OMNI INDEMNITY COMPANY

ANNUAL STATEMENT OF THE OMNI INDEMNITY COMPANY OF Chicago IN THE STATE OF Illinois TO THE INSURANCE DEPARTMENT OF THE STATE OF FOR THE YEAR ENDED DECEMBER 3, 00 PROPERTY AND CASUALTY 00

INDEX TO PROPERTY AND CASUALTY ANNUAL STATEMENT Accident and Health Exhibit (SCH H) Aggregate Statement and Market Values of Bonds and Preferred Stock (SCH DM) Analysis of Losses and Loss Expenses (SCH P) Analysis of Non-Admitted Assets and Related Items (EX ) Assets (Admitted) Assumed Reinsurance (SCH F, PT ) Bonds (SCH D, PT ) Bonds - Aggregate Statement and Market Values (SCH DM) Bonds - Quality & Maturity Distribution of All Bonds at Statement Values and by Major Types of Issues and NAIC Designations (SCH D, PT A, SN ) Bonds - Maturity Distribution of All Bonds at Statement Values by Major Type and Subtype of Issues (SCH D, PT A, SN ) Capital and Surplus Account 46 E3 49 3 0 38 E08 E3 7 30 04 Other Long-Term Invested Assets (SCH BA) Overflow Page for Write-Ins Portfolio Reinsurance (SCH F, PT) Preferred Stock (SCH D, PT, SN ) Preferred Stock, Aggregate Statement and Fair Values (SCH DM) Premiums Earned (PT ) Premiums Written (PT B) Real Estate (SCH A) Recapitulation of All Premiums (Unearned Premiums) (PT A) Reinsurance (SCH F) Replicated (Synthetic) Assets (SCHDB, PTF) Schedule E-Part -Special Deposits Schedule P Interrogatories E06 39 E09 E3 06 08 E0 07 38 36 E5 07 Cash (SCH E, PT ) Cash Flow Ceded Reinsurance (SCH F, PT 3) Collar, Swap and Forward Agreements (SCH DB, PT C) Common Stock (SCH D, PT, SN ) Counterparty Exposure from Derivative Instruments (SCH DB, PT E) Detailed Information of Losses and Loss Expenses (SCH P, PT ) Exhibit of Net Investment Income Exhibit of Capital Gains (Losses) Exhibit of Premiums and Losses - Business in the State of (Separate Page for Each State) Exhibit of Premiums Written (allocated by state) (SCH T) Exhibit - Analysis of Nonadmitted Assets and Related Items Expenses (PT 3) Futures Contracts (SCH DB, PT D) Five-Year Historical Data General Interrogatories Part General Interrogatories Part History of Bulk and Incurred But Not Reported Reserves (SCH P, PT4) History of Claims (Direct and Assumed): Closed with Loss Payments, Outstanding and Reported (SCH P, PT 5) History of Incurred Losses and Allocated Expenses Reported (SCH P, PT) History of Loss Sensitive Contracts (SCH P, PT 7) History of Paid Losses and Allocated Expenses (SCH P, PT 3) History of Premiums Earned: Direct and Assumed, and Ceded (SCH P, PT 6) Holding Company Activities of Insurer Members (SCH Y) Liabilities, Surplus and Other Funds Losses Paid and Incurred (PT ) Mortgage Loans (SCH B) Notes to Financial Statement Options, Caps and Floors (SCH DB, PT A) Options, Caps and Floors Written (SCH DB, PT B) Organizational Chart (SCH Y, PT ) E4 05 40 E9 E0 E 49 4 08 3 E0 6 0 50 87 50 03 77 98 0 03 09 E04 4 E6 E7 09 Schedules: A - Real Estate E0 B - Mortgage Loans E04 BA - Other Long-Term Invested Assets E06 D - Bonds and Stocks E08 DA - Short-Term Investments E5 DB - Derivative Instruments E6 DM - Aggregate Statement and Fair Values of Bonds and Preferred Stock E3 E - Part - Cash E4 E - Part - Special Deposits E5 F - Reinsurance 38 H - Accident and Health Exhibit 46 P - Analysis of Losses and Loss Expenses 49 Y - Information Concerning Activities of Insurer Members of Holding Company 09 T - Exhibit of Premiums Written Allocated by States and Territories 08 Short-Term Investments (SCH DA) E5 Special Deposits E5 State Page 4 Statement of Income 04 Summary Investment Schedule 5 Supplemental Exhibits and Schedules Interrogatories Title Page and Jurat 0 Transactions With Any Affiliates (SCH Y, PT ) 0 Unpaid Losses and Loss Adjustment Expenses (PT A) 0 Verifications: Schedule A, B, BA 5 Schedule D Summary 6 Schedule DA - Part 33 Schedule DB - Parts A & B 34 Schedule DB - Parts C, D, & E 35

Statement of Actuarial Opinion Omni Indemnity Company Chicago, Illinois Statement of Actuarial Opinion Annual Statement as of December 3, 00 Identification I, Carl J. Leo, am a Senior Vice President and an officer of Omni Indemnity Company (the Company). I am a member of the American Academy of Actuaries and meet its qualification standards. I am an Associate of the Casualty Actuarial Society. I was appointed by the Board of Directors on December 8, 998 to render this opinion. I have examined the reserves listed below, as shown in the Annual Statement of the Company as prepared for filing with state regulatory officials, as of December 3, 00. Scope A. Reserve for Unpaid Losses (Page 3, Line ): $ 3,99,37. B. Reserve for Unpaid Loss Adjustment Expenses (Page 3, Line 3): C. Reserve for Unpaid Losses - Direct and Assumed (Schedule P, Part, Totals from Cols. 3 and 5) $ 3,934,000. $,33,99. D. Reserve for Unpaid Loss Adjustment Expenses - Direct and Assumed (Schedule P, Part, Totals from Cols. 7, 9 and ) $,34,000. E. Total claims made extended loss and expense reserve (Schedule P, Interrogatories) $ 0. F. Retroactive Reinsurance reserve assumed (Liabilities, Surplus and Other Funds, write-in reserve) $ 0.

Statement of Actuarial Opinion Omni Indemnity Company Statement of Actuarial Opinion Annual Statement as of December 3, 00 Page The above items reflect:. Anticipated salvage and subrogation included as a reduction to loss reserves as reported in Schedule P - Analysis of Losses and Loss Expenses, Underwriting and Investment Exhibit Part 3A and on Page 3 Liabilities, Surplus and Other Funds, Line $,537,000.. Discount included as a reduction to loss reserves and loss expense reserves as reported in Schedule P Analysis of Losses and Loss Expenses, Underwriting and Investment Exhibit Part 3A, and on Page 3-Liabilities, Surplus and Other Funds, Lines and None 3. The net reserves for loss and expenses for the company s share of voluntary and involuntary underwriting pools and associations unpaid losses and expenses which are included in the reserves shown on Page 3 Liabilities, Surplus and Other Funds, Lines and None 4. The net reserves for loss and loss adjustment expenses that the company carries for Asbestos liabilities and Environmental liabilities, which are included in the reserves on Page 3 Liabilities, Surplus and Other Funds, Lines and, and disclosed in the Notes to Financial Statements None 5. In the total reserves for losses and loss adjustment expenses, the company reported the extended loss and expense reserve, that are reported in the Schedule P Interrogatories None The Company does not record loss and loss adjustment expense reserves on a discounted basis. As of year-end 00, the Company s participation in voluntary and involuntary pools was limited to the Florida Automobile JUA. I have reviewed the latest available participation report from the Florida Automobile JUA. This report indicates that the Company s participation, in terms of premiums earned and losses incurred, is minimal and insignificant. Consequently, the Company has not accrued any additional loss and loss adjustment reserves for this participation. In my opinion, the reserves from this participation are immaterial. The Company writes only Personal Automobile business and has not provided coverage that could reasonably be expected to produce material levels of asbestos or environmental liability claims. As of December 3, 00, the Company does not have any reinsurance contracts that have been or should have been accounted for as retroactive reinsurance or financial reinsurance. The total ceded loss and loss adjustment expense reserve as of December 3, 00 is $ 5,567, which is less than one percent of surplus.

Statement of Actuarial Opinion Omni Indemnity Company Statement of Actuarial Opinion Annual Statement as of December 3, 00 Page 3 All of the ceded loss and loss adjustment expense reserves are with reinsurance companies rated A+ or better by A.M. Best Company. All of the reinsurance amounts recoverable as of December 3, 00 were current. Concerning terrorist attack losses, there are no paid or pending claims to date. In my opinion the risk of significant liabilities as of December 3, 00 arising form terrorist attack losses is remote given the nature of the coverages provided by the company. During the past year, the company strengthened net reserves for prior accident years by $ 3,000,000. Most of the increase was for bodily injury claims on automobile liability for accident years 999 and 000. This extraordinary loss strengthening caused exceptional values for the NAIC Iris Test regarding Two Year Reserve Development to Surplus. My examination of the loss and allocated loss adjustment expense was based upon policy and claims data recorded, compiled and prepared by responsible employees of the Company. While I relied on the accuracy of the data used in the analysis, I evaluated that data for reasonableness and consistency. Also, I reconciled that data to Schedule P of the Company's current Annual Statement. In other respects, my examination included the use of such actuarial assumptions and methods and such tests of the calculations as I considered necessary. Opinion In my opinion, the reserves listed under the Scope section of this opinion:. meet the requirements of the insurance laws of the state of Illinois.. are consistent with reserves computed in accordance with accepted loss reserving standards and principles. 3. make a reasonable provision for the unpaid loss and loss adjustment expense obligations of the Company under the terms of its policies and agreements. In evaluating whether the reserves make a reasonable provision for unpaid loss and allocated loss expenses, it is necessary to project future loss and loss adjustment expense payments. Since actual loss and expense payments are subject to uncertainty with respect to future events, they may, in fact, vary significantly from projections. No warranty is expressed or implied that actual losses will not vary from the projected amounts. Furthermore, the projections make no provision for extraordinary future emergence of new types of losses not sufficiently represented in the historical data, nor do the projections make provision for any material broadening of coverage under the Company's policies due to legislative action or judicial interpretation.

Statement of Actuarial Opinion Omni Indemnity Company Statement of Actuarial Opinion Annual Statement as of December 3, 00 Page 4 This statement of opinion is intended solely for the use of the Company, and the state insurance departments with which it files its Annual Statement. Use for any other purpose is disclaimed. An actuarial report, including the underlying workpapers, supporting the findings expressed in this Statement of Actuarial Opinion, is available for regulatory examination. The report will be retained for a period of seven years in the administrative offices of the Company. Carl J. Leo, ACAS, MAAA Omni Insurance Group 08 Powers Ferry Road Atlanta, Georgia 30339 770-957-4500 Date: February 3, 003

PROPERTY AND CASUALTY COMPANIES ASSOCIATION EDITION ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER 3, 00 OF THE CONDITION AND AFFAIRS OF THE OMNI INDEMNITY COMPANY NAIC Group Code 009 0354 NAIC Company Code 34940 Employer s ID Number 58-8987 (Current Period) (Prior Period) Organized under the Laws of Illinois, State of Domicile or Port of Entry Illinois Country of Domicile United States of America Incorporated 8973 Commenced Business 080974 Statutory Home Office 5 South LaSalle Street, Suite 3600, Chicago, IL 60603 (Street and Number) (City or Town, State and Zip Code) Main Administrative Office 08 Powers Ferry Road (Street and Number) Atlanta, GA 30339 770-95-4500 (City or Town, State and Zip Code) (Area Code) (Telephone Number) Mail Address P.O. Box 05440, Atlanta, GA 30348 (Street and Number or P.O. Box) (City or Town, State and Zip Code) Primary Location of Books and Records 08 Powers Ferry Road (Street and Number) Atlanta, GA 30339 770-95-4500 (City or Town, State and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.omniins.com Statement Contact Michael Benzion Smith 770-95-4500 (Name) (Area Code) (Telephone Number) (Extension) michael.smith@thehartford.com 770-303-45 (E-mail Address) (Fax Number) Policyowner Relations Contact 08 Powers Ferry Road (Street and Number) Atlanta, GA 30339 770-95-4500 (City or Town, State and Zip Code) (Area Code) (Telephone Number) (Extension) OFFICERS President James Paul Kennedy Treasurer Susan Hamlett Scalf Secretary Brian Stuart Becker # VICE PRESIDENTS Neal Steven Wolin Brian Stuart Becker # Michael John Dury John Nicholas Giamalis # William Bernard Malchodi Robert William Paiano Robert Jennings Price # David Mark Znamierowski # Lawrence Jerome Korth Carl John Leo David Scott Peters Susan Hamlett Scalf Mary Elizabeth Skeeles Kathy Renee'Weese DIRECTORS OR TRUSTEES Ramani Ayer Randolph Amory Dalton Timothy Francis Galvin III David Philip Halper Donald Joseph LaValley Thomas Michael Marra # Carol Diane Murphy David Mark Znamierowski # David Kenneth Zwiener State of County of Georgia Cobb ss The officers of this reporting entity, being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures manual except to the extent that: () state law may differ; or, () that state rules or regulations require differences in reporting not related to accounting practices and procedures, according to the best of their information, knowledge and belief, respectively. James Paul Kennedy Susan Hamlett Scalf Wayne Kendall Whiten, Asst. Secretary President Treasurer Secretary a. Is this an original filing? Subscribed and sworn to before me this b. If no, 9th day of February, 003. State the amendment number. Date filed 3. Number of pages attached

ASSETS Assets Current Year Nonadmitted Assets 3 Net Admitted Assets (Cols. - ) Prior Year 4 Net Admitted Assets. Bonds. Stocks:. Preferred stocks (Schedule D, Part, Section ). Common stocks (Schedule D, Part, Section ) 3. Mortgage loans on real estate (Schedule B): 3. First liens 3. Other than first liens 4. Real estate (Schedule A): 4. Properties occupied by the company (less $ encumbrances) 4. Properties held for the production of income (less $ encumbrances) 4.3 Properties held for sale (less $ encumbrances) 5. Cash ($ Schedule E, Part ) and short-term investments($ Schedule DA, Part ) 6. Other invested assets (Schedule BA) 7. Receivable for securities 8. Aggregate write-ins for invested assets 9. Subtotals, cash and invested assets (Lines to 8) 0. Agents'balances or uncollected premiums: 0. Premiums and agents'balances in course of collection 0. Premiums, agents'balances and installments booked but deferred and not yet due (Including $ earned but unbilled premiums) 0.3 Accrued retrospective premiums. Funds held by or deposited with reinsured companies. Bills receivable, taken for premiums 3. Amounts receivable under high deductible policies 4. Reinsurance recoverables on loss and loss adjustment expense payments (Schedule F, Part 3, Cols. 7 and 8) 5. Federal and foreign income tax recoverable and interest thereon (including $ net deferred tax asset) 6. Guaranty funds receivable or on deposit 7. Electronic data processing equipment and software 8. Interest, dividends and real estate income due and accrued 9. Net adjustments in assets and liabilities due to foreign exchange rates 0. Receivable from parent, subsidiaries and affiliates. Amount due fromto protected cells. Equities and deposits in pools and associations 3. Amounts receivable relating to uninsured accident and health plans 4. Other assets nonadmitted (Exhibit ) 5. Aggregate write-ins for other than invested assets 6. Total assets excluding protected cell assets (Lines 9 through 5) 7. Protected cell assets 8. TOTALS (Lines 6 and 7) 080. 080. 0803. DETAILS OF WRITE-INS 0898. Summary of remaining write-ins for Line 8 from overflow page 0899. Totals (Lines 080 thru 0803 plus 0898) (Line 8 above) 50. 50. 503. 598. Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 503 plus 598) (Line 5 above)

3 LIABILITIES, SURPLUS AND OTHER FUNDS Current Year Prior Year. Losses (Part A, Line 34, Column 8). Reinsurance payable on paid loss and loss adjustment expenses (Schedule F, Part, Column 6) 3. Loss adjustment expenses (Part A, Line 34, Column 9) 4. Commissions payable, contingent commissions and other similar charges 5. Other expenses (excluding taxes, licenses and fees) 6. Taxes, licenses and fees (excluding federal and foreign income taxes) 7. Federal and foreign income taxes (including $ on realized capital gains (losses)) (including $ net deferred tax liability) 8. Borrowed money $ and interest thereon $ 9. Unearned premiums (Part A, Line 37, Column 5) (after deducting unearned premiums for ceded reinsurance of $ and including warranty reserves of $ ) 0. Advance premiums. Dividends declared and unpaid:. Stockholders. Policyholders. Ceded reinsurance premiums payable (net of ceding commissions) 3. Funds held by company under reinsurance treaties (Schedule F, Part 3, Column 9) 4. Amounts withheld or retained by company for account of others 5. Remittances and items not allocated 6. Provision for reinsurance (Schedule F, Part 7) 7. Net adjustments in assets and liabilities due to foreign exchange rates 8. Drafts outstanding 9. Payable to parent, subsidiaries and affiliates 0. Payable for securities. Liability for amounts held under uninsured accident and health plans. Capital Notes $ and interest thereon $ 3. Aggregate write-ins for liabilities 4. Total liabilities excluding protected cell liabilities (Lines through 3) 5. Protected cell liabilities 6. Total liabilities (Lines 4 and 5) 7. Aggregate write-ins for special surplus funds 8. Common capital stock 9. Preferred capital stock 30. Aggregate write-ins for other than special surplus funds 3. Surplus notes 3. Gross paid in and contributed surplus 33. Unassigned funds (surplus) 34. Less treasury stock, at cost: 34. shares common (value included in Line 8 $ ) 34. shares preferred (value included in Line 9 $ ) 35. Surplus as regards policyholders (Lines 7 to 33, less 34) (Page 4, Line 38) 36. TOTALS (Page, Line 8, Col. 3) DETAILS OF WRITE-INS 30. 30. 303. 398. Summary of remaining write-ins for Line 3 from overflow page 399. Totals (Lines 30 thru 303 plus 398) (Line 3 above) 70. 70. 703. 798. Summary of remaining write-ins for Line 7 from overflow page 799. Totals (Lines 70 thru 703 plus 798) (Line 7 above) 300. 300. 3003. 3098. Summary of remaining write-ins for Line 30 from overflow page 3099. Totals (Lines 300 thru 3003 plus 3098) (Line 30 above)

4 UNDERWRITING AND INVESTMENT EXHIBIT STATEMENT OF INCOME Current Year Prior Year UNDERWRITING INCOME. Premiums earned (Part, Line 34, Column 4) DEDUCTIONS. Losses incurred (Part, Line 34, Column 7) 3. Loss expenses incurred (Part 3, Line 5, Column ) 4. Other underwriting expenses incurred (Part 3, Line 5, Column ) 5. Aggregate write-ins for underwriting deductions 6. Total underwriting deductions (Lines through 5) 7. Net income of protected cells 8. Net underwriting gain or (loss) (Line minus Line 6 plus Line 7) INVESTMENT INCOME 9. Net investment income earned (Exhibit of Net Investment Income, Line 7) 0. Net realized capital gains or (losses) (Exhibit of Capital Gains (Losses)). Net investment gain or (loss) (Lines 9 + 0) OTHER INCOME. Net gain or (loss) from agents'or premium balances charged off (amount recovered $ amount charged off $ ) 3. Finance and service charges not included in premiums 4. Aggregate write-ins for miscellaneous income 5. Total other income (Lines through 4) 6. Net income before dividends to policyholders and before federal and foreign income taxes (Lines 8 + + 5) 7. Dividends to policyholders 8. Net income, after dividends to policyholders but before federal and foreign income taxes (Line 6 minus Line 7) 9. Federal and foreign income taxes incurred 0. Net income (Line 8 minus Line 9) (to Line ) CAPITAL AND SURPLUS ACCOUNT. Surplus as regards policyholders, December 3 prior year (Page 4, Line 38, Column ) GAINS AND (LOSSES) IN SURPLUS. Net income (from Line 0) 3. Net unrealized capital gains or (losses) 4. Change in net unrealized foreign exchange capital gain (loss) 5. Change in net deferred income tax 6. Change in nonadmitted assets (Exhibit, Line 5, Col. 3) 7. Change in provision for reinsurance (Page 3, Line 6, Column minus Column ) 8. Change in surplus notes 9. Surplus (contributed to) withdrawn from protected cells 30. Cumulative effect of changes in accounting principles 3. Capital changes: 3.. Paid in 3.. Transferred from surplus (Stock Dividend) 3.3. Transferred to surplus 3. Surplus adjustments: 3.. Paid in 3.. Transferred to capital (Stock Dividend) 3.3. Transferred from capital 33. Net remittances from or (to) Home Office 34. Dividends to stockholders (cash) 35. Change in treasury stock (Page 3, Lines 34. and 34., Column minus Column ) 36. Aggregate write-ins for gains and losses in surplus 37. Change in surplus as regards policyholders for the year (Lines through 36) 38. Surplus as regards policyholders, December 3 current year (Line plus Line 37) (Page 3, Line 35) DETAILS OF WRITE-INS 050. 050. 0503. 0598. Summary of remaining write-ins for Line 5 from overflow page 0599. Totals (Lines 050 thru 0503 plus 0598) (Line 5 above) 40. 40. 403. 498. Summary of remaining write-ins for Line 4 from overflow page 499. Totals (Lines 40 thru 403 plus 498) (Line 4 above) 360. 360. 3603. 3698. Summary of remaining write-ins for Line 36 from overflow page 3699. Totals (Lines 360 thru 3603 plus 3698) (Line 36 above)

5 Cash from Operations CASH FLOW Current Year Prior Year. Premiums collected net of reinsurance. Loss and loss adjustment expenses paid (net of salvage and subrogation) 3. Underwriting expenses paid 4. Other underwriting income (expenses) 5. Cash from underwriting (Line minus Line minus Line 3 plus Line 4) 6. Net investment income 7. Other income (expenses): 7. Agents balances charged off 7. Net funds held under reinsurance treaties 7.3 Net amount withheld or retained for account of others 7.4 Aggregate write-ins for miscellaneous items 7.5 Total other income (Lines 7. to 7.4) 8. Dividends to policyholders on direct business, less $ dividends on reinsurance assumed or ceded (net) 9. Federal and foreign income taxes (paid) recovered 0. Net cash from operations (Line 5 plus Line 6 plus Line 7.5 minus Line 8 plus Line 9). Proceeds from investments sold, matured or repaid: Cash from Investments. Bonds. Stocks.3 Mortgage loans.4 Real estate.5 Other invested assets.6 Net gains or (losses) on cash and short-term investments.7 Miscellaneous proceeds.8 Total investment proceeds (Lines. to.7). Cost of investments acquired (long-term only):. Bonds. Stocks.3 Mortgage loans.4 Real estate.5 Other invested assets.6 Miscellaneous applications.7 Total investments acquired (Lines. to.6) 3. Net Cash from investments (Line.8 minus Line.7) 4. Cash provided: 4. Surplus notes, capital and surplus paid in Cash from Financing and Miscellaneous Sources 4. Capital notes $ less amounts repaid $ 4.3 Net transfers from affiliates 4.4 Borrowed funds received 4.5 Other cash provided 4.6 Total (Lines 4. to 4.5) 5. Cash applied: 5. Dividends to stockholders paid 5. Net transfers to affiliates 5.3 Borrowed funds repaid 5.4 Other applications 5.5 Total (Lines 5. to 5.4) 6. Net cash from financing and miscellaneous sources (Line 4.6 minus Line 5.5) RECONCILIATION OF CASH AND SHORT-TERM INVESTMENTS 7. Net change in cash and short-term investments (Line 0, plus Line 3, plus Line 6) 8. Cash and short-term investments: 8. Beginning of year 8. End of year (Line 7 plus Line 8.) DETAILS OF WRITE-INS 07.40!"#$" 07.40 %&&'#()"!&*+ 07.403 07.498 Summary of remaining write-ins for Line 7.4 from overflow page 07.499 Totals (Lines 07.40 thru 07.403 plus 07.498) (Line 7.4 above)

6 UNDERWRITING AND INVESTMENT EXHIBIT Lines of Business PART - PREMIUMS EARNED Net Premiums Written per Column 6, Part B Unearned Premiums Dec. 3 Prior Year - per Col. 3, Last Year s Part 3 Unearned Premiums Dec. 3 Current Year - per Col. 5 Part A 4 Premiums Earned During Year (Cols. + - 3). Fire. Allied lines 3. Farmowners multiple peril 4. Homeowners multiple peril 5. Commercial multiple peril 6. Mortgage guaranty 8. Ocean marine 9. Inland marine 0. Financial guaranty. Medical malpractice - occurrence. Medical malpractice - claims-made. Earthquake 3. Group accident and health 4. Credit accident and health (group and individual) 5. Other accident and health 6. Workers'compensation 7. Other liability - occurrence 7. Other liability - claims-made 8. Products liability - occurrence 8. Products liability - claims-made 9.,9. Private passenger auto liability 9.3,9.4 Commercial auto liability. Auto physical damage. Aircraft (all perils) 3. Fidelity 4. Surety 6. Burglary and theft 7. Boiler and machinery 8. Credit 9. International 30. Reinsurance - Nonproportional Assumed Property 3. Reinsurance - Nonproportional Assumed Liability 3. Reinsurance - Nonproportional Assumed Financial Lines 33. Aggregate write-ins for other lines of business 34. TOTALS DETAILS OF WRITE-INS 330. 330. 3303. 3398. Summary of remaining write-ins for Line 33 from overflow page 3399. Totals (Lines 330 thru 3303 plus 3398) (Line 33 above)

7 UNDERWRITING AND INVESTMENT EXHIBIT Line of Business PART A - RECAPITULATION OF ALL PREMIUMS (a) Gross premiums (less reinsurance) and unearned premiums on all unexpired risks and reserve for return premiums under rate credit or retrospective rating plans based upon experience, viz: 3 Amount Unearned Amount Unearned (Running One Year or (Running More Than Less from Date of One Year from Date Earned Policy) of Policy) but (b) (b) Unbilled Premium 4 Reserve for Rate Credits and Retrospective Adjustments Based on Experience 5 Total Reserve for Unearned Premiums Cols. + + 3 + 4. Fire. Allied lines 3. Farmowners multiple peril 4. Homeowners multiple peril 5. Commercial multiple peril 6. Mortgage guaranty 8. Ocean marine 9. Inland marine 0. Financial guaranty. Medical malpractice - occurrence. Medical malpractice - claims-made. Earthquake 3. Group accident and health 4. Credit accident and health (group and individual) 5. Other accident and health 6. Workers'compensation 7. Other liability - occurrence 7. Other liability - claims-made 8. Products liability - occurrence 8. Products liability - claims-made 9.,9. Private passenger auto liability 9.3,9.4 Commercial auto liability. Auto physical damage. Aircraft (all perils) 3. Fidelity 4. Surety 6. Burglary and theft 7. Boiler and machinery 8. Credit 9. International 30. Reinsurance - Nonproportional Assumed Property 3. Reinsurance - Nonproportional Assumed Liability 3. Reinsurance - Nonproportional Assumed Financial Lines 33. Aggregate write-ins for other lines of business 34. TOTALS 35. Accrued retrospective premiums based on experience 36. Earned but unbilled premiums 37. Balance (Sum of Line 34 through 36) 330. 330. 3303. DETAILS OF WRITE-INS 3398. Summary of remaining write-ins for Line 33 from overflow page 3399. Totals (Lines 330 thru 3303 plus 3398) (Line 33 above) (a) By gross premiums is meant the aggregate of all the premiums written in the policies or renewals in force. Are they so returned in this statement? (b) State here basis of computation used in each case. &&, &((- &+&.

8. Fire UNDERWRITING AND INVESTMENT EXHIBIT PART B - PREMIUMS WRITTEN Gross Premiums (Less Return Premiums), Including Policy and Membership Fees Written and Renewed During Year Reinsurance Assumed Reinsurance Ceded 6 Line of Business Direct Business (a) From Affiliates 3 From Non-Affiliates 4 To Affiliates 5 To Non-Affiliates Net Premiums Written Cols. + + 3-4 - 5. Allied lines 3. Farmowners multiple peril 4. Homeowners multiple peril 5. Commercial multiple peril 6. Mortgage guaranty 8. Ocean marine 9. Inland marine 0. Financial guaranty. Medical malpractice - occurrence. Medical malpractice - claims-made. Earthquake 3. Group accident and health 4. Credit accident and health (group and individual) 5. Other accident and health 6. Workers'compensation 7. Other liability - occurrence 7. Other liability - claims-made 8. Products liability - occurrence 8. Products liability - claims-made 9.,9. Private passenger auto liability 9.3,9.4 Commercial auto liability. Auto physical damage. Aircraft (all perils) 3. Fidelity 4. Surety 6. Burglary and theft 7. Boiler and machinery 8. Credit 9. International 30. Reinsurance - Nonproportional Assumed Property 3. Reinsurance - Nonproportional Assumed Liability 3. Reinsurance - Nonproportional Assumed Financial Lines 33. Aggregate write-ins for other lines of business XXX XXX XXX 34. TOTALS 330. 330. 3303. DETAILS OF WRITE-INS 3398. Summary of remaining writeins for Line 33 from overflow page 3399. Totals (Lines 330 thru 3303 plus 3398) (Line 33 above) (a) Does the company s direct premiums written include premiums recorded on an installment basis? If yes:. The amount of such installment premiums $. Amount at which such installment premiums would have been reported had they been reported on an annualized basis $

9 Line of Business UNDERWRITING AND INVESTMENT EXHIBIT PART - LOSSES PAID AND INCURRED Losses Paid Less Salvage 5 6 7 8 Direct Business Reinsurance Assumed 3 Reinsurance Recovered 4 Net Payments (Cols. + - 3) Net Losses Unpaid Current Year (Part A, Col. 8) Net Losses Unpaid Previous Year Losses Incurred Current Year (Cols. 4 + 5-6) Percentage of Losses Incurred (Col. 7, Part ) to Premiums Earned (Col. 4, Part ). Fire. Allied lines 3. Farmowners multiple peril 4. Homeowners multiple peril 5. Commercial multiple peril 6. Mortgage guaranty 8. Ocean marine 9. Inland marine 0. Financial guaranty. Medical malpractice - occurrence. Medical malpractice - claims-made. Earthquake 3. Group accident and health 4. Credit accident and health (group and individual) 5. Other accident and health 6. Workers'compensation 7. Other liability - occurrence 7. Other liability - claims-made 8. Products liability - occurrence 8. Products liability - claims-made 9.,9. Private passenger auto liability 9.3,9.4 Commercial auto liability. Auto physical damage. Aircraft (all perils) 3. Fidelity 4. Surety 6. Burglary and theft 7. Boiler and machinery 8. Credit 9. International 30. Reinsurance - Nonproportional Assumed Property XXX 3. Reinsurance - Nonproportional Assumed Liability XXX 3. Reinsurance - Nonproportional Assumed Financial Lines XXX 33. Aggregate write-ins for other lines of business 34. TOTALS DETAILS OF WRITE-INS 330. 330. 3303. 3398. Summary of remaining write-ins for Line 33 from overflow page 3399. Totals (Lines 330 thru 3303 plus 3398) (Line 33 above)

0 Line of Business UNDERWRITING AND INVESTMENT EXHIBIT PART A - UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES Reported Losses Incurred But Not Reported 8 9 Direct Reinsurance Assumed 3 Deduct Reinsurance Recoverable from Authorized and Unauthorized Companies 4 Net Losses Excl. Incurred But Not Reported (Cols. + - 3) 5 Direct 6 Reinsurance Assumed 7 Reinsurance Ceded Net Losses Unpaid (Cols. 4 +5 + 6-7). Fire. Allied lines 3. Farmowners multiple peril 4. Homeowners multiple peril 5. Commercial multiple peril 6. Mortgage guaranty 8. Ocean marine 9. Inland marine 0. Financial guaranty. Medical malpractice - occurrence. Medical malpractice - claims-made. Earthquake 3. Group accident and health & 4. Credit accident and health (group and individual) 5. Other accident and health & 6. Workers'compensation 7. Other liability - occurrence 7. Other liability - claims-made 8. Products liability - occurrence 8. Products liability - claims-made 9.,9. Private passenger auto liability 9.3,9.4 Commercial auto liability. Auto physical damage. Aircraft (all perils) 3. Fidelity 4. Surety 6. Burglary and theft 7. Boiler and machinery 8. Credit 9. International 30. Reinsurance - Nonproportional Assumed Property XXX XXX 3. Reinsurance - Nonproportional Assumed Liability XXX XXX 3. Reinsurance - Nonproportional Assumed Financial Lines XXX XXX 33. Aggregate write-ins for other lines of business 34. TOTALS DETAILS OF WRITE-INS 330. 330. 3303. 3398. Summary of remaining write-ins for Line 33 from overflow page 3399. Totals (Lines 330 thru 3303 plus 3398) (Line 33 above) (a) Including $ for present value of life indemnity claims. Unpaid Loss Adjustment Expenses

. Claim adjustment services: UNDERWRITING AND INVESTMENT EXHIBIT PART 3 - EXPENSES Loss Adjustment Expenses Other Underwriting Expenses 3 Investment Expenses. Direct. Reinsurance assumed.3 Reinsurance ceded.4 Net claim adjustment service (. +. -.3). Commission and brokerage:. Direct excluding contingent. Reinsurance assumed excluding contingent.3 Reinsurance ceded excluding contingent.4 Contingent-direct.5 Contingent-reinsurance assumed.6 Contingent-reinsurance ceded.7 Policy and membership fees.8 Net commission and brokerage (. +. -.3 +.4 +.5 -.6 +.7) 3. Allowances to managers and agents 4. Advertising 5. Boards, bureaus and associations 6. Surveys and underwriting reports 7. Audit of assureds'records 8. Salary and related items: 8. Salaries 8. Payroll taxes 9. Employee relations and welfare 0. Insurance. Directors'fees. Travel and travel items 3. Rent and rent items 4. Equipment 5. Cost or depreciation of EDP equipment and software 6. Printing and stationery 7. Postage, telephone and telegraph, exchange and express 8. Legal and auditing 9. Totals (Lines 3 to 8) 0. Taxes, licenses and fees: 0. State and local insurance taxes deducting guaranty association credits of $ 0. Insurance department licenses and fees 0.3 Gross guaranty association assessments 0.4 All other (excluding federal and foreign income and real estate) 0.5 Total taxes, licenses and fees (0. + 0. + 0.3 + 0.4). Real estate expenses. Real estate taxes 3. Reimbursements by uninsured accident and health plans 4. Aggregate write-ins for miscellaneous expenses 5. Total expenses incurred (a) 6. Less unpaid expenses - current year 7. Add unpaid expenses - prior year 8. Amounts receivable relating to uninsured accident and health plans, prior year 9. Amounts receivable relating to uninsured accident and health plans, current year 30. TOTAL EXPENSES PAID (Lines 5-6 + 7-8 + 9) DETAILS OF WRITE-INS 40. 0 * &("++& 3 40. $!&&-# 403. 498. Summary of remaining write-ins for Line 4 from overflow page 499. Totals (Lines 40 thru 403 plus 498) (Line 4 above) (a) Includes management fees of $ paid to affiliates and $ paid to non-affiliates. 4 Total

EXHIBIT OF NET INVESTMENT INCOME Collected During Year Earned During Year. U.S. Government bonds (a). Bonds exempt from U.S. tax (a). Other bonds (unaffiliated) (a).3 Bonds of affiliates (a). Preferred stocks (unaffiliated) (b). Preferred stocks of affiliates (b). Common stocks (unaffiliated). Common stocks of affiliates 3. Mortgage loans (c) 4. Real estate (d) 5. Contract loans 6. Cashshort-term investments (e) 7. Derivative instruments (f) 8. Other invested assets 9. Aggregate write-ins for investment income 0. Total gross investment income. Investment expenses (g). Investment taxes, licenses and fees, excluding federal income taxes (g) 3. Interest expense (h) 4. Depreciation on real estate and other invested assets (i) 5. Aggregate write-ins for deductions from investment income 6. Total (Lines through 5) 7. Net Investment Income - (Line 0 minus Line 6) DETAILS OF WRITE-INS 090. "++& $" 090. 0903. 0998. Summary of remaining write-ins for Line 9 from overflow page 0999. Totals (Lines 090 through 0903 plus 0998) (Line 9, above) 50. 50. 503. 598. Summary of remaining write-ins for Line 5 from overflow page 599. Total (Lines 50 through 503 plus 598) (Line 5, above) (a) Includes $ accrual of discount less $ amortization of premium and less $ 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 $ accrual of discount less $ amortization of premium and less $ paid for accrued interest on purchases. (f) Includes $ accrual of discount less $ 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) Realized Gain (Loss) On Sales or Maturity Other Realized Adjustments 3 Increases (Decreases) by Adjustment 4 Net Gain (Loss) from Change in Difference Between Basis Book Adjusted Carrying and Admitted Values. U.S. Government bonds. Bonds exempt from U.S. tax. Other bonds (unaffiliated).3 Bonds of affiliates. Preferred stocks (unaffiliated). Preferred stocks of affiliates. Common stocks (unaffiliated). Common stocks of affiliates 3. Mortgage loans 4. Real estate 5. Contract loans 6. CashShort-term investments 7. Derivative instruments 8. Other invested assets 9. Aggregate write-ins for capital gains (losses) 0. Total capital gains (losses) DETAILS OF WRITE-INS 090. 4(&3& &+5(+ 090. 0903. 0998. Summary of remaining write-ins for Line 9 from overflow page 0999. Totals (Lines 090 through 0903 plus 0998) (Line 9, above) 5 Total

3 EXHIBIT - ANALYSIS OF NONADMITTED ASSETS AND RELATED ITEMS End of Current Year End of Prior Year 3 Changes for Year (Increase) Decrease. Summary of Items Page, Lines 0 to 7 and 9 to 3, Column. Other Nonadmitted Assets:. Bills receivable. Furniture, equipment and supplies.3 Leasehold improvements.4 Loans on personal security, endorsed or not 3. Total (Lines. to.4) 4. Aggregate write-ins for other assets 5. Total (Line plus Lines 3 and 4) 040. 040. 0403. 0498. Summary of remaining write-ins for Line 4 from overflow page 0499. Totals (Lines 040 thru 0403 plus 0498) (Line 4 above)

4 67) 4 $%$#$078700968$%9:$0$ NOTES TO FINANCIAL STATEMENTS & 7"" -&"" 8,&"" &'-4&"&+& 49$('0 &'0 &',&!*&(,*& 4&"" -&"" "*( (*',$++ & 4$&" 8,& 4$++ ;&"" &( "+(,& 4$++ &,& '4&"&+& &"" (&".,,& &+7 "& 4$&"0 <7$07"" -&""&( "(&&+*=" &' (!& "*( (*',$++ $&"& * 6 4&,&& 4,#&"&+ & 8,&& 44&"&+&;&&- &>&&(&,&&44", (& +&*+!&(3$&+ ;&,("+ 4" -&&(+&*+7"&++ " +((444,& " 7"" - +" &&(!,+4 4, +"&(&"" &"6&(&&*+,( "!,3( 4,. ",!&" (*' &&, (4 ("*&(&*&( "!( 4 "(-" &4 &"&(3"(" ".,&";-.&"*"+(- &"; " ",&&+" &",&-( & &"(3"(&("(4 "(-&++.&" "!( "!&*+ $&((,0 &',4 ++.-&"" - +"?, @!&&(&& 5(!&+-,, ( @!-&(, @!& &(&,+. 4& 5(!&+ 4&!&+ A ( *&">(*',+ &&&(&& 5(!&+-,, ( @!-&(* (&&(&,+. 4& 5(!&+ 4&!&+ 0 ">,,&! "> 4*(&&(&44+&&&(&&> 8,0 &'. 4( "> 8,0 &',& -&-+ & &+& 8,0 &',& + &@*&">(" 8,0 &',&!*(&'&(&44+&(" & 8,0 &',&!=!&, +(+&*+'" & 8,0 &',& (!&! 8,0 &'( &"&!" &&4&" (4""'"&+"+& 6&(+ &(+ &(=3"+(&& ((4 (!(&+"&&&(+ &(& & *&( &3"4 + "(* ( ",+&*+&"&+'*&( & &( &&(.,+&&-*+!,& &(;&,+&+&*+'&'*3" 4 +,&,&!((8,, (4 &>-",&&(4 &*+,-,+-+&*+'&" &++'!.(&(&' &(=&4+"(, ((( 700968$%0B7% &(09))08$9 9#))9) & 7"" -0,&-9,8,&0 (4"& &(0 " 4 * 7"" -0,&-&&)+ 40 (4"& 8,0 &'&& '4&"&+&" 4 '.,,&"" -&"""*( (*', $++ & 4$&"8,& 4$++ ;&"" &( "+(,& 4$++ &, & '4&"&+&&"" (&".,,7$07"" -&""&( "(&&+*=" &'(!& ( *',$++ & 4$&"&'",&-.&(,&&+44"!C&&'&&+ 4,7$0 D0 (4"& ="E 7"" -",&-&( ( " 4.,,! 4,.7$07"" -&""&( "(&&+& (& ",&-&"" -"+8,"+&!44" 4",&-&"" -"+ (&&&(= &-( 4(+, ( 4,",&-&"" -"+8,"+&!44",(44"*.,& 4 +"', +(<+&,*-- 4,'&&(,& 4 +"', +(<+,&. +(,&!* (&,&(& 4,.&"" -"+,&(*&+( &"!+'4 &++ (7&+ 4,",&-,0 &' (&"+&!44" 4",&-&"" -"+,&"&(&-(4(*'F4," (- 4 &(((4(&3&& 4C&&' A6 $ 09A$78$9 &(%99G$:: $ 098$69)78$9 $H 88 & -&-: &"+(-55&)&+&: & * *)"- " )! -&- ( : &@A&">( "

4. NOTES TO FINANCIAL STATEMENTS )",&7- C9$8H86) 7)8) B$ &(:$$8:$7A$:$8097$ $H 88$09 7++!" (&(&""(.,&,&&!(&'&(&3"+((4 +7 4"*,. & 3"+(( )$H78$H$ 8)68 $0987 & 0 4,(4(&3&&((4(&3+&*+'&"*&&4 ++.? "* 8 &+- (4(&3& F 8 &+- (4(&3+&*+ (4(&3& &(((4(&3& &(((4(&3& F $"&("& &(((4(&3& "* F F * 6" -5((4(&3+&*+ " 08&3&(0,&-4(8&3 8,! 4 "(&3 &-4,'&(("*&? #(&+" &33*4 F F (&(= #(&+" &3"( F F 8,&344" 4 &'(44",&-! -4"& 4,(4(&3&&((4(&3+&*+ &&4 ++.? 4(&3& "* "* 0,&-&(! F F " - 4&(+ &(:7 7+&!&3"( )&+5(!&(= @ 6&+5("&&++ @ 9, 8 &+(4(&3& &(((4(&3& 7(((4(&3& 4(&3+&*+ " - 4&(&+!&-&(* -& 9, 8 &+(4(&3+&*+ &(((4(&3& F F 8,",&-(4(" &3.&" ( 4,4 ++.-? "* "* 0,&- 8 &+- (4(&3& F F F 8 &+- (4(&3+&*+ (4(&3& 4(&3 ",&-&+5(-&+ 0,&-(4(" &3 F

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

4.4 NOTES TO FINANCIAL STATEMENTS %7$9):9 898B)9)8$%8$8#)96$ 6)7NB:7 78B6$ 6)9)8$99#7)8$7::$ 6):7 $)08)$6G)$88I)960A77%$%%)7:7%8 I8B$)7)87$$ 8)789) 98B)$8 & 3& (&'$ * 8 *+(*)"-?* " 9,"+ ( 6" ++"*+)"!&*+ 7"*&(,0 &',&(&((& 4F&(F"!+'"!&*+(4 +"', +(&-&("(-8,0 &' +'&," ++"*+' 4,"!&*+A&( 0 &' 3"&'" ++"*+"!&*+& 4"*& 3"( 3"(,!4 " ++"*+&! +'&*+,(&(,4 &(( &+! 4 " ++"*+&,&*" ((8, &+4 &'&(( &+ + *+!( *&&+,0 &'<4&"&+" ( )&"7"" (4 && 4 +++0 $&" - 55&)&+&: &, B&+,0&)"!&*+ *! &&++."(&&+ 4, &&"> 4 * = )&+& > &"&- +" + 4""')! 8,0 &',& " ((&'(4""'!7&( O0,0 &'( &"&!".,!&+&-,(4 &'",! "&,8&&" H8 6A K68 & 8,.! ""-*; "*.,",. +(,&!&&&+44",4&"&+" ( 4,0 &' )$ 6)70 )8)9 08$H:)78098)708 7098)708 6AC0889)8)$78$9 0B7% $$06)):9 7:9 7C6 88 8,&(" 4+ &(+ &(=3&*&*+ (! 4 '&"&(*'& 3&+'F(- 8,& 3&+'J 4&(+ &(+ &(=3 4F& 4"*$"& ("& 4,& ""&,+ 4"+&+(-,"'&&(&&(( &+4 & "!(-&(-(!(&+ "+&"&-",&-4, -&+& 4," 4,"+&)"+ (!+ (&&+ &> &""!&+&-,!&++&(;&"' 4&(+ &(+ 3 $8)09799:$%7))7%8 8)6086) 88:8 B$%B608$A:

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5. Bonds: SUMMARY INVESTMENT SCHEDULE Investment Categories Amount Gross Investment Holdings Percentage Admitted Assets as Reported in the Annual Statement 3 Amount 4 Percentage. U.S. Treasury securities. U.S. government agency and corporate obligations (excluding mortgagebacked securities):. Issued by U.S. government agencies. Issued by U.S. government sponsored agencies.3 Foreign government (including Canada, excluding mortgaged-backed securities).4 Securities issued by states, territories, and possessions and political subdivisions in the U.S.:.4 States, territories and possessions general obligations.4 Political subdivisions of states, territories and possessions and political subdivisions general obligations.43 Revenue and assessment obligations.44 Industrial development and similar obligations.5 Mortgage-backed securities (includes residential and commercial MBS):.5 Pass-through securities:.5 Guaranteed by GNMA.5 Issued by FNMA and FHLMC.53 Privately issued.5 CMOs and REMICs:.5 Issued by FNMA and FHLMC.5 Privately issued and collateralized by MBS issued or guaranteed by GNMA, FNMA, or FHLMC.53 All other privately issued. Other debt and other fixed income securities (excluding short-term):. Unaffiliated domestic securities (includes credit tenant loans rated by the SVO). Unaffiliated foreign securities.3 Affiliated securities 3. Equity interests: 3. Investments in mutual funds 3. Preferred stocks: 3. Affiliated 3. Unaffiliated 3.3 Publicly traded equity securities (excluding preferred stocks): 3.3 Affiliated 3.3 Unaffiliated 3.4 Other equity securities: 3.4 Affiliated 3.4 Unaffiliated 3.5 Other equity interests including tangible personal property under lease: 3.5 Affiliated 3.5 Unaffiliated 4. Mortgage loans: 4. Construction and land development 4. Agricultural 4.3 Single family residential properties 4.4 Multifamily residential properties 4.5 Commercial loans 5. Real estate investments: 5. Property occupied by the company 5. Property held for the production of income (includes $ of property acquired in satisfaction of debt) 5.3 Property held for sale ($ including 6. Policy loans property acquired in satisfaction of debt) 7. Receivables for securities 8. Cash and short-term investments 9. Other invested assets 0. Total invested assets

6 GENERAL INTERROGATORIES PART - COMMON INTERROGATORIES GENERAL. Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of which is an insurer?. If yes, did the reporting entity register and file with its domiciliary State Insurance Commissioner, Director or Superintendent, or with such regulatory official of the state of domicile of the principal insurer in the Holding Company System, a registration statement providing disclosure substantially similar to the standards adopted by the National Association of Insurance Commissioners (NAIC) in its Model Insurance Holding Company System Regulatory Act and model regulations pertaining thereto, or is the reporting entity subject to standards and disclosure requirements substantially similar to those required by such Act and regulations?.3 State Regulating? $++. Has any change been made during the year of this statement in the charter, by-laws, articles of incorporation, or deed of settlement of the reporting entity?. If yes, date of change: If not previously filed, furnish herewith a certified copy of the instrument as amended. 7 3. State as of what date the latest financial examination of the reporting entity was made or is being made. II 3. State the as of date that the latest financial examination report became available from either the state of domicile or the reporting entity. This date should be the date of the examined balance sheet and not the date the report was completed or released. 3.3 State as of what date the latest financial examination report became available to other states or the public from either the state of domicile or the reporting entity. This is the release date or completion date of the examination report and not the date of the examination (balance sheet date). 3.4 By what department or departments? Illinois Department of Insurance 4. During the period covered by this statement, did any agent, broker, sales representative, non-affiliated salesservice organization or any combination thereof under common control (other than salaried employees of the reporting entity), receive credit or commissions for or control a substantial part (more than 0 percent of any major line of business measured on direct premiums) of: II II 4. sales of new business? 4. renewals? 4. During the period covered by this statement, did any salesservice organization owned in whole or in part by the reporting entity or an affiliate, receive credit or commissions for or control a substantial part (more than 0 percent of any major line of business measured on direct premiums) of: 4. sales of new business? 4. renewals? 5. Has the reporting entity been a party to a merger or consolidation during the period covered by this statement? 5. If yes, provide the name of the entity, NAIC Company Code, and state of domicile (use two letter state abbreviation) for any entity that has ceased to exist as a result of the merger or consolidation. Name of Entity NAIC Company Code 3 State of Domicile 6. Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by any governmental entity during the reporting period? (You need not report an action, either formal or informal, if a confidentiality clause is part of the agreement.) 6. If yes, give full information: 7. Does any foreign (non-united States) person or entity directly or indirectly control 0% or more of the reporting entity? 7. If yes, 7. State the percentage of foreign control; 7. State the nationality(s) of the foreign person(s) or entity(s) or if the entity is a mutual or reciprocal, the nationality of its manager or attorney in fact; and identify the type of entity(s) (e.g., individual, corporation or government, manager or attorney in fact). Nationality Type of Entity