* * LIFE AND ACCIDENT AND HEALTH COMPANIES ASSOCIATION EDITION
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1 * * LIFE AND ACCIDENT AND HEALTH COMPANIES ASSOCIATION EDITION ANNUAL STATEMENT For the Year Ended December, 04 OF THE CONDITION AND AFFAIRS OF THE CINCINNATI LIFE INSURANCE COMPANY NAIC Group Code 0044, 0044 NAIC Company Code 766 Employer s ID Number -778 (Current Period) (Prior Period) Organized under the Laws of Ohio, State of Domicile or Port of Entry Ohio Country of Domicile United States Incorporated/Organized 07/0/987 Commenced Business 0/0/988 Statutory Home Office 600 SOUTH GILMORE ROAD, FAIRFIELD, OH, US (Street and Number) (City or Town, State, Country and Zip Code) Main Administrative Office 600 SOUTH GILMORE ROAD FAIRFIELD, OH, US (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Mail Address 600 SOUTH GILMORE ROAD, FAIRFIELD, OH, US (Street and Number or P.O. Box) (City or Town, State, Country and Zip Code) Primary Location of Books and Records 600 SOUTH GILMORE ROAD FAIRFIELD, OH, US (Street and Number) (City or Town, State, Country and Zip Code) (Area Code) (Telephone Number) Internet Web Site Address Statutory Statement Contact JOSEPH DAVID WURZELBACHER (Name) (Area Code) (Telephone Number) (Extension) JOE_WURZELBACHER@CINFIN.COM ( Address) (FAX Number) OFFICERS Name Title Name Title DAVID HUGH POPPLEWELL, PRESIDENT MICHAEL JAMES SEWELL, CFO & SENIOR VICE PRESIDENT TODD HANCOCK PENDERY, TREASURER & VICE PRESIDENT ROGER ANDREW BROWN, ACTUARY & VICE PRESIDENT OTHER OFFICERS KENNETH WILLIAM STECHER, CHAIRMAN OF THE BOARD STEVEN JUSTUS JOHNSTON, CHIEF EXECUTIVE OFFICER JACOB FERDINAND SCHERER JR, EXECUTIVE VICE PRESIDENT BRAD ERIC BEHRINGER, SENIOR VICE PRESIDENT TERESA CURRIN CRACAS, SENIOR VICE PRESIDENT MARTIN FRANCIS HOLLENBECK, SENIOR VICE PRESIDENT JOHN SCOTT KELLINGTON, SENIOR VICE PRESIDENT LISA ANNE LOVE, SENIOR VICE PRESIDENT ERIC NEIL MATHEWS, SENIOR VICE PRESIDENT GLENN DOUGLAS NICHOLSON, SENIOR VICE PRESIDENT STEPHEN MICHAEL SPRAY, SENIOR VICE PRESIDENT TIMOTHY LEE TIMMEL, SENIOR VICE PRESIDENT MICHAEL RAY ABRAMS, VICE PRESIDENT ROGER ANDREW BROWN, VICE PRESIDENT DAVID LEWIS BURBRINK, VICE PRESIDENT ANTHONY WAYNE DUNN, VICE PRESIDENT WILLIAM JAMES GEIER, VICE PRESIDENT SCOTT ALAN GILLIAM, VICE PRESIDENT THERESA ANN HOFFER, VICE PRESIDENT THOMAS CHRISTOPHER HOGAN, VICE PRESIDENT HELEN KYRIOS, VICE PRESIDENT RICHARD LOUIS MATHEWS, VICE PRESIDENT RICHARD PARKS MATSON, VICE PRESIDENT DENNIS EUGENE MCDANIEL, VICE PRESIDENT FRANCIS TIMOTHY OBERMEYER #, VICE PRESIDENT MICHAEL KEVIN O'CONNOR, VICE PRESIDENT CAROL ANN OLER, VICE PRESIDENT TODD HANCOCK PENDERY, VICE PRESIDENT THOMAS JOSEPH SCHEID, VICE PRESIDENT GREGORY DALE SCHMIDT, VICE PRESIDENT STEVEN ANTHONY SOLORIA, VICE PRESIDENT DOUGLAS WAYNE STANG, VICE PRESIDENT BRETT JOSEPH STARR #, VICE PRESIDENT MONTGOMERY LEE TROTTIER, VICE PRESIDENT GERALD LEE VARNEY, VICE PRESIDENT MICHAEL BERNARD WEDIG, VICE PRESIDENT MARK ALAN WELSH, VICE PRESIDENT BRIAN KEITH WOOD, VICE PRESIDENT DIRECTORS OR TRUSTEES WILLIAM FORREST BAHL GREGORY THOMAS BIER ROGER ANDREW BROWN MARTIN FRANCIS HOLLENBECK STEVEN JUSTUS JOHNSTON WILLIAM RODNEY MCMULLEN MARTIN JOSEPH MULLEN GLENN DOUGLAS NICHOLSON DAVID PUTNAM OSBORN # DAVID HUGH POPPLEWELL JACOB FERDINAND SCHERER JR JOHN JEFFERSON SCHIFF JR THOMAS REID SCHIFF MICHAEL JAMES SEWELL KENNETH WILLIAM STECHER TIMOTHY LEE TIMMEL State of County of OHIO BUTLER 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. DAVID HUGH POPPLEWELL MICHAEL JAMES SEWELL TODD HANCOCK PENDERY PRESIDENT CFO & SENIOR VICE PRESIDENT TREASURER & VICE PRESIDENT a. Is this an original filing? Yes [ X ] No [ ] Subscribed and sworn to before me this b. If no: 0th day of February, 05. State the amendment number. Date filed. Number of pages attached KAREN S. DONNER, NOTARY PUBLIC OCTOBER 6, 09
2 ASSETS Current Year Prior Year 4 Assets Nonadmitted Assets Net Admitted Assets (Cols. - ) Net Admitted Assets. Bonds (Schedule D),848,064,59,848,064,59,77,740,0. Stocks (Schedule D):. Preferred stocks 5,046,800 5,046,800 7,07,800. Common stocks. Mortgage loans on real estate (Schedule B):. First liens. 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. Properties held for sale (less $ encumbrances) 5. Cash ($ 65,44,098, Schedule E-Part ), cash equivalents ($, Schedule E-Part ) and short-term investments ($, Schedule DA) 65,44,098 65,44,098 5,5,58 6. Contract loans (including $ premium notes) 0,6,78,,9 9,58,986 4,8,84 7. Derivatives (Schedule DB) 8. Other invested assets (Schedule BA) 56,86,740 56,86,740 46,7,0 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 ),005,57,75,,9,004,459,98,866,80,47. Title plants less $ charged off (for Title insurers only) 4. Investment income due and accrued 7,57,696 7,57,696 7,68,70 5. Premiums and considerations: 5. Uncollected premiums and agents balances in the course of collection 8,676, 87 8,675,440 8,046,4 5. Deferred premiums, agents balances and installments booked but deferred and not yet due (including $ earned but unbilled premiums) 09,08,547 09,08,547 0,5, Accrued retrospective premiums 6. Reinsurance: 6. Amounts recoverable from reinsurers 5,5,99 5,5,99 47,07 6. Funds held by or deposited with reinsured companies 6. Other amounts receivable under reinsurance contracts,688,86,688,86,68, Amounts receivable relating to uninsured plans 8. Current federal and foreign income tax recoverable and interest thereon 8. Net deferred tax asset 9,4,0 6,94,94 9,46,78 4,094,7 9. Guaranty funds receivable or on deposit 0. Electronic data processing equipment and software 6,6 6,6. Furniture and equipment, including health care delivery assets ($ ) 7,5 7,5. Net adjustment in assets and liabilities due to foreign exchange rates. Receivables from parent, subsidiaries and affiliates,798,79,798,79,97,8 4. Health care ($ ) and other amounts receivable 8,49 8,49 5. Aggregate write-ins for other-than-invested assets,74,80 78,47,456,9,57,4 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5),67,70,6 66,07,6,0,,7,054,9,77 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 74,84, 74,84, 68,9, Total (Lines 6 and 7),98,0,856 66,07,6,95,974,595,77,5,76 DETAILS OF WRITE-INS Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98) (Line above) 50. SEPARATE ACCOUNTS MANAGEMENT FEE RECEIVABLE,64,89,64,89,64, PREPAID EXPENSES 8,564 8, GUARANTY FUNDS 56,0 56,0 84, Summary of remaining write-ins for Line 5 from overflow page 75,4 9,86 5,45 88, 599. Totals (Lines 50 through 50 plus 598) (Line 5 above),74,80 78,47,456,9,57,4
3 LIABILITIES, SURPLUS AND OTHER FUNDS Prior Year Current Year. Aggregate reserve for life contracts $,669,9,57 (Exhibit 5, Line ) less $ included in Line 6. (including $ Modco Reserve),669,9,57,500,699,06. Aggregate reserve for accident and health contracts (including $ Modco Reserve) 6,9,000 6,088,87. Liability for deposit-type contracts (Exhibit 7, Line 4, Col. ) (including $ Modco Reserve) 8,8,00 90,066,58 4. Contract claims: 4. Life (Exhibit 8, Part, Line 4.4, Col. less sum of Cols. 9, 0 and ) 6,599,087 7,96,8 4. Accident and health (Exhibit 8, Part, Line 4.4, sum of Cols. 9, 0 and ),74,5,090, Policyholders' dividends $ and coupons $ due and unpaid (Exhibit 4, Line 0) 6. Provision for policyholders' dividends and coupons payable in following calendar year estimated amounts: 6. Dividends apportioned for payment (including $ Modco) 0 6. Dividends not yet apportioned (including $ Modco) 6. Coupons and similar benefits (including $ Modco) 7. Amount provisionally held for deferred dividend policies not included in Line 6 8. Premiums and annuity considerations for life and accident and health contracts received in advance less $ discount; including $, accident and health premiums (Exhibit, Part, Col., sum of Lines 4 and 4),80,78 946,04 9. Contract liabilities not included elsewhere: 9. Surrender values on canceled contracts 9. Provision for experience rating refunds, including the liability of $ accident and health experience rating refunds of which $ is for medical loss ratio rebate per the Public Health Service Act 9. Other amounts payable on reinsurance, including $ assumed and $ 6,455,750 ceded 6,455,750 5,707, Interest Maintenance Reserve (IMR, Line 6) 9,09,6 5,44, Commissions to agents due or accrued-life and annuity contracts $,870,54 accident and health $ 0,408 and deposit-type contract funds $,900,9,07,57. Commissions and expense allowances payable on reinsurance assumed. General expenses due or accrued (Exhibit, Line, Col. 6),65,656 4,77,656. Transfers to Separate Accounts due or accrued (net) (including $ accrued for expense allowances recognized in reserves, net of reinsured allowances) 4. Taxes, licenses and fees due or accrued, excluding federal income taxes (Exhibit, Line 9, Col. 5),58,796,589,904 5.Current federal and foreign income taxes, including $,78,94 on realized capital gains (losses),89,74 4,85, Net deferred tax liability 6. Unearned investment income 550,89 685, Amounts withheld or retained by company as agent or trustee 596,466 59, Amounts held for agents' account, including $ 8 agents' credit balances Remittances and items not allocated,40,78,847,70 0. Net adjustment in assets and liabilities due to foreign exchange rates. Liability for benefits for employees and agents if not included above. Borrowed money $ and interest thereon $. Dividends to stockholders declared and unpaid 4. Miscellaneous liabilities: 4.0 Asset valuation reserve (AVR, Line 6, Col. 7) 7,90,0 7,6, Reinsurance in unauthorized and certified ($ ) companies 4.0 Funds held under reinsurance treaties with unauthorized and certified ($ ) reinsurers 4.04 Payable to parent, subsidiaries and affiliates 4,06 509, Drafts outstanding 4.06 Liability for amounts held under uninsured plans 4.07 Funds held under coinsurance 4.08 Derivatives 4.09 Payable for securities 0,50, Payable for securities lending 4. Capital notes $ and interest thereon $ 5. Aggregate write-ins for liabilities 4,00,6 4,55,5 6. Total liabilities excluding Separate Accounts business (Lines to 5),977,679,44,807,7,55 7. From Separate Accounts statement 74,84, 68,9, Total liabilities (Lines 6 and 7),69,50,568,490,59, Common capital stock,000,000,000, Preferred capital stock. Aggregate write-ins for other than special surplus funds. Surplus notes. Gross paid in and contributed surplus (Page, Line, Col. plus Page 4, Line 5., Col. ),000,000,000, Aggregate write-ins for special surplus funds 5. Unassigned funds (surplus) 9,454,08 4,99,46 6. Less treasury stock, at cost: 6. shares common (value included in Line 9 $ ) 6. shares preferred (value included in Line 0 $ ) 7. Surplus (Total Lines ) (including $ in Separate Accounts Statement) 0,454,08 4,99,46 8. Totals of Lines 9, 0 and 7 (Page 4, Line 55),454,08 46,99,46 9. Totals of Lines 8 and 8 (Page, Line 8, Col. ),95,974,595,77,5,76 DETAILS OF WRITE-INS 50. RETAINED ASSET LIABILITY,847,9 4,,4 50. PAYABLES CLEARING 78,78 8, ACCOUNTS PAYABLE - LONG TERM CARE 80,09 96, Summary of remaining write-ins for Line 5 from overflow page,87, Totals (Lines 50 through 50 plus 598) (Line 5 above) 4,00,6 4,55, Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98) (Line above) Summary of remaining write-ins for Line 4 from overflow page 499. Totals (Lines 40 through 40 plus 498) (Line 4 above)
4 SUMMARY OF OPERATIONS Current Year Prior Year. Premiums and annuity considerations for life and accident and health contracts (Exhibit, Part, Line 0.4, Col., less Col. ) 4,85,9 5,,95. Considerations for supplementary contracts with life contingencies 5,69 8,007. Net investment income (Exhibit of Net Investment Income, Line 7) 48,80,858 4,098,65 4. Amortization of Interest Maintenance Reserve (IMR, Line 5) 5,068,497,7,95 5. Separate Accounts net gain from operations excluding unrealized gains or losses 6. Commissions and expense allowances on reinsurance ceded (Exhibit, Part, Line 6., Col. ) 5,965,55 6,, Reserve adjustments on reinsurance ceded 8. Miscellaneous Income: 8. Income from fees associated with investment management, administration and contract guarantees from Separate Accounts 5,8,4 4,48, Charges and fees for deposit-type contracts 8. Aggregate write-ins for miscellaneous income 9. Totals (Lines to 8.) 409,08,4 9,7, Death benefits 97,670,66 7,50,089. Matured endowments (excluding guaranteed annual pure endowments) 78,9 04,864. Annuity benefits (Exhibit 8, Part, Line 6.4, Cols ) 6,88,7 50,765,44. Disability benefits and benefits under accident and health contracts,5,957,064,04 4. Coupons, guaranteed annual pure endowments and similar benefits 5. Surrender benefits and withdrawals for life contracts,9,80,8, Group conversions 7. Interest and adjustments on contract or deposit-type contract funds 0,4,6 0,4,4 8. Payments on supplementary contracts with life contingencies 5,000 5,95 9. Increase in aggregate reserves for life and accident and health contracts 68,69,88 80,4, Totals (Lines 0 to 9) 6,55,886 9,66,. Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only) (Exhibit, Part, Line, Col. ) 7,786,77 8,699,654. Commissions and expense allowances on reinsurance assumed (Exhibit, Part, Line 6., Col. ). General insurance expenses (Exhibit, Line 0, Columns,, and 4),60,7 6,0,87 4. Insurance taxes, licenses and fees, excluding federal income taxes (Exhibit, Line 7, Cols. + + ) 6,66,8 6,98, Increase in loading on deferred and uncollected premiums (5,8,59) (7,655,40) 6. Net transfers to or (from) Separate Accounts net of reinsurance (6,87,948) (48,94) 7. Aggregate write-ins for deductions Totals (Lines 0 to 7) 49,59,857 4,84,6 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8) (0,,446) (,8,7) 0. Dividends to policyholders 09. Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0) (0,,555) (,8,484). Federal and foreign income taxes incurred (excluding tax on capital gains) (7,549,00) (,,898). Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) (,78,55) (0,697,585) 4. Net realized capital gains (losses) (excluding gains (losses) transferred to the IMR) less capital gains tax of $,90 (excluding taxes of $,704,84 transferred to the IMR) (5,8,8),05,4 5. Net income (Line plus Line 4) (8,65,98) (9,68,4) CAPITAL AND SURPLUS ACCOUNT 6. Capital and surplus, December, prior year (Page, Line 8, Col. ) 46,99,46 75,809,06 7. Net income (Line 5) (8,65,98) (9,68,4) 8. Change in net unrealized capital gains (losses) less capital gains tax of $ (7,666) 9. Change in net unrealized foreign exchange capital gain (loss) 40. Change in net deferred income tax,050,567 9,, Change in nonadmitted assets (6,94,4) (8,667,87) 4. Change in liability for reinsurance in unauthorized and certified companies 4. Change in reserve on account of change in valuation basis, (increase) or decrease (6,0,98) 44. Change in asset valuation reserve (7,059) (,09,99) 45. Change in treasury stock (Page, Lines 6. and 6. Col. minus Col. ) 46. Surplus (contributed to) withdrawn from Separate Accounts during period 47. Other changes in surplus in Separate Accounts statement 48. Change in surplus notes 49. Cumulative effect of changes in accounting principles 50. Capital changes: 50. Paid in 50. Transferred from surplus (Stock Dividend) 50. Transferred to surplus 5. Surplus adjustment: 5. Paid in 5. Transferred to capital (Stock Dividend) 5. Transferred from capital 5.4 Change in surplus as a result of reinsurance 5. Dividends to stockholders 5. Aggregate write-ins for gains and losses in surplus 68,64 77, Net change in capital and surplus for the year (Lines 7 through 5) (,58,8) (8,86,87) 55. Capital and surplus, December, current year (Lines ) (Page, Line 8),454,08 46,99,45 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8. from overflow page Totals (Lines 08.0 through 08.0 plus 08.98) (Line 8. above) 70. INCREASE/(DECREASE) IN RETIRED LIVES RESERVE Summary of remaining write-ins for Line 7 from overflow page 799. Totals (Lines 70 through 70 plus 798) (Line 7 above) PRE-99 WHOLE LIFE DEFICIENCY RESERVE 68,64 77, Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 through 50 plus 598) (Line 5 above) 68,64 77,76 4
5 CASH FLOW Current Year Prior Year Cash from Operations. Premiums collected net of reinsurance 4,9,69,08,007. Net investment income 47,8,97 4,9,4. Miscellaneous income,78,657 9,95, Total (Lines through ) 40,9,69 86,, Benefit and loss related payments 89,90,490 4,59,65 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts (6,87,948) (48,94) 7. Commissions, expenses paid and aggregate write-ins for deductions 79,6, 80,85, Dividends paid to policyholders 0 9. Federal and foreign income taxes paid (recovered) net of $,55,64 tax on capital gains (losses) (,87,6) (5,69,) 0. Total (Lines 5 through 9) 60,977,57 8,555,0. Net cash from operations (Line 4 minus Line 0) 40,5,7 67,557,64 Cash from Investments. Proceeds from investments sold, matured or repaid:. Bonds 7,989,40,554,86. Stocks 5,000,000 4,8,6. Mortgage loans.4 Real estate.5 Other invested assets.6 Net gains or (losses) on cash, cash equivalents and short-term investments (4,64).7 Miscellaneous proceeds 0,50,000.8 Total investment proceeds (Lines. to.7) 89,9,40 6,894,979. Cost of investments acquired (long-term only):. Bonds 9,0,95 456,99,09. Stocks. Mortgage loans.4 Real estate.5 Other invested assets 0,60,854.6 Miscellaneous applications,000,000.7 Total investments acquired (Lines. to.6) 40,7, ,99,09 4. Net increase (decrease) in contract loans and premium notes (4,989,546) (,,6) 5. Net cash from investments (Line.8 minus Line.7 minus Line 4) (07,044,858) (49,90,48) Cash from Financing and Miscellaneous Sources 6. Cash provided (applied): 6. Surplus notes, capital notes 6. Capital and paid in surplus, less treasury stock 6. Borrowed funds 6.4 Net deposits on deposit-type contracts and other insurance liabilities (7,07,64) (5,698,998) 6.5 Dividends to stockholders 6.6 Other cash provided (applied) (,089,78) (,96,7) 7. Net cash from financing and miscellaneous sources (Lines 6. to 6.4 minus Line 6.5 plus Line 6.6) (9,6,59) (7,66,70) 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) 4,07,54 704,98 9. Cash, cash equivalents and short-term investments: 9. Beginning of year 5,5,58 50,60,60 9. End of year (Line 8 plus Line 9.) 65,44,098 5,5,58 5
6 6 ANALYSIS OF OPERATIONS BY LINES OF BUSINESS Ordinary 6 Group Accident and Health Aggregate of All Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance (a) Annuities Group Credit (Group and Individual) Other Other Lines of Business. Premiums and annuity considerations for life and accident and health contracts 4,85,9 9,500 0,0,579 7,45,68,649,554 70,9,88,089. Considerations for supplementary contracts with life contingencies 5,69 5,69. Net investment income 48,80,858 07,7 89,448,79 5,6,609,006,58 5,405 9,68,495 4,49,5 4. Amortization of Interest Maintenance Reserve (IMR) 5,068,497 8,976,068,77,908,7 7,89 7,90,986 0,7 5. Separate Accounts net gain from operations excluding unrealized gains or losses 6. Commissions and expense allowances on reinsurance ceded 5,965,55 5,8,408,4 79,90 7. Reserve adjustments on reinsurance ceded 8. Miscellaneous Income: 8. Fees associated with income from investment management, administration and contract guarantees from Separate Accounts 5,8,4 5,8,4 8. Charges and fees for deposit-type contracts 8. Aggregate write-ins for miscellaneous income 9. Totals (Lines to 8.) 409,08,4 49,646 99,757,45 9,99,60,79,600 7,47,096 54,07 947,49,965,757 4,49,5 0. Death benefits 97,670,66 4,088 90,80,08 6,506,070. Matured endowments (excluding guaranteed annual pure endowments) 78,9,64 56,88. Annuity benefits 6,88,7 6,77,46 08,78. Disability benefits and benefits under accident and health contracts,5,957 9,66,8,08 858,65 4. Coupons, guaranteed annual pure endowments and similar benefits 5. Surrender benefits and withdrawals for life contracts,9,80 06,56,0,4 6. Group conversions 7. Interest and adjustments on contract or deposit-type contract funds 0,4,6 6,4 9,890,8 54,79 8. Payments on supplementary contracts with life contingencies 5,000 5, Increase in aggregate reserves for life and accident and health contracts 68,69,85 (44,98) 64,665,987,56, ,97 6, (56,74) 460, Totals (Lines 0 to 9) 6,55,88 7,90 77,8,86 75,90,40 859,876 7,040,997 4,97 98,96,9,08. Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only) 7,786,77 5,45,787,6,979 78,96. Commissions and expense allowances on reinsurance assumed. General insurance expenses,60,74 484,5 8,6,45,699,09 84,,67 78,05,95, Insurance taxes, licenses and fees, excluding federal income taxes 6,66,8 6,570 6,8,65,768 8, ,47 5,89 5. Increase in loading on deferred and uncollected premiums (5,8,59) 6 (5,8,76) 6. Net transfers to or (from) Separate Accounts net of reinsurance (6,87,948) (6,87,948) 7. Aggregate write-ins for deductions Totals (Lines 0 to 7) 49,59, ,08 4,6,70 79,6,59 859, ,65 7,77,95,766,586, 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8) (0,,44) (89,9) (4,605,58),59,4 9,74 6,496,70 (6,409) (48,48) (60,66) 4,49,5 0. Dividends to policyholders Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0) (0,,55) (89,9) (4,605,67),59,4 9,74 6,496,70 (6,409) (48,48) (60,66) 4,49,5. Federal income taxes incurred (excluding tax on capital gains) (7,549,07) (0,607) (,807,05),7,45 80,94,496,99 (,9) (0,9) (,4),445,46. Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) (,78,55) (68,784) (8,798,4) 9,66,997 9,50,999,8 (4,6) (7,45) (97,),974,06 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8. from overflow page Total (Lines 08.0 through 08.0 plus 08.98) (Line 8. above) 70. INCREASE IN RETIRED LIVES RESERVES Summary of remaining write-ins for Line 7 from overflow page 799. Total (Lines 70 through 70 plus 798) (Line 7 above) (a) Includes the following amounts for FEGLI/SGLI: Line Line 0 Line 6 Line Line 4
7 ANALYSIS OF INCREASE IN RESERVES DURING THE YEAR Ordinary 6 Group Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance 8 Annuities Involving Life or Disability Contingencies (Reserves) (Net of Reinsurance Ceded). Reserve December, prior year,500,699,0 0,068,00,6,577,80 849,54,54,64,459 4,45,08 54,8. Tabular net premiums or considerations 40,68,49,777 7,099,65 7,45,4 5,69,649,554. Present value of disability claims incurred 94,6 94,6 XXX 4. Tabular interest 97,4,697 9,794 7,585,05 5,97,650 50,94 8, Tabular less actual reserve released,50,979 0,57,0,80 49,695 76,7 6. Increase in reserve on account of change in valuation basis 7. Other increases (net) (05) (05) 8. Totals (Lines to 7),0,04,49 0,49,666,066,658, 95,97,98,977,67 5,994,76 656,5 9. Tabular cost 44,89,58 0,08 4,46,447 XXX,0,79 0. Reserves released by death 6,85,404 5,00 6,7,076 XXX XXX,98 XXX 7. Reserves released by other terminations (net) 9,57,487 80,9 8,60,6 47,58. Annuity, supplementary contract, and disability payments involving life contingencies 6,4,666 5,49 6,77,46 5,000 08,78. Net transfers to or (from) Separate Accounts 4. Total deductions (Lines 9 to ) 4,904,85 66,404 78,48,68 6,47,08 5,000,5,07 08,78 5. Reserve December, current year,669,9,54 9,8,6,788,75,595 85,050,90,64,67 4,879,75 547,45
8 EXHIBIT OF NET INVESTMENT INCOME Collected During Year Earned During Year. U.S. Government bonds (a) 74,0 65,409. Bonds exempt from U.S. tax (a) 8,40,80 8,67,00. Other bonds (unaffiliated) (a) 4,97, 4,874,76. Bonds of affiliates (a). Preferred stocks (unaffiliated) (b) 75,65 75,65. Preferred stocks of affiliates (b). Common stocks (unaffiliated). Common stocks of affiliates. Mortgage loans (c) 4. Real estate (d) 5. Contract loans,08,70,,45 6. Cash, cash equivalents and short-term investments (e) Derivative instruments (f) 8. Other invested assets,466,06,575,07 9. Aggregate write-ins for investment income 0. Total gross investment income 49,84,887 50,7,4. Investment expenses (g),64,860. Investment taxes, licenses and fees, excluding federal income taxes (g) 9,66. Interest expense (h) 7,76 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),956,8 7. Net investment income (Line 0 minus Line 6) 48,80,858 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 090 through 090 plus 0998) (Line 9 above) Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 through 50 plus 598) (Line 5 above) (a) Includes $ 5,40,485 accrual of discount less $ 4,665,9 amortization of premium and less $ 684,90 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 Realized Gain (Loss) On Sales or Maturity Other Realized Adjustments Total Realized Capital Gain (Loss) (Columns + ). U.S. Government bonds. Bonds exempt from U.S. tax. Other bonds (unaffiliated) 8,75,67 (5,859,7),56,400. Bonds of affiliates. Preferred stocks (unaffiliated),974,000,974,000. Preferred stocks of affiliates. Common stocks (unaffiliated). Common stocks of affiliates. 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) 9,744 9, Total capital gains (losses),89,6 (5,859,7) 5,50,45 DETAILS OF WRITE-INS 090. CAPITAL GAINS FROM LOSSES PREVIOUSLY CHARGED OFF 9,744 9, Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 090 through 090 plus 0998) (Line 9 above) 9,744 9,744 Change in Unrealized Capital Gain (Loss) Change in Unrealized Foreign Exchange Capital Gain (Loss) 8
9 9 EXHIBIT - PART - PREMIUMS AND ANNUITY CONSIDERATIONS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS Ordinary 5 Group Accident and Health Total Industrial Life Life Insurance Individual Annuities Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual) Other Aggregate of All Other Lines of Business FIRST YEAR (other than single). Uncollected (07,07) (07,07). Deferred and accrued 5,59,50 5,59,50. Deferred, accrued and uncollected:. Direct 5,79,75 5,79,75. Reinsurance assumed. Reinsurance ceded 6,68 6,68.4 Net (Line + Line ) 5,5,49 5,5,49 4. Advance 98,09 98,09 5. Line.4 - Line 4 5,054,454 5,054, Collected during year: 6. Direct 8,70,54 7,44,05 86, Reinsurance assumed 6. Reinsurance ceded,4,79,4, Net 7,5,776 6,99,87 86, Line 5 + Line 6.4,90,0,5,74 86, Prior year (uncollected + deferred and accrued - advance) 5,8,5 5,8,5 9. First year premiums and considerations: 9. Direct 7,9,7 7,076,784 86, Reinsurance assumed 9. Reinsurance ceded,06,574,06, Net (Line 7 - Line 8) 6,806,699 5,970,0 86,489 SINGLE 0. Single premiums and considerations: 0. Direct 6,07,9,98,80 4,68,49 0. Reinsurance assumed 0. Reinsurance ceded 0.4 Net 6,07,9,98,80 4,68,49 RENEWAL. Uncollected (,0,07) 54 (,048,5) 48,786 (5,70) (48,04). Deferred and accrued 5,099,60 5,099,60. Deferred, accrued and uncollected:. Direct 57,6, ,877,7 9,648 54,77. Reinsurance assumed,000,000. Reinsurance ceded 6,9,067 5,87,47 44,86 5,70 0,00.4 Net (Line + Line ) 40,898, ,05,58 48,786 (5,70) (48,04) 4. Advance,8,8 766,48,60, 5. Line.4 - Line 4 9,76,4 () 9,90,098 48,786 (5,70) (8,66) 6. Collected during year: 6. Direct 48,4,7 9,4 5,966,6,447,60,70,805,76,7 5,749,68 6. Reinsurance assumed 8,007 8, Reinsurance ceded 59,400,7 5,8,48 90,77 705,04,9, Net 88,95,457 9,4 7,4,8,447,60,780,088 67,679,86,84 7. Line 5 + Line 6.4 8,667,79 9,98,045,99,447,60,98,874 67,977,54, Prior year (uncollected + deferred and accrued - advance) 7,745,87 (58) 7,85,80 79,0 (9,945) (9,4) 9. Renewal premiums and considerations: 9. Direct 5,088,674 9,500 8,77,95,447,60,78,49,76,7 5,678,67 9. Reinsurance assumed 8,6 8,6 9. Reinsurance ceded 60,74,96 54,589,650,068,99 665,79,850, Net (Line 7 - Line 8) 90,9,974 9,500 74,9,549,447,60,649,554 70,9,88,089 TOTAL 0. Total premiums and annuity considerations: 0. Direct 05,09,85 9,500 57,789,59 7,45,68,78,49,76,7 5,678,67 0. Reinsurance assumed 8,6 8,6 0. Reinsurance ceded 6,8,57 55,696,,068,99 665,79,850, Net (Lines ) 4,85,9 9,500 0,0,579 7,45,68,649,554 70,9,88,089
10 0 EXHIBIT - PART - DIVIDENDS AND COUPONS APPLIED, REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES AND COMMISSIONS INCURRED (Direct Business Only) Ordinary 5 Group Accident and Health Total Industrial Life Life Insurance Individual Annuities Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual) Other Aggregate of All Other Lines of Business DIVIDENDS AND COUPONS APPLIED (included in Part ). To pay renewal premiums. All other REINSURANCE COMMISSIONS AND EXPENSE ALLOWANCES INCURRED. First year (other than single):. Reinsurance ceded Reinsurance assumed. Net ceded less assumed Single: 4. Reinsurance ceded 4. Reinsurance assumed 4. Net ceded less assumed 5. Renewal: 5. Reinsurance ceded 5,965,45 5,8,09,4 79,90 5. Reinsurance assumed 5. Net ceded less assumed 5,965,45 5,8,09,4 79,90 6. Totals: 6. Reinsurance ceded (Page 6, Line 6) 5,965,55 5,8,408,4 79,90 6. Reinsurance assumed (Page 6, Line ) 6. Net ceded less assumed 5,965,55 5,8,408,4 79,90 COMMISSIONS INCURRED (direct business only) 7. First year (other than single) 7,9,457 7,9,94 99,56 8. Single,80, 55,06,5,06 9. Renewal 9,,9 8,086, ,95 59, Deposit-type contract funds. Totals (to agree with Page 6, Line ) 7,786,77 5,45,787,6,979 78,96
11 EXHIBIT - GENERAL EXPENSES Insurance 5 6 Accident and Health 4 Life Cost Containment All Other All Other Lines of Business Investment Total. Rent 50,66 8,665 5,97 56,8. Salaries and wages 7,86,96 67,89 8,96 8,0,548. Contributions for benefit plans for employees 497,6 40,74 0, ,84. Contributions for benefit plans for agents. Payments to employees under non-funded benefit plans. Payments to agents under non-funded benefit plans. Other employee welfare,89,64 8,68 56,68 0,05,95,007. Other agent welfare 4. Legal fees and expenses 75,69, ,0 4. Medical examination fees 4,69,58 5,74 4,05,97 4. Inspection report fees 80,469,904 8,7 4.4 Fees of public accountants and consulting actuaries 4,89 60,99,945 76,8 4.5 Expense of investigation and settlement of policy claims,67 0,47, Traveling expenses 7,059 6,99, ,7 5. Advertising Postage, express, telegraph and telephone,47,0 5,0,79,74, Printing and stationery 8,59,9 4,098 88, Cost or depreciation of furniture and equipment 7,787 4,974,46 78, Rental of equipment 44,98 4,08 458,8 5.7 Cost or depreciation of EDP equipment and software,5,0 80,054 0,76,75,80 6. Books and periodicals 66,98,,46 8,55 6. Bureau and association fees 70,465 7,7 77,77 6. Insurance, except on real estate 55,66 9,986 5,66 578,0 6.4 Miscellaneous losses 6.5 Collection and bank service charges 7,78 7, Sundry general expenses 47,89 47, Group service and administration fees 78,04 9,08 8,7 6.8 Reimbursements by uninsured plans 7. Agency expense allowance 4,559 4, Agents' balances charged off (less $ recovered) 7. Agency conferences other than local meetings 9,748 9, Real estate expenses 9. Investment expenses not included elsewhere 80,765 80, Aggregate write-ins for expenses 0. General expenses incurred,486,807 8,68,665,4,64,860 (a) 4,55,58. General expenses unpaid December, prior year 4,50,90 9,88 94,547 4,77,656. General expenses unpaid December, current year,48,78 0,6 8,656,65,656. Amounts receivable relating to uninsured plans, prior year 4. Amounts receivable relating to uninsured plans, current year 5. General expenses paid during year (Lines ),506,989 8,68,69,60,40,75 5,67,58 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 9. from overflow page Totals (Lines 09.0 through ) (Line 9. above) (a) Includes management fees of $ to affiliates and $ to non-affiliates. EXHIBIT - TAXES, LICENSES AND FEES (EXCLUDING FEDERAL INCOME TAXES) Insurance 4 5 Life Accident and Health All Other Lines of Business Investment Total. Real estate taxes. State insurance department licenses and fees,97,450,4 07,67,58,64. State taxes on premiums,796,8 04,9,90,04 4. Other state taxes, incl. $ for employee benefits 59,98 5,866,76 67, U.S. Social Security taxes,069,80 8,69 0,7,8,6 6. All other taxes 5,76 5,946, 7. Taxes, licenses and fees incurred 6,48,05 88,606 9,66 6,946,47 8. Taxes, licenses and fees unpaid December, prior year,49,0 6,895 0,978,589, Taxes, licenses and fees unpaid December, current year,04,70 5,78 08,77,58, Taxes, licenses and fees paid during year (Lines ) 6,76,55 99,78 5,6 7,77,580 EXHIBIT 4 - DIVIDENDS OR REFUNDS Life. Applied to pay renewal premiums. Applied to shorten the endowment or premium-paying period. Applied to provide paid-up additions 4. Applied to provide paid-up annuities 5. Total Lines through 4 6. Paid-in cash Left on deposit Aggregate write-ins for dividend or refund options 9. Total Lines 5 through Amount due and unpaid. Provision for dividends or refunds payable in the following calendar year 0. Terminal dividends. Provision for deferred dividend contracts 4. Amount provisionally held for deferred dividend contracts not included in Line 5. Total Lines 0 through Total from prior year 0 7. Total dividends or refunds (Lines ) 0 Accident and Health DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8 from overflow page Totals (Line 080 through ) (Line 8 above)
12 EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Credit Valuation Standard Total Industrial Ordinary (Group and Individual) Group LIFE INSURANCE '4 CET A ORD 8,04 8, '4 CSO /4% CRVM 8,50 8, '4 CSO /4% NLP '4 CSO % CRVM 64,776 64, '4 CSO % NLP 494,78 494, '4 SI /% NLP '4 SI % CRVM 8,4 8, '4 SI % NLP 4,65 4,07, '4 SI /% CRVM 7,9 7, '4 SI /% NLP 0,978 0, '4 SSI /4% NLP '4 SSI % CRVM 70,475 69,7, '4 SSI /% CRVM '4 SSI % NLP,0,45,095,4 8, '4 SSI 4% NLP '58 CET % NLP 78,46 78, '58 CET /% NLP,09,65 40, , '58 CET 4% NLP 79,948 79, '58 CET 4 /% NLP 46,08 78,776 8, '58 CET 5 /% NLP 7, 7, '58 CSO % CRVM,78,44,78, '58 CSO % NLP,690,5,690, '58 CSO /% CRVM 0,476,94 9,9 0,8, '58 CSO /% NLP 5,7,7 44,58 5,98, '58 CSO 4% CRVM 4,98,854 4,98, '58 CSO 4% NLP,695,8,695, '58 CSO 4 /% CRVM 96,95,00 66,7 96,748, '58 CSO 4 /% NLP 5,68,64 79,798 5,088, '58 CSO 5 /% CRVM '58 CSO 5 /% NLP,69, '6 CIET /% NLP 999, , '6 CSI /% CRVM 540,06 540, '6 CSI /% NLP 4,,545 4,, '80 CET 4% NLP 7,45 7, '80 CET 4 /% NLP,5,5 48,79,47, '80 CET 5% NLP 0,4 0, '80 CET 5 /% NLP 54, 54, '80 CET 7% NLP '80 CSO 4% CRVM,87,6,87, '80 CSO 4% NLP 54,45 54, '80 CSO 4 /% CRVM 89,88, 56,47 84,90,4 4,84, '80 CSO 4 /% NLP 09,84,07 86,580 09,754, '80 CSO 5% CRVM,07,0,07, '80 CSO 5% NLP 5,96,49 5,96, '80 CSO 5 /% CRVM 0,4,86 0,4, '80 CSO 5 /% NLP,8,8,8, '80 CSO 6% CRVM '80 CSO 6% NLP 4,548 4, '80 CSO 6 /4% NLP '80 CSO 7% NLP CSO /% CRVM 55,694,0 55,694, CSO /% NLP,76,086,76, CSO 4% CRVM 7,80,700 7,80, CSO 4% NLP 6,60,457 6,60, CSO 4 /% CRVM 7,0,97 7,0, CSO 4 /% NLP 9,0 9, AE /% NLP PU UNEARNED PREMIUM 8,805 8, Totals (Gross),099,459,647 9,77,0,074,765,67 4,9, Reinsurance ceded 95,885,5 95,84,690 4, Totals (Net),70,574,4 9,77,0,678,9,578 4,879,74 ANNUITIES (excluding supplementary contracts with life contingencies): IAM 4% 7,00 XXX 7,00 XXX IAM 4 /% 7,9,5 XXX 7,9,5 XXX IAM 4 /4%,667 XXX XXX, IAM 4 /4% 8,08 XXX XXX 8, IAM 4 /% 9,85 XXX XXX 9, IAM 4 /4% 7,057 XXX XXX 7, IAM 5% 97,404 XXX 967,4 XXX 5, IAM 5 /4% 8,05,745 XXX 7,98,67 XXX 4, IAM 5 /%,88,49 XXX,88,49 XXX IAM 5 /%,80,69 XXX,86,8 XXX, IAM 5 /4% 4,,79 XXX 4,,79 XXX IAM 6% 6,809,006 XXX 6,776,857 XXX, IAM 6 /4% 8,400,45 XXX 8,80,890 XXX 9, IAM 6 /%,96,40 XXX,908,66 XXX 7, IAM 6 /4% 5,580,79 XXX 4,977,4 XXX 60, IAM 7%,99 XXX,99 XXX IAM 7 /4% 0,7 XXX 0,7 XXX IAM 7 /% 7,49 XXX XXX 7, IAM 7 /% XXX XXX IAM 7 /4% 0,06 XXX 0,06 XXX IAM 8 %,650,48 XXX,650,48 XXX IAM 8 %,478,09 XXX,45,906 XXX 5, IAM 8 /4%,7,47 XXX,7,47 XXX IAM 8 /4% 6,479 XXX 6,479 XXX IAM 8 /% 78,6 XXX 78,6 XXX IAM 8 /% 4,05 XXX 4,05 XXX IAM 8 /4% 585,76 XXX 585,76 XXX IAM /4% XXX XXX IAM 9 /4%,097 XXX,097 XXX IAM % XXX XXX IAM %,757 XXX,757 XXX IAM /4% XXX XXX A % 85,6 XXX 85,6 XXX A % 67,890 XXX 67,890 XXX A %,44 XXX,44 XXX A % 7,5 XXX 7,5 XXX A % 5,9 XXX 5,9 XXX A %,0,754 XXX,0,754 XXX A % 49,707,560 XXX 49,707,560 XXX A % 7,50,575 XXX 7,50,575 XXX A % 95,065,0 XXX 95,065,0 XXX A % 80,7,765 XXX 80,7,765 XXX A % 0,507,66 XXX 0,507,66 XXX
13 EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Credit Valuation Standard Total Industrial Ordinary (Group and Individual) Group A % 47,478,940 XXX 47,478,940 XXX A % 0,854,6 XXX 0,854,6 XXX A000.75% 5,6,97 XXX 5,6,97 XXX A000.50%,005, XXX,005, XXX Totals (Gross) 85,87,955 XXX 85,050,9 XXX 777, Reinsurance ceded 9,60 XXX XXX 9, Totals (Net) 85,598,6 XXX 85,050,9 XXX 547,45 SUPPLEMENTARY CONTRACTS WITH LIFE CONTINGENCIES: IAM 6% IAM 7 /% IAM 5.00% IAM 6.5% 557,04 557, IAM 6.50% 4,577 4, IAM 6.75% 49,59 49, IAM 7.00% IAM 7.5% 4,48 4, IAM 7.75% IAM 8.5% 7,47 7, IAM 8.50% IAM 8 /4% A % 55,7 55, A % 96,87 96, A % 5, 5, A % 7,644 7, A % 74,57 74, A % 49,454 49, A % 4,874 4, A % 78,00 78, A %,858, A % 4,98 4, A % 06,47 06, Totals (Gross),64,67,64, Reinsurance ceded Totals (Net),64,67,64,67 ACCIDENTAL DEATH BENEFITS: SI % INTER-CO 94 CSO %,0, ADB & 958 CSO % 8,957 8, ADB & 958 CSO % 67,559,049 64, ADB & 958 CSO /% 5,07 44,70 90, UNEARNED PREMIUM Totals (Gross) 4,707 48,87 6, Reinsurance ceded Totals (Net) 4,707 48,87 6,86 DISABILITY-ACTIVE LIVES: CLASS DIS & '4 CSO % BEN 5 PER & '58 CSO % 8,570,457 8,570, BEN 5 PER & '58 CSO /% 49,995 49, '5 BEN 5 PER & '58 CSO.5% E IND,94, CDT & '58 CSO % 74,60 74, CIDA 4.0% & 80 CSO 4.0% 8,056 8, CIDA 4.5% & 80 CSO 4.5%,474,049,474, CIDA 5% & 80 CSO 5% 6,448 6, Totals (Gross) 0,857,576,94 0,855, Reinsurance ceded,858,478,858, Totals (Net) 6,999,098,94 6,997,57 DISABILITY-DISABLED LIVES: DIS CLASS() & '4 CSO % BEN 5 PER & '58 CSO % 6,807 6, BEN 5 PER & '58 CSO /% 86,9 86, MET DIS & '6 CSI /%,9, MET DIS & '4 SI /% MET DIS & '4 SSI % CDT % '58 CSO 4 /%,786,096,786, CIDA 5% & 80 CSO 4.5% 764, , CIDA 5% & 80 CSO 5% 4,60 4, Totals (Gross),50,4,9,58, Reinsurance ceded 6,698 6, Totals (Net),908,66,9,907,97 MISCELLANEOUS RESERVES For excess of valuation net premiums over corresponding gross premiums on respective policies, compu 99,04, 99,04, For non-deduction of deferred fractional premiums or return of premiums at the death of the insured,6,45,6,45 For surrender values in excess of reserves otherwise required and carried in this schedule Additional actuarial reserves-asset/liability analysis FOR MORTALITY UNDER CONVERTED GROUP RESERVE FOR GUARANTEED PURCHASE OPTION,69, RESERVE FOR IMMEDIATE PYMT OF CLAIMS Totals (Gross) 0,677,49 0,677, Reinsurance ceded,69,68,69, Totals (Net) 98,98,7 98,98, Totals (Net) - Page, Line,669,9,57 9,8,6,64,869,7 5,47,49.
14 * * ANNUAL STATEMENT FOR THE YEAR 04 OF THE CINCINNATI LIFE INSURANCE COMPANY EXHIBIT 5 - INTERROGATORIES. Has the reporting entity ever issued both participating and non-participating contracts? Yes [ X ] No [ ]. If not, state which kind is issued:. Does the reporting entity at present issue both participating and non-participating contracts? Yes [ ] No [ X ]. If not, state which kind is issued: NON-PARTICIPATING. Does the reporting entity at present issue or have in force contracts that contain non-guaranteed elements? Yes [ X ] No [ ] If so, attach a statement that contains the determination procedures, answers to the interrogatories and an actuarial opinion as described in the instructions. 4. Has the reporting entity any assessment or stipulated premium contracts in force? Yes [ ] No [ X ] If so, state: 4. Amount of insurance: $ 4. Amount of reserve: $ 4. Basis of reserve: 4.4 Basis of regular assessments: 4.5 Basis of special assessments: 4.6 Assessments collected during the year: $ 5. If the contract loan interest rate guaranteed in any one or more of its currently issued contracts is less than 5%, not in advance, state the contract loan rate guarantees on any such contracts: 6. Does the reporting entity hold reserves for any annuity contracts that are less than the reserves that would be held on a standard basis? Yes [ ] No [ X ] 6. If so, state the amount of reserve on such contracts on the basis actually held: $ 6. That would have been held (on an exact or approximate basis) using the actual ages of the annuitants; the interest rate(s) used in 6.; and the same mortality basis used by the reporting entity for the valuation of comparable annuity benefits issued to standard lives. If the reporting entity has no comparable annuity benefits for standard lives to be valued, the mortality basis shall be the table most recently approved by the state of domicile for valuing individual annuity benefits: $ Attach statement of methods employed in their valuation. 7. Does the reporting entity have any Synthetic GIC contracts or agreements in effect as of December of the current year? Yes [ ] No [ X ] 7. If yes, state the total dollar amount of assets covered by these contracts or agreements: $ 7. Specify the basis (fair value, amortized cost, etc.) for determining the amount 7. State the amount of reserves established for this business: $ 7.4 Identify where the reserves are reported in the blank 8. Does the reporting entity have any Contingent Deferred Annuity contracts or agreements in effect as of December of the current year? Yes [ ] No [ X ] 8. If yes, state the total dollar amount of account value covered by these contracts or agreements: $ 8. State the amount of reserves established for this business: $ 8. Identify where the reserves are reported in the blank: 9. Does the reporting entity have any Guaranteed Lifetime Income Benefit contracts, agreements or riders in effect as of December of the current year? Yes [ ] No [ X ] 9. If yes, state the total dollar amount of any account value associated with these contracts, agreements or riders: $ 9. State the amount of reserves established for this business: $ 9. Identify where the reserves are reported in the blank: EXHIBIT 5A - CHANGES IN BASES OF VALUATION DURING THE YEAR Valuation Basis 4 Description of Valuation Class Changed From Changed To Increase in Actuarial Reserve Due to Change LIFE CONTRACTS (Including supplementary contracts set upon a basis other than that used to determine benefits) (Exhibit 5) Subtotal (Page 7, Line 6) XXX XXX ACCIDENT AND HEALTH CONTRACTS (Exhibit 6) Subtotal XXX XXX DEPOSIT-TYPE CONTRACTS (Exhibit 7) Subtotal XXX XXX Total (Column 4 only)
15 4 EXHIBIT 6 - AGGREGATE RESERVES FOR ACCIDENT AND HEALTH CONTRACTS 4 Other Individual Contracts Credit Accident and Total Group Accident and Health Health (Group and Individual) Collectively Renewable Non-Cancelable Guaranteed Renewable Non-Renewable for Stated Reasons Only Other Accident Only All Other ACTIVE LIFE RESERVE. Unearned premium reserves,4, ,990 6,4, Additional contract reserves (a) 8,787,599 8,787,599. Additional actuarial reserves - Asset/Liability analysis 4. Reserve for future contingent benefits 5. Reserve for rate credits 6. Aggregate write-ins for reserves 7. Totals (Gross) 0,0, , ,09, Reinsurance ceded,,95,,95 9. Totals (Net) 7,07, , ,096, CLAIM RESERVE 0. Present value of amounts not yet due on claims,56,985 8,67,484,59,50. Additional actuarial reserves-asset/liability analysis. Reserve for future contingent benefits. Aggregate write-ins for reserves 4. Totals (Gross),56,985 8,67,484,59,50 5. Reinsurance ceded,97,76,09,05 9,95,68 6. Totals (Net) 9,84,69 5,68,448,565,80 7. TOTAL (Net) 6,9,000 5,69,47 8, ,66, TABULAR FUND INTEREST,5,45 0,9 95,96 DETAILS OF WRITE-INS Summary of remaining write-ins for Line 6 from overflow page Totals (Lines 060 through 060 plus 0698) (Line 6 above) Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98) (Line above) (a) Attach statement as to valuation standard used in calculating this reserve, specifying reserve bases, interest rates and methods.
16 EXHIBIT 7 DEPOSIT-TYPE CONTRACTS Total Guaranteed Interest Contracts Annuities Certain Supplemental Contracts Dividend Accumulations or Refunds Premium and Other Deposit Funds. Balance at the beginning of the year before reinsurance 90,066,56 6,5,4 8,6,04 6,0 65,598,799. Deposits received during the year 5,08,90 58,670 4,480,. Investment earnings credited to the account 0,850,408 97, ,4 9 9,804, Other net change in reserves (97,86) (7,869) (,78) 46 (57,55) 5. Fees and other charges assessed 0,447 9,76 00, Surrender charges 7. Net surrender or withdrawal payments,6,77,70,9 6,450,649,97,6 8. Other net transfers to or (from) Separate Accounts 9. Balance at the end of current year before reinsurance (Lines ) 8,8,06 5,,64 6,880,4 6,78 6,7,66 0. Reinsurance balance at the beginning of the year 5. Net change in reinsurance assumed. Net change in reinsurance ceded. Reinsurance balance at the end of the year (Lines 0+-) 4. Net balance at the end of current year after reinsurance (Lines 9 + ) 8,8,06 5,,64 6,880,4 6,78 6,7,66
17 . Due and unpaid: ANNUAL STATEMENT FOR THE YEAR 04 OF THE CINCINNATI LIFE INSURANCE COMPANY EXHIBIT 8 - CLAIMS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS PART - Liability End of Current Year Ordinary 6 Group Accident and Health Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual). Direct 4,50,7 4,490,54 7,846,7. Reinsurance assumed. Reinsurance ceded,97,494,9,00,894,400.4 Net,,878,098,054,95 0,87. In course of settlement:. Resisted. Direct,70,56,70,56. Reinsurance assumed. Reinsurance ceded 800, ,000.4 Net 70,56 (b) 70,56 (b) (b) (b) Other 6. Other. Direct 8,966,9 6,580 7,88,6 79,86 7,. Reinsurance assumed. Reinsurance ceded 8,950,65 8,54, ,60.4 Net 0,06,09 6,580 (b) 9,9, (b) (b) (b) 86,96 (b) (b) (b) 7,. Incurred but unreported:. Direct 4,76,65 8,000,,000 6,700 86,9 666,46. Reinsurance assumed. Reinsurance ceded 4,86 4,86.4 Net 4,47,879 8,000 (b),,000 (b) (b) (b) 6,700 (b) 86,9 (b) (b) 4, TOTALS 4. Direct 9,6,46 4,580 6,676,986 89, ,65 75,69 4. Reinsurance assumed 4. Reinsurance ceded,90,045 0,76,05 406,60,894 4, Net 7,97,0 (a) 4,580 (a) 5,940,88 (a) 4,66 866,7 507,94 (a) Including matured endowments (but not guaranteed annual pure endowments) unpaid amounting to $ in Column, $ in Column and $ in Column 7. (b) Include only portion of disability and accident and health claim liabilities applicable to assumed "accrued" benefits. Reserves (including reinsurance assumed and net of reinsurance ceded) for unaccrued benefits for Ordinary Life Insurance $ Individual Annuities $, Credit Life (Group and Individual) $, and Group Life $, are included in Page, Line, (See Exhibit 5, Section on Disability Disabled Lives); and for Group Accident and Health $ 5,68,448, Credit (Group and Individual) Accident and Health $, and Other Accident and Health $,565,80 are included in Page, Line (See Exhibit 6, Claim Reserve).
18 EXHIBIT 8 - CLAIMS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS PART - Incurred During the Year Ordinary 6 Group Accident and Health Industrial Life (a) Life Insurance (b) Supplementary Contracts Credit Life (Group and Individual) Life Insurance (c) Credit (Group and Individual) Total Individual Annuities Annuities Group Other. Settlements during the year:. Direct,4,86 7,757 48,84,9 6,77,46 5,000 6,80,8 08,78,66,489,65,99. Reinsurance assumed 6,8 6,8. Reinsurance ceded 56,99,995 5,76, ,90 77,65,85,96.4 Net (d) 66,8,9 7,757 95,66,68 6,77,46 5,000 6,9,949 08,78 898,854 86,904. Liability December, current year from Part :. Direct 9,6,46 4,580 6,676,986 89, ,65 75,69. Reinsurance assumed. Reinsurance ceded,90,045 0,76,05 406,60,894 4,686.4 Net 7,97,0 4,580 5,940,88 4,66 866,7 507,94. Amounts recoverable from reinsurers December, current year,659,45,55, 8,87 45,44 4,84 4. Liability December, prior year: 4. Direct 5,70,667 49,65,68,98 59, 6,9 70,47 4. Reinsurance assumed 4. Reinsurance ceded 6,88,599 6,50,8 0,500,78 9, Net 8,487,068 49,65 7,07,970 8,6 607,457 48,8 5. Amounts recoverable from reinsurers December, prior year 47,07 8,500 5,794 40,0 6. Incurred benefits: 6. Direct 6,44,865 56,7 5,87,07 6,77,46 5,000 7,40,9 08,78,865,45,70,57 6. Reinsurance assumed 6,8 6,8 6. Reinsurance ceded 64,8,586 60,75,84 895, 67,77,84, Net 6,0,408 56,7 9,5,76 6,77,46 5,000 6,506,070 08,78,8,08 858,65 (a) Including matured endowments (but not guaranteed annual pure endowments) amounting to $,64 in Line., $,64 in Line.4. $,64 in Line 6. and $,64 in Line 6.4. (b) Including matured endowments (but not guaranteed annual pure endowments) amounting to $ 56,88 in Line., $ 56,88 in Line.4. $ 56,88 in Line 6. and $ 56,88 in Line 6.4. (c) Including matured endowments (but not guaranteed annual pure endowments) amounting to $ in Line., $ in Line.4. $ in Line 6. and $ in Line 6.4. (d) Includes $ 9,66 premiums waived under total and permanent disability benefits.
19 EXHIBIT OF NONADMITTED ASSETS Current Year Total Nonadmitted Assets Prior Year Total Nonadmitted Assets Change in Total Nonadmitted Assets (Col. - Col. ). Bonds (Schedule D). Stocks (Schedule D):. Preferred stocks. Common stocks. 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 5. Cash (Schedule E-Part ), cash equivalents (Schedule E-Part ) and short-term investments (Schedule DA) 6. Contract loans,,9,9,08 6, 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 ),,9,9,08 6,690. 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 87 9,790 8,98 5. Deferred premiums, agents balances and installments booked but deferred and not yet due 5. Accrued retrospective premiums 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 6,94,94 56,96,64 (6,998,760) 9. Guaranty funds receivable or on deposit 0. Electronic data processing equipment and software 6,6 804,6 8,87. Furniture and equipment, including health care delivery assets 7,5 5,596 5,46. Net adjustment in assets and liabilities due to foreign exchange rates. Receivables from parent, subsidiaries and affiliates 4. Health care and other amounts receivable 8,49 55,05 (87,4) 5. Aggregate write-ins for other-than-invested assets 78,47 86,045 7,69 6. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines to 5) 66,07,6 59,,89 (6,94,4) 7. From Separate Accounts, Segregated Accounts and Protected Cell Accounts 8. Total (Lines 6 and 7) 66,07,6 59,,89 (6,94,4) DETAILS OF WRITE-INS Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 through 0 plus 98) (Line above) 50. PREPAID EXPENSES 8,564 4,4, AGENTS' BALANCES 7,6,977 4, TUITION REIMBURSEMENT RECEIVABLE,646, Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 through 50 plus 598) (Line 5 above) 78,47 86,045 7,69 8
20 NOTES TO FINANCIAL STATEMENTS. Summary of Significant Accounting Policies A. Accounting Policies The financial statements of the Cincinnati Life Insurance Company are presented on the basis of accounting practices prescribed or permitted by the Ohio Department of Insurance. The Ohio Department of Insurance recognizes only statutory accounting practices prescribed or permitted by the State of Ohio for determining and reporting the financial condition and results of operations of an insurance company, for determining its solvency under the Ohio Insurance Law. The National Association of Insurance Commissioners (NAIC) Accounting Practices and Procedures manual, (NAIC SAP) has been adopted as a component of prescribed or permitted practices by the State of Ohio. STATE OF 04 0 DOMICILE NET INCOME () Company state basis (Page 4, Line 5, Ohio ($8,65,98) ($9,68,4) Columns & ) () State Prescribed Practices that Ohio 0 0 increase/(decrease) NAIC SAP () State Permitted Practices that Ohio 0 0 increase/(decrease) NAIC SAP (4) NAIC SAP (--=4) Ohio ($8,65,98) ($9,68,4) SURPLUS (5) Company state basis (Page, Line 8, Ohio $,454,08 $46,99,46 Columns & ) (6) State Prescribed Practices that Ohio 0 0 increase/(decrease) NAIC SAP (7) State Permitted Practices that Ohio 0 0 increase/(decrease) NAIC SAP (8) NAIC SAP (5-6-7=8) Ohio $,454,08 $46,99,46 B. Use of Estimates in the Preparation of the Financial Statements The preparation of financial statements in conformity with Statutory Accounting Principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities. It also requires disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Actual results could differ from those estimates C. Accounting Policies The Company uses the following accounting policies:. Not applicable. Bonds are stated at amortized cost using the scientific method. Not applicable 4. Preferred Stocks are stated at book value 5. Not applicable 6. Not applicable 7. Not applicable 8. Not applicable 9. Not applicable 0. Not applicable. Unpaid accident and health losses include an amount determined from individual case estimates and an amount based on historic experience, for pending losses and losses incurred but not reported. Such liabilities are 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 reserves established. The reserve factors used to establish the resulting liabilities are periodically reviewed and any adjustments are reflected in the period determined.. The Company has not modified its capitalization policy from the prior period. Accounting Changes and Corrections of Errors None. Business Combinations and Goodwill A. Statutory Purchase Method Not Applicable B. Statutory Merger Not Applicable C. Assumption Reinsurance Not Applicable D. Impairment Loss Not Applicable 4. Discontinued Operations None 5. Investments A. Mortgage Loans None B. Debt Restructuring None C. Reverse Mortgages None D. Loan Backed Securities. Not Applicable.. Not Applicable.. Not Applicable. 4. Not Applicable. 5. Not Applicable. E. Repurchase Agreements None F. Real Estate. Real Estate Improvement None. Real Estate Held for Sale None. Change in Plan of Sale None 4. Retail Land Sales None 5. Real Estate with Participating Lone Features None G. Low Income Housing Tax Credits None 9
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