Reinsurance ceded (Page 6, Line 6)......57,911,691...0...53,098,233...(12,320)...0...0...0...0...0...4,825,779...0 26.2 Reinsurance assumed (Page 6, Line 22)......1,159...0...1,159...0...0...0...0...0...0...0...0 26.3 Net ceded less assumed......57,910,532...0...53,097,074...(12,320)...0...0...0...0...0...4,825,779...0 COMMISSIONS INCURRED (direct business only) 27. First year (other than single)......39,147,508...0...38,552,030...499,416...0...0...0...0...0...96,062...0 28. Single......122,197...0...0...122,197...0...0...0...0...0...0...0 29. Renewal......13,832,579...0...12,452,224...681,040...0...0...4,666...0...0...694,649...0 30. Deposit-type contract funds......0...0...0...0...0...0...0...0...0...0...0 31. Totals (to agree with Page 6, Line 21)......53,102,284...0...51,004,254...1,302,653...0...0...4,666...0...0...790,711...0
EXHIBIT 2 - GENERAL EXPENSES Insurance 5 6 1 Accident and Health 4 2 3 All Other Lines Life Cost Containment All Other of Business Investment Total 1. Rent......6,734,601...0...0...0...0...6,734,601 2. Salaries and wages......68,811,858...0...147,331...0...0...68,959,189 3.11 Contributions for benefit plans for employees......21,310,521...0...45,627...0...0...21,356,149 3.12 Contributions for benefit plans for agents......4,637,771...0...0...0...0...4,637,771 3.21 Payments to employees under non-funded benefit plans......0...0...0...0...0...0 3.22 Payments to agents under non-funded benefit plans......3,690,133...0...0...0...0...3,690,133 3.31 Other employee welfare......(1,118,069)...0...0...0...0...(1,118,069) 3.32 Other agent welfare......(331,520)...0...0...0...0...(331,520) 4.1 Legal fees and expenses......792,587...0...0...0...0...792,587 4.2 Medical examination fees......6,489,614...0...0...0...0...6,489,614 4.3 Inspection report fees......11,790...0...0...0...0...11,790 4.4 Fees of public accountants and consulting actuaries......990,019...0...0...0...0...990,019 4.5 Expense of investigation and settlement of policy claims......174,028...0...0...0...0...174,028 5.1 Traveling expenses......2,948,005...0...0...0...0...2,948,005 5.2 Advertising......925,761...0...0...0...0...925,761 5.3 Postage, express, telegraph and telephone......2,458,446...0...5,264...0...0...2,463,710 5.4 Printing and stationery......3,120,614...0...6,681...0...0...3,127,295 5.5 Cost or depreciation of furniture and equipment......2,852,375...0...0...0...0...2,852,375 5.6 Rental of equipment......14,417,336...0...0...0...0...14,417,336 5.7 Cost or depreciation of EDP equipment and software......31,420,855...0...67,274...0...0...31,488,129 6.1 Books and periodicals......110,177...0...0...0...0...110,177 6.2 Bureau and association fees......628,600...0...0...0...0...628,600 6.3 Insurance, except on real estate......966,994...0...0...0...0...966,994 6.4 Miscellaneous losses......0...0...0...0...0...0 6.5 Collection and bank service charges......639,800...0...0...0...0...639,800 6.6 Sundry general expenses......(8,304,985)...0...(17,782)...0...0...(8,322,766) 6.7 Group service and administration fees......0...0...0...0...0...0 6.8 Reimbursements by uninsured plans......0...0...0...0...0...0 7.1 Agency expense allowance......18,010,509...0...0...0...0...18,010,509 7.2 Agents' balances charged off (less...0 recovered)......109,429...0...0...0...0...109,429 7.3 Agency conferences other than local meetings......2,784,735...0...0...0...0...2,784,735 9.1 Real estate expenses......(3,406,089)...0...0...0...0...(3,406,089) 9.2 Investment expenses not included elsewhere......0...0...0...0...15,587,090...15,587,090 9.3 Aggregate write-ins for expenses......(15,673,669)...0...(18,444)...0...0...(15,692,113) 10. General expenses Incurred......166,202,227...0...235,952...0...15,587,090 (a)...182,025,269 11. General expenses unpaid December 31, prior year......42,575,923...0...0...0...0...42,575,923 12. General expenses unpaid December 31, current year......49,486,264...0...0...0...0...49,486,264 13. Amounts receivable relating to uninsured plans, prior year......0...0...0...0...0...0 14. Amounts receivable relating to uninsured plans, current year......0...0...0...0...0...0 15. General expenses paid during year (Lines 10+11-12-13+14)......159,291,886...0...235,952...0...15,587,090...175,114,928 DETAILS OF WRITE-INS 09.301. Computer Services for LSW provided by NLIC......(32,138,695)...0...0...0...0...(32,138,695) 09.302. Investment Expenses Reclass to Investment Income......(4,286,000)...0...0...0...0...(4,286,000) 09.303. All Other......(6,618,915)...0...(18,444)...0...0...(6,637,359) 09.398. Summary of remaining write-ins for Line 9.3 from overflow page....27,369,941...0...0...0...0...27,369,941 09.399. Totals (Lines 09.301 thru 09.303 plus 09.398)(Line 9.3 above)......(15,673,669)...0...(18,444)...0...0...(15,692,113) (a) Includes management fees of...4,857,389 to affiliates and...0 to non-affiliates. EXHIBIT 3 - TAXES, LICENSES AND FEES (EXCLUDING FEDERAL INCOME TAXES) Insurance 4 5 1 2 3 Accident All Other Lines Life and Health of Business Investment Total 1. Real estate taxes......103,533...0...0...2,382,948...2,486,481 2. State insurance department licenses and fees......29,120...0...0...0...29,120 3. State taxes on premiums......3,757,060...272,823...0...0...4,029,883 4. Other state taxes, including...0 for employee benefits......1,486,911...0...0...0...1,486,911 5. U.S. Social Security taxes......5,753,113...0...0...0...5,753,113 6. All other taxes......(575,832)...0...0...0...(575,832) 7. Taxes, licenses and fees incurred......10,553,907...272,823...0...2,382,948...13,209,678 8. Taxes, licenses and fees unpaid December 31, prior year......2,151,863...0...0...0...2,151,863 9. Taxes, licenses and fees unpaid December 31, current year......1,609,429...0...0...0...1,609,429 10. Taxes, licenses and fees paid during year (Lines 7 + 8-9)......11,096,340...272,823...0...2,382,948...13,752,111 EXHIBIT 4 - DIVIDENDS OR REFUNDS 1 2 Life Accident and Health 1. Applied to pay renewal premiums......8,968,847...0 2. Applied to shorten the endowment or premium-paying period......0...0 3. Applied to provide paid-up additions......15,475,985...0 4. Applied to provide paid-up annuities......357,937...0 5. Total Lines 1 through 4......24,802,768...0 6. Paid-in cash......9,531,558...0 7. Left on deposit......2,859,043...0 8. Aggregate write-ins for dividend or refund options......0...0 9. Total Lines 5 through 8......37,193,369...0 10. Amount due and unpaid......1,808,036...0 11. Provision for dividends or refunds payable in the following calendar year......9,422,263...0 12. Terminal dividends......3,746,562...0 13. Provision for deferred dividend contracts......0...0 14. Amount provisionally held for deferred dividend contracts not included in Line 13......0...0 15. Total Lines 10 through 14......14,976,860...0 16. Total from prior year......78,475,191...0 17. Total dividends or refunds (Lines 9 + 15-16)......(26,304,961)...0 DETAILS OF WRITE-INS 0801.......0...0 0802.......0...0 0803.......0...0 0898. Summary of remaining write-ins for Line 8 from overflow page......0...0 0899. Totals (Line 0801 thru 0803 plus 0898) (Line 8 above)......0...0 11
Life Insurance: EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS 1 2 3 4 5 6 Credit (Group and Valuation Standard Total Industrial Ordinary Individual) Group 0100001. NLP AE 3% to 12/31/47......134,820...0...134,820...0...0 0100002. NLP 41 CSO 2.5% from 1/1/48-12/31/63......3,071,058...0...3,071,058...0...0 0100003. NLP 58 CSO 2.25% from 1/1/64......797,276...0...797,276...0...0 0100004. NLP 58 CSO 3%/20/2% from 1/1/66......7,553,240...0...7,553,240...0...0 0100005. NLP 58 CSO 3.5%/20/2.5% from 4/1/73......15,365,825...0...15,365,825...0...0 0100006. NLP 58 CSO 3.5% from 9/15/74......5,013,866...0...5,013,866...0...0 0100007. NLP 58 CSO 4% from 5/1/78......30,519,238...0...30,519,238...0...0 0100008. NLP 58 CSO 4%/20/2.5% from 1/1/80......13,333,243...0...13,333,243...0...0 0100009. NLP 58 CSO 4%/10/3% from 1/1/80......2,049,680...0...2,049,680...0...0 0100010. NLP 58 CSO 4.5% from 1/1/81......726,073,802...0...726,073,802...0...0 0100011. NLP 80 CSO 6% from 7/1/85......29,828,466...0...29,828,466...0...0 0100012. NLP 80 CSO 5.5% from 1/1/87......168,494,668...0...168,494,668...0...0 0100013. NLP 80 CSO 4% from 1/1/88......52,301,086...0...52,301,086...0...0 0100014. NLP 80 CSO 5% from 7/1/92......164,587,279...0...164,587,279...0...0 0100015. NLP 80 CSO 5%PP4% from 1/1/93......31...0...31...0...0 0100016. NLP 80 CSO 4.5%PP4% from 1/1/96......11,971...0...11,971...0...0 0100017. NLP 80 CSO 4.5% from 1/1/93......138,411,697...0...138,411,697...0...0 0100018. MOD 58 CSO 3.5%/20/2.5% from 1/1/74......2,973,103...0...2,973,103...0...0 0100019. MOD 58 CSO 3.5% from 9/15/74......4,406,868...0...4,406,868...0...0 0100020. MOD 58 CSO 4% from 5/1/78......18,685,334...0...18,685,334...0...0 0100021. MOD 58 CSO 4%/20/2.5% from 1/1/80......15,640,309...0...15,640,309...0...0 0100022. MOD 58 CSO 4%/10/3% from 1/1/80......114,864,820...0...114,864,820...0...0 0100023. MOD 58 CSO 4.5% from 1/1/80......126,771,719...0...126,771,719...0...0 0100024. CRVM 58 CSO 4.5% from 1/1/83......113,277,959...0...113,277,959...0...0 0100025. CRVM 80 CSO 4% from 1/1/88......174,385,292...0...174,385,292...0...0 0100026. CRVM 80 CSO 6% from 7/1/85......116,356,024...0...116,356,024...0...0 0100027. CRVM 80 CSO 5.5% from 1/1/87......579,670,475...0...579,670,475...0...0 0100028. CRVM 80 CSO 5% from 7/1/92......222,506,831...0...222,506,831...0...0 0100029. CRVM 80 CSO 5%PP4% from 1/1/93......8,604,788...0...8,604,788...0...0 0100030. CRVM 80 CSO 4.5%PP4% from 1/1/96......14,100,063...0...14,100,063...0...0 0100031. CRVM 80 CSO 4.5% from 1/1/93......547,849,765...0...547,849,765...0...0 0100032. NY 147 80 CSO 4.5% from 1/1/94......5,894,457...0...5,894,457...0...0 0100033. 1999 XXX 80 CSO 4.5% from 1/1/2000......58,993,936...0...58,993,936...0...0 0100034. NLP 2001 CSO 4% from 1/1/05......50,369,119...0...50,369,119...0...0 0100035. CRVM 2001 CSO 4% from 1/1/05......82,904,946...0...82,904,946...0...0 0100036. 1999 XXX 2001CSO 4.5% from 1/1/2005......11,339,687...0...11,339,687...0...0 0100037. 1999 XXX 2001CSO 4% from 1/1/2006......52,831,392...0...52,831,392...0...0 0100038. NLP 2001 CSO 3.5% from 1/1/13......17,165,007...0...17,165,007...0...0 0100039. CRVM 2001 CSO 3.5% from 1/1/13......13,945,764...0...13,945,764...0...0 0100040. 1999 XXX 2001CSO 3.5% from 1/1/2013......12,664,576...0...12,664,576...0...0 0100041. Universal Life CRVM 80 CSO 6% 86......8,339,525...0...8,339,525...0...0 0100042. Universal Life CRVM 80 CSO 5.5% 87-91......62,607,974...0...62,607,974...0...0 0100043. Universal Life CRVM 80 CSO 4.5% 92 -......9,516,827...0...9,516,827...0...0 0100044. Universal Life CRVM 80 CSO 4% 87 -......319,298,293...0...319,298,293...0...0 0100045. Universal Life FUND VALUE 87-92......2,109,349...0...2,109,349...0...0 0100046. Universal Life CRVM 58 CSO 4.5% 83-89......88,323,861...0...88,323,861...0...0 0100047. Universal Life CRVM 80 CSO 3.0% 04-......135,829,838...0...135,829,838...0...0 0100048. Universal Life CRVM 2001 CSO 2.0% 05-......15,985,293...0...15,985,293...0...0 0100049. Universal Life CRVM 2001 CSO 4.0% 06-......285,413,443...0...285,413,443...0...0 0100050. Universal Life CRVM 2001 CSO 3.0% 09-......120,308...0...120,308...0...0 0100051. Universal Life CRVM 2001 CSO 2.5% 11 -......196,300,236...0...196,300,236...0...0 0100052. Universal Life CRVM 2001 CSO 3.5% 13 -......9,685,041...0...9,685,041...0...0 0100053. Universal Life California Method......392,748...0...392,748...0...0 0100054. Reinsurance Assumed - Various Valuation Bases......1,671,156...0...1,671,156...0...0 0100055. Substandard Extra......22,065,778...0...22,065,778...0...0 0199997. Totals (Gross)......4,881,409,150...0...4,881,409,150...0...0 0199998. Reinsurance ceded......3,137,638,057...0...3,137,638,057...0...0 0199999. Totals (Net)......1,743,771,093...0...1,743,771,093...0...0 Annuities (excluding supplementary contracts with life contingencies): 0200001. A-1949 Projected Modified 3 1/2% I......1,500,919...XXX......1,500,919...XXX......0 0200002. Retirement Annuities 3% Various Tables * D......1,353,144...XXX......1,353,144...XXX......0 0200003. Retirement Annuities 2-3/4% 37 STD Ann * D......76...XXX......76...XXX......0 0200004. Retirement Annuities 2% 37 STD Ann * D......162,282...XXX......162,282...XXX......0 0200005. Retirement Annuities 6%(5)/3% Projected A-49 * D......35,504,128...XXX......35,504,128...XXX......0 0200006. Retirement Annuities 4 1/2% Projected A-49 * D......55,072,808...XXX......55,072,808...XXX......0 0200007. Company Retirement Plans; 4% 51 GA* B......105,827,100...XXX......0...XXX......105,827,100 0200008. Group Annuities 4.5% D......3,727,331...XXX......0...XXX......3,727,331 0200009. 83 IAM, 9% I......593,931...XXX......593,931...XXX......0 0200010. 83 IAM, 8 3/4% I......1,441,100...XXX......1,441,100...XXX......0 0200011. 83 IAM, 8 1/4% I......3,437,843...XXX......3,437,843...XXX......0 0200012. 83 IAM, 8% I......422,111...XXX......422,111...XXX......0 0200013. 83 IAM, 7 3/4% I......2,792,126...XXX......2,792,126...XXX......0 12