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NAIC BLANKS (E) WORKING GROUP Blanks Agenda Item Submission Form CONTACT PERSON: TELEPHONE: EMAIL ADDRESS: ON BEHALF OF: NAME: Joseph Fritsch DATE: 03/14/2011 FOR NAIC USE ONLY Agenda Item # 2011-33BWG MOD Year 2012 Changes to Existing Reporting [ X ] New Reporting Requirement [ ] REVIEWED FOR ACCOUNTING PRACTICES AND PROCEDURES IMPACT No Impact [ X ] Modifies Required Disclosure [ ] DISPOSITION TITLE: AFFILIATION: ADDRESS: Chair SAPWG New York Department of Insurance 25 Beaver St. New York, NY 10004-2319 [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ ] Received For Public Comment [ X ] Adopted Date 06/30/2011 [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify) BLANK(S) TO WHICH PROPOSAL APPLIES [ X ] ANNUAL STATEMENT [ X ] QUARTERLY STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] BLANK [ X ] Life and Accident & Health [ X ] Property/Casualty [ X ] Health [ X ] Separate Accounts [ X ] Fraternal [ X ] Title [ ] Other Specify Anticipated Effective Date: First Quarter 2012 IDENTIFICATION OF ITEM(S) TO CHANGE Add new Note 20D instruction and illustration to reflect changes adopted to SSAP No. 100, Fair Value Measurements. The illustration for 20D and 20E will be data captured. Add or modify electronic only columns to capture fair value hierarchy, method used to obtain fair value and source used to obtain fair value information for various investment schedules that capture fair value. REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is to reflect disclosure changes adopted for SSAP No. 100, Fair Value Measurements. NAIC STAFF COMMENTS Comment on Effective Reporting Date: First Quarter 2012 should not be a problem Other Comments: ** This section must be completed on all forms. Revised 6/13/2009 2010 National Association of Insurance Commissioners 419

ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS LIFE, HEALTH, PROPERTY, FRATERNAL & TITLE NOTES TO FINANCIAL STATEMENTS 20. Fair Value Measurements C. The reporting entity is encouraged, but not required, to combine the fair value information disclosed under SSAP No. 100, Fair Value Measurements, with the fair value information disclosed under other accounting pronouncements (for example, disclosures about fair value of financial instruments) in the periods in which those disclosures are required, if practicable. The reporting entity also is encouraged, but not required, to disclose information about other similar measurements, if practicable. D. A reporting entity shall disclose in the notes to the financial statements, as of each date for which a statement of financial position is presented in the quarterly or annual financial statements, the aggregate fair value for all financial instruments and the level within the fair value hierarchy in which the fair value measurements in their entirety fall. This disclosure shall be summarized by type of financial instrument, for which it is practicable to estimate fair value, except for certain financial instruments identified below. The disclosures about fair value prescribed in paragraph above are not required for the following (Note, these exclusions are specific to note 20D and do not impact the reporting of fair value that may be required in other SSAPs or statutory accounting schedules.): Employers' and plans' obligations for pension benefits, other postretirement benefits including health care and life insurance benefits, postemployment benefits, employee stock option and stock purchase plans, and other forms of deferred compensation arrangements, as defined in SSAP No. 12, Employee Stock Ownership Plans; SSAP No. 13, Stock Options and Stock Purchase Plans; SSAP No. 14, Postretirement Benefits Other Than Pensions; and SSAP No. 89, Accounting for Pensions, A Replacement of SSAP No. 8. Substantively extinguished debt subject to the disclosure requirements of SSAP No. 91R, Accounting for Transfer and Servicing of Financial Assets and Extinguishments of Liabilities. Insurance contracts, other than financial guarantees and deposit-type contracts Lease contracts as defined in SSAP No. 22, Leases. Warranty obligations and rights. Investments accounted for under the equity method. Equity instruments issued by the entity. Fair value disclosed in the notes shall be presented together with the related admitted values in a form that makes it clear whether the fair values and admitted values represent assets or liabilities and to which line items in the Statement of Assets, Liabilities, Surplus and Other Funds they relate. Unless specified otherwise in another SSAP, the disclosures may be made net of encumbrances, if the asset or liability is so reported. A reporting entity shall also disclose the method(s) and significant assumptions used to estimate the fair value of financial instruments. If it is not practicable for a reporting entity to estimate the fair value of the financial instrument or a class of financial instruments, the aggregate carrying amount for those items shall be reported in the not practicable column with additional disclosure as required in paragraph E below. 2010 National Association of Insurance Commissioners 420

DE. If it is not practicable for an entity to estimate the fair value of a financial instrument or a class of financial instruments, the following shall be disclosed: Illustration: (1) Information pertinent to estimating the fair value of that financial instrument or class of financial instruments, such as the carrying amount, effective interest rate, and maturity; and (2) The reasons why it is not practicable to estimate fair value. D. (1) Type of Financial Instrument (2) Aggregate Fair Value (3) Admitted Assets (4) (Level 1) (5) (Level 2) (6) (Level 3) (7) Not Practicalble (Carrying Value) Bonds $... $... $... $... $... $... Common Stock.................. Perpetual Preferred Stock.................. Mortgage Loans........................................................................................................................... NOTE: Description column shows examples of types of financial instruments that can be disclosed. E. Not Practicable to Estimate Fair Value (1) Type or Class of Financial Instrument (2) Carrying Value (3) Effective Interest Rate (4) Maturity Date (5) Explanation Bonds $... $......... Common Stock............ Perpetual Preferred Stock............ Mortgage Loans Description 1............ Description 2......................................................... NOTE: Description column shows examples of types or classes of financial instruments that can be disclosed. 2010 National Association of Insurance Commissioners 421

ANNUAL STATEMENT INSTRUCTIONS ALL STATEMENT TYPES SCHEDULE D PART 1 LONG-TERM BONDS OWNED DECEMBER 31 OF CURRENT YEAR ** Column 23, 24, 25 and 26 will be electronic only ** Column 23 State Abbreviation Applies to: U.S. States, Territories and Possessions Include appropriate state abbreviation for the state where the security is issued (e.g., MO for Missouri). U.S. Political Subdivisions of States, Territories and Positions Include appropriate state abbreviation for the state where the security is issued. U.S. Special Revenue, Special Assessments Obligations and all Non-Guaranteed Obligations of Agencies and Authorities of Governments and Their Political Subdivisions Include appropriate state abbreviation for the state where the security is issued. Use US for federal agency issues. Column 24 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 2010 National Association of Insurance Commissioners 422

The following is a listing of the valid method indicators for bonds Insert the code forto show the method used by the reporting entity to determine the Rate Per Share Used to Obtain Fair Value. Following is a listing of the valid method indicators for bonds: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 25 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 423

SCHEDULE D PART 2 SECTION 1 PREFERRED STOCKS OWNED DECEMBER 31 OF CURRENT YEAR ** Column 22 and 23 will be electronic only ** Column 22 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators for stocks Insert the code forto show the method used by the reporting entity to determine the Rate Per Share Used to Obtain Fair Value. Following is a listing of the valid method indicators for stocks: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 23 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 424

SCHEDULE D PART 2 SECTION 2 COMMON STOCKS OWNED DECEMBER 31 OF CURRENT YEAR ** Column 19 and 20 will be electronic only ** Column 19 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators for stocks Insert the code forto show the method used by the reporting entity to determine the Rate Per Share Used to Obtain Fair Value. Following is a listing of the valid method indicators for stocks: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 20 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 425

SCHEDULE A PART 1 REAL ESTATE OWNED DECEMBER 31 OF CURRENT YEAR Column 17 Taxes, Repairs and Expenses Incurred Include: Exclude: Amounts paid or accrued for taxes, repairs and other related expenses. Interest incurred on encumbrances. ** Column 18 and 19 will be electronic only ** Column 18 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators for real estate to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. (Reporting entities shall utilize source c to capture any other method used by the reporting entity to obtain observable inputs resulting in a hierarchy Level 1 or Level 2. Documentation of this source shall then be included in column 19.) d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. 2010 National Association of Insurance Commissioners 426

Column 19 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. SCHEDULE BA PARTS 1, 2 AND 3 OTHER LONG-TERM INVESTED ASSETS OWNED DECEMBER 31 OF CURRENT YEAR GENERAL INSTRUCTIONS Column 20 Percentage of Ownership Include: Exclude: The share that the company s current investment represents of the total outstanding amount of this investment. Applies only to such investments as hedge funds and limited partnerships. Commitment for additional investment. ** Column 21 and 22 will be electronic only ** Column 21 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 2010 National Association of Insurance Commissioners 427

The following is a listing of the valid method indicators to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. (Reporting entities shall utilize source c to capture any other method used by the reporting entity to obtain observable inputs resulting in a hierarchy Level 1 or Level 2. Documentation of this source shall then be included in column 19.) d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 2522 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 428

SCHEDULE DB PART A SECTION 1 OPTIONS, CAPS, FLOORS, COLLARS, SWAPS AND FORWARDS OPEN DECEMBER 31 OF CURRENT YEAR ** Columns 24 and 25 will be electronic only ** Column 24 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the amount of money the reporting entity would receive (pay) in order to close the derivative position at the market price. Fair value should only be determined analytically when the market price-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators for derivatives Insert the code forto show the method used by the reporting entity to determine the Fair Value. Following is a listing of the valid method codes: a For derivatives where the fair value is determined by a pricing service. b For derivatives where the fair value is determined by a stock exchange. c For derivatives where the fair value is determined by a broker or the reporting entity s custodian. To use this method 1) the broker must be approved by the reporting entity as a derivative counterparty; and 2) the reporting entity shall obtain and retain the pricing policy of the broker or custodian that provided the quotations. d For derivatives where the fair value is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 25 Source Used to Obtain Fair Value For Method Code a, identify the specific pricing service used. For Method Code b, identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web site: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c, identify the specific broker or custodian used. For Method Code d, leave blank. 2010 National Association of Insurance Commissioners 429

SCHEDULE DB PART B SECTION 1 FUTURES CONTRACTS OPEN DECEMBER 31 OF CURRENT YEAR Column 20 Hedge Effectiveness at Inception and at Year-end For hedge transactions show, as a percentage expressed as (XX / YY), where XX shows the hedge effectiveness percentage at inception and YY shows the hedge effectiveness percentage at reporting date. When hedge effectiveness cannot be calculated, enter a reference code number in this column (e.g., 0001, 0002, etc.) then disclose the financial or economic impact of the hedge at the end of the reporting period in Schedule DB footnotes for each reference code number used in the schedule. A reference code number may be used multiple times in this column to indicate the same explanation. For example: 0001 Reduces bond portfolio duration by.2 years. a) Fair Value Hedges: How much of the change in value of the hedged item(s) was hedged by the change in value of the derivative, both: At the inception of the derivative transaction; and At reporting date. b) Cash Flow Hedges: ** Column 21 and 22 will be electronic only ** How much of the change in cash flows or present value of cash flows of the hedged item(s) was hedged by the change in cash flows or present value of cash flows of the derivative, both: At the inception of the derivative transaction; and At reporting date. Column 21 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 2010 National Association of Insurance Commissioners 430

The following is a listing of the valid method indicators for derivatives to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 22 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 431

SCHEDULE DB PART C SECTION 1 REPLICATION (SYNTHETIC ASSET) TRANSACTIONS (RSATs) OPEN ON DECEMBER 31 OF CURRENT YEAR Column 16 Fair Value of Cash Instrument(s) Held Enter the fair value of cash instrument(s) used in the RSAT. ** Column 17 and 18 will be electronic only ** Column 17 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. 2010 National Association of Insurance Commissioners 432

Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 18 Source Used to Obtain Fair Value For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 2010 National Association of Insurance Commissioners 433

SCHEDULE DL PART 1 SECURITIES LENDING COLLATERAL ASSETS Reinvested Collateral Assets Owned December 31 Current Year Column 6 Maturity Date On bonds purchased at a premium, the maturity date producing the lowest amortized value should be used. For Class One Bond Mutual Funds and Exchange Traded Funds, leave blank. For perpetual bonds, enter 01/01/YYYY where YYYY is equal to 9999. ** Columns 7 and 8 will be electronic only ** Column 7 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. 2010 National Association of Insurance Commissioners 434

Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 8 Source Used to Obtain Fair Value General Interrogatories: For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 1. The total activity for the year represents the net increase (decrease) from the prior year-end to the current year-end. 2. The average balance for the year is the average daily balance. Average daily balance: Total of daily balances divided by the number of days. 2010 National Association of Insurance Commissioners 435

SCHEDULE DL PART 2 SECURITIES LENDING COLLATERAL ASSETS Reinvested Collateral Assets Owned December 31 Current Year Column 6 Maturity Date On bonds purchased at a premium, the maturity date producing the lowest amortized value should be used. For Class One Bond Mutual Funds and Exchange Traded Funds, leave blank. For perpetual bonds, enter 01/01/YYYY where YYYY is equal to 9999. ** Column 7 and 8 will be electronic only ** Column 7 Fair Value Hierarchy Level and Method Used to Obtain Fair Value Code Whenever possible, fair value should represent the price at which the security could be sold, based on market information. Fair value should only be determined analytically when the market-based value cannot be obtained. The following is a listing of valid fair value level indicators to show the fair value hierarch level. 1 for Level 1 2 for Level 2 3 for Level 3 The following is a listing of the valid method indicators to show the method used by the reporting entity to determine the Rate Used to Obtain Fair Value.: a for securities where the rate is determined by a pricing service. b for securities where the rate is determined by a stock exchange. c for securities where the rate is determined by a broker or custodian. The reporting entity should obtain and maintain the pricing policy for any broker or custodian used as a pricing source. In addition, the broker must either be approved by the reporting entity as a counterparty for buying and selling securities or be an underwriter of the security being valued. d for securities where the rate is determined by the reporting entity. The reporting entity is required to maintain a record of the pricing methodology used. e for securities where the rate is determined by the unit price published in the NAIC Valuation of Securities. 2010 National Association of Insurance Commissioners 436

Enter a combination of hierarchy and method indicator report the level and method used to obtain fair value. The fair value hierarchy level indicator would be listed first and the method used to determine fair value indicator would be listed next. For example, use 1b to report Level 1 for the fair value hierarchy level and stock exchange for the method used to determine fair value. Column 8 Source Used to Obtain Fair Value General Interrogatories: For Method Code a identify the specific pricing service used. For Method Code b identify the specific stock exchange used. The listing of most stock exchange codes can be found in the Investment Schedules General Instructions or the following Web address: www.fixprotocol.org/specifications/exchanges.shtml For Method Code c identify the specific broker or custodian used. For Method Code d leave blank. For Method Code e leave blank. 1. The total activity for the year represents the net increase (decrease) from the prior year-end to the current yea- end. 2. The average balance for the year is the average daily balance. Average daily balance: Total of daily balances divided by the number of days. W:\QA\BlanksProposals\2011-33BWG_Modified.doc 2010 National Association of Insurance Commissioners 437

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