PROPERTY AND CASUALTY COMPANIES - ASSOCIATION EDITION ANNUAL STATEMENT FOR THE YEAR ENDED DECEMBER, 06 OF THE CONDITION AND AFFAIRS OF THE ASHMERE INSURANCE COMPANY *40980600000* NAIC Group Code 49 9 NAIC Company Code 4098 Employer's ID Number 6-557 (Current) (Prior) Organized under the Laws of Florida, State of Domicile or Port of Entry FL Country of Domicile United States of America Incorporated/Organized 0/06/98 Commenced Business 0/0/98 Statutory Home Office 40 E. Las Olas Blvd., Suite 540, Fort Lauderdale, FL, US 0 (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 40 E. Las Olas Blvd., Suite 540 (Street and Number) Fort Lauderdale, FL, US 0, 954-44-7 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address 40 E. Las Olas Blvd., Suite 540, Fort Lauderdale, FL, US 0 (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 40 E. Las Olas Blvd., Suite 540 (Street and Number) Fort Lauderdale, FL, US 0, 954-44-7 (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Website Address www.ashmereins.com Statutory Statement Contact BRANDON CLINTON DRISCOLL, 954-556-6 (Name) (Area Code) (Telephone Number) bdriscoll@ashmereins.com, (E-mail Address) (FAX Number) OFFICERS President CHARLES KEVIN SCHUVER # Treasurer BRANDON CLINTON DRISCOLL # Secretary GARY WILLIAM ROCHE # OTHER DIRECTORS OR TRUSTEES CHARLES KEVIN SCHUVER # BRANDON CLINTON DRISCOLL # ERNEST NICOLAE CSISZAR # RONALD PATRICK FORMENTO # CHARLES HENRY WALSH JR. # State of County of Florida Broward 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. CHARLES KEVIN SCHUVER BRANDON CLINTON DRISCOLL GARY WILLIAM ROCHE PRESIDENT AND CEO CFO AND TREASURER COO AND SECRETARY a. Is this an original filing? Yes [ X ] No [ ] Subscribed and sworn to before me this b. If no, 7th day of February 07. State the amendment number. Date filed. Number of pages attached
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company ASSETS Assets Current Year Nonadmitted Assets Net Admitted Assets (Cols. - ) Prior Year 4 Net Admitted Assets. Bonds (Schedule D) 4,870,7 4,870,7 5,008,886. Stocks (Schedule D):. Preferred stocks 0 0. Common stocks 0 0. Mortgage loans on real estate (Schedule B):. First liens 0 0. Other than first liens 0 0 4. Real estate (Schedule A): 4. Properties occupied by the company (less $ 0 encumbrances) 0 0 4. Properties held for the production of income (less $ 0 encumbrances) 0 0 4. Properties held for sale (less $ 0 encumbrances) 0 0 5. Cash ($,0,698, Schedule E - Part ), cash equivalents ($ 6,55, Schedule E - Part ) and short-term investments ($ 80,6, Schedule DA) 4,09,7 4,09,7 7,0,06 6. Contract loans (including $ premium notes) 0 0 7. Derivatives (Schedule DB) 0 0 8. Other invested assets (Schedule BA) 0 0 9. Receivable for securities 5,05 5,05,75 0. Securities lending reinvested collateral assets (Schedule DL) 0 0. Aggregate write-ins for invested assets 0 0 0 0. Subtotals, cash and invested assets (Lines to ) 8,894,579 0 8,894,579,044,97. Title plants less $ charged off (for Title insurers only) 0 0 4. Investment income due and accrued 4,87 4,87 7,57 5. Premiums and considerations: 5. Uncollected premiums and agents' balances in the course of collection 5,74 5,74 0 5. Deferred premiums and agents' balances and installments booked but deferred and not yet due (including $ earned but unbilled premiums) 0,68 0,68 0 5. Accrued retrospective premiums ($ ) and 6. Reinsurance: contracts subject to redetermination ($ ) 0 0 6. Amounts recoverable from reinsurers 0 0 6. Funds held by or deposited with reinsured companies 0 0 6. Other amounts receivable under reinsurance contracts 0 0 7. Amounts receivable relating to uninsured plans 0 0 8. Current federal and foreign income tax recoverable and interest thereon 0 49,800 8. Net deferred tax asset 86,85 86,85 0 9. Guaranty funds receivable or on deposit 0 0 0. Electronic data processing equipment and software 0 0. Furniture and equipment, including health care delivery assets ($ ) 0 0. Net adjustment in assets and liabilities due to foreign exchange rates 0 0. Receivables from parent, subsidiaries and affiliates 0 0 4. Health care ($ ) and other amounts receivable 0 0 5. Aggregate write-ins for other than invested assets 0 0 0,48 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5) 9,5,0 0 9,5,0,4,69 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 0 0 8. Total (Lines 6 and 7) 9,5,0 0 9,5,0,4,69 0. 0. 0. DETAILS OF WRITE-INS 98. Summary of remaining write-ins for Line from overflow page 0 0 0 0 99. Totals (Lines 0 thru 0 plus 98)(Line above) 0 0 0 0 50. Taxes Recoverable 0,8 50. Other Assets 0 00 50. 598. Summary of remaining write-ins for Line 5 from overflow page 0 0 0 0 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 0 0 0,48
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company LIABILITIES, SURPLUS AND OTHER FUNDS Current Year Prior Year. Losses (Part A, Line 5, Column 8) 4 0. Reinsurance payable on paid losses and loss adjustment expenses (Schedule F, Part, Column 6) 0 0. Loss adjustment expenses (Part A, Line 5, Column 9) 4 0 4. Commissions payable, contingent commissions and other similar charges 5,84 5. Other expenses (excluding taxes, licenses and fees) 59,6 6. Taxes, licenses and fees (excluding federal and foreign income taxes) 87 7. Current federal and foreign income taxes (including $ on realized capital gains (losses)) 7. Net deferred tax liability 8. Borrowed money $ and interest thereon $ 9. Unearned premiums (Part A, Line 8, Column 5) (after deducting unearned premiums for ceded reinsurance of $ 0 and including warranty reserves of $ and accrued accident and health experience rating refunds including $ 0 for medical loss ratio rebate per the Public Health Service Act) 5,4 0 0. Advance premium. Dividends declared and unpaid:. Stockholders. Policyholders. Ceded reinsurance premiums payable (net of ceding commissions) 0. Funds held by company under reinsurance treaties (Schedule F, Part, Column 9) 0 0 4. Amounts withheld or retained by company for account of others 5. Remittances and items not allocated 6. Provision for reinsurance (including $ 0 certified) (Schedule F, Part 8) 0 7. Net adjustments in assets and liabilities due to foreign exchange rates 8. Drafts outstanding 9. Payable to parent, subsidiaries and affiliates 6,50 0. Derivatives 0 0. Payable for securities. Payable for securities lending. Liability for amounts held under uninsured plans 4. Capital notes $ and interest thereon $ 5. Aggregate write-ins for liabilities 0 0 6. Total liabilities excluding protected cell liabilities (Lines through 5) 0,58 6,50 7. Protected cell liabilities 8. Total liabilities (Lines 6 and 7) 0,58 6,50 9. Aggregate write-ins for special surplus funds 0 0 0. Common capital stock 5,007,000 5,007,000. Preferred capital stock. Aggregate write-ins for other than special surplus funds 0 0. Surplus notes 0 0 4. Gross paid in and contributed surplus,99,6 5,99,85 5. Unassigned funds (surplus) 50,,47,8 6. Less treasury stock, at cost: 6. shares common (value included in Line 0 $ ) 6. shares preferred (value included in Line $ ) 7. Surplus as regards policyholders (Lines 9 to 5, less 6) (Page 4, Line 9) 9,50,945,47,90 8. TOTALS (Page, Line 8, Col. ) 9,5,0,4,69 50. 50. 50. DETAILS OF WRITE-INS 598. Summary of remaining write-ins for Line 5 from overflow page 0 0 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 0 0 90. 90. 90. 998. Summary of remaining write-ins for Line 9 from overflow page 0 0 999. Totals (Lines 90 thru 90 plus 998)(Line 9 above) 0 0 0. 0. 0. 98. Summary of remaining write-ins for Line from overflow page 0 0 99. Totals (Lines 0 thru 0 plus 98)(Line above) 0 0
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company STATEMENT OF INCOME Current Year UNDERWRITING INCOME Prior Year. Premiums earned (Part, Line 5, Column 4) 47 0 DEDUCTIONS:. Losses incurred (Part, Line 5, Column 7) 4 0. Loss adjustment expenses incurred (Part, Line 5, Column ) 64 0 4. Other underwriting expenses incurred (Part, Line 5, Column ) 74,69 9, 5. Aggregate write-ins for underwriting deductions 0 0 6. Total underwriting deductions (Lines through 5) 74,997 9, 7. Net income of protected cells 8. Net underwriting gain or (loss) (Line minus Line 6 plus Line 7) (74,560) (9,) INVESTMENT INCOME 9. Net investment income earned (Exhibit of Net Investment Income, Line 7) 80,74 7,8 0. Net realized capital gains or (losses) less capital gains tax of $ (Exhibit of Capital Gains (Losses) ) 89,40. Net investment gain (loss) (Lines 9 + 0) 8,65 75, OTHER INCOME. Net gain (loss) from agents or premium balances charged off (amount recovered $ amount charged off $ ) 0 0. Finance and service charges not included in premiums 4. Aggregate write-ins for miscellaneous income (4) 0 5. Total other income (Lines through 4) (4) 0 6. Net income before dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes (Lines 8 + + 5) 7. Dividends to policyholders (66,58) (6,879) 8. Net income, after dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes (Line 6 minus Line 7) (66,58) (6,879) 9. Federal and foreign income taxes incurred 0 0. Net income (Line 8 minus Line 9)(to Line ) (66,58) (6,879) CAPITAL AND SURPLUS ACCOUNT. Surplus as regards policyholders, December prior year (Page 4, Line 9, Column ),47,90,544,069. Net income (from Line 0) (66,58) (6,879). Net transfers (to) from Protected Cell accounts 4. Change in net unrealized capital gains or (losses) less capital gains tax of $ 5. Change in net unrealized foreign exchange capital gain (loss) 6. Change in net deferred income tax 86,85 7. Change in nonadmitted assets (Exhibit of Nonadmitted Assets, Line 8, Col. ) 0 8. Change in provision for reinsurance (Page, Line 6, Column minus Column ) 0 0 9. Change in surplus notes 0. Surplus (contributed to) withdrawn from protected cells. Cumulative effect of changes in accounting principles. Capital changes:. Paid in. Transferred from surplus (Stock Dividend). Transferred to surplus. Surplus adjustments:. Paid in. Transferred to capital (Stock Dividend). Transferred from capital 4. Net remittances from or (to) Home Office 5. Dividends to stockholders (,999,0) 0 (,00,48) 6. Change in treasury stock (Page, Lines 6. and 6., Column minus Column ) 0 0 7. Aggregate write-ins for gains and losses in surplus 0 0 8. Change in surplus as regards policyholders for the year (Lines through 7) (,76,45) (6,879) 9. Surplus as regards policyholders, December current year (Line plus Line 8) (Page, Line 7) 9,50,945,47,90 050. 050. 050. DETAILS OF WRITE-INS 0598. Summary of remaining write-ins for Line 5 from overflow page 0 0 0599. Totals (Lines 050 thru 050 plus 0598)(Line 5 above) 0 0 40. INTEREST ON FUNDS HELD 0 40. MISCELLANEOUS INCOME (4) 0 40. 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) (4) 0 70. 70. 70. 798. Summary of remaining write-ins for Line 7 from overflow page 0 0 799. Totals (Lines 70 thru 70 plus 798)(Line 7 above) 0 0 4
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company CASH FLOW Current Year Prior Year Cash from Operations. Premiums collected net of reinsurance () 0. Net investment income 48,845 0,77. Miscellaneous income (4) 0 4. Total (Lines through ) 48,4 0,77 5. Benefit and loss related payments 0 0 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts 0 0 7. Commissions, expenses paid and aggregate write-ins for deductions 77,8 9, 8. Dividends paid to policyholders 0 0 9. Federal and foreign income taxes paid (recovered) net of $ tax on capital gains (losses) (49,800) (,50) 0. Total (Lines 5 through 9) 87,58 78,86. Net cash from operations (Line 4 minus Line 0) (9,097) (77,5) Cash from Investments. Proceeds from investments sold, matured or repaid:. Bonds,875,90 6,04,44. Stocks 77 0. Mortgage loans 0 0.4 Real estate 0 0.5 Other invested assets 0 0.6 Net gains or (losses) on cash, cash equivalents and short-term investments 89 0.7 Miscellaneous proceeds 0 9,8.8 Total investment proceeds (Lines. to.7),876,85 6,06,957. Cost of investments acquired (long-term only):. Bonds,74,67 0,0. Stocks 0 0. Mortgage loans 0 0.4 Real estate 0 0.5 Other invested assets 0 0.6 Miscellaneous applications,750 0.7 Total investments acquired (Lines. to.6),74,97 0,0 4. Net increase (decrease) in contract loans and premium notes 0 0 5. Net cash from investments (Line.8 minus Line.7 minus Line 4),96 5,95,755 Cash from Financing and Miscellaneous Sources 6. Cash provided (applied): 6. Surplus notes, capital notes 0 0 6. Capital and paid in surplus, less treasury stock (,999,0) 0 6. Borrowed funds 0 0 6.4 Net deposits on deposit-type contracts and other insurance liabilities 0 0 6.5 Dividends to stockholders,00,48 0 6.6 Other cash provided (applied) (4,957) (6,99) 7. Net cash from financing and miscellaneous sources (Lines 6. to 6.4 minus Line 6.5 plus Line 6.6) (,006,659) (6,99) RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 8. Net change in cash, cash equivalents and short-term investments (Line, plus Lines 5 and 7) (,0,80) 5,868,68 9. Cash, cash equivalents and short-term investments: 9. Beginning of year 7,0,07,6,99 9. End of period (Line 8 plus Line 9.) 4,09,7 7,0,07 Note: Supplemental disclosures of cash flow information for non-cash transactions: 5
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT Line of Business PART - PREMIUMS EARNED Net Premiums Written per Column 6, Part B Unearned Premiums Dec. Prior Year - per Col., Last Year s Part Unearned Premiums Dec. Current Year - per Col. 5 Part A 4 Premiums Earned During Year (Cols. + - ). Fire 0 0 0 0. Allied lines 0 0 0 0. Farmowners multiple peril 0 0 0 0 4. Homeowners multiple peril 0 0 0 0 5. Commercial multiple peril 0 0 0 0 6. Mortgage guaranty 0 0 0 0 8. Ocean marine 0 0 0 0 9. Inland marine 0 0 0 0 0. Financial guaranty 0 0 0 0. Medical professional liability - occurrence 0 0 0 0. Medical professional liability - claims-made 0 0 0 0. Earthquake 0 0 0 0. Group accident and health 0 0 0 0 4. Credit accident and health (group and individual) 0 0 0 0 5. Other accident and health 0 0 0 0 6. Workers' compensation 5,870 0 5,4 47 7. Other liability - occurrence 0 0 0 0 7. Other liability - claims-made 0 0 0 0 7. Excess workers' compensation 0 0 0 0 8. Products liability - occurrence 0 0 0 0 8. Products liability - claims-made 0 0 0 0 9., 9. Private passenger auto liability 0 0 0 0 9., 9.4 Commercial auto liability 0 0 0 0. Auto physical damage 0 0 0 0. Aircraft (all perils) 0 0 0 0. Fidelity 0 0 0 0 4. Surety 0 0 0 0 6. Burglary and theft 0 0 0 0 7. Boiler and machinery 0 0 0 0 8. Credit 0 0 0 0 9. International 0 0 0 0 0. Warranty 0 0 0 0. Reinsurance - nonproportional assumed property 0 0 0 0. Reinsurance - nonproportional assumed liability 0 0 0 0. Reinsurance - nonproportional assumed financial lines 0 0 0 0 4. Aggregate write-ins for other lines of business 0 0 0 0 5. TOTALS 5,870 0 5,4 47 DETAILS OF WRITE-INS 40. 40. 40. 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0 0 0 0 6
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT Line of Business PART A - RECAPITULATION OF ALL PREMIUMS Amount Unearned (Running One Year or Less from Date of Policy) (a) Amount Unearned (Running More Than One Year from Date of Policy) (a) Earned But Unbilled Premium 4 Reserve for Rate Credits and Retrospective Adjustments Based on Experience 5 Total Reserve for Unearned Premiums Cols. + + + 4. Fire 0. Allied lines 0. Farmowners multiple peril 0 4. Homeowners multiple peril 0 5. Commercial multiple peril 0 6. Mortgage guaranty 0 8. Ocean marine 0 9. Inland marine 0 0. Financial guaranty 0. Medical professional liability - occurrence 0. Medical professional liability - claims-made 0. Earthquake 0. Group accident and health 0 4. Credit accident and health (group and individual) 0 5. Other accident and health 0 6. Workers' compensation 5,4 0 0 0 5,4 7. Other liability - occurrence 0 7. Other liability - claims-made 0 7. Excess workers' compensation 0 8. Products liability - occurrence 0 8. Products liability - claims-made 0 9., 9. Private passenger auto liability 0 9., 9.4 Commercial auto liability 0. Auto physical damage 0. Aircraft (all perils) 0. Fidelity 0 4. Surety 0 6. Burglary and theft 0 7. Boiler and machinery 0 8. Credit 0 9. International 0 0. Warranty 0. Reinsurance - nonproportional assumed property 0. Reinsurance - nonproportional assumed liability 0. Reinsurance - nonproportional assumed financial lines 0 4. Aggregate write-ins for other lines of business 0 0 0 0 0 5. TOTALS 5,4 0 0 0 5,4 6. Accrued retrospective premiums based on experience 7. Earned but unbilled premiums 8. Balance (Sum of Line 5 through 7) 5,4 40. 40. 40. DETAILS OF WRITE-INS 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0 0 0 0 0 (a) State here basis of computation used in each case 7
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT PART B - PREMIUMS WRITTEN Line of Business Reinsurance Assumed Reinsurance Ceded 6 4 5 Net Premiums Written Direct Business (a) From Affiliates From Non-Affiliates To Affiliates To Non-Affiliates Cols. ++-4-5. Fire 0 0. Allied lines 0 0. Farmowners multiple peril 0 0 4. Homeowners multiple peril 0 0 5. Commercial multiple peril 0 0 6. Mortgage guaranty 0 0 8. Ocean marine 0 0 9. Inland marine 0 0 0. Financial guaranty 0 0. Medical professional liability - occurrence 0. Medical professional liability - claims-made 0. Earthquake 0 0. Group accident and health 0 0 4. Credit accident and health (group and individual) 0 0 5. Other accident and health 0 0 6. Workers' compensation 5,89 5,870 7. Other liability - occurrence 0 0 7. Other liability - claims-made 0 0 7. Excess workers' compensation 0 0 8. Products liability - occurrence 0 8. Products liability - claims-made 0 9., 9. Private passenger auto liability 0 0 9., 9.4 Commercial auto liability 0 0. Auto physical damage 0 0. Aircraft (all perils) 0 0. Fidelity 0 0 4. Surety 0 0 6. Burglary and theft 0 0 7. Boiler and machinery 0 0 8. Credit 0 0 9. International 0 0. Warranty 0 0. Reinsurance - nonproportional assumed property XXX 0. Reinsurance - nonproportional assumed liability XXX 0. Reinsurance - nonproportional assumed financial lines XXX 0 4. Aggregate write-ins for other lines of business 0 0 0 0 0 0 5. TOTALS 5,89 0 0 0 5,870 40. 40. 40. DETAILS OF WRITE-INS 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0 0 0 0 0 0 (a) Does the company's direct premiums written include premiums recorded on an installment basis? Yes [ ] No [ X ] 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 $ 8
9 ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT PART - LOSSES PAID AND INCURRED Losses Paid Less Salvage 5 6 7 8 4 Net Losses Unpaid Current Year (Part A, Col. 8) Losses Incurred Current Year (Cols. 4 + 5-6) Percentage of Losses Incurred (Col. 7, Part ) to Premiums Earned (Col. 4, Part ) Reinsurance Reinsurance Net Payments Net Losses Unpaid Line of Business Direct Business Assumed Recovered (Cols. + - ) Prior Year. Fire 0 0 0 0 0 0.0. Allied lines 0 0 0 0 0 0.0. Farmowners multiple peril 0 0 0 0 0 0.0 4. Homeowners multiple peril 0 0 0 0 0 0.0 5. Commercial multiple peril 0 0 0 0 0 0.0 6. Mortgage guaranty 0 0 0 0 0 0.0 8. Ocean marine 0 0 0 0 0 0.0 9. Inland marine 0 0 0 0 0 0.0 0. Financial guaranty 0 0 0 0 0 0.0. Medical professional liability - occurrence 0 0 0 0 0.0. Medical professional liability - claims-made 0 0 0 0 0.0. Earthquake 0 0 0 0 0 0.0. Group accident and health 0 0 0 0 0 0.0 4. Credit accident and health (group and individual) 0 0 0 0 0 0.0 5. Other accident and health 0 0 0 0 0 0.0 6. Workers' compensation 0 0 4 0 4 55.4 7. Other liability - occurrence 0 0 0 0 0 0.0 7. Other liability - claims-made 0 0 0 0 0 0.0 7. Excess workers' compensation 0 0 0 0 0 0.0 8. Products liability - occurrence 0 0 0 0 0.0 8. Products liability - claims-made 0 0 0 0 0.0 9., 9. Private passenger auto liability 0 0 0 0 0 0.0 9., 9.4 Commercial auto liability 0 0 0 0 0 0.0. Auto physical damage 0 0 0 0 0 0.0. Aircraft (all perils) 0 0 0 0 0 0.0. Fidelity 0 0 0 0 0 0.0 4. Surety 0 0 0 0 0 0.0 6. Burglary and theft 0 0 0 0 0 0.0 7. Boiler and machinery 0 0 0 0 0 0.0 8. Credit 0 0 0 0 0 0.0 9. International 0 0 0 0 0.0 0. Warranty 0 0 0 0 0 0.0. Reinsurance - nonproportional assumed property XXX 0 0 0 0 0.0. Reinsurance - nonproportional assumed liability XXX 0 0 0 0 0.0. Reinsurance - nonproportional assumed financial lines XXX 0 0 0 0 0.0 4. Aggregate write-ins for other lines of business 0 0 0 0 0 0 0 0.0 5. TOTALS 0 0 0 0 4 0 4 55.4 DETAILS OF WRITE-INS 40. 40. 40. 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0 0 0 0 0 0 0
0 ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT PART A - UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES Reported Losses Incurred But Not Reported 8 9 4 5 6 7 Deduct Reinsurance Recoverable Net Losses Excl. Incurred But Not Reported (Cols. + - ) Net Unpaid Loss Adjustment Expenses Reinsurance Reinsurance Reinsurance Net Losses Unpaid Line of Business Direct Assumed Direct Assumed Ceded (Cols. 4 + 5 + 6-7). Fire 0 0. Allied lines 0 0. Farmowners multiple peril 0 0 4. Homeowners multiple peril 0 0 5. Commercial multiple peril 0 0 6. Mortgage guaranty 0 0 8. Ocean marine 0 0 9. Inland marine 0 0 0. Financial guaranty 0 0. Medical professional liability - occurrence 0 0. Medical professional liability - claims-made 0 0. Earthquake 0 0. Group accident and health 0 (a) 0 4. Credit accident and health (group and individual) 0 0 5. Other accident and health 0 (a) 0 6. Workers' compensation 0 0 0 0 4 0 0 4 4 7. Other liability - occurrence 0 0 7. Other liability - claims-made 0 0 7. Excess workers' compensation 0 0 8. Products liability - occurrence 0 0 8. Products liability - claims-made 0 0 9., 9. Private passenger auto liability 0 0 9., 9.4 Commercial auto liability 0 0. Auto physical damage 0 0. Aircraft (all perils) 0 0. Fidelity 0 0 4. Surety 0 0 6. Burglary and theft 0 0 7. Boiler and machinery 0 0 8. Credit 0 0 9. International 0 0 0. Warranty 0 0. Reinsurance - nonproportional assumed property XXX 0 XXX 0. Reinsurance - nonproportional assumed liability XXX 0 XXX 0. Reinsurance - nonproportional assumed financial lines XXX 0 XXX 0 4. Aggregate write-ins for other lines of business 0 0 0 0 0 0 0 0 0 5. TOTALS 0 0 0 0 4 0 0 4 4 DETAILS OF WRITE-INS 40. 40. 40. 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 0 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0 0 0 0 0 0 0 0 0 (a) Including $ for present value of life indemnity claims.
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company UNDERWRITING AND INVESTMENT EXHIBIT PART - EXPENSES 4. Claim adjustment services: Loss Adjustment Expenses Other Underwriting Expenses Investment Expenses. Direct 64 64. Reinsurance assumed 0 0. Reinsurance ceded 0 0.4 Net claim adjustment service (. +. -.) 64 0 0 64. Commission and brokerage:. Direct excluding contingent 0 5,84 5,84. Reinsurance assumed, excluding contingent 0 0. Reinsurance ceded, excluding contingent 0 0.4 Contingent - direct 0 0.5 Contingent - reinsurance assumed 0 0.6 Contingent - reinsurance ceded 0 0.7 Policy and membership fees 0 0.8 Net commission and brokerage (. +. -. +.4 +.5 -.6 +.7) 0 5,84 0 5,84. Allowances to managers and agents 0 0 4. Advertising 0 0 0 5. Boards, bureaus and associations 0,7,7 6. Surveys and underwriting reports 0 0 0 7. Audit of assureds records 0 0 0 8. Salary and related items: 8. Salaries 0 40,68 40,68 8. Payroll taxes 0 4,08 4,08 9. Employee relations and welfare 0 0 0 0. Insurance 0 979 979. Directors fees 0 75, 75,. Travel and travel items 0 0. Rent and rent items 0 7,500 7,500 4. Equipment 0 7 7 5. Cost or depreciation of EDP equipment and software 0 0 0 6. Printing and stationery 0 9 9 7. Postage, telephone and telegraph, exchange and express 0,768,768 8. Legal and auditing 0 470,89 470,89 9. Totals (Lines to 8) 0 647,08 0 647,08 0. Taxes, licenses and fees: 0. State and local insurance taxes deducting guaranty association credits of $ 7,04 7,04 0. Insurance department licenses and fees 7,694 7,694 0. Gross guaranty association assessments 0 0 0.4 All other (excluding federal and foreign income and real estate) 0 0 0.5 Total taxes, licenses and fees (0. + 0. + 0. + 0.4) 0 88,998 0 88,998. Real estate expenses 0. Real estate taxes 0. Reimbursements by uninsured plans 0 4. Aggregate write-ins for miscellaneous expenses 0,0,905 4,06 5. Total expenses incurred 64 74,69,905 (a) 765,660 6. Less unpaid expenses - current year 4 4 7. Add unpaid expenses - prior year 0 0 0 0 8. Amounts receivable relating to uninsured plans, prior year 0 0 0 0 9. Amounts receivable relating to uninsured plans, current year 0 0. TOTAL EXPENSES PAID (Lines 5-6 + 7-8 + 9) 74,69,905 765,67 DETAILS OF WRITE-INS 40. Bank Fees,0,905 4,06 40. 40. 498. Summary of remaining write-ins for Line 4 from overflow page 0 0 0 0 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above) 0,0,905 4,06 (a) Includes management fees of $ to affiliates and $ to non-affiliates. Total
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company EXHIBIT OF NET INVESTMENT INCOME Collected During Year Earned During Year. U.S. Government bonds (a) 04,087 99,79. Bonds exempt from U.S. tax (a). Other bonds (unaffiliated) (a). Bonds of affiliates (a). Preferred stocks (unaffiliated) (b). Preferred stocks of affiliates (b). Common stocks (unaffiliated). Common stocks of affiliates. Mortgage loans (c) 4. Real estate (d) 5 Contract loans 6 Cash, cash equivalents and short-term investments (e) 4,50 4,50 7 Derivative instruments (f) 8. Other invested assets 9. Aggregate write-ins for investment income 0 0 0. Total gross investment income 08,47 0,69. Investment expenses (g),905. Investment taxes, licenses and fees, excluding federal income taxes (g) 0. Interest expense (h) 4. Depreciation on real estate and other invested assets (i) 5. Aggregate write-ins for deductions from investment income 0 6. Total deductions (Lines through 5),905 7. Net investment income (Line 0 minus Line 6) 80,74 DETAILS OF WRITE-INS 090. 090. 090. 0998. Summary of remaining write-ins for Line 9 from overflow page 0 0 0999. Totals (Lines 090 thru 090 plus 0998) (Line 9, above) 0 0 50. 50. 50. 598. Summary of remaining write-ins for Line 5 from overflow page 0 599. Totals (Lines 50 thru 50 plus 598) (Line 5, above) 0 (a) Includes $,95 accrual of discount less $ 7,598 amortization of premium and less $,457 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) 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 9 0 9 0 0. Bonds exempt from U.S. tax 0. Other bonds (unaffiliated) 0 0 0 0 0. Bonds of affiliates 0 0 0 0 0. Preferred stocks (unaffiliated) 0 0 0 0 0. Preferred stocks of affiliates 0 0 0 0 0. Common stocks (unaffiliated) 77 0 77 0 0. Common stocks of affiliates 0 0 0 0 0. Mortgage loans 0 0 0 0 4. Real estate 0 0 0 5. Contract loans 0 6. Cash, cash equivalents and short-term investments 0 7. Derivative instruments 0 8. Other invested assets 0 0 0 0 9. Aggregate write-ins for capital gains (losses) 0 0 0 0 0 0. Total capital gains (losses) 89 0 89 0 0 DETAILS OF WRITE-INS 090. 090. 090. 0998. Summary of remaining write-ins for Line 9 from overflow page 0 0 0 0 0 0999. Totals (Lines 090 thru 090 plus 0998) (Line 9, above) 0 0 0 0 0
. Bonds (Schedule D). Stocks (Schedule D):. Preferred stocks. Common stocks ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company. Mortgage loans on real estate (Schedule B):. First liens. Other than first liens 4. Real estate (Schedule A): 4. Properties occupied by the company 4. Properties held for the production of income 4. Properties held for sale EXHIBIT OF NON-ADMITTED ASSETS 5. Cash (Schedule E - Part ), cash equivalents (Schedule E - Part ) and short-term investments (Schedule DA) 6. Contract loans 7. Derivatives (Schedule DB) 8. Other invested assets (Schedule BA) 9. Receivables for securities 0. Securities lending reinvested collateral assets (Schedule DL). Aggregate write-ins for invested assets. Subtotals, cash and invested assets (Lines to ). Title plants (for Title insurers only) 4. Investment income due and accrued 5. Premiums and considerations: 5. Uncollected premiums and agents' balances in the course of collection Current Year Total Nonadmitted Assets 5. Deferred premiums, agents' balances and installments booked but deferred and not yet due 5. Accrued retrospective premiums and contracts NONE subject to redetermination 6. Reinsurance: 6. Amounts recoverable from reinsurers 6. Funds held by or deposited with reinsured companies 6. Other amounts receivable under reinsurance contracts 7. Amounts receivable relating to uninsured plans 8. Current federal and foreign income tax recoverable and interest thereon 8. Net deferred tax asset 9. Guaranty funds receivable or on deposit 0. Electronic data processing equipment and software. Furniture and equipment, including health care delivery assets. Net adjustment in assets and liabilities due to foreign exchange rates. Receivables from parent, subsidiaries and affiliates 4. Health care and other amounts receivable 5. Aggregate write-ins for other than invested assets 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5) 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 8. Total (Lines 6 and 7) 0. 0. 0. DETAILS OF WRITE-INS 98. Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 thru 0 plus 98)(Line above) 50. 50. 50. 598. Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) Prior Year Total Nonadmitted Assets Change in Total Nonadmitted Assets (Col. - Col. )
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES A. Accounting Practices The accompanying financial statements of Ashmere Insurance Company (the Company) have been prepared on the basis of accounting practices prescribed or permitted by the Illinois Insurance Department. The State of Florida requires insurance companies to prepare their statutory financial statements in accordance with National Association of Insurance Commissioners (NAIC) Accounting Practices and Procedures Manual, subject to any deviations prescribed or permitted by the Florida Office of Insurance Regulation. There are differences between some Florida prescribed practices and NAIC accounting practices, but none impact the Company s financial statements. B. Use of Estimates in the Preparation of Financial Statements The preparation of the financial statements in conformity with Statutory Accounting Practices requires management to make informed estimates and assumptions that affect the reported amounts of assets and liabilities, as well as the disclosure of contingent assets and liabilities at the date of the financial statements. Estimates and assumptions are also made on the amounts of revenues and expenses reported during the period. Actual results may differ from these estimates. C. Accounting Policies () Short-term investments consist of securities that have original maturities of greater than three months and less than twelve months at date of purchase. Short-term investments are stated at amortized cost. Cash and cash equivalents include deposits with financial institutions, cash on hand and highly liquid debt instruments that have original maturities of three months or less at date of purchase and are stated at amortized cost. () Bonds are stated at amortized cost. () The Company has no investments in common stocks at December, 06. (4) The Company has no investments in preferred stocks at December, 06. (5) The Company has no investments in mortgage loans during the statement periods. (6) The Company has no investments in loan-backed securities. (7) The Company has no investments in subsidiaries, controlled or affiliated entities during the statement periods. (8) The Company has no investments in joint ventures, partnerships or limited liability companies during the statement periods. (9) The Company has no investment in derivative instruments during the statement periods. (0) The Company does not have a premium deficiency reserve during the statement periods. If calculated the company would use future anticipated investment income as a factor in determining its premium deficiency reserve. Unpaid losses and loss adjustment expenses include an amount determined from individual case estimates, loss reports and an amount based on past experience, for losses incurred but not reported. Such liabilities are necessarily based on assumptions and estimates and while management believes the amounts are adequate, the ultimate liability may be in excess of or less than the amount provided. The methods for making such estimates and for establishing the resulting liabilities are continually reviewed and any adjustments are reflected in the period determined. () Unpaid losses and loss adjustment expenses include an amount determined for losses incurred but not yet reported. Such liabilities are necessarily based on assumptions and estimates and, while management believes the amount is adequate, the ultimate liability may be in excess of or less than the amount provided. The Company does not have liabilities or claims relating to environmental or asbestos exposures. () The Company has not modified its capitalization policy from the prior period. () The Company has no pharmaceutical rebate receivables. D. Going Concern: Not Applicable. ACCOUNTING CHANGES AND CORRECTIONS OF ERRORS A. Material Changes in Accounting Principles and/or Correction of Errors None. BUSINESS COMBINATIONS AND GOODWILL A. Statutory Purchase B. Statutory Merger 4
C. Impairment Loss ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company The Company has no business combinations and/or goodwill related to items A through C listed above during the statement periods. 4. DISCONTINUED OPERATIONS The Company has no discontinued operations during the statement periods. 5. INVESTMENTS A. Mortgage Loans, including Mezzanine Real Estate Loans: Not applicable B. Debt Restructuring: Not applicable C. Reverse Mortgages: Not applicable D. Loan-Backed Securities (LBS): Not applicable E. Repurchase Agreements and/or Securities Lending Transactions: Not applicable F. Real Estate: Not applicable G. Investments in Low Income Housing Credits (LIHTC): Not applicable H. Restricted Assets: The Company has no restricted assets other than those on deposit with various states. Restricted Asset Category Admitted Total Current Gross Total General Total from Increase / Restricted to Year Admitted Restricted to Account Prior Year (Decrease) Total Admitted Restricted Total Assets Assets On deposit with states 4,870,8 5,008,887 (8,549) 4,870,8 5% 5% Pledged as collateral not captured in other categories - - - - 0% 0% Total restricted assets 4,870,8 5,008,887 (8,549) 4,870,8 5% 5% I. Working Capital Finance Investments: Not applicable. J. Offsetting and Netting of Assets and Liabilities: Not applicable. K. Structured Notes: Not applicable. 6. JOINT VENTURES, PARTNERSHIPS AND LIMITED LIABILITY COMPANIES A. The Company has no investments in Joint Ventures, Partnerships or Limited Liability Companies that exceed 0% of admitted assets during the statement periods. B. The Company did not recognize any impairment write down for investments in Joint Ventures, Partnerships or Limited Liability Companies during the statement periods. 7. INVESTMENT INCOME The Company has no due and accrued investment income with amounts over 90 days past due excluded from surplus during the statement periods. 8. DERIVATIVE INSTRUMENTS The Company has no investments in derivative instruments during the statement periods. 9. INCOME TAXES A. The components of deferred tax assets ( DTA ) and deferred tax liabilities ( DTL ), for the current and prior period are as follows: 06 05 Change Ordinary Capital Total Ordinary Capital Total Ordinary Capital Total Total gross DTAs 858,07-858,07 65,60-65,60 06,947-06,947 Statutory Valuation Allowance (468,607) (468,607) (649,080) (649,080) 80,47-80,47 Adjusted Gross Deferred Tax Assets 89,500-89,500,080 -,080 87,40-87,40 Deferred Tax Assets Nonadmitted - - - - - - - - Admitted Gross Deferred Tax Assets 89,500-89,500,080 -,080 87,40-87,40 Total Gross DTLs,684 -,684,080 -,080 604-604 Net Admitted Deferred Tax Asset/Liability 86,85-86,85 - - - 86,85-86,85 The amount of each result of the calculations by tax character of paragraphs.a.,.b.i.,.b.ii., and.c. of SSAP 0 are as follows: 06 05 Change Ordinary Capital Total Ordinary Capital Total Ordinary Capital Total Can be recovered through loss carrybacks (.a.) - - - - - - - - Lesser of: Expected to be realized following the B/S date (.b.i) 89,499.46-89,499 - - 89,499-89,499 Adjusted gross DTAs allowed per limit threshold (.b.ii),4,60 -,4,60 - -,4,60 -,4,60 Adjusted gross DTAs offset by gross DTLs (.c.) 0-0,080,080 (,080) - (,080) DTAs Admitted as a Result of the application of 0 89,500-89,500,080 -,080 87,40-87,40 06 05 Ex DTA ACL RBC Ratio Percentage used to Determine Recovery Period and Threshold Limitati 908% 48879.76% Amount of Adjusted C/S used to Determine Recover Period and Threshold Limitation 8,764,0,47,90 4.
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company Tax planning strategies have not been employed by the Company and have no impact upon the determination of adjusted gross and net admitted deferred tax assets. B. Temporary differences for which a DTL has not been established: None C. Current income taxes and change in deferred tax: The provision for federal income tax consists of the following components: Current Tax 06 05 a Federal - - b Foreign c Subtotal - - d Federal income tax on net capital gains (0) - e Utilization of cap loss c/f f PY True Ups - - Federal and foreign income taxes incurred (0) - The tax effects of temporary differences that give rise to significant portions of the deferred tax assets and deferred tax liabilities are as follows: Deferred tax Assets Ordinary: 06 05 Non-admitted asset - - Unearned premiums,409 - Loss discounting - - Accrued expenses - - Fixed Assets - - NOL Carryforward 855,697 65,60 Intangibles Amortization - - Charitable Contributions - - Advanced Premiums - - Bond Discounting - - [Other Ordinary DTA] - - Tax Credits - - Subtotal deferred tax assets 858,07 65,60 Stat valuation allowance 468,607 649,080 Non-admitted - - Admitted ordinary deferred tax assets 89,500,080 Capital: Investment in Passthrough Entities - - Capital loss carryforward - - OTTI - - Unrealized losses - - [Other Capital DTA] - - [Other Capital DTA] - - Subtotal - - Stat valuation allowance - - Non-admitted - - Admitted capital deferred tax assets - - Admitted Deferred Tax Asset 89,500,080 Deferred tax liabilities Ordinary: Bond Market Discount, Net,684,080 Due and accrued dividends - - Fixed Assets - - Salvage and subrogation - - Prepaid expenses - - Deferred Revenue - - [Other Ordinary DTL] - - [Other Ordinary DTL] - - Subtotal,684,080 Capital: Unrealized Gains - - Investment in Passthrough Entities - - [Other Capital DTL] - - Subtotal - - Deferred Tax Liabilities,684,080 Net Admitted Deferred Tax Asset (Liability) 86,85 - The change in net deferred income taxes is comprised of the following, before consideration of non-admitted deferred tax assets: //6 //05 Change Adjusted gross deferred tax assets 89,500,080 (87,40) Total deferred tax liabilities,684,080 (604) Net deferred tax assets (liabilities) 86,85 - (86,85) Tax effect of change in unrealized gains (losses) - Total change in net deferred income tax (86,85) 4.
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company D. Reconciliation of federal income tax rate to actual effective rate: The provision for federal income taxes incurred is different from that which would be obtained by applying the statutory federal income tax rate to income before taxes. The significant items causing the difference are as follows: Amount Tax Effect Amount Tax Effect Provision computed at statutory rate (4,86) 4.00% (6,878) 5.00% Permanent Differences (6) 0.00% 4,08 -.% PY True Up (to Deferred) - 0.00% - 0.00% PY True Up (to Current) - 0.00% - 0.00% Change in Non-admitted Assets - 0.00% - 0.00% Rate Differential 8,545 -.80% - 0.00% Credit Utilization - 0.00% - 0.00% Change in deferred income taxes 86,85-58.49% - 0.00% Change in Valuation Allowance (80,47) 7.9%,770 -.77% Other - 0.00% 0.00% Totals - 0.00% - 0.00% 06 05 Federal and foreign income taxes incurred (0) - Current taxes on realized capital gains 0 - Total statutory income taxes - - E. Operating Loss and Tax Credit Carryforward: () At December, 06, the Company had: Net operating loss carryforwards expiring through the year 06 of: $,56,756 Net capital loss carryforwards of: $0 Foreign tax credit carryforwards of: $0 AMT credit carryforwards, which do not expire in the amount of: $0 () The following is income tax expense for 05 and 06 that is available for recoupment in the event of future net losses: 06 $0 05 $0 () The Company does not have deposits admitted under Section 660 of the Internal Revenue Service (IRS) Code. F. The Company s federal income tax return is consolidated with the following entities: () Deerfield Insurance Holdings, Inc. National Fidelity Holdings, Inc. National Fidelity Insurance Agency, Inc. () The method of allocation among companies is subject to a written agreement approved by the Board of Directors, whereby allocation is made primarily on a separate return basis with a current credit for net losses. 0. INFORMATION CONCERNING PARENT, SUBSIDIARIE,AFFILIATES AND OTHER RELATED PARTIES A, B, & C. On March 0, 0 the Company paid a $8,000,000 extraordinary dividend to its sole stockholder, Chartis International, LLC. On March 0, 0, the Company repurchased 9,90 shares of its common stock, for a cost of $,000,48.50. The 9,90 shares were immediately retired and cancelled. The transaction reduced the Company's paid in surplus by $9,007,48.50 and reduced the capital stock by $,99,000. On March, 0, Sirius Global Solutions Holding Company (f/k/a White Mountains Solutions Holding Company) acquired 00% of the outstanding stock from Chartis International, LLC. On April 7, 06, Guilford Holdings, Inc. acquired 00% of the outstanding Ashmere stock from Sirius Global Solutions Holding Company. On October, 06, National Fidelity Holdings, Inc. acquired 00% of the outstanding Ashmere stock from Guilford Holdings, Inc. D. The Company has balances due to or from parent, subsidiaries or affiliates at December, 06 of $5,405. E. Other than any disclosed in Note 4, there were no material guarantees or undertakings for the benefit of affiliates during the statement periods. F. The Company has entered into an expense allocation agreement and tax allocation agreement with its parent companies. Also, the Company has entered into a Management Services Agreement, Program Administration 4.
ANNUAL STATEMENT FOR THE YEAR 06 OF THE Ashmere Insurance Company Agreement, Managed Care Service Agreement, and Claims Service Agreement with certain affiliates for various insurance services including but not limited to underwriting, claims adjusting, and bill review services. G. There is no control relationship between the Company and an affiliate such that the operating results or financial position of the Company are significantly affected. H. The Company does not own shares of an upstream intermediate or ultimate parent, either directly or indirectly via a downstream subsidiary, controlled or affiliated company. I. The Company has no investment in subsidiary, controlled or affiliated (SCA) companies that exceed 0% of admitted assets during the statement periods. J. The Company did not recognize any impairment write-downs related to investments in subsidiary, controlled or affiliated (SCA) companies during the statement periods. K. The Company has no investment in a foreign insurance subsidiary during the statement periods. L. The Company has no investment in a downstream noninsurance holding company during the statement periods. M. and N. The Company has no investment in subsidiary, controlled or affiliated (SCA) companies.. DEBT The Company has no capital note obligations or liabilities for borrowed money during the statement periods.. RETIREMENT PLANS, DEFERRED COMPENSATION, POSTEMPLOYMENT BENEFITS AND COMPENSATED ABSENCES AND OTHER POSTRETIREMENT BENEFIT PLANS The Company has no employees and none of the following: Employee Retirement Plans, Deferred Compensation Plans, Post Employment Benefits, compensated absences or other post retirement benefit plans.. CAPITAL AND SURPLUS, DIVIDEND RESTRICTIONS AND QUASI-REORGANIZATIONS () The Company has 40,000 shares of common stock authorized, and 50,070 shares issued and outstanding at December, 06. The par value is $00. () The Company has no preferred stock at December, 06. () Dividend payments by a Florida domestic stock property and casualty insurance company are subject to restrictions set forth in Florida Statute 68.7. (4) On March 0, 0, the Company paid a $8,000,000 extraordinary dividend to its sole stockholder, Chartis International, LLC. Also on March 0, 0, the Company repurchased 9,90 shares of its common stock, for a cost of $,000,48.50. The 9,90 shares were immediately retired and cancelled. The transaction reduced the Company's paid in surplus by $9,007,48.50 and reduced the capital stock by $,99,000. Both transactions were approved by the Illinois Department of Insurance. On March, 0, Sirius Global Solutions Holding Company (f/k/a White Mountains Solutions Holding Company) acquired 00% of the outstanding stock from Chartis International, LLC. On April, 06, the State of Illinois approved an extraordinary distribution payable to Ashmere s parent company, Guilford Holdings. On May 6, 06, the extraordinary distribution of $,997,58 return of capital and $,00,48 dividend was paid in cash to the Company s parent, Guilford Holdings. (5) Within the limitations of () above, the Company must obtain written approval from the Florida Office of Insurance Regulations during its first three years as a Florida domestic stock insurance company for profits that may be paid as ordinary dividends to its stockholders. (6) Within the limitations of () above, the Company must obtain written approval from the Florida Office of Insurance Regulations during its first three years as a Florida domestic stock insurance company for distribution of the Company s unassigned funds (surplus). (7) Not applicable. (8) The Company holds none of its shares or shares of its affiliated companies for special purposes during the statement periods. (9) The Company has no special surplus funds during the statement periods. (0) The Company has no unassigned funds (surplus) that is represented or reduced by cumulative unrealized gains and losses during the statement periods. () The Company has no surplus debenture obligations during the statement periods. () The Company has not entered into any quasi-reorganization during the two most recent years for which financial statements are presented. () The Company has not entered into any quasi-reorganization in the past ten years. 4.4