LIFE AND ACCIDENT AND HEALTH COMPANIES - ASSOCIATION EDITION - SEPARATE ACCOUNTS ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER 3, 007 OF THE CONDITION AND AFFAIRS OF THE SEPARATE ACCOUNTS OF THE Massachusetts Mutual Life NAIC Group Code 0435 0435 NAIC Company Code 65935 Employer's ID Number 04-590850 (Current) (Prior) Organized under the Laws of Massachusetts, State of Domicile or Port of Entry Massachusetts Country of Domicile United States of America Incorporated/Organized 05/5/85 Commenced Business 08/0/85 Statutory Home Office 95 State Street, Springfield, MA 0 (Street and Number) (City or Town, State and Zip Code) Main Administrative Office 95 State Street (Street and Number) Springfield, MA 0, 43-788-84 (City or Town, State and Zip Code) (Area Code) (Telephone Number) Mail Address 95 State Street, Springfield, MA 0 (Street and Number or P.O. Box) (City or Town, State and Zip Code) Primary Location of Books and Records 95 State Street (Street and Number) Springfield, MA 0, 43-788-84 (City or Town, State and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.massmutual.com Statutory Statement Contact Trevor W. Gordon, 43-788-84-878 (Name) (Area Code) (Telephone Number) tgordon@massmutual.com, 43-6-4086 (E-mail Address) (FAX Number) OFFICERS President and Chief Executive Officer Stuart Harry Reese Treasurer Edward Morris Kline Secretary Stephen Leslie Kuhn Actuary Isadore Jermyn OTHER Michael Thomas Rollings Executive Vice President and Chief Financial Officer Frederick Charles Castellani Executive Vice President William Francis Glavin Jr # Executive Vice President and Co-Chief Operating Officer John Vincent Murphy Executive Vice President Elaine Ann Sarsynski Executive Vice President and Chief Administrative Officer Roger William Crandall # Executive Vice President, Chief Investment Officer and Co-Chief Operating Officer Mark Douglas Roellig Executive Vice President and General Counsel DIRECTORS OR TRUSTEES Stuart Harry Reese-Chairman # James Robb Birle-Lead Director # Roger Graham Ackerman Gene Chao James Henry DeGraffenreidt Jr Patricia Diaz Dennis James Lapham Dunlap William Ben Ellis Robert Alan Essner Robert Michael Furek Carol Ann Leary William Benoit Marx Jr John Floyd Maypole Marc Francis Racicot William Taylor Spitz # State of County of Massachusetts Hampden 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. Furthermore, the scope of this attestation by the described officers also includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement. Stuart Harry Reese Stephen Leslie Kuhn Edward Morris Kline President and Chief Executive Officer Secretary Treasurer a. Is this an original filing? Yes [ X ] No [ ] Subscribed and sworn to before me this b. If no, day of. State the amendment number. Date filed 3. Number of pages attached
ASSETS General Account Basis Current Year Fair Value Basis 3 Total (Cols. + ) Prior Year 4. Bonds (Schedule D). Stocks (Schedule D):. Preferred stocks. Common stocks 3. Mortgage loans on real estate (Schedule B) 4. Real estate (Schedule A): 4. Properties held for the production of income (less $ encumbrances) 4. Properties held for sale (less $ encumbrances) 5. Contract loans 6. Cash ($, Schedule E - Part ), and cash equivalents ($, Schedule E - Part ) 7. Short-term investments (Schedule DA) 8. Other invested assets (Schedule BA) 9. Aggregate write-ins for invested assets 0. Subtotals, cash and invested assets (Lines to 9). Investment income due and accrued. Receivables for securities 3. Net adjustment in assets and liabilities due to foreign exchange rates 4. Aggregate write-ins for other than invested assets 5. Total (Lines 0 to 4) DETAILS OF WRITE-INS 090. 090. 0903. 0998. Summary of remaining write-ins for Line 9 from overflow page 0999. Totals (Lines 090 thru 0903 plus 0998)(Line 9 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) Total
LIABILITIES AND SURPLUS General Account Basis Current Year Fair Value Basis 3 Total (Cols. + ) Prior Year 4. Aggregate reserve for life, annuity and accident and health contracts (Exhibit 3, Line 9999999, Col. ). Liability for deposit-type contracts (Exhibit 4, Line 9, Col. ) 3. Interest Maintenance Reserve 4. Charges for investment management, administration and contract guarantees due or accrued 5. Investment expenses due or accrued (Exhibit, Line 4) 6. Investment taxes, licenses and fees due or accrued, excluding federal income taxes (Exhibit, Line 8) 7. Federal and foreign income taxes due or accrued (excluding deferred taxes) 8. Reserve for future federal income taxes 9. Unearned investment income 0. Other transfers to general account due or accrued (net) (including $ accrued expense allowances recognized in reserves). Remittances and items not allocated. Payable for securities 3. Net adjustment in assets and liabilities due to foreign exchange rates 4. Aggregate write-ins for liabilities 5. Total liabilities (including $ due or accrued net transfers to or (from) the general account) 6. Contributed surplus 7. Aggregate write-ins for special surplus funds 8. Unassigned funds 9. Surplus (Lines 6 through 8) 0. Totals DETAILS OF WRITE-INS 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) 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) Total 3
SUMMARY OF OPERATIONS Current Year Prior Year. Transfers to Separate Accounts:. Net premiums and annuity considerations for life and accident and health contracts. Considerations for supplementary contracts with life contingencies.3 Aggregate write-ins for other transfers to Separate Accounts.4 Totals (Lines. to.3). Transfers on account of deposit-type contracts (including $ deposits less $ withdrawals) 3. Net investment income and capital gains and losses 4. Aggregate write-ins for other income 5. Totals (Lines.4 to 4) DEDUCT: 6. Transfers from the Separate Account on account of contract benefits: 6. Death benefits 6. Matured endowments 6.3 Annuity benefits 6.4 Payments on supplementary contracts with life contingencies 6.5 Accident and health benefits 6.6 Surrender benefits and withdrawals for life contracts 6.7 Aggregate write-ins for other transfers from Separate Accounts on account of contract benefits 7. Transfers on account of policy loans 8. Net transfer of reserves from or (to) Separate Accounts 9. Other transfers from the Separate Accounts: 9. Federal and foreign income taxes incurred 9. Change in expense allowances recognized in reserves 9.3 Aggregate write-ins for other transfers from Separate Accounts 0. Subtotals (Lines 6. to 9.3). Fees associated with charges for investment management, administration and contract guarantees. Increase in aggregate reserve for life and accident and health contracts 3. Increase in liability for deposit-type contracts 4. Increase in reserve for future federal income taxes 5. Aggregate write-ins for reserves and funds 6. Totals (Lines 0 to 5) 7. Net gain from operations (including $ unrealized capital gains) (Line 5 minus Line 6) SURPLUS ACCOUNT 8. Surplus, December 3, prior year 9. Net gain from operations (Line 7) 0. Surplus contributed or (withdrawn) during year. Change in reserve on account of change in valuation basis, (increase) or decrease. Transfer from Separate Accounts of the change in expense allowances recognized in Line 3. Aggregate write-ins for gains and losses in surplus 4. Surplus, December 3, current year (Page 3, Line 9) DETAILS OF WRITE-INS 0.30. 0.30.!" 0.303. 0.398. Summary of remaining write-ins for Line.3 from overflow page 0.399. Totals (Lines 0.30 thru 0.303 plus 0.398)(Line.3 above) 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) 06.70. 06.70. 06.703. 06.798. Summary of remaining write-ins for Line 6.7 from overflow page 06.799. Totals (Lines 06.70 thru 06.703 plus 06.798)(Line 6.7 above) 09.30. 09.30. 09.303. 09.398. Summary of remaining write-ins for Line 9.3 from overflow page 09.399. Totals (Lines 09.30 thru 09.303 plus 09.398)(Line 9.3 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) 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) 4
5 ANNUAL STATEMENT FOR THE YEAR 007 OF THE SEPARATE ACCOUNTS OF THE Massachusetts Mutual Life ANALYSIS OF OPERATIONS BY LINES OF BUSINESS Ordinary Group Accident and Health 9 Total Life Insurance 3 Individual Annuities 4 Supplementary Contracts 5 Life Insurance 6 Annuities 7 Group 8 Other Aggregate of All Other Lines of Business. Transfers to Separate Accounts:. Net premiums and annuity considerations for life and accident and health contracts. Considerations for supplementary contracts with life contingencies.3 Aggregate write-ins for other transfers to Separate Accounts.4 Totals (Lines. to.3). Transfers on account of deposit-type contracts (including deposits less $ withdrawals) 3. Net investment income and capital gains and losses 4. Aggregate write-ins for other income 5. Totals (Lines.4 to 4) DEDUCT: 6. Transfers from the Separate Account on account of contract benefits: 6. Death benefits 6. Matured endowments 6.3 Annuity benefits 6.4 Payments on supplementary contracts with life contingencies 6.5 Accident and health benefits 6.6 Surrender benefits and withdrawals for life contracts 6.7 Aggregate write-ins for other transfers from Separate Accounts on account of contract benefits 7. Transfers on account of policy loans 8. Net transfer of reserves from or (to) Separate Accounts 9. Other transfers from the Separate Accounts: 9. Federal and foreign income taxes incurred 9. Change in expense allowances recognized in reserves 9.3 Aggregate write-ins for other transfers from Separate Accounts 0. Subtotals (Lines 6. to 9.3). Fees associated with charges for investment management, administration and contract guarantees. Increase in aggregate reserve for life and accident and health contracts 3. Increase in liability for deposit-type contracts 4. Increase in reserve for future federal income taxes 5. Aggregate write-ins for reserves and funds 6. Totals (Lines 0 to 5) 7. Net gain from operations (including $ unrealized capital gains) (Line 5 minus Line 6) DETAILS OF WRITE-INS 0.30. 0.30. 0.303. 0.398. Summary of remaining write-ins for Line.3 from overflow page 0.399. Totals (Lines 0.30 thru 0.303 plus 0.398) (Line.3 above) 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) 06.70. 06.70. 06.703. 06.798. Summary of remaining write-ins for Line 6.7 from overflow page 06.799. Totals (Lines 06.70 thru 06.703 plus 06.798) (Line 6.7 above) 09.30. 09.30. 09.303. 09.398. Summary of remaining write-ins for Line 9.3 from overflow page 09.399. Totals (Lines 09.30 thru 09.303 plus 09.398) (Line 9.3 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)
ANALYSIS OF INCREASE IN RESERVES DURING THE YEAR Ordinary Group Total Life Insurance 3 Individual Annuities 4 Supplementary Contracts 5 Life Insurance 6 Annuities. Reserve Dec. 3 of prior year. Tabular net premiums and considerations for annuities and supplementary contracts with life contingencies 3. Increase or (decrease) from investment results after provision for federal income taxes 4. Tabular less actual reserve released 5. Increase in reserve on account of change in valuation basis 6. Other increases (net) 7. Totals (Lines to 6) 8. Net transfer of reserves from or (to) Separate Accounts 9. Tabular cost 0. Reserves released by death. Reserves released by other terminations (net). Transfers on account of annuity and supplementary contract payments involving life contingencies 3. Charges for investment management, administration and contract guarantees 4. Aggregate write-ins for other decreases in reserves 5. Total deductions (Lines 8 to 4) 6. Reserve December 3 of current year DETAILS OF WRITE-INS 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) 6
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 Cash, cash equivalents and short-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 deductions (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 thru 0903 plus 0998) (Line 9, 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) (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) 3 4 5 Total Realized Capital Gain (Loss) (Columns + ) Change in Unrealized Capital Gain (Loss) Change in Unrealized Foreign Exchange Capital Gain (Loss) Realized Gain (Loss) On Sales or Maturity Other Realized Adjustments. U.S. Government bonds. 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. Cash, cash equivalents and short-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. 090. 0903. 0998. Summary of remaining write-ins for Line 9 from overflow page 0999. Totals (Lines 090 thru 0903 plus 0998) (Line 9, above) 7
EXHIBIT - INVESTMENT EXPENSES. Rent. Salaries and wages 3. Contributions for benefit plans for employees (a) 4. Payments to employees under non-funded benefit plans 5. Other employee welfare 6. Legal fees and expenses 7. Fees of public accountants and consulting actuaries 8. Traveling expenses 9. Postage, express, telegraph and telephone 0. Printing and stationery. Cost or depreciation of furniture and equipment. Rental of equipment 3. Books and periodicals 4. Bureau and association fees 5. Insurance, except on real estate 6. Miscellaneous losses 7. Collection and bank service charges 8. Sundry general expenses 9. Real estate expenses 0. Investment expenses not included elsewhere. Aggregate write-ins for other investment expenses. Investment expenses incurred Reconciliation with Exhibit 5 3. Investment expenses unpaid December 3, prior year 4. Investment expenses unpaid December 3, current year 5. Investment expenses paid during year (Lines + 3-4) (to Exhibit 5, Line ) 0. 0. 03. DETAILS OF WRITE-INS 98. Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 thru 03 plus 98) (Line above) Amount (a) Includes $ on account of prior service. EXHIBIT - INVESTMENT TAXES, LICENSES AND FEES (EXCLUDING FEDERAL INCOME TAXES) Amount. Real estate taxes. State insurance department fees 3. Other state taxes, including $ for employee benefits 4. U.S. Social Security taxes 5. All other taxes 6. Taxes, licenses and fees incurred Reconciliation with Exhibit 5 7. Taxes, licenses and fees unpaid December 3, prior year 8. Taxes, licenses and fees unpaid December 3, current year 9. Taxes, licenses and fees paid during year (Lines 6 + 7-8) (to Exhibit 5, Line 3) 8
EXHIBIT 3 - AGGREGATE RESERVE FOR LIFE, ANNUITY AND ACCIDENT AND HEALTH CONTRACTS 4 6 Description of Valuation Basis Total Ordinary Group! "! " #$ %%$&' 099999. Totals ())$$*+ $$*),&'&$ $$*),+-!. -)#/0((%&$"''&$ $$*), 099999. Totals ") ))$)&'$3%(),4)56)&$&))$4 %4' 0599999. Totals 9999999. Totals (to Page 3, Line ) EXHIBIT 3 - INTERROGATORIES. Has the reporting entity ever issued both participating and non-participating variable life insurance contracts? 789: 8:. Does the reporting entity at present issue both participating and non-participating variable life insurance contracts? 789: 8:. If not, state which kind is issued 3. Is any surrender value promised in excess of the reserve as legally computed? 78: 89: ;8: 3. If so, the amount of such excess must be included in surrender values in excess of reserves otherwise required and carried in this schedule. Has this been done? Attach a statement of methods employed in the valuation of variable life insurance contracts issued at, or subsequently subject to, an extra premium or in the valuation of contracts otherwise issued on lives classified as substandard for the plan of contract issued or on special class lives (including paid-up variable life insurance). 78: 8: ;89: EXHIBIT 3A - CHANGES IN BASIS OF VALUATION DURING THE YEAR (Including supplementary contracts set up on a basis other than that used to determine benefits) NONE Valuation Basis 4 3 Description of Valuation Class Changed From Changed To 9999999 - Totals (Page 6, Line 5, Analysis of Increase in Reserves) Increase in Actuarial Reserve Due to Change 9
EXHIBIT 4 - DEPOSIT TYPE CONTRACTS Total Guaranteed Interest Contracts 3 Annuities Certain 4 Supplemental Contracts 5 Dividend Accumulations or Refunds 6 Premium and Other Deposit Funds. Balance at the beginning of the year. Deposits received during the year 3. Investment earnings credited to account 4. Other net change in reserves 5. Fees and other charges assessed 6. Surrender charges 7. Net surrender or withdrawal payments 8. Other net transfer to or (from) general account 9. Balance at the end of current year (Lines ++3+4-5-6-7-8) 0
EXHIBIT 5 - RECONCILIATION OF CASH AND INVESTED ASSETS DEVELOPMENT OF INCREASE IN CASH. Transfers to Separate Accounts on account of:. Net premiums and considerations for annuities and supplementary contracts with life contingencies. Aggregate write-ins for other transfers to Separate Accounts. Deposits on deposit-type contract funds and other liabilities without life or disability contingencies 3. Investment income collected 4. Consideration on disposal of short-term bonds net of purchases 5. Consideration on disposal of investments (excluding short-term bonds) 6. Aggregate write-ins for other increases in funds from operations 7. Total (Lines to 6) 8. Cost of investments acquired (excluding short-term bonds) 9. Transfers from Separate Accounts on account of contract benefits: 9. Death benefits 9. Matured endowments 9.3 Annuity benefits 9.4 Supplementary contract benefits with life contingencies 9.5 Accident and health benefits 9.6 Surrender benefits and withdrawals for life contracts 9.7 Policy loans (net) 9.8 Transfers of reserves (net) 9.9 Aggregate write-ins for other transfers from Separate Accounts on account of contract benefits 0. Other transfers from Separate Accounts: 0. Federal income taxes 0. Aggregate write-ins for other transfers from Separate Accounts. Withdrawals on deposit-type contract funds and other liabilities without life or disability contingencies. Investment expenses (Exhibit, Line 5). Fees associated with investment management, administration and contract guarantees 3. Investment taxes, licenses and fees, excluding federal income taxes (Exhibit, Line 9) 4. Total (Lines 8 to 3) 5. Funds from operations (Line 7 minus Line 4) 6. Surplus contributed or (withdrawn) during year 7. Aggregate write-ins for other changes in funds 8. Total funds (includes $ net transfers from general account) (Lines 5 to 7) 9. Increase in payable for investments acquired, net of receivable for investments sold 0. Decrease in policy loans. Aggregate write-ins for other reconciling items. Increase in cash (Line 8 to ) RECONCILIATION BETWEEN YEARS 3. Cash and invested assets, December 3st of prior year 4. Increase in cash (Line ) 5. Cost of invested assets acquired 6. Adjusted cost of assets disposed of 7. Increase in policy loans 8. Accrual of discount less amortization of premium 9. Depreciation on real estate and other invested assets 30. Increase in net unrealized gains 3. Aggregate write-ins for other reconciling items 3. Cash and invested assets, December 3st of current year 0.0. 0.0. 0.03. DETAILS OF WRITE-INS 0.98. Summary of remaining write-ins for Line. from overflow page 0.99. Totals (Lines 0.0 thru 0.03 plus 0.98) (Line. above) 060. 060. 0603. 0698. Summary of remaining write-ins for Line 6 from overflow page 0699. Totals (Lines 060 thru 0603 plus 0698) (Line 6 above) 09.90. 09.90. 09.903. 09.998. Summary of remaining write-ins for Line 9.9 from overflow page 09.999. Totals (Lines 09.90 thru 09.903 plus 09.998) (Line 09.9 above) 0.0. 0.0. 0.03.! " # # 0.98. Summary of remaining write-ins for Line 0. from overflow page 0.99. Totals (Lines 0.0 thru 0.03 plus 0.98) (Line 0. 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) 0. % & " 0. 03. 98. Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 thru 03 plus 98) (Line above) 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) Amount
EXHIBIT 6 - GUARANTEED INSURANCE AND ANNUITY PRODUCTS Amount Percent of Total. Aggregate reserve for life, annuity and accident and health contracts (Included in Exhibit 3):. Life insurance. Annuities.3 Supplementary contracts with life contingencies.4 Accident and health.5 Miscellaneous reserves.6 Total. Liability for deposit-type contracts (included in Exhibit 4):. Guaranteed interest contracts. Annuities certain.3 Supplemental Contracts.4 Dividend accumulations or refunds.5 Premium and other deposit funds.6 Total 3. Other liabilities (included in Page 3, Lines 4, 0, 3 & 4) 4. Total liabilities associated with guarantees (Lines.6 +.6 + 3) 5. Total liabilities not associated with guarantees 6. Total Separate Accounts liabilities (Lines 4 + 5 = Page 3, Line 5) %
Interest Maintenance Reserve N O N E Interest Maintenance Reserve - Amortization N O N E Asset Valuation Reserve - Default Component N O N E Asset Valuation Reserve - Equity Component N O N E Asset Valuation Reserve Replications (Synthetic) Assets N O N E 3, 4,5, 6,7,8, 9
SCHEDULE A - VERIFICATION BETWEEN YEARS Real Estate. Book/adjusted carrying value, December 3, prior year. Increase (decrease) by adjustment:. Totals, Part, Column. Totals, Part 3, Column 8 3. Cost of acquired (Totals, Part, Column 6, net of encumbrances (Column 7) and net of additions and permanent improvements (Column 9)) 4. Cost of additions and permanent improvements: 4. Totals, Part, Column 4 4. Totals, Part 3, Column 0 5. Total profit (loss) on sales, Part 3, Column 5 6. Increase (decrease) by foreign exchange adjustment: 6. Totals, Part, Column 6. Totals, Part 3, Column 9 7. Amounts received on sales, Part 3, Column and Part, Column 3 8. Book/adjusted carrying value at end of current period 9. Total valuation allowance 0. Subtotal (Lines 8 plus 9). Total nonadmitted amounts. Statement value, current period (Page, real estate lines, Net Admitted Assets column) SCHEDULE B - VERIFICATION BETWEEN YEARS Mortgage Loans. Book value/recorded investment excluding accrued interest on mortgages owned, December 3 of prior year. Amount loaned during year:.. Actual cost at time of acquisitions.. Additional investment made after acquisitions 3. Accrual of discount and mortgage interest points and commitment fees 4. Increase (decrease) by adjustment 5. Total profit (loss) on sale 6. Amounts paid on account or in full during the year 7. Amortization of premium 8. Increase (decrease) by foreign exchange adjustment 9. Book value/recorded investment excluding accrued interest on mortgages owned at end of current period 0. Total valuation allowance. Subtotal (Lines 9 plus 0). Total nonadmitted amounts 3. Statement value of mortgages owned at end of current period (Page, mortgage lines, Net Admitted Assets column) SCHEDULE BA - VERIFICATION BETWEEN YEARS Long-Term Invested Assets. Book/adjusted carrying value of long-term invested assets owned, December 3 of prior year. Cost of acquisitions during year:.. Actual cost at time of acquisitions.. Additional investment made after acquisitions 3. Accrual of discount 4. Increase (decrease) by adjustment 5. Total profit (loss) on sale 6. Amounts paid on account or in full during the year 7. Amortization of premium 8. Increase (decrease) by foreign exchange adjustment 9. Book/adjusted carrying value of long-term invested assets at end of current period 0. Total valuation allowance. Subtotal (Lines 9 plus 0). Total nonadmitted amounts 3. Statement value of long-term invested assets at end of current period (Page, Line 7, Column 3) 0
SCHEDULE D - SUMMARY BY COUNTRY BONDS Governments (Including all obligations guaranteed by governments) States, Territories and Possessions (Direct and guaranteed) Political Subdivisions of States, Territories and Possessions (Direct and guaranteed) Special revenue and special assessment obligations and all nonguaranteed obligations of agencies and authorities of governments and their political subdivisions Description Long-Term Bonds and Stocks OWNED December 3 of Current Year Book/Adjusted Carrying Value Fair Value Actual Cost Par Value of Bonds. United States. Canada 3. Other Countries 4. Totals 5. United States 6. Canada 7. Other Countries 8. Totals 9. United States 0. Canada. Other Countries. Totals 3. United States 4. Canada 5. Other Countries 6. Totals Public Utilities (unaffiliated) 7. United States 8. Canada 9. Other Countries 0. Totals Industrial and Miscellaneous and Credit Tenant Loans (unaffiliated) Parent, Subsidiaries and Affiliates 5. Totals PREFERRED STOCKS Public Utilities (unaffiliated) Banks, Trust and Insurance Companies (unaffiliated) Industrial and Miscellaneous (unaffiliated). United States. Canada 3. Other Countries 4. Totals 6. Total Bonds 7. United States 8. Canada 9. Other Countries 30. Totals 3. United States 3. Canada 33. Other Countries 34. Totals 35. United States 36. Canada 37. Other Countries 38. Totals Parent, Subsidiaries and Affiliates 39. Totals COMMON STOCKS Public Utilities (unaffiliated) Banks, Trust and Insurance Companies (unaffiliated) Industrial and Miscellaneous (unaffiliated) Parent, Subsidiaries and Affiliates 53. Totals 40. Total Preferred Stocks 4. United States 4. Canada 43. Other Countries 44. Totals 45. United States 46. Canada 47. Other Countries 48. Totals 49. United States 50. Canada 5. Other Countries 5. Totals 54. Total Common Stocks 55. Total Stocks 56. Total Bonds and Stocks 3 4 SCHEDULE D - VERIFICATION BETWEEN YEARS Bonds and Stocks. Book/adjusted carrying value of bonds and stocks, 7. Amortization of premium prior year 8. Foreign Exchange Adjustment:. Cost of bonds and stocks acquired, Col. 7, Part 3 8. Col. 5, Part 3. Accrual of discount 8. Col. 9, Part, Sec. 4. Increase (decrease) by adjustment: 8.3 Col. 6, Part, Sec. 4. Col. - 4, Part 8.4 Col. 5, Part 4 4. Col. 5-7, Part, Sec. 9. Book/adjusted carrying value at end of current period 4.3 Col. 5, Part, Sec. 0. Total valuation allowance 4.4 Col. - 3, Part 4. Subtotal (Lines 9 plus 0) 5. Total gain (loss), Col. 9, Part 4. Total nonadmitted amounts 6. Deduct consideration for bonds and stocks disposed 3. Statement value of bonds and stocks, current period of Column 7, Part 4
SCHEDULE DA - PART - VERIFICATION BETWEEN YEARS Short-Term Investments Total Bonds 3 Mortgage Loans 4 Other Short-term Investment Assets (a) 5 Investments in Parent, Subsidiaries and Affiliates. Book/adjusted carrying value, December 3 of prior year. Cost of short-term investments acquired 3. Increase (decrease) by adjustment 4. Increase (decrease) by foreign exchange adjustment 5. Total profit (loss) on disposal of short-term investments 6. Consideration received on disposal of short-term investments 7. Book/adjusted carrying value, current year 8. Total valuation allowance 9. Subtotal (Lines 7 plus 8) 0. Total nonadmitted amounts. Statement value (Lines 9 minus 0). Income collected during year 3. Income earned during year (a) Indicate the category of such assets, for example, joint ventures, transportation equipment:
SCHEDULE DB - PART A - VERIFICATION BETWEEN YEARS Options, Caps, Floors and Insurance Futures Options Owned. Book value, December 3, prior year (Line 8, prior year). Cost/Option Premium (Section, Column 7) 3. Increase/(Decrease) by Adjustment (Section, Column ) plus (Section 3, Column 3) 4. Gain/(Loss) on Termination: 4. Recognized (Section 3, Column 4) 4. Used to Adjust Basis of Hedged Item (Section 3, Column 5) 5. Consideration Received on Terminations (Section 3, Column ) 6. Used to Adjust Basis on Open Contracts (Section, Column 3) 7. Disposition of Deferred Amount on Contracts Terminated in Prior Year: 7. Recognized 7. Used to Adjust Basis of Hedged Item 8. Book value, December 3, current year (Lines ++3+4-5-6-7) SCHEDULE DB - PART B - VERIFICATION BETWEEN YEARS Options, Caps, Floors and Insurance Futures Options Written. Book value, December 3, prior year (Line 8, prior year). Consideration received (Section, Column 7) 3. Increase/(Decrease) by Adjustment (Section, Column ) plus (Section 3, Column 3) 4. Gain/(Loss) on Termination: 4. Recognized (Section 3, Column 4) 4. Used to Adjust Basis (Section 3, Column 5) 5. Consideration Paid on Terminations (Section 3, Column ) 6. Used to Adjust Basis on Open Contracts (Section, Column 3) 7. Disposition of Deferred Amount on Contracts Terminated in Prior Year: 7. Recognized 7. Used to Adjust Basis 8. Book value, December 3, current year 3
SCHEDULE DB - PART C - VERIFICATION BETWEEN YEARS Swaps and Forwards. Book value, December 3, prior year (Line 8, prior year). Cost or (Consideration Received) (Section, Column 7) 3. Increase/(Decrease) by Adjustment (Section, Column ) plus (Section 3, Column 3) 4. Gain/(Loss) on Termination: 4. Recognized (Section 3, Column 4) 4. Used to Adjust Basis of Hedged Item (Section 3, Column 5) 5. Consideration Received (or Paid) on Terminations (Section 3, Column ) 6. Used to Adjust Basis of Hedged Item on Open Contracts (Section, Column 3) 7. Disposition of Deferred Amount on Contracts Terminated in Prior Year: 7. Recognized 7. Used to Adjust Basis of Hedged Item 8. Book value, December 3, current year (Lines ++3+4-5-6-7) SCHEDULE DB - PART D- VERIFICATION BETWEEN YEARS Futures Contracts and Insurance Futures Contracts. Book value, December 3, prior year (Line 8, prior year). Change in total Variation Margin on Open Contracts (Difference between years - Section, Column 6) 3. Change in Variation Margin on Open Contracts Used to Adjust Basis of Hedged Item (Section, Column ) 3. Change in Variation Margin on Open Contracts Recognized (Difference between years - Section, Column 0) 4. Variation Margin on Contracts Terminated During the Year (Section 3, Column 6) 4. Less: 4. Gain/(Loss) Recognized in Current Year (Section 3, Column ) 4. Gain/(Loss) Used to Adjust Basis of Hedge (Section 3, Column ) 4.3 Subtotal (Line 4. minus Line 4.) 5. Net additions to Cash Deposits (Section, Column 7) 5. Less: Net Reductions to Cash Deposits (Section 3, Column 9) 6. Subtotal (Lines - + 3. + 3. - 4.3 + 5.) 7. 7. Disposition of Gain/(Loss) on Contracts Terminated in Prior Year: 7. Recognized 7. Used to Adjust Basis of Hedged Item 8. Book value, December 3, current year (Lines 6+7.+7.) SCHEDULE DB - PART E - VERIFICATION Statement Value and Fair Value of Open Contracts Statement Value. Part A, Section, Column 0. Part B, Section, Column 0 3. Part C, Section, Column 0 4. Part D, Section, Column 9-5. Lines () - () + (3) + (4) 6. Part E, Section, Column 4 7. Part E, Section, Column 5 8. Lines (5) - (6) - (7) Fair Value 9. Part A, Section, Column 0. Part B, Section, Column. Part C, Section, Column. Part D, Section, Column 9 3. Lines (9) - (0) + () + () 4. Part E, Section, Column 7 5. Part E, Section, Column 8 6. Lines (3) - (4) - (5) 4
Schedule DB - Part F - Section N O N E Schedule DB - Part F - Section N O N E 5, 6
OVERFLOW PAGE FOR WRITE-INS Additional Write-ins for Assets Line 4 404. 405. 497. Summary of remaining write-ins for Line 4 from overflow page Additional Write-ins for Liabilities Line 4 404.! "## 497. Summary of remaining write-ins for Line 4 from overflow page Additional Write-ins for Exhibit 5 Line 0. 0.04. $% &' 0.05. ( 0.06. $%) #% &' 0.07. (# % & ' 0.08. (% 0.09. &' 0.0. $ * 0.. +, & ' 0.. &' 0.97. Summary of remaining write-ins for Line 0. from overflow page & ' 7