!! "#$% &'&& "(%)*"+!,! - $./ -0/ 1#$02$.3#4*5 6.#.5"070(.5$.% 6 $7#.91#$02 99:&: ""$7*0$**,99:&: -..#$"+??@/ - 0.%4$.#. $.%#$;0 /

Transcription

1 #$% &'&& (%)*+, - $./ -0/ #$0$.#4*5 6.#.5070(.5$.% 6 $.%5070( 8 $7#.9#$0 99:&: $7*0$**,99:&:.#..% 507 8&: -..#$+/ - 0.%4$.#. $.%#$;0 / #0$0$0*.#.0< 507 = > -..#$+/ = 8&& ' - 0.%4$.#. $.%#$;0 / -# /-($+/ #0(** = > = 8&& -..#$+??@/ - 0.%4$.#. $.%#$;0 / 0#%7#.0$5A*#$7* = > -..#$+/ = 8&& ' - 0.%4$.#. $.%#$;0 / -# /-($+/ $.$.=+*0.** ===??.#..%.#.$. $.#7. 6>B '', -#/ -# /-($+/ >BC? '&''&' -#0(**/ -D+/ #0#$E [email protected]< 507 B *0$. 050$#$70#( 507 B8 >07*0$.E7.#% $0>07*0$.E 0577$.0$ 507 = B= 68 F >07*0$.E#* > B8 = B 6.#.5 #(05$0# $.%5 #$ G 507*5.0*.0$$.0.%+0$(%*4$#7*#$*#%.#..%#.*70+507*5*#0.0$$.0.%#$.#.$..0$0*.#.#+< #(5.0$*70+#**.*4.#+*(..%5.*#0.0$$.0.%5#$7(#5#$%(0$*7(#0*.$@7.#*0$*.#.#$.#..0* *.#.$...40.(#.@0+0.**7(*#$@(#$#.0$*.0$7$.#0$#[email protected]*#5(#$.*.#.$.5#(.#**.*#$(0#+0(0.0*#$5. 7$0.0$#$#5#0*5.*#0.0$$.0.%#*5..0$0*.#.#+<#$50.*0$7#$7.0$*.55.0$#$#<+$7(. 0$#77#$740.. $$#(.#.$.$*.7.0$*#$77$.0$#7.07*#$7*#$#(@7...@.$..#.G-/*.#.(#4#%05H-/.#.*.#. (*(#.0$*I005$7*0$.0$$.(#..#77$.0$#7.07*#$7*#770$..+*.5.00$5#.0$A$4(#$+(05*7.0<(%?..*75.0*#.*.#.0$+%.*70+507*#(*0$7(*.(#.7*$0$(7.$0750(0$40.. 4$I0.#.0*#$@#7.7% [email protected]#.0$05$7*.(7.$0750(0$/5.$7(**.#.$.?(7.$0750(0$#%+I*.+%<#0*(#.*0$(050$#0.0$.. $7(**.#.$.? B#*#*0* 0#$7.0* 4##(% #0#$E [email protected]< 050$#$70#( 507 $0>07*0$.E 0577$.0$ 507 #?*.0*#$00$#(50(0$J? *KDLKL +*70+#$*4$.+5.0* +? 5$?.#..#$$.$+?? #.50(? #%5'?+5#*#.#7? +% -/B#*#*0*<.$.+#*0*5*#.0*5#7.%<0$7.+.*$4##+5#$ +% -/0#$7.0*<.$.+#*0*5*#.0*5#7.%<0$7.+.*$4##+5#$ +% -/4##(%<.$.+#*0*5*#.0*5#7.%<0$7.+.*$4##+5? MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM 0$#.5.#%+(07

2 ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSETS Assets Current Year Nonadmitted Assets Net Admitted Assets (Cols. - ) Prior Year 4 Net Admitted Assets. 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 (less $ encumbrances) 4. Properties held for the production of income (less $ encumbrances) 4. Properties held for sale (less $ encumbrances) 5. Cash ($, Schedule E - Part ), cash equivalents ($, Schedule E - Part ) and short-term investments ($, Schedule DA) 6. Contract loans (including $ premium notes) 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 less $ charged off (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 5. Deferred premiums and agents' balances and installments booked but deferred and not yet due (including $ earned but unbilled premiums) 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 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) 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) Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above)

3 ANNUAL STATEMENT FOR THE YEAR 0 OF THE LIABILITIES, SURPLUS AND OTHER FUNDS Prior Year Current Year. Aggregate reserve for life contracts $ (Exh. 5, Line ) less $ included in Line 6. (including $ Modco Reserve). Aggregate reserve for accident and health contracts (including $ Modco Reserve). Liability for deposit-type contracts (Exhibit 7, Line 4, Col. ) (including $ Modco Reserve) 4. Contract claims: 4. Life (Exhibit 8, Part, Line 4.4, Col. less sum of Cols. 9, 0 and ) 4. Accident and health (Exhibit 8, Part, Line 4.4, sum of Cols. 9, 0 and ) 5. 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) 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) 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 $ ceded 9.4 Interest maintenance reserve (IMR, Line 6) 0. Commissions to agents due or accrued-life and annuity contracts $ accident and health $ and deposit-type contract funds $. Commissions and expense allowances payable on reinsurance assumed. General expenses due or accrued (Exhibit, Line, Col. 6). 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) 5. Current federal and foreign income taxes including $ on realized capital gains (losses) 5. Net deferred tax liability 6. Unearned investment income 7. Amounts withheld or retained by company as agent or trustee 8. Amounts held for agents'account, including $ agents'credit balances 9. Remittances and items not allocated 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 $. Dividends to stockholders declared and unpaid 4. Miscellaneous liabilities: 4.0 Asset valuation reserve (AVR, Line 6, Col. 7) 4.0 Reinsurance in unauthorized and certified ($ ) companies 4.0 Funds held under reinsurance treaties with unauthorized and certified ($ ) reinsurers 4.04 Payable to parent, subsidiaries and affiliates 4.05 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 4.0 Payable for securities lending 4. Capital notes $ and interest thereon $ 5. Aggregate write-ins for liabilities 6. Total Liabilities excluding Separate Accounts business (Lines to 5) 7. From Separate Accounts Statement 8. Total Liabilities (Lines 6 and 7) 9. Common capital stock 0. 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. ) 4. Aggregate write-ins for special surplus funds 5. Unassigned funds (surplus) 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) 8. Totals of Lines 9, 0 and 7 (Page 4, Line 55) 9. Totals of Lines 8 and 8 (Page, Line 8, Col. ) DETAILS OF WRITE-INS # 598. Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 0. $%&& Summary of remaining write-ins for Line from overflow page 99. Totals (Lines 0 thru 0 plus 98)(Line above) Summary of remaining write-ins for Line 4 from overflow page 499. Totals (Lines 40 thru 40 plus 498)(Line 4 above)

4 ANNUAL STATEMENT FOR THE YEAR 0 OF THE 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. ). Considerations for supplementary contracts with life contingencies. Net investment income (Exhibit of Net Investment Income, Line 7) 4. Amortization of interest maintenance reserve (IMR, Line 5) 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. ) 7. Reserve adjustments on reinsurance ceded 8. Miscellaneous Income: 8. Income from fees associated with investment management, administration and contract guarantees from Separate Accounts 8. Charges and fees for deposit-type contracts 8. Aggregate write-ins for miscellaneous income 9. Total (Lines to 8.) 0. Death benefits. Matured endowments (excluding guaranteed annual pure endowments). Annuity benefits (Exhibit 8, Part, Line 6.4, Cols ). Disability benefits and benefits under accident and health contracts 4. Coupons, guaranteed annual pure endowments and similar benefits 5. Surrender benefits and withdrawals for life contracts 6. Group conversions 7. Interest and adjustments on contract or deposit-type contract funds 8. Payments on supplementary contracts with life contingencies 9. Increase in aggregate reserves for life and accident and health contracts 0. Totals (Lines 0 to 9). Commissions on premiums, annuity considerations, and deposit-type contract funds (direct business only) (Exhibit, Part, Line, Col. ). Commissions and expense allowances on reinsurance assumed (Exhibit, Part, Line 6., Col. ). General insurance expenses (Exhibit, Line 0, Cols.,, and 4) 4. Insurance taxes, licenses and fees, excluding federal income taxes (Exhibit, Line 7, Cols. + + ) 5. Increase in loading on deferred and uncollected premiums 6. Net transfers to or (from) Separate Accounts net of reinsurance 7. Aggregate write-ins for deductions 8. Totals (Lines 0 to 7) 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8) 0. Dividends to policyholders. Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0). Federal and foreign income taxes incurred (excluding tax on capital gains). Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) 4. Net realized capital gains (losses) (excluding gains (losses) transferred to the IMR) less capital gains tax of $ (excluding taxes of $ transferred to the IMR) 5. Net income (Line plus Line 4) CAPITAL AND SURPLUS ACCOUNT 6. Capital and surplus, December, prior year (Page, Line 8, Col. ) 7. Net income (Line 5) 8. Change in net unrealized capital gains (losses) less capital gains tax of $ 9. Change in net unrealized foreign exchange capital gain (loss) 40. Change in net deferred income tax 4. Change in nonadmitted assets 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 44. Change in asset valuation reserve 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 54. Net change in capital and surplus for the year (Lines 7 through 5) 55. Capital and surplus, December, current year (Lines ) (Page, Line 8) DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8. from overflow page Totals (Lines 08.0 thru 08.0 plus 08.98)(Line 8. above) 70. #$ $%&' 798. Summary of remaining write-ins for Line 7 from overflow page 799. Totals (Lines 70 thru 70 plus 798)(Line 7 above) 50. ( 50. )$& 50. *'( Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 4

5 ANNUAL STATEMENT FOR THE YEAR 0 OF THE CASH FLOW Current Year Prior Year Cash from Operations. Premiums collected net of reinsurance. Net investment income. Miscellaneous income 4. Total (Lines through ) 5. Benefit and loss related payments 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts 7. Commissions, expenses paid and aggregate write-ins for deductions 8. Dividends paid to policyholders 9. Federal and foreign income taxes paid (recovered) net of $ tax on capital gains (losses) 0. Total (Lines 5 through 9). Net cash from operations (Line 4 minus Line 0) Cash from Investments. Proceeds from investments sold, matured or repaid:. Bonds. Stocks. Mortgage loans.4 Real estate.5 Other invested assets.6 Net gains or (losses) on cash, cash equivalents and short-term investments.7 Miscellaneous proceeds.8 Total investment proceeds (Lines. to.7). Cost of investments acquired (long-term only):. Bonds. Stocks. Mortgage loans.4 Real estate.5 Other invested assets.6 Miscellaneous applications.7 Total investments acquired (Lines. to.6) 4. Net increase (decrease) in contract loans and premium notes 5. Net cash from investments (Line.8 minus Line.7 minus Line 4) 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 6.5 Dividends to stockholders 6.6 Other cash provided (applied) 7. Net cash from financing and miscellaneous sources (Lines 6. to 6.4 minus Line 6.5 plus Line 6.6) 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) 9. Cash, cash equivalents and short-term investments: 9. Beginning of year 9. End of year (Line 8 plus Line 9.) Note: Supplemental disclosures of cash flow information for non-cash transactions: ## $%% & $%% & ' (## ) & * ) & ) *, - ', +).)' 5

6 6 ANNUAL STATEMENT FOR THE YEAR 0 OF THE 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. Considerations for supplementary contracts with life contingencies. Net investment income 4. Amortization of Interest Maintenance Reserve (IMR) 5. Separate Accounts net gain from operations excluding unrealized gains or losses 6. Commissions and expense allowances on reinsurance ceded 7. Reserve adjustments on reinsurance ceded 8. Miscellaneous Income: 8. Fees associated with income from investment management, administration and contract guarantees from Separate Accounts 8. Charges and fees for deposit-type contracts 8. Aggregate write-ins for miscellaneous income 9. Totals (Lines to 8.) 0. Death benefits. Matured endowments (excluding guaranteed annual pure endowments). Annuity benefits. Disability benefits and benefits under accident and health contracts 4. Coupons, guaranteed annual pure endowments and similar benefits 5. Surrender benefits and withdrawals for life contracts 6. Group conversions 7. Interest and adjustments on contract or deposit-type contract funds 8. Payments on supplementary contracts with life contingencies 9. Increase in aggregate reserves for life and accident and health contracts 0. Totals (Lines 0 to 9). Commissions on premiums, annuity considerations and deposit-type contract funds (direct business only). Commissions and expense allowances on reinsurance assumed. General insurance expenses 4. Insurance taxes, licenses and fees, excluding federal income taxes 5. Increase in loading on deferred and uncollected premiums 6. Net transfers to or (from) Separate Accounts net of reinsurance 7. Aggregate write-ins for deductions 8. Totals (Lines 0 to 7) 9. Net gain from operations before dividends to policyholders and federal income taxes (Line 9 minus Line 8) 0. Dividends to policyholders. Net gain from operations after dividends to policyholders and before federal income taxes (Line 9 minus Line 0). Federal income taxes incurred (excluding tax on capital gains). Net gain from operations after dividends to policyholders and federal income taxes and before realized capital gains or (losses) (Line minus Line ) DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8. from overflow page Totals (Lines 08.0 thru 08.0 plus 08.98) (Line 8. above) #$ 798. Summary of remaining write-ins for Line 7 from overflow page 799. Totals (Lines 70 thru 70 plus 798) (Line 7 above) (a) Includes the following amounts for FEGLI/SGLI: Line, Line 0, Line 6, Line, Line 4

7 ANNUAL STATEMENT FOR THE YEAR 0 OF THE 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. Tabular net premiums or considerations. Present value of disability claims incurred XXX 4. Tabular interest 5. Tabular less actual reserve released 7 6. Increase in reserve on account of change in valuation basis 7. Other increases (net) 8. Totals (Lines to 7) 9. Tabular cost XXX 0. Reserves released by death XXX XXX XXX. Reserves released by other terminations (net). Annuity, supplementary contract and disability payments involving life contingencies. Net transfers to or (from) Separate Accounts 4. Total Deductions (Lines 9 to ) 5. Reserve December, current year

8 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT OF NET INVESTMENT INCOME Collected During Year Earned During Year. U.S. Government bonds (a). Bonds exempt from U.S. tax (a). Other bonds (unaffiliated) (a). 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) 7 Derivative instruments (f) 8. Other invested assets 9. Aggregate write-ins for investment income 0. Total gross investment income. Investment expenses (g). Investment taxes, licenses and fees, excluding federal income taxes (g). Interest expense (h) 4. Depreciation on real estate and other invested assets (i) 5. Aggregate write-ins for deductions from investment income 6. Total deductions (Lines through 5) 7. Net investment income (Line 0 minus Line 6) DETAILS OF WRITE-INS Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 090 thru 090 plus 0998) (Line 9, above) Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598) (Line 5, above) (a) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued interest on purchases. (b) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued dividends on purchases. (c) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued interest on purchases. (d) Includes $ for company s occupancy of its own buildings; and excludes $ interest on encumbrances. (e) Includes $ accrual of discount less $ amortization of premium and less $ paid for accrued interest on purchases. (f) Includes $ accrual of discount less $ amortization of premium. (g) Includes $ investment expenses and $ investment taxes, licenses and fees, excluding federal income taxes, attributable to segregated and Separate Accounts. (h) Includes $ interest on surplus notes and $ interest on capital notes. (i) Includes $ depreciation on real estate and $ depreciation on other invested assets. EXHIBIT OF CAPITAL GAINS (LOSSES) 4 5 Total Realized Capital Gain (Loss) (Columns + ) Change in Unrealized Capital Gain (Loss) Change in Unrealized Foreign Exchange Capital Gain (Loss) Realized Gain (Loss) On Sales or Maturity Other Realized Adjustments. U.S. Government bonds. Bonds exempt from U.S. tax. Other bonds (unaffiliated). Bonds of affiliates. Preferred stocks (unaffiliated). 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) 0. Total capital gains (losses) DETAILS OF WRITE-INS Summary of remaining write-ins for Line 9 from overflow page Totals (Lines 090 thru 090 plus 0998) (Line 9, above) 8

9 9 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT - PART - PREMIUMS AND ANNUITY CONSIDERATIONS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS Ordinary 5 Group Accident and Health Aggregate of All Total Industrial Life Life Insurance Individual Annuities Credit Life (Group and Individual) Life Insurance Annuities Group Credit (Group and Individual) Other Other Lines of Business FIRST YEAR (other than single). Uncollected. Deferred and accrued. Deferred, accrued and uncollected:. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (Line + Line ) 4. Advance 5. Line.4 - Line 4 6. Collected during year: 6. Direct 6. Reinsurance assumed 6. Reinsurance ceded 6.4 Net 7. Line 5 + Line Prior year (uncollected + deferred and accrued - advance) 9. First year premiums and considerations: 9. Direct 9. Reinsurance assumed 9. Reinsurance ceded 9.4 Net (Line 7 - Line 8) SINGLE 0. Single premiums and considerations: 0. Direct 0. Reinsurance assumed 0. Reinsurance ceded 0.4 Net RENEWAL. Uncollected. Deferred and accrued. Deferred, accrued and uncollected:. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (Line + Line ) 4. Advance 5. Line.4 - Line 4 6. Collected during year: 6. Direct 6. Reinsurance assumed 6. Reinsurance ceded 6.4 Net 7. Line 5 + Line Prior year (uncollected + deferred and accrued - advance) 9. Renewal premiums and considerations: 9. Direct 9. Reinsurance assumed 9. Reinsurance ceded 9.4 Net (Line 7 - Line 8) TOTAL 0. Total premiums and annuity considerations: 0. Direct 0. Reinsurance assumed 0. Reinsurance ceded 0.4 Net (Lines )

10 0 DIVIDENDS AND COUPONS APPLIED (included in Part ) ANNUAL STATEMENT FOR THE YEAR 0 OF THE 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. 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 4. Single: 4. Reinsurance ceded 4. Reinsurance assumed 4. Net ceded less assumed 5. Renewal: 5. Reinsurance ceded 5. Reinsurance assumed 5. Net ceded less assumed 6. Totals: 6. Reinsurance ceded (Page 6, Line 6) 6. Reinsurance assumed (Page 6, Line ) 6. Net ceded less assumed COMMISSIONS INCURRED (direct business only) 7. First year (other than single) 8. Single 9. Renewal 0. Deposit-type contract funds. Totals (to agree with Page 6, Line )

11 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT - GENERAL EXPENSES Insurance 5 6 Accident and Health 4 Life Cost Containment All Other All Other Lines of Business Investment Total. Rent. Salaries and wages. Contributions for benefit plans for employees. 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. Other agent welfare 4. Legal fees and expenses 4. Medical examination fees 4. Inspection report fees 4.4 Fees of public accountants and consulting actuaries 4.5 Expense of investigation and settlement of policy claims 5. Traveling expenses 5. Advertising 5. Postage, express, telegraph and telephone 5.4 Printing and stationery 5.5 Cost or depreciation of furniture and equipment 5.6 Rental of equipment 5.7 Cost or depreciation of EDP equipment and software 6. Books and periodicals 6. Bureau and association fees 6. Insurance, except on real estate 6.4 Miscellaneous losses 6.5 Collection and bank service charges 6.6 Sundry general expenses 6.7 Group service and administration fees 6.8 Reimbursements by uninsured plans 7. Agency expense allowance 7. Agents balances charged off (less $ recovered) 7. Agency conferences other than local meetings 9. Real estate expenses 9. Investment expenses not included elsewhere 9. Aggregate write-ins for expenses 0. General expenses incurred (a). General expenses unpaid December, prior year. General expenses unpaid December, current year. Amounts receivable relating to uninsured plans, prior year 4. Amounts receivable relating to uninsured plans, current year 5. General expenses paid during year (Lines ) DETAILS OF WRITE-INS Summary of remaining write-ins for Line 9. from overflow page Totals (Lines 09.0 thru 09.0 plus 09.98) (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. State taxes on premiums 4. Other state taxes, including $ for employee benefits 5. U.S. Social Security taxes 6. All other taxes 7. Taxes, licenses and fees incurred 8. Taxes, licenses and fees unpaid December, prior year 9. Taxes, licenses and fees unpaid December, current year 0. Taxes, licenses and fees paid during year (Lines ) EXHIBIT 4 - DIVIDENDS OR REFUNDS Life Accident and Health. 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 7. Left on deposit 8. Aggregate write-ins for dividend or refund options 9. Total Lines 5 through 8 0. Amount due and unpaid. Provision for dividends or refunds payable in the following calendar year. Terminal dividends. Provision for deferred dividend contracts 4. Amount provisionally held for deferred dividend contracts not included in Line 5. Total Lines 0 through 4 6. Total from prior year 7. Total dividends or refunds (Lines ) DETAILS OF WRITE-INS 080. #$ Summary of remaining write-ins for Line 8 from overflow page Totals (Lines 080 thru 080 plus 0898) (Line 8 above)

12 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial 4 Ordinary 5 Credit (Group and Individual) 6 Group Totals (Gross) Reinsurance ceded Life Insurance: Totals (Net) # XXX XXX # XXX XXX $ # XXX XXX

13 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial 4 Ordinary 5 Credit (Group and Individual) 6 Group XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX.

14 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial 4 Ordinary 5 Credit (Group and Individual) 6 Group XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000. XXX XXX 000. XXX XXX 000. XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000. XXX XXX 000. XXX XXX 000. XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000. XXX XXX 000. XXX XXX 000. XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ##$ ## ## XXX XXX Totals (Gross) XXX XXX Reinsurance ceded XXX XXX Annuities: Totals (Net) XXX XXX Totals (Gross) Reinsurance ceded SCWLC: Totals (Net)

15 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 5 - AGGREGATE RESERVE FOR LIFE CONTRACTS Valuation Standard Total Industrial 4 Ordinary 5 Credit (Group and Individual) 6 Group Totals (Gross) Reinsurance ceded Accidental Death Benefits: Totals (Net) Totals (Gross) Reinsurance ceded Disability-Active Lives: Totals (Net) Totals (Gross) Reinsurance ceded Disability-Disabled Lives: Totals (Net) ## Totals (Gross) Reinsurance ceded Miscellaneous Reserves: Totals (Net) Totals (Net) - Page, Line.

16 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 5 - INTERROGATORIES. Has the reporting entity ever issued both participating and non-participating contracts?. If not, state which kind is issued.. Does the reporting entity at present issue both participating and non-participating contracts?. If not, state which kind is issued.. Does the reporting entity at present issue or have in force contracts that contain non-guaranteed elements? 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? 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? 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? 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? 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? 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: $ $( $%& *#( 9. Identify where the reserves are reported in the blank: # EXHIBIT 5A - CHANGES IN BASES OF VALUATION DURING THE YEAR Valuation Basis 4 Description of Valuation Class Changed From Changed To Increase in Actuarial Reserve Due to Change,-.,/0.4 -,5 5,-.,0-6 (( #* ($ Subtotal (Page 7, Line 6) XXX XXX (( #* ($ Subtotal XXX XXX Subtotal XXX XXX Total (Column 4, only) (( #* ($

17 ANNUAL STATEMENT FOR THE YEAR 0 OF THE.

18 4 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 6 - AGGREGATE RESERVES FOR ACCIDENT AND HEALTH CONTRACTS 4 Other Individual Contracts Credit Accident Total Group Accident and Health and Health (Group and Individual) Collectively Renewable Non-Cancelable Guaranteed Renewable Non-Renewable for Stated Reasons Only Other Accident Only ACTIVE LIFE RESERVE. Unearned premium reserves. Additional contract reserves (a). 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) 8. Reinsurance ceded 9. Totals (Net) CLAIM RESERVE 0. Present value of amounts not yet due on claims. Additional actuarial reserves-asset/liability analysis. Reserve for future contingent benefits. Aggregate write-ins for reserves 4. Totals (Gross) 5. Reinsurance ceded 6. Totals (Net) 7. TOTAL (Net) 8. TABULAR FUND INTEREST DETAILS OF WRITE-INS Summary of remaining write-ins for Line 6 from overflow page TOTALS (Lines 060 thru 060 plus 0698) (Line 6 above) Summary of remaining write-ins for Line from overflow page 99. TOTALS (Lines 0 thru 0 plus 98) (Line above) (a) Attach statement as to valuation standard used in calculating this reserve, specifying reserve bases, interest rates and methods. 9 All Other

19 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 7 - DEPOSIT TYPE CONTRACTS Total Guaranteed Interest Contracts Annuities Certain 4 Supplemental Contracts 5 Dividend Accumulations or Refunds 6 Premium and Other Deposit Funds. Balance at the beginning of the year before reinsurance. Deposits received during the year. Investment earnings credited to the account 4. Other net change in reserves 5. Fees and other charges assessed 6. Surrender charges 7. Net surrender or withdrawal payments 8. Other net transfers to or (from) Separate Accounts 5 9. Balance at the end of current year before reinsurance (Lines ) 0. Reinsurance balance at the beginning of the year. 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 + )

20 . Due and unpaid:. In course of settlement: ANNUAL STATEMENT FOR THE YEAR 0 OF THE 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. Reinsurance assumed. Reinsurance ceded.4 Net. Resisted. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (b) (b) (b) (b) Other 6. Other. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (b) (b) (b) (b) (b) (b) (b). Incurred but unreported:. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (b) (b) (b) (b) (b) (b) (b) 4. TOTALS 4. Direct 4. Reinsurance assumed 4. Reinsurance ceded 4.4 Net (a) (a) (a) (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 $ Credit (Group and Individual) Accident and Health $, and Other Accident and Health $ are included in Page, Line (See Exhibit 6, Claim Reserve).

21 7 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT 8 - CLAIMS FOR LIFE AND ACCIDENT AND HEALTH CONTRACTS PART - Incurred During the Year Ordinary 6 Group Accident and Health Total Industrial Life (a) Life Insurance (b) Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance (c) Annuities Group Credit (Group and Individual). Settlements During the Year:. Direct. Reinsurance assumed. Reinsurance ceded.4 Net (d). Liability December, current year from Part :. Direct. Reinsurance assumed. Reinsurance ceded.4 Net. Amounts recoverable from reinsurers December, current year 4. Liability December, prior year: 4. Direct 4. Reinsurance assumed 4. Reinsurance ceded 4.4 Net 5. Amounts recoverable from reinsurers December, prior year 6. Incurred Benefits 6. Direct 6. Reinsurance assumed 6. Reinsurance ceded 6.4 Net (a) Including matured endowments (but not guaranteed annual pure endowments) amounting to $ in Line., $ in Line.4. $ in Line 6., and $ in Line 6.4. (b) Including matured endowments (but not guaranteed annual pure endowments) amounting to $ in Line., $ in Line.4. $ in Line 6., and $ 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 $ premiums waived under total and permanent disability benefits. Other

22 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT OF NON-ADMITTED 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 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 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 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) 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) Summary of remaining write-ins for Line 5 from overflow page 599. Totals (Lines 50 thru 50 plus 598)(Line 5 above) 8

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

25 *C # ' ' (8*'+,*)'%%7+' # $%# %%7+/ 09 < $ # %%7+%*+ ( 8*' +,*)' %% *,+' #&' # & ( $ (8*'+,*)'%%*,)' () *+ # & ( $ (8*'+,*)'@ (( (( %%C6', -. /0 %(&( ( & %( & (( %*7 (8*'+,*5& %%*,9# & ( # %%+,'# '& & ( =/ %%*,9 & %%*,9' H ( +,*5# & 8*'+,*5 ),'+,*5& ( & & %%*,9 / +,*)' ( D ( ('& (/ # ( ( D 8*'+,*)0) &< #. ( ( (%? 0*9+ #. (. ( 0+96

26 A '.. * #= & +,*)& A= A ( 69,; )67; 5)7; 5)7; 9+9; )76; A.. 966; 966; + #= ( '= ( &C+; )*' )*' +,*) +,*+ ) #=''( 0, 0, 5 > A.. # I *>( 0, 0, 07'*+')5+ 0, 0'5C'*9'5+ 0*C9')C7'5) 0'75+'65'+9* ),@97,,,,,,, 6,@C7,,,,,,, 7,@*7,,,,,,, *C,J,,,,,,, + 7,@*7 >( 0, 0, 0, 0, 0, 0, 0,,,,,,,, ) *C,J >( 0, 0, 0, 0, 0, 0, 0,,,,,,,, 5> >( 0, 0, 0, 0, 0+')7',+6 0, 0+')7',+6,,,, *, * >,,,, 95, 95 I *>( 0, 0, 0+99'76C 0, 06'7*'*C7'67) 0+,,'5C'6C5 0'**'7+5')59 ),@97,,,,, 66')9,',,, 66')9,',,, 6,@C7,,,,,,, 7,@*7,,,, )'5*7')*5, )'5*7')*5 *C,J,,,,,,, + 7,@*7 >( 0, 0, 0, 0, 0)'5*7')*5 0, 0)'5*7')*5,,,, *+,'+9), *+,'+9) ) *C,J >( 0, 0, 0, 0, 0, 0, 0,,,,,,,, 5> >( 0, 0, 0, 0, 0)'+*6')97 0, 0)'+*6')97,,,, *, * >,,,, 9), 9) 9 ( & & & > A.. # I * & 0, 0, 0, 0, 0, 0, 0, +&,,,, 9'C)7'C*+, 9'C)7'C*+ I * & 0, 0, 0, 0, 0, 0, 0, +&,,,, 6'6)9'6) 66')9,',,, +'7C9'6)

27 6 ( K ( ('.' > A.. # I *(>( 0, 0, 0, 0, 09'7)C'))6 0, 09'7)C'))6 +>.,,,, *7C'9*C, *7C'9*C )>( %,,,,,,, 5 A,,,, +*,')5+, +*,')5+ I *(>( 0, 0, 0, 0, 0C'66+'6C5 066')9,',,, 09',*+'6C5 +>.,,,, 5+'CC5 9)*'99) 95'5) )>( %,,,,,,, 5 A,,,, 5+'CC5 9)*'99) 95'5) )*' )*' & +,*) +,*+? 0, 0,,, &,, >( (,,? 0, 0, C#.? > )*' )*' +,*) +,*+ * # ( 0C'5)6'*69 0+9'567'+C* '@ + #. *)5'9C +'6,7'7+6 ) # = & (&(,, 5 # = & # & (

28 '& %%5)>'*+ ' &. ##' ' ' ( (. ##.*L+,*) 0, 0, 0, 0, *.?? ## + ) ##>. + + *@+J+ ( (.,,,, #*L+,*) 0, 0, 0, 0, ##.+L+,*) 09C'7)7'C,9 0, 05'5)5',, 095'9,9')9 ( (.,,,, #+L+,*) 09C'7)7'C,9 0, 05'5)5',, 095'9,9')9 ##.)L+,*) 0, 0, 0, 0, ( (.,,,, #)L+,*) 0, 0, 0, 0, ##.5L+,*) < 0, 0, 0, 0, ( (.,,,, #5L+,*) 0, 0, 0, 0, # 0, 05'5)5',, ) & ##. ' &(&=.,+*9*?7 0*'*95'69 0*6'*9+'65 0*',,+'**C 0*6'*9+'65 0*9'7C6'67 )D)*D+,*) *+966L 9 +9'6*6'959 +5'6)7'*+6 7'5*7 +5'6)7'*+6 +5'6+6'5C 6D),D+,*) 7+7+9:8+ ))'7,+'5+7 )+'+7'77, *'6++'5)7 )+'+7'77, )*'5C'+6 6D),D+,*) +,*9A) +'+5'+9 +'))+')*C )7*'7)7 +'))+')*C +'))+')*C 6D),D+,*) *6*69F) 9',,*'*+ )')*)'76, *'6C'+*+ )')*)'76, )'*76'79) 7D),D+,*) 5966F 7'**5'*9* C'97'5 9*6'5,5 C'97'5 ',))'79 *+D)*D+,*) 965)+ *C'C99'595 *'6*C',,, *'+)'595 *'6*C',,, *5'76C'C+, *+D)*D+,*) # 0'5)5'7C9?D< 4.? ## 4 < & >. ##. 4 ## ## % >

29 )*'+,*) (.& ##.. &.##@ &@. 9 & ( ' ( ' & = (' ('' & G$ ( (. G $ < & < < ( & >D * '/ *,+; ( +,*)' 0*7 )*' +,*)' 0*+* & & / ( + ) > ( > ( #. )*' +,*) * *+A 0+6'57+'6+) + *+A C+',7+'579 # ( &. * *+A 07),'9,6'+9+ + *+A 5'65C'979 4 *> ), )*6, 6*7, :#7, %@# 0, % > ( *+')7C'797 #> ( 0*+')7C'797 +% ) > # (-%#& ( =# && > * )*'+,*)'079 ( % + ( ) 5 > 9 : ( & = F# * # ( = = # / $F# ( + #$F# (<( & ) #$F# (=*,; 5 >. 9 &

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

32 & ((= & '=# = & (' '=' = # & ( & = -% # %%C6', -. /0 ' ( ( ( (# & '& < ( ( ' ' ' & = # ( & ( ( ( ( ' & ( ( (/ & & ( ( ( ( ( ( <. '= )*'+,*)'09) = ( / - '= ( ' $ ( = ( )*'+,*)'.. ( ( / & )*'+,*)'.. 0) ( (/ ( ( (& * +

33 # #=D )*& * )*'+,*) ) * +*J+ # := 0*'55'95+'6*+ 05+'*56'6C+ 0*'5C7'6C7'+75 %( &<,,, <=*@* *'55'95+'6*+ 5+'*56'6C+ *'5C7'6C7'+75 = 55)'6)',,,, 55)'6)',,, % =*@* *',,)'7,9'6*+ 5+'*56'6C+ *',56',9+'+75 = *+'6),'59+ +*C'7++'C5+ )56'99)'+75 =D= *@* 0C6'+9'*6, 0*6'6'*6, 0677'577',,, )*'+,* J9 # := 0*')C,'9C+'76) 09*'+++',66 0*'5)*'C,9',+7 %( &<,,, <=*@* *')C,'9C+'76) 9*'+++',66 *'5)*'C,9',+7 = )+7'96*',,,, )+7'96*',,, % =*@* *',9*',+*'76) 9*'+++',66 *'*,+'+55',+7 = *)+'595',+7 +,'+C5',,, 5,+')C',+7 =D= *@* 07*C'96'7)5 0+*7',6*'7)5 0677'9,6',,, +,*) C +@9 *@5 7 JC # := 066'797'657 07',9')C5 09'CC5'+69 %( &<,,, <=*@* 66'797'657 7',9')C5 9'CC5'+69 = **5',6',,,, **5',6',,, % =*@* 5'**6')9* 7',9')C5 96'*7*')9 = 5'C+)'9 9*')6*'*9C 96'*C5')9 =D= *@* 05+'+7+'5 05+'+C9'5 0',,,

34 + %%*,* )*'+,*) ) * + *J+ # = ( 0, 0, 0, <==. = =+( +* ++& 677'577',,,, 677'577',,, *<==. & 677'577',,,, 677'577',,, +<=& OOO OOO C67'*C'76* <== =++( = *+'6),'59+ +*C'7++'C5+ )56'99)'+75 = %%*,* #+J+J+ 0C+'*+7'59+ 0+*C'7++'C5+ 0*',56',9+'+75 %%*,* )*'+,* J9 # = ( 0, 0, 0, <==. = =+( +* ++& 677'9,6',,,, 677'9,6',,, *<==. & 677'9,6',,,, 677'9,6',,, +<=& OOO OOO C*7'7*9'6), <== =++( = *)+'595',+7 +,'+C5',,, 5,+')C',+7 = %%*,* #+J+J+ 0C)*'76,',+7 0+,'+C5',,, 0*'*,+'+55',+7 %%*,* +,*) C 7 *@5 +@9 JC # = ( 0, 0, 0, <==. = =+( +* ++& ',,,, ',,, *<==. & ',,,, ',,, +<=& OOO OOO 57'++'))* <== =++( = 5'C+)'9 9*')6*'*9C 96'*C5')9 = %%*,* #+J+J+ 05'C),'9 09*')6*'*9C 096'*7*')9

35 ) +,*) +,*+ > ( 6,6; 9)9; < ( ++( 09'75'9C6'5,9 09'566'*,5'+,) 5 = )*'+,*) * + <=' ='= *< #7* 0*'55'95+'6*+ 05+'*56'6C+ +< #= =,;,; ) < #7* *',,)'7,9'6*+ 5+'*56'6C+ 5 < #= = +6;,; )*'+,*+ ) 5 <=' ='= *< #7* 0*')C,'9C+'76) 09*'+++',66 +< #= =,;,; ) < #7* *',9*',+*'76) 9*'+++',66 5 < #= = 96;,; 9 6 *@) +@5 <=' ='= *< #7* 066'797'657 07',9')C5 +< #= =,;,; ) < #7* 5'**6')9* 7',9')C5 5 < #= H=@ P

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

38 * )*'+,*)'0)57 & ' ( =' = & +#& = & ( +,*) 0, +,*+, +,**, ) % 66,)>(%( & * #$ = & & A F A F' 'B'>4':'% ' ( '' = > O>' :( ' ( ' > >?> + # = & < & = ' (? & =. =' ( =' : = $ '?'#( & ( % & :5+'+*( -%: %%I'+ (( %' (( ( $( ( &' ' (( $ ' (='=' ( &'= = ( )*'+,*)+,*+&0**+ 07, ' ( (='=' ( %& %% ' '( & ( ( &#( ' % '. '& ( ( ( '% 0*,* 076 )*'+,*)+,*+' ( )*'+,*)+,*+'0,5 0,C ' (' ' A F' ('0* 0*7 ' (' )*'+,*)+,*+'06, 0*6 ' (' $ 7, +,*)': )*'+,*)'0*,, A )*'+,*5 B& &0+, ( #&& )*'+,*) :A+7'+,*,' & > >'&@& ' >> - Q -Q( ( -Q'' > # ( & (> %*5+ 8*'+,*)' & > >>& & -% ( -% >& #( ( (( (( : ( ' A A ( ( %*'*77# ( ' $ 'A F' A&( - ('A F&&9*; ( ' &&*,,;( F #& ' ( & ' % # ( % =*,;

39 8 #. & & ( % +,*) Q & <-%:( >.@( & *K*+# 0,, #& )*'+,*)+,*+ '05,, (( ' +,*6' & & )*'+,*)+,*+# ( )*'+,*)+,*+'& & ( *) # ( & ( #& & )*'+,*)?# F?F?## (( F?#$( ( & F? # / ' ( & #( C,7 )*'+,*)+,*+' (%)+:? > # # %= (> %> )*'+,*) +,*+' &09) 09, ' (# ( )*'+,*) +,*+&. #( ( )*'+,*)+,*+' & 0*, 0+, ' (# ( )*'+,*)+,*+&.# (

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

42 )*'+,*)+,*+ +,*) )),; 5,,; D D > 59,; < )*'+,*)+,*+ +,*) 5),; )),; > 59,; 59,; 7 # &09) 09, )*'+,*)+,*+ *, (' ( C,;FA&+,*)#&9,;+,57 ( ** ( &(& )*'+,*) ( 056',,, 05*',,, D D *+ #& '& =( ' '= I +,*5 06'C99')), +,*9 6',6'C,, +,*6 9'5)C'76+ +,* 9'*99'*6, +,*C 5'CC,')5) +,*7+,+9 +*'57'C6) *) #( / +,*5= +,*506 0* *5 *9 ( (. *6 % ( * *C *7 +,? (?? )*' )*' +,*) +,*) < D 09+'9C'67, 0*,')99',,, (,, - 09+'9C'67, 0*,')99',,, %. 0, 0,

43 +*# %%7+'? )*' +,*) 05'69',,,.. )76',,,.. 5'+7',,,. 0,?( ( 4 * 4A > + 4A () 4F ( (=@ #( > (%( >%( #$>% 9;$ '= 6; #$ >%0)* 0)* )*'+,*) +,*+ # # /# = ' ' # $ &09 )*'+,*)+,*+ : DF F? A A.? # A % *+# (. ' ( %&'( * # 6,,',,,.' & ( 09,,, # + #. ) ( # ( < % &#&/ ( ( ( & &(=*,; )* &( )*? +,*)'09*9 ( )*'+,*5 '& ( '< / 5 +,*)' 0+,, ( 9 )(' ( 6 # ( C # 7 # *, # (. 097*

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

45 * #& FB0)9, 0+, ' ('( #&& )*'+,*) ' & % ' ( / # % 0* 0* )*'+,*)+,*+ )*'+,*)'09+ ( % '< (' ' %'%?'*'*7 )*'+,*)'0*9* / ( # F# ( + ' & ' ( / H H. ' = & %%9> - / A = / ( ' > =%% 9> * - - > =%% 9>* - - > =%% 9>* - - ( & *+D)*D*) *+D)*D*) *+D)*D*) # - - OOO )? * +,*)' ( & (( #$ = 0) &. =0,5 % 0+6 )*'+,*) + =&. )*' +,*) 06'567'*CC = : :. 69'5++ )96'5,9 *'C+9'767 0'+6)')),

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

47 ? ( ') ) *#&. $ )*' )*' )*' )*' +,*) +,*+ +,*) +,*+ %&D& 05'9,)'67*',, 07'6,'++6',69 0, 0, 5*6')99'979,,, 5'57)'C*,'6,6 '*,*'79,',C+,, # 07'5*)'C9'7,* 0*6'+'*6'*5 0, 0, %%? + # (( ( '= &F&('( ( ' # ( ((& ( / ((H %*C (( ) # ( (( ' = ( ( # = & & ' '= ' & %=%& # ( +,*+ (. ' = (( &( & = ( ( (( & ' (' # (( )*'+,*)+,*+?=@= ( ' ( ' / #/ =& # / 5 # =$ (( ( & & & & %#. = ( / = (( & (@ # #> (>%? #%( % * $ ( ' / & $ ( + # )&' )*'+,*) / & ), #?4 % % % : D? ) * 0*'7C*'55, 0*'7,',,, 0+*'C7) %,,,, %,,,,

48 %? % A % %?> * *' # # # A : = (? D :R? A F **+9 %'% 7,, '>7+,7 7)@**C7C+ # OOO OOO OOO OOO 05)'677',6 R@ $ #H (( ' ' %%*,,' # (/ (&( # & (.( ( (*-</ ((* & (= (+( (* '/ (G/ (G@ (( & ( (+ ( ( ( ()4 (( / & (() / ( / ( 05)'677',6

49 * 4A 4 )*'+,*) (* (+ () # (? > >A?% 0, 0C5C'6 0, 0C5C'6, *'75C'5), *'75C'5) #?, *C'7'**5, *C'7'**5 % A,, *9,',,, *9,',,, #%,, *9,',,, *9,',,, % A 5,,'+)7 *')9* C'*7*'9+ C'97)')5+ 79'+)+'967 R, )'95'** 7C'C,'+C, #% 79'6)+'C,C *')9* **')7'56) *,'))'6++ (( > %&, C9'7)9'77+, C9'7)9'77+ / (( *+'+5,'6++, *6,'*5'CC7 *+'5*9'9**, 9*')56 9*')56 # (( *+'+5,'6++ C9'7C'))C *6,'*5'CC7 +9C'5,+'C57 % 9C'+95'5C6'*67 *,6')+')56 *9C'6**')** 9C'9*7'C+7'C+6 # ( 09C')6+')97'977 0+**'9*C'*57 0)),'69'66) 09C'7,5'99)'5** ( (( > %& 0, 0*C+'+CC'955 0, 0*C+'+CC'955 / ((,, *5'+7)'7,6 *5'+7)'7,6, *C+'9,9, *C+'9,9 # ((, *C+'5*',57 *5'+7)'7,6 )+7'65'799 # ( 0, 0*C+'5*',57 0*5'+7)'7,6 0)+7'65'799 R #& &(*(+ )*'+,*) + 4A () 4F? 8*' # # # # +,*) () () % % % # () ( ( # () & ( ( #()( ( )*' +,*)? >A?% 09'96)',C5 0)+'67 06'C*'79+ 06C'5* 07+)')* 0, 0, 0, 0))+'597 0, '977'7C) *5'C65',)9 56')75'),7H *'+5*'79C +)'+** +6'5)',++, *'*69',,, )+'7C5, % A *9,',,,,,,,,,,, *9,',,, % A C'*,C')5,, +'7,6 C,'577,,,, C'*7*'9+ )'7*'+C,,, +5)'96,,,, )'95'** ((' *56'6))'C*6,, *5'+75',7 *6)'C*'+C +7)'++9,, *9'55*'*9, *+'CC,'7C) % **+'))7'9), 7'9,, 7'C'59, 9)'+69'575, *9')9'+6 6C'+9 *9C'6**')** # 0+C5'*C6',7, 0*9'976')+ 095'*C7'6* 0++'5',)* 0*6+'C)'C+ 0C,',)*'5* 0, 0*6'7,,'+6 0*5'666'7C+ 0*C)')C*'9 #() (=./ ) # D./

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

54 ) ( :?D?D D?>? I *, 09',C9'5C6, 0, D> D I *9 C'*,5'6,, ( > I D 9'6)9 D, > I D> D, D, #%- I,,,, D> D & I +5 C',)9'*9+,, D?> I EJJ@@@ 7C 09'*6,'656, 0, F 8 %( & # ((/ )*'+,*)+C'+,*5' %& 0,?= >?0, > > % *K: * ' %%@ '& =*,;' ' (' '' P ISTSOT' ( + F( & - % = -%? & =*,; ' ' P ISOTST' ( # & - F > ''? '& &@ &( ( ( '& ' ( ( % +K> >K * ( & P ISTSOT '& ' & '& P ' = '& ' P + ( & ' & & ' = P ISTSOT' (

55 % )K> >K? * '& % + ( ' ' P ' = 0* + F( & = = ' 8* ' & & = ( ( P ISOTST'& '& ' &P07+)? - > > > > &%%<>( + # )*'+,*)+,*+'&0+* 0+) ( )*'+,*)' ( &0*, ',)5; ( # ( ( (? # ( 07 $ * #& ( # ( ( /((' ' ( ( + & = '( (9,;= & '( (= ( ( & ='( ( ) )*'+,*)'0+6 & ( % 5 '# '# >( >' # ( ' '# & 9 ## ((

56 6 #(' # ( % : : ( #( (' ( (' ( >4A =& 0*)9')C'9C 0, 0*),'6*'++C 0**+',) 0, 0, 0+6'5,) 05'C59'77 >(?> 9')67'*,, 9')67'*,,,,,, # 0+*,'5C'+7 0, 0+,6',5,'7)C 0**+',) 0, 0, 0+6'5,) 05'C59'77 )*'+,*)' ( (& / 05, ' : % % # ; & : # %< & & * (< 09'56+'6,'++ 0, 0, 09'56+'6,'++ C; + (9;R *'*57'977'5*7,, *'*57'977'5*7 *; ) ( )'C66'95, 9,'+5',*)'++) 9,'7'C7', 5; 5 #& < (*) 6'6C6'++6'+)C, 9,'+5',*)'++) 9'5*,'+)7'56* C); 9 (& < < 5'66C'975'77+,, 5'66C'975'77+ ;? < & & 6'C5')C'6)) 6)'C+7'675 +'57C'C9 6'75,'*6'+,+ *,; # *C'++7'+,C'C6) 6)'C+7'675 9,'+6'9*+',7C 67',*7'99,'699 *,,; > *)'+)+'97,, *)'+)+'97 #RR@ 0*C'+*9'76'+66 06)'C+7'675 09,'+6'9*+',7C 067',,6')*C',9C R & &( ('& RR> ( B BF% * = 9' % '# 0*6'5,*'),,'5C + = 9'%& % '# )')95'C6C ) = *5'* *'C**')+,'7** 5 % *C'+*9'76'+66 %% 9 = )'+',+77777'+ 9,'+*'5'796 6 = )'+',)77777'+, (, C, 7 :, *, 6C'97)'C)6 ** % 9,'7,')5*'7+ *+ # 067',,6')*C',9C : F? * # F?## ' F?# =( 0, )*'+,*)#& (' & ( ' %%9+',0 ' $. ' F?# & & %% *9', &%**?( )*' )*' +,*) +,*+ + F?D& 0'776',,, 0'5)'*,, ) F?, *9*')*'75 5 (, 9'*)+'7)5 9 #(, *9,',,,',,, 6 :, *9*')*'75, *9,',,,',,, %,,,,

57 )*'+,*) % ( *#. )*'+,*)' & ( +& & ' & # ( ( )*'+,*) )*'+,*+'$ 09C6 09)5 ' (# )*'+,*) & )*'+,*) : * 0, 0, 0, + & *,'6++'C)7 *,'7,C'*)5 +C9'+79 ) & 5C'76',9) 57'+6+' '7,6 5,,, 9 :,,, 6 : *66'5C'7*C *66'5C'7*C, # 0*,6'CC7',+6 0*,6'),'C+9 09C*'+,* % 4 09*'66,')7'))7 0, 4 - ( 6'C7C'9,'5C), 6)'77,')*9 **'599'9++ # 09C'6++'C'*) 0**'599'9++ ) & & ' & ( ' ( ( ' & )*'+,*)'$= 0++ # ' & +,*) 0)5+'676'C9* +,*+ 0+7'))')C +,** 0+65'+7'7*5 +,,7 +,*, 0+56'*99'+7 )*'+,*)' 0*6 & )*'+,*+'+,**+,*,&0+5 ' ' ( 5 % #

58 ? : % % ( ( ( ( # ( % & &( # & 4>/ % & %& : : * + ) 5 9 = = : : % = 5; A 5; # * ' &( )*'+,*) 0, 0, 0, 05',9'7C7'56) 05',9'7C7'56) + >( )*'+,*) & ( 0, 0, 0, 09'9+C'+7*'+* 09'9+C'+7*'+*., 6)'C+7'675,, 6)'C+7'675 #(R 0, 06)'C+7'675 0, 09'9+C'+7*'+* 09'97+'*+*'5*9 )?& & %< & & 0, 0, 0, 0, 0, (<,,,,, (& (<& 9;,,,,, (,,, 9'9+9'7+'C56 9'9+9'7+'C56 (& (<& 9;,,,,, %,,, 9'9+9'7+'C56 9'9+9'7+'C56 < & &, 6)'C+7'675, +'57C'C9 66')+C'967 # 0, 06)'C+7'675 0, 09'9+C'+7*'+* 09'97+'*+*'5*9 R +/ ) 5 >( 4> > ##% * # % %% #%5' *5 #%5' *, %@ + > < D 05'+C'+69'*97 9'6,5'9**'79 C6'+56'6)6 +'+76'++C ) # % ' B F%*J+E5' +6 * # 0CC'95+'C65

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

60 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES 8. Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board? 8. If response to 8. is yes, please identify the name of the bank holding company. 8. Is the company affiliated with one or more banks, thrifts or securities firms? 8.4 If response to 8. is yes, please provide below the names and location (city and state of the main office) of any affiliates regulated by a federal regulatory services agency [i.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Federal Deposit Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify the affiliate's primary federal regulator. Affiliate Name Location (City, State) FRB 4 OCC 5 FDIC 6 SEC 9. What is the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit? DELOITTE LLP, 695 TOWN CENTER DRIVE, SUITE 00, COSTA MESA, CA Has the insurer been granted any exemptions to the prohibited non-audit services provided by the certified independent public accountant requirements as allowed in Section 7H of the Annual Financial Reporting Model Regulation (Model Audit Rule), or substantially similar state law or regulation? 0. If the response to 0. is yes, provide information related to this exemption: 0. Has the insurer been granted any exemptions related to the other requirements of the Annual Financial Reporting Model Regulation as allowed for in Section 7A of the Model Regulation, or substantially similar state law or regulation? 0.4 If the response to 0. is yes, provide information related to this exemption: 0.5 Has the reporting entity established an Audit Committee in compliance with the domiciliary state insurance laws? 0.6 If the response to 0.5 is no or n/a, please explain. What is the name, address and affiliation (officer/employee of the reporting entity or actuary/consultant associated with an actuarial consulting firm) of the individual providing the statement of actuarial opinion/certification? GARY L. FALDE, VICE PRESIDENT & CHIEF ACTUARY 700 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA Does the reporting entity own any securities of a real estate holding company or otherwise hold real estate indirectly?. Name of real estate holding company. Number of parcels involved. Total book/adjusted carrying value $. If, yes provide explanation: LISTED IN SCHEDULE BA ARE 0 LIMITED PARTNERSHIPS AND LOW INCOME HOUSING TAX CREDITS INDIRECTLY OWNING VARIOUS REAL ESTATE INVESTMENTS. IN ADDITION, PACIFIC ASSET HOLDING LLC (PAH), IS A WHOLLY-OWNED SUBSIDIARY OF THE COMPANY, THAT INVESTS IN COMMERCIAL REAL ESTATE PROPERTIES AND VENTURES, AND INVESTS IN AND/OR MANAGES PRIVATE EQUITY INVESTMENTS.. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY:. What changes have been made during the year in the United States manager or the United States trustees of the reporting entity?. Does this statement contain all business transacted for the reporting entity through its United States Branch on risks wherever located?. Have there been any changes made to any of the trust indentures during the year?.4 If answer to (.) is yes, has the domiciliary or entry state approved the changes? 4. Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions) of the reporting entity subject to a code of ethics, which includes the following standards? (a) Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships; (b) Full, fair, accurate, timely and understandable disclosure in the periodic reports required to be filed by the reporting entity; (c) Compliance with applicable governmental laws, rules and regulations; (d) The prompt internal reporting of violations to an appropriate person or persons identified in the code; and (e) Accountability for adherence to the code. 4. If the response to 4. is No, please explain: 4. Has the code of ethics for senior managers been amended? 4. If the response to 4. is yes, provide information related to amendment(s). 4. Have any provisions of the code of ethics been waived for any of the specified officers? 4. If the response to 4. is yes, provide the nature of any waiver(s). 0.

61 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES 5. Is the reporting entity the beneficiary of a Letter of Credit that is unrelated to reinsurance where the issuing or confirming bank is not on the SVO Bank List? 5. If the response to 5. is yes, indicate the American Bankers Association (ABA) Routing Number and the name of the issuing or confirming bank of the Letter of Credit and describe the circumstances in which the Letter of Credit is triggered. American Bankers Association (ABA) Routing Number Issuing or Confirming Bank Name Circumstances That Can Trigger the Letter of Credit 4 Amount BOARD OF DIRECTORS 6. Is the purchase or sale of all investments of the reporting entity passed upon either by the board of directors or a subordinate committee thereof? 7. Does the reporting entity keep a complete permanent record of the proceedings of its board of directors and all subordinate committees thereof? 8. Has the reporting entity an established procedure for disclosure to its board of directors or trustees of any material interest or affiliation on the part of any of its officers, directors, trustees or responsible employees that is in conflict with the official duties of such person? FINANCIAL 9. Has this statement been prepared using a basis of accounting other than Statutory Accounting Principles (e.g., Generally Accepted Accounting Principles)? 0. Total amount loaned during the year (inclusive of Separate Accounts, exclusive of policy loans): 0. To directors or other officers $ 0. To stockholders not officers $ 0. Trustees, supreme or grand (Fraternal Only) $ 0. Total amount of loans outstanding at the end of year (inclusive of Separate Accounts, exclusive of policy loans): 0. To directors or other officers $ 0. To stockholders not officers $ 0. Trustees, supreme or grand (Fraternal Only) $. Were any assets reported in this statement subject to a contractual obligation to transfer to another party without the liability for such obligation being reported in the statement?. If yes, state the amount thereof at December of the current year:. Rented from others $. Borrowed from others $. Leased from others $.4 Other $. Does this statement include payments for assessments as described in the Annual Statement Instructions other than guaranty fund or guaranty association assessments?. If answer is yes:. Amount paid as losses or risk adjustment $. Amount paid as expenses $. Other amounts paid $. Does the reporting entity report any amounts due from parent, subsidiaries or affiliates on Page of this statement?. If yes, indicate any amounts receivable from parent included in the Page amount: $ INVESTMENT 4.0 Were all the stocks, bonds and other securities owned December of current year, over which the reporting entity has exclusive control, in the actual possession of the reporting entity on said date? (other than securities lending programs addressed in 4.0) 4.0 If no, give full and complete information relating thereto 4.0 For security lending programs, provide a description of the program including value for collateral and amount of loaned securities, and whether collateral is carried on or off-balance sheet. (an alternative is to reference Note 7 where this information is also provided) 4.04 Does the Company's security lending program meet the requirements for a conforming program as outlined in the Risk-Based Capital Instructions? 4.05 If answer to 4.04 is yes, report amount of collateral for conforming programs. $ 4.06 If answer to 4.04 is no, report amount of collateral for other programs. $ 4.07 Does your securities lending program require 0% (domestic securities) and 05% (foreign securities) from the counterparty at the outset of the contract? 4.08 Does the reporting entity non-admit when the collateral received from the counterparty falls below 00%? 4.09 Does the reporting entity or the reporting entity s securities lending agent utilize the Master Securities lending Agreement (MSLA) to conduct securities lending? 0.

62 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES 4.0 For the reporting entity s security lending program state the amount of the following as December of the current year: 4.0 Total fair value of reinvested collateral assets reported on Schedule DL, Parts and. $ 4.0 Total book adjusted/carrying value of reinvested collateral assets reported on Schedule DL, Parts and $ 4.0 Total payable for securities lending reported on the liability page. $ 5. Were any of the stocks, bonds or other assets of the reporting entity owned at December of the current year not exclusively under the control of the reporting entity, or has the reporting entity sold or transferred any assets subject to a put option contract that is currently in force? (Exclude securities subject to Interrogatory. and 4.0). 5. If yes, state the amount thereof at December of the current year: 5. Subject to repurchase agreements $ 5. Subject to reverse repurchase agreements $ 5. Subject to dollar repurchase agreements $ 5.4 Subject to reverse dollar repurchase agreements $ 5.5 Pledged as collateral $ 5.6 Placed under option agreements $ 5.7 Letter stock or other securities restricted as to sale $ 5.8 On deposit with state or other regulatory body $ 5.9 Other $ 5. For category (5.7) provide the following: Nature of Restriction Description Amount 6. Does the reporting entity have any hedging transactions reported on Schedule DB? 6. If yes, has a comprehensive description of the hedging program been made available to the domiciliary state? If no, attach a description with this statement. 7. Were any preferred stocks or bonds owned as of December of the current year mandatorily convertible into equity, or, at the option of the issuer, convertible into equity? 7. If yes, state the amount thereof at December of the current year. $ 8. Excluding items in Schedule E - Part - Special Deposits, real estate, mortgage loans and investments held physically in the reporting entity's offices, vaults or safety deposit boxes, were all stocks, bonds and other securities, owned throughout the current year held pursuant to a custodial agreement with a qualified bank or trust company in accordance with Section, III - General Examination Considerations, F. Outsourcing of Critical Functions, Custodial or Safekeeping Agreements of the NAIC Financial Condition Examiners Handbook? 8.0 For agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following: Name of Custodian(s) #$ % && % #$ % %'#(% %# $'$(' Custodian's Address 8.0 For all agreements that do not comply with the requirements of the NAIC Financial Condition Examiners Handbook, provide the name, location and a complete explanation: Name(s) Location(s) Complete Explanation(s) 8.0 Have there been any changes, including name changes, in the custodian(s) identified in 8.0 during the current year? 8.04 If yes, give full and complete information relating thereto: Old Custodian New Custodian Date of Change 4 Reason 8.05 Identify all investment advisors, brokers/dealers or individuals acting on behalf of brokers/dealers that have access to the investment accounts, handle securities and have authority to make investments on behalf of the reporting entity: Central Registration Depository Number(s) Name $)* %' $)+'##)'#'#$ %$$ $)* %$''$' ))+'##$ %$$ Address 0.

63 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES 9. Does the reporting entity have any diversified mutual funds reported in Schedule D, Part (diversified according to the Securities and Exchange Commission (SEC) in the Investment Company Act of 940 [Section 5(b)()])? 9. If yes, complete the following schedule: CUSIP # Name of Mutual Fund Book/Adjusted Carrying Value Total 9. For each mutual fund listed in the table above, complete the following schedule: Name of Mutual Fund (from above table) Name of Significant Holding of the Mutual Fund Amount of Mutual Fund's Book/Adjusted Carrying Value Attributable to the Holding 4 Date of Valuation 0. Provide the following information for all short-term and long-term bonds and all preferred stocks. Do not substitute amortized value or statement value for fair value. Statement (Admitted) Value Excess of Statement over Fair Value (-), or Fair Value over Statement (+) Fair Value 0. Bonds 0. Preferred stocks 0. Totals 0.4 Describe the sources or methods utilized in determining the fair values: SEE NOTE 0 FOR EXPLANATION OF SOURCES AND METHODS UTILIZED IN DETERMINING THE FAIR VALUES.. Was the rate used to calculate fair value determined by a broker or custodian for any of the securities in Schedule D?. If the answer to. is yes, does the reporting entity have a copy of the broker s or custodian s pricing policy (hard copy or electronic copy) for all brokers or custodians used as a pricing source?. If the answer to. is no, describe the reporting entity s process for determining a reliable pricing source for purposes of disclosure of fair value for Schedule D: SEE NOTE 0 FOR EXPLANATION OF PROCESS FOR DETERMINING A RELIABLE PRICING SOURCE FOR PURPOSES OF DISCLOSURE OF FAIR VALUE.. Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Securities Valuation Office been followed?. If no, list exceptions: 0.4

64 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES OTHER. Amount of payments to trade associations, service organizations and statistical or rating bureaus, if any? $. List the name of the organization and the amount paid if any such payment represented 5% or more of the total payments to trade associations, service organizations and statistical or rating bureaus during the period covered by this statement. Name Amount Paid 4. Amount of payments for legal expenses, if any? $ 4. List the name of the firm and the amount paid if any such payment represented 5% or more of the total payments for legal expenses during the period covered by this statement. Name Amount Paid 5. Amount of payments for expenditures in connection with matters before legislative bodies, officers or departments of government, if any? $ 5. List the name of the firm and the amount paid if any such payment represented 5% or more of the total payment expenditures in connection with matters before legislative bodies, officers or departments of government during the period covered by this statement. Name Amount Paid #$% &%'(&%$')$)$& (## * 0.5

65 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES PART - LIFE INTERROGATORIES. Does the reporting entity have any direct Medicare Supplement Insurance in force?. If yes, indicate premium earned on U.S. business only $. What portion of Item (.) is not reported on the Medicare Supplement Insurance Experience Exhibit? $. Reason for excluding:.4 Indicate amount of earned premium attributable to Canadian and/or Other Alien not included in Item (.) above. $.5 Indicate total incurred claims on all Medicare Supplement insurance. $.6 Individual policies: Most current three years:.6 Total premium earned $.6 Total incurred claims $.6 Number of covered lives All years prior to most current three years.64 Total premium earned $.65 Total incurred claims $.66 Number of covered lives.7 Group policies: Most current three years:.7 Total premium earned $.7 Total incurred claims $.7 Number of covered lives. Health Test: All years prior to most current three years.74 Total premium earned $.75 Total incurred claims $.76 Number of covered lives Current Year Prior Year. Premium Numerator. Premium Denominator. Premium Ratio (./.).4 Reserve Numerator.5 Reserve Denominator.6 Reserve Ratio (.4/.5). Does this reporting entity have Separate Accounts?. If yes, has a Separate Accounts Statement been filed with this Department?. What portion of capital and surplus funds of the reporting entity covered by assets in the Separate Accounts statement, is not currently distributable from the Separate Accounts to the general account for use by the general account? $.4 State the authority under which Separate Accounts are maintained: NEBRASKA REVISED STATUTES CHAPTER 44 - SECTIONS 40.0 THROUGH Was any of the reporting entity s Separate Accounts business reinsured as of December?.6 Has the reporting entity assumed by reinsurance any Separate Accounts business as of December?.7 If the reporting entity has assumed Separate Accounts business, how much, if any, reinsurance assumed receivable for reinsurance of Separate Accounts reserve expense allowances is included as a negative amount in the liability for Transfers to Separate Accounts due or accrued (net)? 4. Are personnel or facilities of this reporting entity used by another entity or entities or are personnel or facilities of another entity or entities used by this reporting entity (except for activities such as administration of jointly underwritten group contracts and joint mortality or morbidity studies)? 4. Net reimbursement of such expenses between reporting entities: 4. Paid $ 4. Received $ 5. Does the reporting entity write any guaranteed interest contracts? 5. If yes, what amount pertaining to these lines is included in: 6. FOR STOCK REPORTING ENTITIES ONLY: 5. Page, Line $ 5. Page 4, Line $ 6. Total amount paid in by stockholders as surplus funds since organization of the reporting entity: $ 7. Total dividends paid stockholders since organization of the reporting entity: 7. Cash $ 7. Stock $

66 ANNUAL STATEMENT FOR THE YEAR 0 OF THE GENERAL INTERROGATORIES 8. Does the company reinsure any Workers Compensation Carve-Out business defined as: Reinsurance (including retrocessional reinsurance) assumed by life and health insurers of medical, wage loss and death benefits of the occupational illness and accident exposures, but not the employers liability exposures, of business originally written as workers compensation insurance. 8. If yes, has the reporting entity completed the Workers Compensation Carve-Out Supplement to the Annual Statement? 8. If 8. is yes, the amounts of earned premiums and claims incurred in this statement are: Reinsurance Assumed Reinsurance Ceded Net Retained 8. Earned premium 8. Paid claims 8. Claim liability and reserve (beginning of year) 8.4 Claim liability and reserve (end of year) 8.5 Incurred claims 8.4 If reinsurance assumed included amounts with attachment points below $,000,000, the distribution of the amounts reported in Lines 8. and 8.4 for Column () are: Attachment Point Earned Premium Claim Liability and Reserve 8.4 <$5, $5,000-99, $00,000-49, $50, , $,000,000 or more 8.5 What portion of earned premium reported in 8., Column was assumed from pools? $ 9. Does the company have variable annuities with guaranteed benefits? 9. If 9. is yes, complete the following table for each type of guaranteed benefit. Guaranteed Death Benefit Type Waiting Guaranteed Period Account Value Total Related Gross Amount Location of Portion Living Benefit Remaining Related to Col. Account Values of Reserve Reserve Reinsured Reinsurance Reserve Credit #$%&#&'(%) *+%,-. /// // 0 4-5#'5) *+%,-. /// // 0 65 #7 *+%,-. // 0 8 #$%&#&'(%) *+%,-. /// // 0.

67 Guaranteed Death Benefit ANNUAL STATEMENT FOR THE YEAR 0 OF THE Type Waiting Guaranteed Period Account Value Total Related Gross Amount Location of Portion Living Benefit Remaining Related to Col. Account Values of Reserve Reserve Reinsured Reinsurance Reserve Credit #$%& '# ()) *)) +,-# () *. * ( * #/(0 #$%& '# *)) )) +,-#.)(* &# #4.(.()) +,-# 0#5%6607% 85#6%#%& #4 *. *).)).*)) +,-# * #4 (. (. )) )) +,-# #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4 * *))).)) +,-# 86#&%#%& #4 ))) ()) +,-# #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4 (. )(.)).*)) +,-#.) ). 85#6%#%& #4 ( ()) )) +,-# ) ( ).( #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4 *( )*()) )) +,-# 85#6%#%& #4 )) )) +,-# #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4 )) +,-# 85#6%#%& #4 )) +,-# #/(0 (%#0# #4 )) +,-# 0#5%6607% (&# #4 ))) )) +,-#.) ). 85#6%#%& #4..))) )) +,-# ) )* #/(0 %#0# #4 )) )) +,-# () * 0#5%6607% (&# #4 (* (*)) )) +,-# 86#&%#%& #4 )) +,-# #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4.. )) )) +,-# 85#6%#%& #4 * *)) +,-# #/(0 %#0# #4 )) +,-# 0#5%6607% &# #4 )) +,-# 85#6%#%& #4 ( ()) +,-# #/(0 (%#0# #4 +,-# #4 #4- )) +,-# 0#5%6607% #4 #4- )*()) *)) +,-# #4 #4- ))) )) +,-# #/(0 #4 #4- ()) )) +,-# ) )* 977'7'+/07::7;' 790+:+0+78( : '<+'7'8:''0+:+0+ ;:'<+'7'8: =>;:'+=0+: '7'+ /888+: 8;=+:7+7'0': '<?*79+0: ++9'?970'<: ++9'0+'+ '7'80+8'+= 7;'8;+: * For reporting entities having sold annuities to another insurer where the insurer purchasing the annuities has obtained a release of liability from the claimant (payee) as the result of the purchase of an annuity from the reporting entity only: 0. Amount of loss reserves established by these annuities during the current year: $ 0. List the name and location of the insurance company purchasing the annuities and the statement value on the purchase date of the annuities. P&C Insurance Company And Location Statement Value on Purchase Date of Annuities (i.e., Present Value)..

68 ANNUAL STATEMENT FOR THE YEAR 0 OF THE. Do you act as a custodian for health savings accounts?. If yes, please provide the amount of custodial funds held as of the reporting date. $. Do you act as an administrator for health savings accounts?.4 If yes, please provide the balance of funds administered as of the reporting date. $..

69 Life Insurance in Force (Exhibit of Life Insurance) ANNUAL STATEMENT FOR THE YEAR 0 OF THE FIVE-YEAR HISTORICAL DATA Show amounts in whole dollars only, no cents; show percentages to one decimal place, i.e Show amounts of life insurance in this exhibit in thousands (OMIT $000) Ordinary - whole life and endowment (Line 4, Col. 4). Ordinary - term (Line, Col. 4, less Line 4, Col. 4). Credit life (Line, Col. 6) 4. Group, excluding FEGLI/SGLI (Line, Col. 9 less Lines 4 & 44, Col. 4) 5. Industrial (Line, Col. ) 6. FEGLI/SGLI (Lines 4 & 44, Col. 4) 7. Total (Line, Col. 0) New Business Issued (Exhibit of Life Insurance) 8. Ordinary - whole life and endowment (Line 4, Col. ) 9. Ordinary - term (Line, Col. 4, less Line 4, Col. ) 0. Credit life (Line, Col. 6). Group (Line, Col. 9). Industrial (Line, Col. ). Total (Line, Col. 0) Premium Income - Lines of Business (Exhibit - Part ) 4. Industrial life (Line 0.4, Col. ) 5. Ordinary-life insurance (Line 0.4, Col. ) 5. Ordinary-individual annuities (Line 0.4, Col. 4) 6 Credit life (group and individual) (Line 0.4, Col. 5) 7. Group life insurance (Line 0.4, Col. 6) 7. Group annuities (Line 0.4, Col. 7) 8. A & H-group (Line 0.4, Col. 8) 8. A & H-credit (group and individual) (Line 0.4, Col. 9) 8. A & H-other (Line 0.4, Col. 0) 9. Aggregate of all other lines of business (Line 0.4,Col. ) 0. Total Balance Sheet (Pages & ). Total admitted assets excluding Separate Accounts business (Page, Line 6, Col. ). Total liabilities excluding Separate Accounts business (Page, Line 6). Aggregate life reserves (Page, Line ) 4. Aggregate A & H reserves (Page, Line ) 5. Deposit-type contract funds (Page, Line ) 6. Asset valuation reserve (Page, Line 4.0) 7. Capital (Page, Lines 9 and 0) 8. Surplus (Page, Line 7) Cash Flow (Page 5) 9. Net Cash from Operations (Line ) Risk-Based Capital Analysis 0. Total adjusted capital. Authorized control level risk - based capital Percentage Distribution of Cash, Cash Equivalents and Invested Assets (Page, Col. ) (Line No. /Page, Line, Col. ) x Bonds (Line ). Stocks (Lines. and.) 4. Mortgage loans on real estate(lines. and. ) 5. Real estate (Lines 4., 4. and 4.) 6. Cash, cash equivalents and short-term investments (Line 5) 7. Contract loans (Line 6) 8. Derivatives (Page, Line 7) XXX 9. Other invested assets (Line 8) 40. Receivables for securities (Line 9) 4. Securities lending reinvested collateral assets (Line 0) XXX 4. Aggregate write-ins for invested assets (Line ) 4. Cash, cash equivalents and invested assets (Line )

70 Investments in Parent, Subsidiaries and Affiliates ANNUAL STATEMENT FOR THE YEAR 0 OF THE FIVE-YEAR HISTORICAL DATA 0 (Continued) 44. Affiliated bonds (Schedule D Summary, Line, Col. ) 45. Affiliated preferred stocks (Schedule D Summary, Line 8, Col. ) 46. Affiliated common stocks (Schedule D Summary Line 4, Col. ), 47. Affiliated short-term investments (subtotal included in Schedule DA Verification, Col. 5, Line 0) 48. Affiliated mortgage loans on real estate 49. All other affiliated 50. Total of above Lines 44 to Total Investment in Parent included in Lines 44 to 49 above Total Nonadmitted and Admitted Assets 5. Total nonadmitted assets (Page, Line 8, Col. ) 5. Total admitted assets (Page, Line 8, Col. ) Investment Data 54. Net investment income (Exhibit of Net Investment Income) 55. Realized capital gains (losses) (Page 4, Line 4, Column ) 56. Unrealized capital gains (losses) (Page 4, Line 8, Column ) 57. Total of above Lines 54, 55 and 56 Benefits and Reserve Increases (Page 6) 58. Total contract benefits - life (Lines 0,,,, 4 and 5 Col., minus Lines 0,,,, 4 and 5 Cols. 9, 0 and ) 59. Total contract benefits - A & H (Lines & 4, Cols. 9, 0 & ) 60. Increase in life reserves - other than group and annuities (Line 9, Cols. and ) 6. Increase in A & H reserves (Line 9, Cols. 9, 0 & ) 6. Dividends to policyholders (Line 0, Col. ) Operating Percentages 6. Insurance expense percent (Page 6, Col., Lines, &, less Line 6)/(Page 6, Col., Line plus Exhibit 7, Col., Line ) x Lapse percent (ordinary only) [(Exhibit of Life Insurance, Col. 4, Lines 4 & 5) / / (Exhibit of Life Insurance, Col. 4, Lines & )] x A & H loss percent (Schedule H, Part, Lines 5 and 6, Col. ) 66. A & H cost containment percent (Schedule H, Pt., Line 4, Col. ) 67. A & H expense percent excluding cost containment expenses (Schedule H, Pt., Line 0, Col. ) A & H Claim Reserve Adequacy 68. Incurred losses on prior years claims - group health (Schedule H, Part, Line. Col. ) 69. Prior years claim liability and reserve - group health (Schedule H, Part, Line. Col. ) 70. Incurred losses on prior years claims-health other than group (Schedule H, Part, Line. Col. less Col. ) 7. Prior years claim liability and reserve-health other than group (Schedule H, Part, Line. Col. less Col. ) Net Gains From Operations After Federal Income Taxes by Lines of Business (Page 6, Line ) 7. Industrial life (Col. ) 7. Ordinary - life (Col. ) 74. Ordinary - individual annuities (Col. 4) 75. Ordinary-supplementary contracts (Col. 5) 76. Credit life (Col. 6) 77. Group life (Col. 7) 78. Group annuities (Col. 8) 79. A & H-group (Col. 9) 80. A & H-credit (Col. 0) 8. A & H-other (Col. ) 8. Aggregate of all other lines of business (Col. ) 8. Total (Col. ) NOTE: If a party to a merger, have the two most recent years of this exhibit been restated due to a merger in compliance with the disclosure requirements of SSAP No., Accounting Changes and Correction of Errors? If no, please explain:

71 ANNUAL STATEMENT FOR THE YEAR 0 OF THE DIRECT BUSINESS IN THE STATE OF Grand Total DURING THE YEAR 0 NAIC Group Code 0709 LIFE INSURANCE NAIC Company Code DIRECT PREMIUMS AND ANNUITY CONSIDERATIONS Ordinary Credit Life (Group and Individual) Group Industrial Total. Life insurance. Annuity considerations. Deposit-type contract funds XXX XXX 4. Other considerations 5. Totals (Sum of Lines to 4) DIRECT DIVIDENDS TO POLICYHOLDERS Life insurance: 6. Paid in cash or left on deposit 6. Applied to pay renewal premiums 6. Applied to provide paid-up additions or shorten the endowment or premium-paying period 6.4 Other 6.5 Totals (Sum of Lines 6. to 6.4) Annuities: 7. Paid in cash or left on deposit 7. Applied to provide paid-up annuities 7. Other 7.4 Totals (Sum of Lines 7. to 7.) 8. Grand Totals (Lines 6.5 plus 7.4) DIRECT CLAIMS AND BENEFITS PAID 9. Death benefits 0. Matured endowments. Annuity benefits. Surrender values and withdrawals for life contracts. Aggregate write-ins for miscellaneous direct claims and benefits paid 4. All other benefits, except accident and health 5. Totals DETAILS OF WRITE-INS Summary of Line from overflow page 99. Totals (Lines 0 thru 0 plus 98) (Line above) DIRECT DEATH BENEFITS AND MATURED ENDOWMENTS INCURRED Ordinary Credit Life (Group and Individual) Group Industrial Total No. of Ind.Pols. & Gr. Certifs. No. Amount Amount Amount No. Amount No. Amount 6. Unpaid December, prior year 7. Incurred during current year Settled during current year: 8. By payment in full 8. By payment on compromised claims 8. Totals paid 8.4 Reduction by compromise 8.5 Amount rejected 8.6 Total settlements 9. Unpaid Dec., current year ( ) No. of POLICY EXHIBIT Policies 0. In force December, prior year (a). Issued during year. Other changes to in force (Net). In force December of current year (a) (a) Includes Individual Credit Life Insurance prior year $, current year $ Includes Group Credit Life Insurance Loans less than or equal to 60 months at issue, prior year $, current year $ Loans greater than 60 months at issue BUT NOT GREATER THAN 0 MONTHS, prior year $, current year $ No. of Certifs. ACCIDENT AND HEALTH INSURANCE Direct Premiums Direct Premiums Earned Dividends Paid Or Credited On Direct Business 4. Group Policies (b) 4. Federal Employees Health Benefits Plan premium (b) 4. Credit (Group and Individual) 4. Collectively renewable policies (b) 4.4 Medicare Title XVIII exempt from state taxes or fees Other Individual Policies: NONE 5. Non-cancelable (b) 5. Guaranteed renewable (b) 5. Non-renewable for stated reasons only (b) 5.4 Other accident only 5.5 All other (b) 5.6 Totals (sum of Lines 5. to 5.5) 6. Totals (Lines ) 4 Direct Losses Paid (b) For health business on indicated lines report: Number of persons insured under PPO managed care products and number of persons insured under indemnity only products. 5 0 Direct Losses Incurred 4.GT

72 5 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT OF LIFE INSURANCE Industrial Ordinary Credit Life (Group and Individual) Group Number of 9 Number of Policies Amount of Insurance (a) Number of Policies Amount of Insurance (a) Number of Individual Policies and Group Certificates Amount of Insurance (a) 7 Policies 8 Certificates Amount of Insurance (a) Total Amount of Insurance (a). In force end of prior year. Issued during year. Reinsurance assumed 4. Revived during year 5. Increased during year (net) 6. Subtotals, Lines to 5 7. Additions by dividends during year XXX XXX XXX XXX XXX 8. Aggregate write-ins for increases 9. Totals (Lines and 6 to 8) Deductions during year: 0. Death XXX. Maturity XXX. Disability XXX. Expiry 4. Surrender 5. Lapse 6. Conversion XXX XXX XXX 7. Decreased (net) 8. Reinsurance 9. Aggregate write-ins for decreases 0. Totals (Lines 0 to 9). In force end of year (Line 9 minus Line 0). Reinsurance ceded end of year XXX XXX XXX XXX XXX. Line minus Line XXX XXX XXX (b) XXX XXX DETAILS OF WRITE-INS Summary of remaining write-ins for Line 8 from overflow page TOTALS (Lines 080 thru 080 plus 0898) (Line 8 above) Summary of remaining write-ins for Line 9 from overflow page TOTALS (Lines 90 thru 90 plus 998) (Line 9 above) (a) Amounts of life insurance in this exhibit shall be shown in thousands (omit 000) (b) Group $ ; Individual $

73 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT OF LIFE INSURANCE (Continued) ADDITIONAL INFORMATION ON INSURANCE IN FORCE END OF YEAR Industrial Ordinary Number of Policies Amount of Insurance (a) Number of Policies 4 Amount of Insurance (a) 4. Additions by dividends XXX XXX 5. Other paid-up insurance 6. Debit ordinary insurance XXX XXX ADDITIONAL INFORMATION ON ORDINARY INSURANCE Issued During Year (Included in Line ) Amount of Insurance Term Insurance Excluding Extended Term Insurance Number of Policies (a) In Force End of Year (Included in Line ) 4 Amount of Insurance (a) Number of Policies 7. Term policies - decreasing 8. Term policies - other 9. Other term insurance - decreasing XXX XXX 0. Other term insurance XXX XXX. Totals (Lines 7 to 0) Reconciliation to Lines and :. Term additions XXX XXX. Totals, extended term insurance XXX XXX 4. Totals, whole life and endowment 5. Totals (Lines to 4) CLASSIFICATION OF AMOUNT OF INSURANCE (a) BY PARTICIPATING STATUS Issued During Year (Included in Line ) Non-Participating Participating In Force End of Year (Included in Line ) Non-Participating 4 Participating 6 Industrial 7. Ordinary 8. Credit Life (Group and Individual) 9. Group 40. Totals (Lines 6 to 9) ADDITIONAL INFORMATION ON CREDIT LIFE AND GROUP INSURANCE Credit Life Group 4 Number of Individual NONE Policies and Group Amount of Insurance Amount of Insurance Certificates (a) Number of Certificates (a) 4. Amount of insurance included in Line ceded to other companies XXX XXX 4. Number in force end of year if the number under shared groups is counted on a pro-rata basis XXX XXX 4. Federal Employees Group Life Insurance included in Line 44. Servicemen s Group Life Insurance included in Line 45. Group Permanent Insurance included in Line ADDITIONAL ACCIDENTAL DEATH BENEFITS 46. Amount of additional accidental death benefits in force end of year under ordinary policies (a) BASIS OF CALCULATION OF ORDINARY TERM INSURANCE 47. State basis of calculation of (47.) decreasing term insurance contained in Family Income, Mortgage Protection, etc., policies and riders and of (47.) term insurance on wife and children under Family, Parent and Children, etc., policies and riders included above POLICIES WITH DISABILITY PROVISIONS Industrial Ordinary Credit Group Number of Number of Amount of Insurance Number of Amount of Insurance Number of Amount of Insurance Certificates Policies (a) Policies (a) Policies (a) 8 Amount of Insurance (a) Disability Provisions 48. Waiver of Premium 49. Disability Income 50. Extended Benefits XXX XXX 5. Other 5. Total (b) (b) (b) (b) (a) Amounts of life insurance in this exhibit shall be shown in thousands (omit 000) (b) See Paragraph 9 of the Annual Audited Financial Reports in the General section of the annual statement instructions 6

74 ANNUAL STATEMENT FOR THE YEAR 0 OF THE EXHIBIT OF NUMBER OF POLICIES, CONTRACTS, CERTIFICATES, INCOME PAYABLE AND ACCOUNT VALUES IN FORCE FOR SUPPLEMENTARY CONTRACTS, ANNUITIES, ACCIDENT & HEALTH AND OTHER POLICIES SUPPLEMENTARY CONTRACTS Ordinary Involving Life Contingencies Not Involving Life Contingencies Involving Life Contingencies Group 4 Not Involving Life Contingencies. In force end of prior year. Issued during year. Reinsurance assumed 4. Increased during year (net) 5. Total (Lines to 4) Deductions during year: 6. Decreased (net) 7. Reinsurance ceded 8. Totals (Lines 6 and 7) 9. In force end of year 0. Amount on deposit (a) (a). Income now payable. Amount of income payable (a) (a) (a) (a) ANNUITIES Ordinary Group Immediate Deferred Contracts 4 Certificates. In force end of prior year. Issued during year. Reinsurance assumed 4. Increased during year (net) 5. Totals (Lines to 4) Deductions during year: 6. Decreased (net) 7. Reinsurance ceded 8. Totals (Lines 6 and 7) 9. In force end of year Income now payable: 0. Amount of income payable (a) XXX XXX (a) Deferred fully paid:. Account balance XXX (a) XXX (a) Deferred not fully paid:. Account balance XXX (a) XXX (a) ACCIDENT AND HEALTH INSURANCE Group Credit Other Certificates Premiums in Force Policies 4 Premiums in Force 5 Policies 6 Premiums in Force. In force end of prior year. Issued during year. Reinsurance assumed 4. Increased during year (net) XXX XXX XXX 5. Totals (Lines to 4) XXX XXX XXX Deductions during year: 6. Conversions XXX XXX XXX XXX XXX 7. Decreased (net) XXX XXX XXX 8. Reinsurance ceded XXX XXX XXX 9. Totals (Lines 6 to 8) XXX XXX XXX 0. In force end of year (a) (a) (a) DEPOSIT FUNDS AND DIVIDEND ACCUMULATIONS Dividend Deposit Funds Accumulations Contracts Contracts. In force end of prior year. Issued during year. Reinsurance assumed 4. Increased during year (net) 5. Totals (Lines to 4) Deductions During Year: 6. Decreased (net) 7. Reinsurance ceded 8. Totals (Lines 6 and 7) 9. In force end of year 0. Amount of account balance (a) (a) (a) See Paragraph 9 of the Annual Audited Financial Reports in the General section of the annual statement instructions. 7

75 ANNUAL STATEMENT FOR THE YEAR 0 OF THE FORM FOR CALCULATING THE INTEREST MAINTENANCE RESERVE INTEREST MAINTENANCE RESERVE Amount. Reserve as of December, Prior Year. Current year s realized pre-tax capital gains/(losses) of $ transferred into the reserve net of taxes of $. Adjustment for current year s liability gains/(losses) released from the reserve 4. Balance before reduction for amount transferred to Summary of Operations (Line + Line + Line ) 5. Current year s amortization released to Summary of Operations (Amortization, Line, Column 4) 6. Reserve as of December, current year (Line 4 minus Line 5) AMORTIZATION 4 Year of Amortization Reserve as of December, Prior Year Current Year s Realized Capital Gains/(Losses) Transferred into the Reserve Net of Taxes Adjustment for Current Year s Liability Gains/(Losses) Released From the Reserve Balance Before Reduction for Current Year s Amortization (Cols. + + ) and Later. Total (Lines to ) 8

76 ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE 9 Other Than Mortgage Loans Default Component Mortgage Loans Total (Cols. + ) 4 Common Stock Equity Component 5 Real Estate and Other Invested Assets. Reserve as of December, prior year. Realized capital gains/(losses) net of taxes - General Account. Realized capital gains/(losses) net of taxes - Separate Accounts 4. Unrealized capital gains/(losses) net of deferred taxes - General Account 5. Unrealized capital gains/(losses) net of deferred taxes - Separate Accounts 6. Capital gains credited/(losses charged) to contract benefits, payments or reserves 7. Basic contribution 8. Accumulated balances (Lines through ) 9. Maximum reserve 0. Reserve objective. 0% of (Line 0 - Line 8). Balance before transfers (Lines 8 + ). Transfers XXX 4. Voluntary contribution 5. Adjustment down to maximum/up to zero 6. Reserve as of December, current year (Lines ) 6 Total (Cols ) 7 Total Amount (Cols. + 6)

77 0 Line Number NAIC Designation ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS DEFAULT COMPONENT Description 4 Basic Contribution Reserve Objective Maximum Reserve Reclassify Balance for AVR Related Party Add Third Party Reserve Calculations Amount Amount Encumbrances Encumbrances (Cols. + + ) Factor (Cols.4 x 5) Factor (Cols. 4 x 7) Factor Book/Adjusted Carrying Value LONG-TERM BONDS. Exempt Obligations XXX XXX. Highest Quality XXX XXX. High Quality XXX XXX 4. Medium Quality XXX XXX 5. 4 Low Quality XXX XXX 6. 5 Lower Quality XXX XXX 7. 6 In or Near Default XXX XXX 8. Total Unrated Multi-class Securities Acquired by Conversion XXX XXX XXX XXX XXX 9. Total Bonds (Sum of Lines through 8) XXX XXX XXX XXX XXX PREFERRED STOCK 0. Highest Quality XXX XXX. High Quality XXX XXX. Medium Quality XXX XXX. 4 Low Quality XXX XXX 4. 5 Lower Quality XXX XXX 5. 6 In or Near Default XXX XXX 6. Affiliated Life with AVR XXX XXX 7. Total Preferred Stocks (Sum of Lines 0 through 6) XXX XXX XXX XXX XXX SHORT - TERM BONDS 8. Exempt Obligations XXX XXX 9. Highest Quality XXX XXX 0. High Quality XXX XXX. Medium Quality XXX XXX. 4 Low Quality XXX XXX. 5 Lower Quality XXX XXX 4. 6 In or Near Default XXX XXX 5. Total Short - Term Bonds (Sum of Lines 8 through 4) XXX XXX XXX XXX XXX Amount (Cols. 4 x 9)

78 Line Number NAIC Designation ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE (Continued) BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS DEFAULT COMPONENT Description 4 Basic Contribution Reserve Objective Maximum Reserve Reclassify Balance for AVR Related Party Add Third Party Reserve Calculations Amount Amount Encumbrances Encumbrances (Cols. + + ) Factor (Cols.4 x 5) Factor (Cols. 4 x 7) Factor Book/Adjusted Carrying Value DERIVATIVE INSTRUMENTS 6. Exchange Traded XXX XXX 7. Highest Quality XXX XXX 8. High Quality XXX XXX 9. Medium Quality XXX XXX 0. 4 Low Quality XXX XXX. 5 Lower Quality XXX XXX. 6 In or Near Default XXX XXX. Total Derivative Instruments XXX XXX XXX XXX XXX 4. Total (Lines ) XXX XXX XXX XXX XXX MORTGAGE LOANS In Good Standing: 5. Farm Mortgages XXX 6. Residential Mortgages - Insured or Guaranteed XXX 7. Residential Mortgages - All Other XXX 8. Commercial Mortgages - Insured or Guaranteed XXX 9. Commercial Mortgages - All Other XXX 40. In Good Standing With Restructured Terms XXX Overdue, Not in Process: 4. Farm Mortgages XXX 4. Residential Mortgages - Insured or Guaranteed XXX 4. Residential Mortgages - All Other XXX 44. Commercial Mortgages - Insured or Guaranteed XXX 45. Commercial Mortgages - All Other XXX In Process of Foreclosure: 46. Farm Mortgages XXX 47. Residential Mortgages - Insured or Guaranteed XXX 48. Residential Mortgages - All Other XXX 49. Commercial Mortgages - Insured or Guaranteed XXX 50. Commercial Mortgages - All Other XXX 5. Total Schedule B Mortgages (Sum of Lines 5 through 50) XXX XXX XXX XXX 5. Schedule DA Mortgages XXX 5. Total Mortgage Loans on Real Estate (Lines 5 + 5) XXX XXX XXX XXX Amount (Cols. 4 x 9)

79 Line Number NAIC Designation ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS EQUITY AND OTHER INVESTED ASSET COMPONENT 4 Basic Contribution Reserve Objective Maximum Reserve Reclassify Balance for AVR Related Party Add Third Party Reserve Calculations Amount Amount Encumbrances Encumbrances (Cols. + + ) Factor (Cols.4 x 5) Factor (Cols. 4 x 7) Factor Book/Adjusted Carrying Value Description COMMON STOCK. Unaffiliated - Public XXX XXX (a) (a). Unaffiliated - Private XXX XXX. Federal Home Loan Bank XXX XXX 4. Affiliated - Life with AVR XXX XXX Affiliated - Investment Subsidiary: 5. Fixed Income - Exempt Obligations XXX XXX XXX 6. Fixed Income - Highest Quality XXX XXX XXX 7. Fixed Income - High Quality XXX XXX XXX 8. Fixed Income - Medium Quality XXX XXX XXX 9. Fixed Income - Low Quality XXX XXX XXX 0. Fixed Income - Lower Quality XXX XXX XXX. Fixed Income - In/Near Default XXX XXX XXX. Unaffiliated Common Stock - Public (a) (a). Unaffiliated Common Stock - Private 4. Mortgage Loans 5. Real Estate (b) (b) (b) 6. Affiliated - Certain Other (See SVO Purposes and Procedures Manual) XXX XXX 7. Affiliated - All Other XXX XXX 8. Total Common Stock (Sum of Lines through 7) XXX XXX XXX REAL ESTATE 9. Home Office Property (General Account only) 0. Investment Properties. Properties Acquired in Satisfaction of Debt. Total Real Estate (Sum of Lines 9 through ) XXX XXX XXX OTHER INVESTED ASSETS INVESTMENTS WITH THE UNDERLYING CHARACTERISTICS OF BONDS. Exempt Obligations XXX XXX 4. Highest Quality XXX XXX 5. High Quality XXX XXX 6. Medium Quality XXX XXX 7. 4 Low Quality XXX XXX 8. 5 Lower Quality XXX XXX 9. 6 In or Near Default XXX XXX 0. Total with Bond Characteristics (Sum of Lines through 9) XXX XXX XXX XXX XXX Amount (Cols. 4 x 9)

80 Line Number NAIC Designation ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE (Continued) BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS EQUITY AND OTHER INVESTED ASSET COMPONENT Description INVESTMENTS WITH THE UNDERLYING CHARACTERISTICS 4 Basic Contribution Reserve Objective Maximum Reserve Reclassify Balance for AVR Related Party Add Third Party Reserve Calculations Amount Amount Encumbrances Encumbrances (Cols. + + ) Factor (Cols.4 x 5) Factor (Cols. 4 x 7) Factor Book/Adjusted Carrying Value OF PREFERRED STOCKS. Highest Quality XXX XXX. High Quality XXX XXX. Medium Quality XXX XXX 4. 4 Low Quality XXX XXX 5. 5 Lower Quality XXX XXX 6. 6 In or Near Default XXX XXX 7. Affiliated Life with AVR XXX XXX 8. Total with Preferred Stock Characteristics (Sum of Lines through 7) XXX XXX XXX XXX XXX INVESTMENTS WITH THE UNDERLYING CHARACTERISTICS OF MORTGAGE LOANS In Good Standing: 9. Farm Mortgages XXX 40. Residential Mortgages - Insured or Guaranteed XXX 4. Residential Mortgages - All Other XXX XXX 4. Commercial Mortgages - Insured or Guaranteed XXX 4. Commercial Mortgages - All Other XXX 44. In Good Standing With Restructured Terms XXX Overdue, Not in Process: 45. Farm Mortgages XXX 46. Residential Mortgages - Insured or Guaranteed XXX 47. Residential Mortgages - All Other XXX 48. Commercial Mortgages - Insured or Guaranteed XXX 49. Commercial Mortgages - All Other XXX In Process of Foreclosure: 50. Farm Mortgages XXX 5. Residential Mortgages - Insured or Guaranteed XXX 5. Residential Mortgages - All Other XXX 5. Commercial Mortgages - Insured or Guaranteed XXX 54. Commercial Mortgages - All Other XXX 55. Total with Mortgage Loan Characteristics (Sum of Lines 9 through 54) XXX XXX XXX XXX Amount (Cols. 4 x 9)

81 4 Line Number NAIC Designation ANNUAL STATEMENT FOR THE YEAR 0 OF THE ASSET VALUATION RESERVE (Continued) BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS EQUITY AND OTHER INVESTED ASSET COMPONENT Description INVESTMENTS WITH THE UNDERLYING CHARACTERISTICS 4 Basic Contribution Reserve Objective Maximum Reserve Reclassify Balance for AVR Related Party Add Third Party Reserve Calculations Amount Amount Encumbrances Encumbrances (Cols. + + ) Factor (Cols.4 x 5) Factor (Cols. 4 x 7) Factor Book/Adjusted Carrying Value OF COMMON STOCK 56. Unaffiliated Public XXX XXX (a) (a) 57. Unaffiliated Private XXX XXX 58. Affiliated Life with AVR XXX XXX 59. Affiliated Certain Other (See SVO Purposes & Procedures Manual) XXX XXX 60. Affiliated Other - All Other XXX XXX 6. Total with Common Stock Characteristics (Sum of Lines 56 through 60) XXX XXX XXX XXX XXX INVESTMENTS WITH THE UNDERLYING CHARACTERISTICS OF REAL ESTATE 6. Home Office Property (General Account only) 6. Investment Properties 64 Properties Acquired in Satisfaction of Debt 65. Total with Real Estate Characteristics (Lines 6 through 64) XXX XXX XXX LOW INCOME HOUSING TAX CREDIT INVESTMENTS 66. Guaranteed Federal Low Income Housing Tax Credit 67. Non-guaranteed Federal Low Income Housing Tax Credit 68. Guaranteed State Low Income Housing Tax Credit 69. Non-guaranteed State Low Income Housing Tax Credit 70. All Other Low Income Housing Tax Credit 7. Total LIHTC XXX XXX XXX ALL OTHER INVESTMENTS 7. NAIC Working Capital Finance Investments XXX 7. NAIC Working Capital Finance Investments XXX 74. Other Invested Assets - Schedule BA XXX 75. Other Short-Term Invested Assets - Schedule DA XXX 76. Total All Other (Sum of Lines 7 + 7, 74 and 75) XXX XXX XXX XXX 77. Total Other Invested Assets - Schedules BA & DA (Sum of Lines 0, 8, 55, 6, 65, 7 and 76) XXX XXX XXX (a) Times the company s weighted average portfolio beta (Minimum.0, Maximum.0). (b) Determined using the same factors and breakdowns used for directly owned real estate. Amount (Cols. 4 x 9)

82 ANNUAL STATEMENT FOR THE YEAR 0 OF THE Asset Valuation Reserve Replications (Synthetic) Assets N O N E Schedule F - Claims N O N E 5, 6

83 Amount Total % ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE H - ACCIDENT AND HEALTH EXHIBIT Group Accident and Health 4 Amount % Credit Accident and Health (Group and Individual) Collectively Renewable Non-Cancelable Guaranteed Renewable Amount % Amount % Amount % Amount % PART. - ANALYSIS OF UNDERWRITING OPERATIONS Other Individual Contracts Non-Renewable for Stated Reasons Only Other Accident Only All Other Amount % Amount % Amount 8 %. Premiums written XXX XXX XXX XXX XXX XXX XXX XXX XXX. Premiums earned XXX XXX XXX XXX XXX XXX XXX XXX XXX. Incurred claims 4. Cost containment expenses 5. Incurred claims and cost containment expenses (Lines and 4) 6. Increase in contract reserves 7. Commissions (a) 8. Other general insurance expenses 9. Taxes, licenses and fees 0. Total other expenses incurred 7. Aggregate write-ins for deductions. Gain from underwriting before dividends or refunds. Dividends or refunds 4. Gain from underwriting after dividends or refunds 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) (a) Includes $ reported as Contract, membership and other fees retained by agents.

84 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE H - ACCIDENT AND HEALTH EXHIBIT (Continued) 4 Other Individual Contracts Credit Accident and Health Non-Renewable Total Group Accident and Health (Group and Individual) Collectively Renewable Non-Cancelable Guaranteed Renewable for Stated Reasons Only PART. - RESERVES AND LIABILITIES A. Premium Reserves:. Unearned premiums. Advance premiums. Reserve for rate credits 4. Total premium reserves, current year 5. Total premium reserves, prior year 6. Increase in total premium reserves B. Contract Reserves:. Additional reserves (a). Reserve for future contingent benefits. Total contract reserves, current year 4. Total contract reserves, prior year. 5. Increase in contract reserves C. Claim Reserves and Liabilities:. Total current year. Total prior year. Increase 8 Other Accident Only 9 All Other 8 PART. - TEST OF PRIOR YEAR'S CLAIM RESERVES AND LIABILITIES. Claims paid during the year:. On claims incurred prior to current year. On claims incurred during current year. Claim reserves and liabilities, December, current year:. On claims incurred prior to current year. On claims incurred during current year. Test:. Lines. and.. Claim reserves and liabilities, December, prior year. Line. minus Line. PART 4. - REINSURANCE A. Reinsurance Assumed:. Premiums written. Premiums earned. Incurred claims 4. Commissions B. Reinsurance Ceded:. Premiums written. Premiums earned. Incurred claims 4. Commissions (a) Includes $ premium deficiency reserve.

85 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE H - PART 5 - HEALTH CLAIMS Medical Dental Other 4 Total A. Direct:. Incurred Claims. Beginning Claim Reserves and Liabilities. Ending Claim Reserves and Liabilities 4. Claims Paid B. Assumed Reinsurance: 5. Incurred Claims 6. Beginning Claim Reserves and Liabilities 7. Ending Claim Reserves and Liabilities 8. Claims Paid C. Ceded Reinsurance: 9. Incurred Claims 0. Beginning Claim Reserves and Liabilities. Ending Claim Reserves and Liabilities. Claims Paid D. Net:. Incurred Claims 4. Beginning Claim Reserves and Liabilities 5. Ending Claim Reserves and Liabilities 6. Claims Paid E. Net Incurred Claims and Cost Containment Expenses: 7. Incurred Claims and Cost Containment Expenses 8. Beginning Reserves and Liabilities 9. Ending Reserves and Liabilities 0. Paid Claims and Cost Containment Expenses 9

86 40 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as of December, Current Year Type of Reinsurance Payable Modified Effective Domiciliary Reinsurance Amount of In Force at on Paid and Coinsurance Date Name of Reinsured Jurisdiction Assumed End of Year Reserve Premiums Unpaid Losses Reserve ID Number Funds Withheld Under Coinsurance Total General Account - U.S. Affiliates # # General Account - Non-U.S. Affiliates - Other Total General Account - Non-U.S. Affiliates Total General Account - Affiliates $ # # $ # # #% & # # &' # # # # # # # # # # ( # ( # ( ) # # ( ) # # # # # # # # *% # # # + # # + # + # #,) # #,) #, )%, ), ) # % #( *#) # # #

87 40. NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as of December, Current Year Type of Reinsurance Payable Modified Effective Domiciliary Reinsurance Amount of In Force at on Paid and Coinsurance Date Name of Reinsured Jurisdiction Assumed End of Year Reserve Premiums Unpaid Losses Reserve ID Number Funds Withheld Under Coinsurance # $ $ $ %& %& $ $ #' & & & & & &# &# &# & & & ((( ((( ((( ((( % % % % &# & &

88 40. NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsured Company as of December, Current Year Type of Reinsurance Payable Modified Effective Domiciliary Reinsurance Amount of In Force at on Paid and Coinsurance Date Name of Reinsured Jurisdiction Assumed End of Year Reserve Premiums Unpaid Losses Reserve ID Number Funds Withheld Under Coinsurance General Account - U.S. Non-Affiliates #$% #$% & ' ' ' ' ' $%' $%' $%' $%' $%' $%' $%' General Account - Non-U.S. Non-Affiliates Total General Account - Non-Affiliates Total General Account Total Separate Accounts - U.S. Affiliates Total Separate Accounts - Non-U.S. Affiliates Total Separate Accounts - Affiliates Total Separate Accounts - Non-Affiliates Total Separate Accounts Total U.S. (Sum of , , and ) Total Non-U.S. (Sum of , , and ) Totals

89 4 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Assumed Accident and Health Insurance Listed by Reinsured Company as of December, Current Year Type of Reinsurance Assumed 9 Reserve Liability Other Than for Unearned Premiums 0 Reinsurance Payable on Paid and Unpaid Losses Modified Coinsurance Reserve ID Number Effective Date Name of Reinsured Domiciliary Jurisdiction Premiums Unearned Premiums Funds Withheld Under Coinsurance Total - U.S. Affiliates Total - Non-U.S. Affiliates Total - Affiliates # $ $ $ U.S. Non-Affiliates $ %& ' ' $ %& ' ' $ %& ' ' $ ' '%%& ' ' $ ' '%%& ' ' $ ' '%%& ' ' Non-U.S. Non-Affiliates Total - Non-Affiliates Total U.S. (Sum of and ) Total Non-U.S. (Sum of and ) Totals

90 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART Reinsurance Recoverable on Paid and Unpaid Losses Listed by Reinsuring Company as of December, Current Year ID Number Effective Date Name of Company Domiciliary Jurisdiction Paid Losses Unpaid Losses Total Life and Annuity - U.S. Affiliates Total Life and Annuity - Non-U.S. Affiliates Total Life and Annuity - Affiliates # # $% $% & & & & & & ' ( ' ( ' ( ' ( ' ( ' ( ' ( ' ( ' ' ' ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( $&&%& ( (# (# (# (# (# (# (# (# (# (# & & & & & & & & & & & & & & & & & Life and Annuity - U.S. Non-Affiliates )( ( )&&& )&&& '( '' ( '( '' ) $% ( '(( ' ##* ( & 7 4

91 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART Reinsurance Recoverable on Paid and Unpaid Losses Listed by Reinsuring Company as of December, Current Year ID Number Effective Date Name of Company Domiciliary Jurisdiction Paid Losses Unpaid Losses # $ #%$$ % %&%' % % &'$ (%$ ( ) $ * ( )$&' Life and Annuity - Non-U.S. Non-Affiliates Total Life and Annuity - Non-Affiliates Total Life and Annuity Total Accident and Health - U.S. Affiliates Total Accident and Health - Non-U.S. Affiliates Total Accident and Health - Affiliates Total Accident and Health - Non-Affiliates Total Accident and Health Total U.S. (Sum of , , and ) Total Non-U.S. (Sum of , , and ) Totals - Life, Annuity and Accident and Health 7 4.

92 4 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance General Account - Authorized U.S. Affiliates - Captive Total General Account - Authorized U.S. Affiliates Total General Account - Authorized Non-U.S. Affiliates Total General Account - Authorized Affiliates # $ % % % % % % % % % %&' #$ % % %

93 4. NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance

94 4. NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance #$

95 4. NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance #$ #$ #$ #$ #$ #$ #$ #$ #$ #$ #$ #$ #$

96 4.4 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance # $ $ $ $ $ $ $ $ $ $ $

97 4.5 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance General Account - Authorized U.S. Non-Affiliates #$$%$ General Account - Authorized Non-U.S. Non-Affiliates Total General Account - Authorized Non-Affiliates Total General Account Authorized &' && ( General Account - Unauthorized U.S. Affiliates - Captive Total General Account - Unauthorized U.S. Affiliates & ) General Account - Unauthorized Non-U.S. Affiliates - Other Total General Account - Unauthorized Non-U.S. Affiliates Total General Account - Unauthorized Affiliates &$ (#$$ (*&** ($*&** & &&( $$ $ $& # # +$ ) $ &*&&& & &&&& &,$$#$ * #** $ $ $ * )* )& ' )+ *

98 4.6 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits Listed by Reinsuring Company as of December, Current Year Reserve Credit Taken 0 Outstanding Surplus Relief Type of Modified ID Effective Domiciliary Reinsurance Amount in Force Coinsurance Number Date Name of Company Jurisdiction Ceded at End of Year Current Year Prior Year Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance # $ # $ $ %$ $ &#$ $ General Account - Unauthorized Non-U.S. Non-Affiliates Total General Account - Unauthorized Non-Affiliates Total General Account Unauthorized Total General Account - Certified U.S. Affiliates Total General Account - Certified Non-U.S. Affiliates Total General Account - Certified Affiliates Total General Account - Certified Non-Affiliates Total General Account Certified Total General Account Authorized, Unauthorized and Certified Total Separate Accounts - Authorized U.S. Affiliates Total Separate Accounts - Authorized Non-U.S. Affiliates Total Separate Accounts - Authorized Affiliates ' $ ' ' %$$' ( ( $ ( $% %')# $ Separate Accounts - Authorized U.S. Non-Affiliates Total Separate Accounts - Authorized Non-Affiliates Total Separate Accounts Authorized ' $ Separate Accounts - Unauthorized U.S. Affiliates - Captive Total Separate Accounts - Unauthorized U.S. Affiliates Total Separate Accounts - Unauthorized Non-U.S. Affiliates Total Separate Accounts - Unauthorized Affiliates $ $ $ Separate Accounts - Unauthorized Non-U.S. Non-Affiliates Total Separate Accounts - Unauthorized Non-Affiliates Total Separate Accounts Unauthorized Total Separate Accounts - Certified U.S. Affiliates Total Separate Accounts - Certified Non-U.S. Affiliates Total Separate Accounts - Certified Affiliates Total Separate Accounts - Certified Non-Affiliates Total Separate Accounts Certified Total Separate Accounts Authorized, Unauthorized and Certified Total U.S. (Sum of , , , , , , , , , , and ) Total Non-U.S. (Sum of , , , , , 99999, , , , , and ) Totals

99 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART - SECTION Reinsurance Ceded Accident and Health Insurance Listed by Reinsuring Company as of December, Current Year Outstanding Surplus Relief Reserve Credit 0 Modified ID Effective Domiciliary Unearned Premiums Taken Other than for Coinsurance Number Date Name of Company Jurisdiction Type Premiums (Estimated) Unearned Premiums Current Year Prior Year Reserve Funds Withheld Under Coinsurance NONE Totals 44

100 45 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART 4 Reinsurance Ceded to Unauthorized Companies Issuing or Funds Paid and Confirming Deposited by Unpaid Losses Bank and Withheld Miscellaneous ID Effective Reserve Recoverable Total Letters of Reference Trust from Balances Number Date Name of Reinsurer Credit Taken (Debit) Other Debits (Cols.5+6+7) Credit Number (a) Agreements Reinsurers Other (Credit) General Account - Life and Annuity U.S. Affiliates - Captive XXX Total General Account - Life and Annuity U.S. Affiliates XXX General Account - Life and Annuity Non-U.S. Affiliates - Other XXX Total General Account - Life and Annuity Non-U.S. Affiliates XXX Total General Account - Life and Annuity Affiliates XXX #$%% #&&& #&&& #% $ &%% '((%$(% ( & $ & & % & ( ) & ) )*%% & % #% % & ) + & General Account - Life and Annuity Non-U.S. Non-Affiliates XXX Total General Account - Life and Annuity Non-Affiliates XXX Total General Account Life and Annuity XXX Total General Account - Accident and Health U.S. Affiliates XXX Total General Account - Accident and Health Non-U.S. Affiliates XXX Total General Account - Accident and Health Affiliates XXX Total General Account - Accident and Health Non-Affiliates XXX Total General Account Accident and Health XXX Total General Account XXX Total Separate Accounts - U.S. Affiliates XXX Total Separate Accounts - Non-U.S. Affiliates XXX Total Separate Accounts - Affiliates XXX Total Separate Accounts - Non-Affiliates XXX Sum of Cols but not in Excess of Col. 8

101 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART 4 Reinsurance Ceded to Unauthorized Companies Issuing or Funds Paid and Confirming Deposited by Unpaid Losses Bank and Withheld Miscellaneous ID Effective Reserve Recoverable Total Letters of Reference Trust from Balances Number Date Name of Reinsurer Credit Taken (Debit) Other Debits (Cols.5+6+7) Credit Number (a) Agreements Reinsurers Other (Credit) Total Separate Accounts XXX Total U.S. (Sum of , , , , and 99999) XXX Total Non-U.S. (Sum of , , , , and 99999) XXX Totals XXX Sum of Cols but not in Excess of Col (a) Issuing or Confirming Bank Reference Number Letters of Credit Code American Bankers Association (ABA) Routing Number Issuing or Confirming Bank Name Letters of Credit Amount #$ %&$'( $ $ ' % $$ ' (#$'

102 ANNUAL STATEMENT FOR THE YEAR 0 OF THE Schedule S - Part 5 N O N E Schedule S - Part 5 - Bank Footnote N O N E 46

103 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART 6 Five Year Exhibit of Reinsurance Ceded Business 0 (000 OMITTED) A. OPERATIONS ITEMS. Premiums and annuity considerations for life and accident and health contracts. Commissions and reinsurance expense allowances. Contract claims 4. Surrender benefits and withdrawals for life contracts 5. Dividends to policyholders 6. Reserve adjustments on reinsurance ceded 7. Increase in aggregate reserve for life and accident and health contracts B. BALANCE SHEET ITEMS 8. Premiums and annuity considerations for life and accident and health contracts deferred and uncollected 9. Aggregate reserves for life and accident and health contracts 0. Liability for deposit-type contracts. Contract claims unpaid. Amounts recoverable on reinsurance. Experience rating refunds due or unpaid 4. Policyholders dividends (not included in Line 0) 5. Commissions and reinsurance expense allowances due 6. Unauthorized reinsurance offset 7. Offset for reinsurance with Certified Reinsurers XXX XXX XXX C. UNAUTHORIZED REINSURANCE (DEPOSITS BY AND FUNDS WITHHELD FROM) 8. Funds deposited by and withheld from (F) 9. Letters of credit (L) 0. Trust agreements (T). Other (O) D. REINSURANCE WITH CERTIFIED REINSURERS (DEPOSITS BY AND FUNDS WITHHELD FROM). Multiple Beneficiary Trust XXX XXX XXX. Funds deposited by and withheld from (F) XXX XXX XXX 4. Letters of credit (L) XXX XXX XXX 5. Trust agreements (T) XXX XXX XXX 6. Other (O) XXX XXX XXX 47

104 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE S - PART 7 Restatement of Balance Sheet to Identify Net Credit for Ceded Reinsurance As Reported (net of ceded) Restatement Adjustments Restated (gross of ceded) ASSETS (Page, Col. ). Cash and invested assets (Line ). Reinsurance (Line 6). Premiums and considerations (Line 5) 4. Net credit for ceded reinsurance XXX 5. All other admitted assets (balance) 6. Total assets excluding Separate Accounts (Line 6) 7. Separate Account assets (Line 7) 8. Total assets (Line 8) LIABILITIES, CAPITAL AND SURPLUS (Page ) 9. Contract reserves (Lines and ) 0. Liability for deposit-type contracts (Line ). Claim reserves (Line 4). Policyholder dividends/reserves (Lines 5 through 7). Premium & annuity considerations received in advance (Line 8) 4. Other contract liabilities (Line 9) 5. Reinsurance in unauthorized companies (Line 4.0 minus inset amount) 6. Funds held under reinsurance treaties with unauthorized reinsurers (Line 4.0 minus inset amount) 7. Reinsurance with Certified Reinsurers (Line 4.0 inset amount) 8. Funds held under reinsurance treaties with Certified Reinsurers (Line 4.0 inset amount) 9. All other liabilities (balance) 0. Total liabilities excluding Separate Accounts (Line 6). Separate Account liabilities (Line 7). Total liabilities (Line 8). Capital & surplus (Line 8) XXX 4. Total liabilities, capital & surplus (Line 9) NET CREDIT FOR CEDED REINSURANCE 5. Contract reserves 6. Claim reserves 7. Policyholder dividends/reserves 8. Premium & annuity considerations received in advance 9. Liability for deposit-type contracts 0. Other contract liabilities. Reinsurance ceded assets. Other ceded reinsurance recoverables. Total ceded reinsurance recoverables 4. Premiums and considerations 5. Reinsurance in unauthorized companies 6. Funds held under reinsurance treaties with unauthorized reinsurers 7. Reinsurance with Certified Reinsurers 8. Funds held under reinsurance treaties with Certified Reinsurers 9. Other ceded reinsurance payables/offsets 40. Total ceded reinsurance payable/offsets 4. Total net credit for ceded reinsurance 48

105 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE T - PREMIUMS AND ANNUITY CONSIDERATIONS Allocated by States and Territories Direct Business Only Life Contracts Accident and Health Insurance Premiums, Including Policy, Total Life Insurance Annuity Membership Other Columns Premiums Considerations and Other Fees Considerations through 5 Deposit-Type Contracts States, Etc. Active Status. Alabama AL. Alaska AK. Arizona AZ 4. Arkansas AR 5. California CA 6. Colorado CO 7. Connecticut CT 8. Delaware DE 9. District of Columbia DC 0. Florida FL. Georgia GA. Hawaii HI. Idaho ID 4. Illinois IL 5. Indiana IN 6. Iowa IA 7. Kansas KS 8. Kentucky KY 9. Louisiana LA 0. Maine ME. Maryland MD. Massachusetts MA. Michigan MI 4. Minnesota MN 5. Mississippi MS 6. Missouri MO 7. Montana MT 8. Nebraska NE 9. Nevada NV 0. New Hampshire NH. New Jersey NJ. New Mexico NM. New York NY 4. North Carolina NC 5. North Dakota ND 6. Ohio OH 7. Oklahoma OK 8. Oregon OR 9. Pennsylvania PA 40. Rhode Island RI 4. South Carolina SC 4. South Dakota SD 4. Tennessee TN 44. Texas TX 45. Utah UT 46. Vermont VT 47. Virginia VA 48. Washington WA 49. West Virginia WV 50. Wisconsin WI 5. Wyoming WY 5. American Samoa AS 5. Guam GU 54. Puerto Rico PR 55. U.S. Virgin Islands VI 56. Northern Mariana Islands MP 57. Canada CAN 58. Aggregate Other Alien OT XXX 59. Subtotal (a) 90. Reporting entity contributions for employee benefits plans XXX 9. Dividends or refunds applied to purchase paid-up additions and annuities XXX 9. Dividends or refunds applied to shorten endowment or premium paying period XXX 9. Premium or annuity considerations waived under disability or other contract provisions XXX 94. Aggregate or other amounts not allocable by State XXX 95. Totals (Direct Business) XXX 96. Plus reinsurance assumed XXX 97 Totals (All Business) XXX 98. Less reinsurance ceded XXX 99. Totals (All Business) less Reinsurance Ceded XXX (b) DETAILS OF WRITE-INS XXX XXX XXX Summary of remaining write-ins for Line 58 from overflow page XXX Totals (Lines 5800 through 5800 plus 58998)(Line 58 above) XXX 940. XXX 940. XXX 940. XXX Summary of remaining write-ins for Line 94 from overflow page XXX Totals (Lines 940 through 940 plus 9498)(Line 94 above) XXX (L) Licensed or Chartered - Licensed Insurance Carrier or Domiciled RRG; (R) Registered - Non-domiciled RRGs; (Q) Qualified - Qualified or Accredited Reinsurer; (E) Eligible - Reporting Entities eligible or approved to write Surplus Lines in the state; (N) None of the above - Not allowed to write business in the state. Explanation of basis of allocation by states, etc., of premiums and annuity considerations Ordinary: Allocated based on address on record of policyowner or payor submitting premium. Groups less than 500 lives: Allocated to states based on employment location of the greatest number of covered members by employer, or based on situs of contract for payor submitting premium. Other Groups: Provided by an employer--allocated based on employment location of each covered group member. Not provided by an employer--allocated based on residence of each group member. (a) Insert the number of L responses except for Canada and Other Alien. (b) Column 4 should balance with Exhibit, Lines 6.4, 0.4, and 6.4, Cols. 8, 9, 0, or with Schedule H, Part, Line, indicate which: # $ $ % $ $ 49

106 States, Etc. ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE T - PART INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN Allocated by States and Territories Life (Group and Individual) Annuities (Group and Individual) Direct Business Only Disability Income (Group and Individual) 4 Long-Term Care (Group and Individual) 5 Deposit-Type Contracts. Alabama AL. Alaska AK. Arizona AZ 4. Arkansas AR 5. California CA 6. Colorado CO 7. Connecticut CT 8. Delaware DE 9. District of Columbia DC 0. Florida FL. Georgia GA. Hawaii HI. Idaho ID 4. Illinois IL 5. Indiana IN 6. Iowa IA 7. Kansas KS 8. Kentucky KY 9. Louisiana LA 0. Maine ME. Maryland MD. Massachusetts MA. Michigan MI 4. Minnesota MN 5. Mississippi MS 6. Missouri MO 7. Montana MT 8. Nebraska NE 9. Nevada NV 0. New Hampshire NH. New Jersey NJ. New Mexico NM. New York NY 4. North Carolina NC 5. North Dakota ND 6. Ohio OH 7. Oklahoma OK 8. Oregon OR 9. Pennsylvania PA 40. Rhode Island RI 4. South Carolina SC 4. South Dakota SD 4. Tennessee TN 44. Texas TX 45. Utah UT 46. Vermont VT 47. Virginia VA 48. Washington WA 49. West Virginia WV 50. Wisconsin WI 5. Wyoming WY 5. American Samoa AS 5. Guam GU 54. Puerto Rico PR 55. U.S. Virgin Islands VI 56. Northern Mariana Islands MP 57. Canada CAN 58. Aggregate Other Alien OT 59. Total 6 Totals 50

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

108 ANNUAL STATEMENT FOR THE YEAR 0 OF THE # $ %% %&' '' * 4'%% *) # 4& 9 **5#: ; 4& < **5#: #; ' **5#'' &&& **5#' %&%% **5# &&'& **5# &%&& **5#%% &&4 **5#%&, 0* #,* &',* &,* &'&%&,*( 4,*( 4,*( %'4&'',*( 4%,, * #: ; &% *) #%' &&'% *-) #%' 4' *) #' % *-) #' % **5# % *) # &'&%''&4 *0 ) # 4' **5#& '4 **5#888 ' **5#' 4'% **5# 4 **5# '4 **5# ' **5# '&4 **5#88( %' 9 **5#: ; ' **5# ' **5#4, **5# 4&& *0 4&&' * # &&' * # 4''' *'' 9 * # 4%4, * # %%% 6* 0## 4&%% 9 * 4'' 9 *%' 44, **5#%' 5.

109 ANNUAL STATEMENT FOR THE YEAR 0 OF THE # $ %% %&' ''%4& *0 0# ''%'& * 44%%4% ( - 4'''& 9 * * %'&4' **5#444' %&%4'4' **5#444% %&%4'4 **5#444& ''4 **5#44 '&& **5#44 %&%4'&' **5#4' %'&4 **5#%&%% %&%4'' **5#%&% %'&& **5#&%% 44' **5#&& %&'&% **5#&' ' **5#&&% %'% **5#&4%' 4 **5#%& &%% **5#%, * * 4'' < # < *-#, *-#' '&'4& **5#88 &4'&' * # * ''&'& ( &' >) - '% >) -( ' >) -( 4'%&,,# '4% ' () *,# ( &' *## &' 6*$ &' 6>)= #$ &' >#7$ 4?=>#$ &' *@?=>7 &' 67 &' A.$ &' AB7 $ &'&'4.= &' AB *7 $ &'&44 *.= 4% #(#$ 4% ( * >$ &' >) # &' >) - %& >) -* '''& >) #( '% >) -( 44&4%& >) #( ' >) -( 5.

110 ANNUAL STATEMENT FOR THE YEAR 0 OF THE # $ %% %&' &' ) # &',7 $ %&4'%,* #0# #$ &' CA-7 $ ''' AC #$ &' -#7$ &' 7$ &' 6= 7 $ 4' -?6= $ &' *## &' ( >7 $ &' #*07 $ %&%%&4 #*00# #$ &' *,# 4'' 7*0# # 444' * 5* 0#$ 4 * 5* 0#-$ 4'&' < * 5* 0## -$ &' 0# ##$ &4'% 4 *@ /* ''&'& ( ''&'& -*0# # '&'4& **5#88 ''&'& -*0# # &&%%4 * # 7 #$ 4''4& * 0# %4'%' *##*0# # %'' 0-*0# # %' *7#, # &%4&& *7#, #- 4& 0 5 %%4' 0 5- %&4 '&4 (),# %% 0 50* %''%'% '%4 *@ *,#,# %&4&,,#,, 0# 4'%,,, 9 = 4''',,# : 7#; &%4 * < ( # < &' < < ( # * 5.

111 5 NAIC Company Code 4 Federal ID Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM Name of Securities Exchange if Publicly Traded (U.S. or International) 8 Names of Parent, Subsidiaries Or Affiliates 9 0 Domiciliary Location Relationship to Reporting Entity Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) Group Code Group Name Federal RSSD CIK Directly Controlled by (Name of Entity/Person) Ultimate Controlling Entity(ies)/Person(s) * #$ %& '( ) * +' %, #$ %& '( ) - +-'*./ /0 % #$ %& '( ++**- %%( / % #$ %& '( +' /%% % #$ %& '( +' 4) % /%% #$ %& '( +' 54) % / /%% +' 54)6 / 54) % +' 54)6 / % *+ 54)6/ / 54) % '''+ 54) %7 / /%% '* 54)67 / 54) %7 '* 54)67 / % --+-*+ 54) %7 / /%% ' 54)67 / 54) %7 ' 54)67 / % - )&$5)% /%% #$ %& +( +' )&$5)((( /0 )&$5)% #$ %& '( -* %7 %) /%% #$ %& '( -* / 5) 7 %7 %) #$ %& '( +' 8/ /%% #$ %& '( +' 854$ % 8/ #$ %& '( +' 9 # /%% #$ %& '( +' 9: /%% #$ %& '( +'+'- ;#$ 9: #$ %& --( +' 9: / /%% #$ %& '( +'+-- /#$ 9: / #$ %& ( +' <9;6 /%% #$ %& '( ''' 9;< %( ( <9;6 #$ %& ( +' 8$ /%% #$ %& '( -' &8$ 6 8$ #$ %& ( +' ) /%% #$ %& '( +' ) 5%) /%% #$ %& '( +' 6 %) /%% #$ %& '( +' /%% /%% #$ %& '( +' 7 5 /%% #$ %& '( +' ;% /= /%% #$ %& '( *+**+- ;% /= = %% ;% /= #$ %& ( +' /,% /%% #$ %& '( *+-'*, / %= %%, #$ %& ( +', /%% #$ %& '( +' )8 /%% #$ %& '( +-'+' %(/( )/ % #$ %& '( ''+'+ 6/=%% % #$ %& ( ''+'+ 6/=%%./ #$ %& '( ) ' '-* /, % (74 74 % #$ %& '( -'' )/=%% % #$ %& '( ---' If Control is Ownership Provide Percentage )/ >/ = %) )/=%% #$ %& '( 4 5

112 5. Group Code Group Name NAIC Company Code 4 Federal ID Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 5 Federal RSSD 6 CIK 7 Name of Securities Exchange if Publicly Traded (U.S. or International) Names of Parent, Subsidiaries Or Affiliates Domiciliary Location Relationship to Reporting Entity Directly Controlled by (Name of Entity/Person) Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) If Control is Ownership Provide Percentage 4 Ultimate Controlling Entity(ies)/Person(s) 5 * % & '(')*%*&+ #$,-, %. #$ % & '(')*%*&+ -, '('$&+% '('($'%*&+ /0+, '(')*%*&+,,- '(''%& %# '('($'%*&+ /0+, '(')*%*&+,-,, *%+*+%*+ '('($'%*&+ /0+, '(')*%*&+,, %'* % *%+*+%*+ /0+, '(')*%*&+,,, %'*% *%+*+%*+ /0+, '(')*%*&+ - %$* 4 *%+++* /0+, '(')*%*&+ -- %'*$$$$& $5 *%+*+%*+ /0+, '(')*%*&+ - %'*$6 $5 *%+*+%*+ /0+, '(')*%*&+, %&& 4 *%+*+%*+ /0+, '(')*%*&+ -- %'* -% *%+*+%*+ /0+, '(')*%*&+ -, %'* % *%+*+%*+ /0+, '(')*%*&+,-,, %'*-,% *%+*+%*+ /0+, '(')*%*&+ -- *%+*++* *%+*+%*+ /0+, '(')*%*&+ --, %%++* *%+++* /0+ - '(')*%*&+,,, %%,, %%++* /0+, '(')*%*&+ %%+&& 4 %%,, /0+, '(')*%*&+,, %'*6$% #6 *%+*+%*+ /0+ - '(')*%*&+,-,- %'*7$7% %'*6$% /0+ '(')*%*&+,-,- %'*7$7% '('($'%*&+ /0+ '(')*%*&+,-,- %'*7$7% '('(8%*&+ /0+ '(')*%*&+ - %7$7)*% %'*7$7% /0+, '(')*%*&+ -- *%+*+9 %7$7)*% /0+, '(')*%*&+,-,- %'*77% *%+*+9 /0+, '(')*%*&+ --- %'*:&; 4 %'*77% /0+, '(')*%*&+ %'*$& $5 %'*77% /0+, '(')*%*&+ %'*<. %'*77% /0+, '(')*%*&+ %'*0 = *%+*+%*+ /0+, '(')*%*&+,-, %'*77$% *%+*+9 /0+, '(')*%*&+ - %9,)*% *%+*+%*+ /0+, '(')*%*&+ --, %9, %9,)*% /0+, '(')*%*&+,, %,&& 4 *%+*++* /0+, '(')*%*&+ *%+*++* /0+, '(')*%*&+ %'*,$& $5 %9$$)*% *%+*+%*+ /0+, '(')*%*&+ -, -,,- *%+*+9$$ %9$$)*% /0+, '(')*%*&+,- %'*776% *%+*+9$$ /0+, '(')*%*&+, %'*% %'*776% /0+, '(')*%*&+, %'*% %'*776% /0+, '(')*%*&+ %'*$$$& $5 %'*776% /0+, '(')*%*&+, %'*:&;$$ 4 %'*776% /0+, '(')*%*&+, %'*77$7% *%+*+9$$ /0+, '(')*%*&+, %'*,% %'*77$7% /0+, '(')*%*&+, %'*% %'*77$7% /0+, '(')*%*&+ %'*% %'*77$7% /0+, '(')*%*&+, %'* % %'*77$7% /0+, '(')*%*&+

113 5. Group Code NAIC Company Code 4 Federal ID Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM Name of Securities Exchange if Publicly Traded (U.S. or International) 8 Names of Parent, Subsidiaries Or Affiliates 9 0 Domiciliary Location Relationship to Reporting Entity Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) Federal Directly Controlled by Ultimate Controlling Group Name RSSD CIK (Name of Entity/Person) Entity(ies)/Person(s) * #$%#&'&()* #+, -.## #& / #$%#&'&()* #+ 0,- &&.#..## #& #$%#&'&()* #+ 0- &&#$'&()* #+ &&.#. #$%#&'&()* #+,,00,0 &&$&# 4 &&#$'&()* #+ #$%#&'&()* #+,- *(#*( %5 &&$&# #$%#&'&()* #+ '&().## #& #$%#&'&()* #+,00 / '&() #$%#&'&()* #+ 6 / #$%#&'&()* #+ - 6 / #$%#&'&()* #+ - 6 / #$%#&'&()* # / #$%#&'&()* #+, 64 / #$%#&'&()* #+, 64 / #$%#&'&()* #+ 0,- 64 / #$%#&'&()* #+ / #$%#&'&()* # / #$%#&'&()* # / #$%#&'&()* # / #$%#&'&()* #+ --, 0- / #$%#&'&()* #+ --- / #$%#&'&()* #+ &&.#$#)*( 6 / #$%#&'&()* #+, 0 6##$#)768*( 6 / #$%#&'&()* #+,- 7+ 8( 9 / #$%#&'&()* #+,- 7*(#8*( %5 / #$%#&'&()* #+,0.## #& #$%#&'&()* #+ 0 #$%#&'&()* #+,0 &#(*( 6 #$%#&'&()* #+, #$%#&'&()* #+,00 :#4 ; #$%#&'&()* #+ -- # #&# # #&#)# ( #$%#&'&()* #+ 000 &&.##&#) ; ( #$%#&'&()* #+,0, # #&#&#(*( 6 ( #$%#&'&()* #+, /'&().## #& #$%#&'&()* #+ 0 ()/ /'&() #$%#&'&()* #+ 0 ()/ #$%#&'&()* # ## #& #$%#&'&()* # ## #& #$%#&'&()* #+ 0--0, 00.## #& #$%#&'&()* #+ 0--0, 0,.## #& #$%#&'&()* #+ 0-0,, -.## #& #$%#&'&()* #+ 0-0, 0 -.## #& #$%#&'&()* #+ 0-0, 0,-.## #& #$%#&'&()* #+ 0-0,0-,.## #& #$%#&'&()* # ,0.## #& #$%#&'&()* #+ 0-0, -.## #& #$%#&'&()* # , -.## #& #$%#&'&()* #+ 0-, -,.## #& #$%#&'&()* # ## #& #$%#&'&()* # ## #& #$%#&'&()* #+ If Control is Ownership Provide Percentage 4 5

114 5. NAIC Company Code 4 Federal ID Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM Name of Securities Exchange if Publicly Traded (U.S. or International) 8 Names of Parent, Subsidiaries Or Affiliates 9 0 Domiciliary Location Relationship to Reporting Entity Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) Group Code Group Name Federal RSSD CIK Directly Controlled by (Name of Entity/Person) Ultimate Controlling Entity(ies)/Person(s) * #$ % &'()*+,- #$ % &'()*+,-. #$ % &'()*+,- /.... #$ % &'()*+, #$ % &'()*+, #$ % &'()*+,-. /.. #$ % &'()*+,- // /.. #$ % &'()*+,-. /./ #$ % &'()*+,-. #$ % &'()*+,-. #$ % &'()*+,- #$ % &'()*+,-../ #$ % &'()*+,- #$ % &'()*+,- /// #$ % &'()*+,- //. #$ % &'()*+,- //. /// #$ % &'()*+,- /// #$ % &'()*+,- 0 $*,$* 0 #$ % &'()*+,- /./ (+$$+-,,$* ( #$ % &'()*+,- 0 $+ #$ % &'()*+,- 0 $+,$* 0 0 $+ #$ % &'()*+,- / &' $*+ 40 &''$ #$ % &'()*+,- / &''$5 -$ $0 40 &''$ #$ % &'()*+,- / $$ )*+ 40 &''$ #$ % &'()*+,- / &''$$)*+ 40 &''$ #$ % &'()*+,-. &''$$)*+,$* 40 &''$$)*+ #$ % &'()*+,- &''$$$ $,$* 40 &''$$)*+,$* #$ % &'()*+,- /./// &''$$,$* 0 &''$$$ $,$* #$ % &'()*+,- 6*$ # $($,$* 40 &''$$$ $,$* #$ % &'()*+,- /./ &''$$78,$* 0 &''$ #$ % &'()*+,- / &''$ / &' $9$$ $ :; 0 &''$ #$ % &'()*+,-. &' $ * &''$0 $,- #$ % &'()*+,- &'& $* * &' $ * #$ % &'()*+,- / &' <$$ $+$& &'& $* * #$ % &'()*+,-. &' <$$ $+$* & 40 &' <$$ $+$& (+$,$ &'()*+,-.// &'& $-0& &'& $* * #$ % &'()*+,-. &'& $-*0& 40 &'& $-0& (+$,$ &'()*+,- /./ &''$$00,$* &''$0 $,- #$ % &'()*+,- / &''$. &' -$ $,- = 0 &''$ #$ % &'()*+,- / &''$.. &'$$$ $,- :; &''$0 $,- #$ % &'()*+,- If Control is Ownership Provide Percentage &'& $-0$$ &''$0 $,- #$ % &'()*+,- / (0)*+ 4: &''$0 $,- #$ % &'()*+,- (0)*+ 4: &''$5 -,- #$ % &'()*+,- &'$$* ( ;) &''$0 $,- 0'$$ &''$* ;) &''$0 $,- 0'$$ /. &''$* ;) &''$0 $,- 0'$$ &''$*+ ( ;) &''$0 $,- 0'$$ 4 5

115 Group Code NAIC Company Code 4 Federal ID Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM Name of Securities Exchange if Publicly Traded (U.S. or International) 8 Names of Parent, Subsidiaries Or Affiliates 9 0 Domiciliary Location Relationship to Reporting Entity Type of Control (Ownership, Board, Management, Attorney-in-Fact, Influence, Other) Federal Directly Controlled by Ultimate Controlling Group Name RSSD CIK (Name of Entity/Person) Entity(ies)/Person(s) * #$ %& If Control is Ownership Provide Percentage 4 5 Asterisk ' ()*** + )*, Explanation 5.4

116 5 NAIC Company Code ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE Y PART - SUMMARY OF INSURER S TRANSACTIONS WITH ANY AFFILIATES Purchases, Sales or Exchanges of Loans, Securities, Real Estate, Mortgage Loans or Other Investments 7 Income/ (Disbursements) Incurred in Connection with Guarantees or Undertakings for the Benefit of any Affiliate(s) 8 Management Agreements and Service Contracts 9 Income/ (Disbursements) Incurred Under Reinsurance Agreements 0 Any Other Material Activity Not in the Ordinary Course of the Insurer s Business Reinsurance Recoverable/ (Payable) on Losses and/or Reserve Credit Taken/(Liability) Federal ID Number Names of Insurers and Parent, Subsidiaries or Affiliates Shareholder Dividends Capital Contributions * Totals # $$ %& $ $$# # $ # $# $# $# $ $ '( # # $$# $ ( ) & * $$ $# ( +, &&) & # $$ $ () & # $ $ - ) & $ $ # (./ $# # (./0& # # $ (./0&%% # # $ (./0&%%% # # $ (& ) & 4 4 $ (&& (.&& $# (&& $# $# $$# $ /(.&& # $# # (.&& $# # $# $ $ & $# $$# $# / $ ) 546# # $$# $$$# # $ ) & -&# # # $ ) & %% # $# $ $$ $. +7 $ $. +7%. ( $ 8&&%4 # $$# $$# $$. & # %%% Control Totals XXX

117 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES The following supplemental reports are required to be filed as part of your statement filing unless specifically waived by the domiciliary state. However, in the event that your domiciliary state waives the filing requirement, your response of WAIVED to the specific interrogatory will be accepted in lieu of filing a NONE report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. Responses MARCH FILING. Will the Supplemental Compensation Exhibit be filed with the state of domicile by March?. Will the confidential Risk-based Capital Report be filed with the NAIC by March?. Will the confidential Risk-based Capital Report be filed with the state of domicile, if required, by March? 4. Will an actuarial opinion be filed by March? APRIL FILING 5. Will Management s Discussion and Analysis be filed by April? 6. Will the Life, Health & Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit be filed with the state of domicile and the NAIC by April? 7. Will the Adjustment Form (if required) be filed with the state of domicile and the NAIC by April? 8. Will the Supplemental Investment Risks Interrogatories be filed by April? JUNE FILING 9. Will an audited financial report be filed by June? 0. Will Accountant's Letter of Qualifications be filed with the state of domicile and electronically with the NAIC by June? AUGUST FILING. Will Communication of Internal Control Related Matters Noted in Audit be filed with the state of domicile by August? The following supplemental reports are required to be filed as part of your annual statement filing. However, in the event that your company does not transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a NONE report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions. MARCH FILING. Will Schedule SIS (Stockholder Information Supplement) be filed with the state of domicile by March?. Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March? 4. Will the Trusteed Surplus Statement be filed with the state of domicile and the NAIC by March? 5. Will the actuarial opinion on participating and non-participating policies as required in Interrogatories and to Exhibit 5 be filed with the state of domicile and electronically with the NAIC by March? 6. Will the actuarial opinion on non-guaranteed elements as required in interrogatory # to Exhibit 5 be filed with the state of domicile and electronically with the NAIC by March? 7. Will the actuarial opinion on X-Factors be filed with the state of domicile and electronically with the NAIC by March? 8. Will the actuarial opinion on Separate Accounts Funding Guaranteed Minimum Benefit be filed with the state of domicile and electronically with the NAIC by March? 9. Will the actuarial opinion on Synthetic Guaranteed Investment Contracts be filed with the state of domicile and electronically with the NAIC by March? 0. Will the Reasonableness of Assumptions Certification required by Actuarial Guideline XXXV be filed with the state of domicile and electronically with the NAIC by March?. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXV be filed with the state of domicile and electronically with the NAIC by March?. Will the Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method required by Actuarial Guideline XXXVI be filed with the state of domicile and electronically with the NAIC by March?. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Average Market Value) be filed with the state of domicile and electronically with the NAIC by March? 4. Will the Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI (Updated Market Value) be filed with the state of domicile and electronically with the NAIC by March? 5. Will the C- RBC Certifications required under C- Phase I be filed with the state of domicile and electronically with the NAIC by March? 6. Will the C- RBC Certifications required under C- Phase II be filed with the state of domicile and electronically with the NAIC by March? 54

118 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES 7. Will the Actuarial Certifications Related to Annuity Nonforfeiture Ongoing Compliance for Equity Indexed Annuities be filed with the state of domicile and electronically with the NAIC by March? 8. Will the actuarial opinion required by the Modified Guaranteed Annuity Model Regulation be filed with the state of domicile and electronically with the NAIC by March? 9. Will the Actuarial Certifications Related to Hedging required by Actuarial Guideline XLIII be filed with the state of domicile and electronically with the NAIC by March? 0. Will the Financial Officer Certification Related to Clearly Defined Hedging Strategy required by Actuarial Guideline XLIII be filed with the state of domicile and electronically with the NAIC by March?. Will the Management Certification That the Valuation Reflects Management s Intent required by Actuarial Guideline XLIII be filed with the state of domicile and electronically with the NAIC by March?. Will the Actuarial Certification Related to the Reserves required by Actuarial Guideline XLIII be filed with the state of domicile and electronically with the NAIC by March?. Will the Actuarial Certification regarding the use of 00 Preferred Class Tables required by the Model Regulation Permitting the Recognition of Preferred Mortality Tables for Use in Determining Minimum Reserve Liabilities be filed with the state of domicile and electronically with the NAIC by March? 4. Will the Worker's Compensation Carve-Out Supplement be filed by March? 5. Will Supplemental Schedule O be filed with the state of domicile and the NAIC by March? 6. Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March? 7. Will an approval from the reporting entity s state of domicile for relief related to the five-year rotation requirement for lead audit partner be filed electronically with the NAIC by March? 8. Will an approval from the reporting entity s state of domicile for relief related to the one-year cooling off period for independent CPA be filed electronically with the NAIC by March? 9. Will an approval from the reporting entity s state of domicile for relief related to the Requirements for Audit Committees be filed electronically with the NAIC by March? APRIL FILING 40. Will the Long-Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April? 4. Will the Interest-Sensitive Life Insurance Products Report Forms be filed with the state of domicile and the NAIC by April? 4. Will the Credit Insurance Experience Exhibit be filed with the state of domicile and the NAIC by April? 4. Will the Accident and Health Policy Experience Exhibit be filed by April? 44. Will the Analysis of Annuity Operations by Lines of Business be filed with the state of domicile and the NAIC by April? 45. Will the Analysis of Increase in Annuity Reserves During the Year be filed with the state of domicile and the NAIC by April? 46. Will the Supplemental Health Care Exhibit (Parts, and ) be filed with the state of domicile and the NAIC by April? 47. Will the regulator only (non-public) Supplemental Health Care Exhibit s Expense Allocation Report be filed with the state of domicile and the NAIC by April? AUGUST FILING 48. Will Management s Report of Internal Control Over Financial Reporting be filed with the state of domicile by August? Explanations: COVERED BY THE TOTAL COMPANY ACTUARIAL OPINION. 9. NOT REQUIRED PER TITLE 0, NEBRASKA ADMINISTRATIVE CODE, CHAPTER NOT REQUIRED TO FILE AS NOT SUBJECT TO RATING RULES BASED ON LTC INSURANCE MODEL REGULATION Bar Codes:. SIS Stockholder Information Supplement [Document Identifier 40]. Medicare Supplement Insurance Experience Exhibit [Document Identifier 60] 4. Trusteed Surplus Statement [Document Identifier 490] 0. Reasonableness of Assumptions Certification required by Actuarial Guideline XXXV [Document Identifier 445]. Reasonableness of Assumptions Certification for Implied Guaranteed Rate Method required by Actuarial Guideline XXXVI [Document Identifier 447]. Reasonableness and Consistency of Assumptions Certification required by Actuarial Guideline XXXVI [Document Identifier 448] 8. Modified Guaranteed Annuity Model Regulation [Document Identifier 45] 4. Workers'Compensation Carve-Out Supplement [Document Identifier 495] 6. Medicare Part D Coverage Supplement [Document Identifier 65] 7. Relief from the five-year rotation requirement for lead audit partner [Document Identifier 4] 8. Relief from the one-year cooling off period for independent CPA [Document Identifier 5] 9. Relief from the Requirements for Audit Committees [Document Identifier 6] 54.

119 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES 4. Credit Insurance Experience Exhibit [Document Identifier 0] 46. Supplemental Health Care Exhibit (Parts, and ) [Document Identifier 6] 47. Supplemental Health Care Exhibit's Expense Allocation Report [Document Identifier 7] 54.

120 ANNUAL STATEMENT FOR THE YEAR 0 OF THE OVERFLOW PAGE FOR WRITE-INS Additional Write-ins for Assets Line 5 Current Year Net Admitted Assets (Cols. - ) Prior Year 4 Net Admitted Assets Assets Nonadmitted Assets Summary of remaining write-ins for Line 5 from overflow page Additional Write-ins for Liabilities Line 5 Current Year Prior Year Summary of remaining write-ins for Line 5 from overflow page Additional Write-ins for Summary of Operations Line 7 Current Year Prior Year Summary of remaining write-ins for Line 7 from overflow page 55

121 ANNUAL STATEMENT FOR THE YEAR 0 OF THE OVERFLOW PAGE FOR WRITE-INS Additional Write-ins for Analysis of Operations Line 7 Ordinary 6 Group Accident and Health Total Industrial Life Life Insurance Individual Annuities Supplementary Contracts Credit Life (Group and Individual) Life Insurance (a) Annuities Group Credit (Group and Individual) Other Summary of remaining write-ins for Line 7 from overflow page Aggregate of All Other Lines of Business 55L

122 . Bonds: ANNUAL STATEMENT FOR THE YEAR 0 OF THE SUMMARY INVESTMENT SCHEDULE Investment Categories Gross Investment Holdings Amount Percentage Amount Admitted Assets as Reported in the Annual Statement 4 5 Securities Lending Reinvested Total Collateral (Col. + 4) Amount Amount 6 Percentage. U.S. treasury securities. U.S. government agency obligations (excluding mortgage-backed securities):. Issued by U.S. government agencies. Issued by U.S. government sponsored agencies. Non-U.S. government (including Canada, excluding mortgaged-backed securities).4 Securities issued by states, territories, and possessions and political subdivisions in the U.S. :.4 States, territories and possessions general obligations.4 Political subdivisions of states, territories and possessions and political subdivisions general obligations.4 Revenue and assessment obligations.44 Industrial development and similar obligations.5 Mortgage-backed securities (includes residential and commercial MBS):.5 Pass-through securities:.5 Issued or guaranteed by GNMA.5 Issued or guaranteed by FNMA and FHLMC.5 All other.5 CMOs and REMICs:.5 Issued or guaranteed by GNMA, FNMA, FHLMC or VA.5 Issued by non-u.s. Government issuers and collateralized by mortgage-backed securities issued or guaranteed by agencies shown in Line.5.5 All other. Other debt and other fixed income securities (excluding short-term):. Unaffiliated domestic securities (includes credit tenant loans and hybrid securities). Unaffiliated non-u.s. securities (including Canada). Affiliated securities. Equity interests:. Investments in mutual funds. Preferred stocks:. Affiliated. Unaffiliated. Publicly traded equity securities (excluding preferred stocks):. Affiliated. Unaffiliated.4 Other equity securities:.4 Affiliated.4 Unaffiliated.5 Other equity interests including tangible personal property under lease:.5 Affiliated.5 Unaffiliated 4. Mortgage loans: 4. Construction and land development 4. Agricultural 4. Single family residential properties 4.4 Multifamily residential properties 4.5 Commercial loans 4.6 Mezzanine real estate loans 5. Real estate investments: 5. Property occupied by company 5. Property held for production of income (including $ of property acquired in satisfaction of debt) 5. Property held for sale (including $ property acquired in satisfaction of debt) 6. Contract loans 7. Derivatives 8. Receivables for securities 9. Securities Lending (Line 0, Asset Page reinvested collateral) XXX XXX XXX 0. Cash, cash equivalents and short-term investments. Other invested assets. Total invested assets SI0

123 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE A - VERIFICATION BETWEEN YEARS Real Estate. Book/adjusted carrying value, December of prior year. Cost of acquired:. Actual cost at time of acquisition (Part, Column 6). Additional investment made after acquisition (Part, Column 9). Current year change in encumbrances:. Totals, Part, Column. Totals, Part, Column 4. Total gain (loss) on disposals, Part, Column 8 5. Deduct amounts received on disposals, Part, Column 5 6. Total foreign exchange change in book/adjusted carrying value: 6. Totals, Part, Column 5 6. Totals, Part, Column 7. Deduct current year s other than temporary impairment recognized: 7. Totals, Part, Column 7. Totals, Part, Column 0 8. Deduct current year s depreciation: 8. Totals, Part, Column 8. Totals, Part, Column 9 9. Book/adjusted carrying value at the end of current period (Lines ) 0. Deduct total nonadmitted amounts. Statement value at end of current period (Line 9 minus Line 0) SCHEDULE B - VERIFICATION BETWEEN YEARS Mortgage Loans. Book value/recorded investment excluding accrued interest, December of prior year. Cost of acquired:. Actual cost at time of acquisition (Part, Column 7). Additional investment made after acquisition (Part, Column 8). Capitalized deferred interest and other:. Totals, Part, Column. Totals, Part, Column 4. Accrual of discount 5. Unrealized valuation increase (decrease): 5. Totals, Part, Column 9 5. Totals, Part, Column 8 6. Total gain (loss) on disposals, Part, Column 8 7. Deduct amounts received on disposals, Part, Column 5 8. Deduct amortization of premium and mortgage interest points and commitment fees 9. Total foreign exchange change in book value/recorded investment excluding accrued interest: 9. Totals, Part, Column 9. Totals, Part, Column 0. Deduct current year s other than temporary impairment recognized: 0. Totals, Part, Column 0. Totals, Part, Column 0. Book value/recorded investment excluding accrued interest at end of current period (Lines ). Total valuation allowance. Subtotal (Line plus ) 4. Deduct total nonadmitted amounts 5. Statement value of mortgages owned at end of current period (Line minus Line 4) SI0

124 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE BA - VERIFICATION BETWEEN YEARS Other Long-Term Invested Assets. Book/adjusted carrying value, December of prior year. Cost of acquired:. Actual cost at time of acquisition (Part, Column 8). Additional investment made after acquisition (Part, Column 9). Capitalized deferred interest and other:. Totals, Part, Column 6. Totals, Part, Column 4. Accrual of discount 5. Unrealized valuation increase (decrease): 5. Totals, Part, Column 5. Totals, Part, Column 9 6. Total gain (loss) on disposals, Part, Column 9 7. Deduct amounts received on disposals, Part, Column 6 8. Deduct amortization of premium and depreciation 9. Total foreign exchange change in book/adjusted carrying value: 9. Totals, Part, Column 7 9. Totals, Part, Column 4 0. Deduct current year s other than temporary impairment recognized: 0. Totals, Part, Column 5 0. Totals, Part, Column. Book/adjusted carrying value at end of current period (Lines ). Deduct total nonadmitted amounts. Statement value at end of current period (Line minus Line ) SCHEDULE D - VERIFICATION BETWEEN YEARS Bonds and Stocks. Book/adjusted carrying value, December of prior year. Cost of bonds and stocks acquired, Part, Column 7. Accrual of discount 4. Unrealized valuation increase (decrease): 4.. Part, Column 4.. Part, Section, Column Part, Section, Column 4.4. Part 4, Column 5. Total gain (loss) on disposals, Part 4, Column 9 6. Deduction consideration for bonds and stocks disposed of, Part 4, Column 7 7. Deduct amortization of premium 8. Total foreign exchange change in book/adjusted carrying value: 8.. Part, Column Part, Section, Column Part, Section, Column Part 4, Column 5 9. Deduct current year s other than temporary impairment recognized: 9.. Part, Column Part, Section, Column Part, Section, Column Part 4, Column 0. Book/adjusted carrying value at end of current period (Lines ). Deduct total nonadmitted amounts. Statement value at end of current period (Line 0 minus Line ) SI0

125 BONDS Governments (Including all obligations guaranteed by governments) ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - SUMMARY BY COUNTRY Description Long-Term Bonds and Stocks OWNED December of Current Year Book/Adjusted Carrying Value Fair Value Actual Cost Par Value of Bonds. United States. Canada. Other Countries 4. Totals U.S. States, Territories and Possessions (Direct and guaranteed) 5. Totals U.S. Political Subdivisions of States, Territories and Possessions (Direct and guaranteed) 6. Totals U.S. Special revenue and special assessment obligations and all nonguaranteed obligations of agencies and authorities of governments and their political subdivisions 7. Totals 8. United States Industrial and Miscellaneous and 9. Canada Hybrid Securities (unaffiliated) 0. Other Countries. Totals Parent, Subsidiaries and Affiliates. Totals. Total Bonds PREFERRED STOCKS 4. United States Industrial and Miscellaneous 5. Canada (unaffiliated) 6. Other Countries 7. Totals Parent, Subsidiaries and Affiliates 8. Totals 9. Total Preferred Stocks COMMON STOCKS Industrial and Miscellaneous (unaffiliated) 0. United States. Canada. Other Countries. Totals Parent, Subsidiaries and Affiliates 4. Totals 5. Total Common Stocks 6. Total Stocks 7. Total Bonds and Stocks 4 SI04

126 SI05 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - PART A - SECTION Quality and Maturity Distribution of All Bonds Owned December, at Book/Adjusted Carrying Values by Major Types of Issues and NAIC Designations Over Year Over 5 Years Over 0 Years Col. 6 as a % of Total from Col. 6 Year or Less Through 5 Years Through 0 Years Through 0 Years Over 0 Years Total Current Year Line 9.7 Prior Year 9 % From Col. 7 Prior Year 0 Total Publicly Traded Total Privately Placed (a) NAIC Designation. U.S. Governments. NAIC. NAIC. NAIC.4 NAIC 4.5 NAIC 5.6 NAIC 6.7 Totals. All Other Governments. NAIC. NAIC. NAIC.4 NAIC 4.5 NAIC 5.6 NAIC 6.7 Totals. U.S. States, Territories and Possessions etc., Guaranteed. NAIC. NAIC. NAIC.4 NAIC 4.5 NAIC 5.6 NAIC 6.7 Totals 4. U.S. Political Subdivisions of States, Territories and Possessions, Guaranteed 4. NAIC 4. NAIC 4. NAIC 4.4 NAIC NAIC NAIC Totals 5. U.S. Special Revenue & Special Assessment Obligations, etc., Non-Guaranteed 5. NAIC 5. NAIC 5. NAIC 5.4 NAIC NAIC NAIC Totals

127 SI06 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - PART A - SECTION (Continued) Quality and Maturity Distribution of All Bonds Owned December, at Book/Adjusted Carrying Values by Major Types of Issues and NAIC Designations Over Year Over 5 Years Over 0 Years Col. 6 as a % of Total from Col. 6 Year or Less Through 5 Years Through 0 Years Through 0 Years Over 0 Years Total Current Year Line 9.7 Prior Year 9 % From Col. 7 Prior Year 0 Total Publicly Traded Total Privately Placed (a) NAIC Designation 6. Industrial & Miscellaneous (Unaffiliated) 6. NAIC 6. NAIC 6. NAIC 6.4 NAIC NAIC NAIC Totals 7. Hybrid Securities 7. NAIC 7. NAIC 7. NAIC 7.4 NAIC NAIC NAIC Totals 8. Parent, Subsidiaries and Affiliates 8. NAIC 8. NAIC 8. NAIC 8.4 NAIC NAIC NAIC Totals

128 SI07 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - PART A - SECTION (Continued) Quality and Maturity Distribution of All Bonds Owned December, at Book/Adjusted Carrying Values by Major Types of Issues and NAIC Designations Over Year Over 5 Years Over 0 Years Col. 6 as a % of Total from Col. 6 Year or Less Through 5 Years Through 0 Years Through 0 Years Over 0 Years Total Current Year Line 9.7 Prior Year 9 % From Col. 7 Prior Year 0 Total Publicly Traded Total Privately Placed (a) NAIC Designation 9. Total Bonds Current Year 9. NAIC (d) XXX XXX 9. NAIC (d) XXX XXX 9. NAIC (d) XXX XXX 9.4 NAIC 4 (d) XXX XXX 9.5 NAIC 5 (d) (c) XXX XXX 9.6 NAIC 6 (d) (c) XXX XXX 9.7 Totals (b) XXX XXX 9.8 Line 9.7 as a % of Col. 6 XXX XXX XXX 0. Total Bonds Prior Year 0. NAIC XXX XXX 0. NAIC XXX XXX 0. NAIC XXX XXX 0.4 NAIC 4 XXX XXX 0.5 NAIC 5 XXX XXX (c) 0.6 NAIC 6 XXX XXX (c) 0.7 Totals XXX XXX (b) 0.8 Line 0.7 as a % of Col. 8 XXX XXX XXX. Total Publicly Traded Bonds. NAIC XXX. NAIC XXX. NAIC XXX.4 NAIC 4 XXX.5 NAIC 5 XXX.6 NAIC 6 XXX.7 Totals XXX.8 Line.7 as a % of Col. 6 XXX XXX XXX XXX.9 Line.7 as a % of Line 9.7, Col. 6, Section 9 XXX XXX XXX XXX. Total Privately Placed Bonds. NAIC XXX. NAIC XXX. NAIC XXX.4 NAIC 4 XXX.5 NAIC 5 XXX.6 NAIC 6 XXX.7 Totals XXX.8 Line.7 as a % of Col. 6 XXX XXX XXX XXX.9 Line.7 as a % of Line 9.7, Col. 6, Section 9 XXX XXX XXX XXX (a) Includes $ freely tradable under SEC Rule 44 or qualified for resale under SEC Rule 44A. (b) Includes $ current year, $ prior year of bonds with Z designations and $, current year $ prior year of bonds with Z* designations. The letter Z means the NAIC designation was not assigned by the Securities Valuation Office (SVO) at the date of the statement. Z* means the SVO could not evaluate the obligation because valuation procedures for the security class are under regulatory review. (c) Includes $ current year, $ prior year of bonds with 5* designations and $, current year $ prior year of bonds with 6* designations. 5* means the NAIC designation was assigned by the (SVO) in reliance on the insurer's certification that the issuer is current in all principal and interest payments. 6* means the NAIC designation was assigned by the SVO due to inadequate certification of principal and interest payments. (d) Includes the following amount of non-rated short-term and cash equivalent bonds by NAIC designation: NAIC $ ; NAIC $ ; NAIC $ ; NAIC 4 $ ; NAIC 5 $ ; NAIC 6 $

129 SI08 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - PART A - SECTION Maturity Distribution of All Bonds Owned December, at Book/Adjusted Carrying Values by Major Type and Subtype of Issues Over Year Over 5 Years Over 0 Years Col. 6 as a % of Year or Less Through 5 Years Through 0 Years Through 0 Years Over 0 Years Total Current Year Line Total from Col. 6 Prior Year 9 % From Col. 7 Prior Year 0 Total Publicly Traded Total Privately Placed Distribution by Type. U.S. Governments. Issuer Obligations. Residential Mortgage-Backed Securities. Commercial Mortgage-Backed Securities.4 Other Loan-Backed and Structured Securities.5 Totals. All Other Governments. Issuer Obligations. Residential Mortgage-Backed Securities. Commercial Mortgage-Backed Securities.4 Other Loan-Backed and Structured Securities.5 Totals. U.S. States, Territories and Possessions, Guaranteed. Issuer Obligations. Residential Mortgage-Backed Securities. Commercial Mortgage-Backed Securities.4 Other Loan-Backed and Structured Securities.5 Totals 4. U.S. Political Subdivisions of States, Territories and Possessions, Guaranteed 4. Issuer Obligations 4. Residential Mortgage-Backed Securities 4. Commercial Mortgage-Backed Securities 4.4 Other Loan-Backed and Structured Securities 4.5 Totals 5. U.S. Special Revenue & Special Assessment Obligations etc., Non- Guaranteed 5. Issuer Obligations 5. Residential Mortgage-Backed Securities 5. Commercial Mortgage-Backed Securities 5.4 Other Loan-Backed and Structured Securities 5.5 Totals 6. Industrial and Miscellaneous 6. Issuer Obligations 6. Residential Mortgage-Backed Securities 6. Commercial Mortgage-Backed Securities 6.4 Other Loan-Backed and Structured Securities 6.5 Totals 7. Hybrid Securities 7. Issuer Obligations 7. Residential Mortgage-Backed Securities 7. Commercial Mortgage-Backed Securities 7.4 Other Loan-Backed and Structured Securities 7.5 Totals 8. Parent, Subsidiaries and Affiliates 8. Issuer Obligations 8. Residential Mortgage-Backed Securities 8. Commercial Mortgage-Backed Securities 8.4 Other Loan-Backed and Structured Securities 8.5 Totals

130 SI09 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE D - PART A - SECTION (Continued) Maturity Distribution of All Bonds Owned December, at Book/Adjusted Carrying Values by Major Type and Subtype of Issues Over Year Over 5 Years Over 0 Years Col. 6 as a % of Year or Less Through 5 Years Through 0 Years Through 0 Years Over 0 Years Total Current Year Line Total from Col. 6 Prior Year 9 % From Col. 7 Prior Year 0 Total Publicly Traded Total Privately Placed Distribution by Type 9. Total Bonds Current Year 9. Issuer Obligations XXX XXX 9. Residential Mortgage-Backed Securities XXX XXX 9. Commercial Mortgage-Backed Securities XXX XXX 9.4 Other Loan-Backed and Structured Securities XXX XXX 9.5 Totals XXX XXX 9.6 Line 9.5 as a % of Col. 6 XXX XXX XXX 0. Total Bonds Prior Year 0. Issuer Obligations XXX XXX 0. Residential Mortgage-Backed Securities XXX XXX 0. Commercial Mortgage-Backed Securities XXX XXX 0.4 Other Loan-Backed and Structured Securities XXX XXX 0.5 Totals XXX XXX 0.6 Line 0.5 as a % of Col. 8 XXX XXX XXX. Total Publicly Traded Bonds. Issuer Obligations XXX. Residential Mortgage-Backed Securities XXX. Commercial Mortgage-Backed Securities XXX.4 Other Loan-Backed and Structured Securities XXX.5 Totals XXX.6 Line.5 as a % of Col. 6 XXX XXX XXX XXX.7 Line.5 as a % of Line 9.5, Col. 6, Section 9 XXX XXX XXX XXX. Total Privately Placed Bonds. Issuer Obligations XXX. Residential Mortgage-Backed Securities XXX. Commercial Mortgage-Backed Securities XXX.4 Other Loan-Backed and Structured Securities XXX.5 Totals XXX.6 Line.5 as a % of Col. 6 XXX XXX XXX XXX.7 Line.5 as a % of Line 9.5, Col. 6, Section 9 XXX XXX XXX XXX

131 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE DA - VERIFICATION BETWEEN YEARS Short-Term Investments Total Bonds Mortgage Loans 4 Other Short-term Investment Assets (a) 5 Investments in Parent, Subsidiaries and Affiliates. Book/adjusted carrying value, December of prior year. Cost of short-term investments acquired. Accrual of discount 4. Unrealized valuation increase (decrease) 5. Total gain (loss) on disposals 6. Deduct consideration received on disposals 7. Deduct amortization of premium 8. Total foreign exchange change in book/adjusted carrying value 9. Deduct current year s other than temporary impairment recognized SI0 0. Book adjusted carrying value at end of current period (Lines ). Deduct total nonadmitted amounts. Statement value at end of current period (Line 0 minus Line ) (a) Indicate the category of such assets, for example, joint ventures, transportation equipment:

132 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE DB - PART A - VERIFICATION BETWEEN YEARS Options, Caps, Floors, Collars, Swaps and Forwards. Book/adjusted carrying value, December, prior year (Line 9, prior year). Cost paid/(consideration received) on additions:. Current year paid/(consideration received) at time of acquisition, still open, Section, Column. Current year paid/(consideration received) at time of acquisition, terminated, Section, Column 4. Unrealized valuation increase/(decrease):. Section, Column 7. Section, Column 9 4. Total gain (loss) on termination recognized, Section, Column 5. Considerations received/(paid) on terminations, Section, Column 5 6. Amortization: 6. Section, Column 9 6. Section, Column 7. Adjustment to the book/adjusted carrying value of hedged item: 7. Section, Column 0 7. Section, Column 8. Total foreign exchange change in book/adjusted carrying value: 8. Section, Column 8 8. Section, Column 0 9. Book/adjusted carrying value at end of current period (Lines ) 0. Deduct nonadmitted assets. Statement value at end of current period (Line 9 minus Line 0) SCHEDULE DB - PART B - VERIFICATION Futures Contracts. Book/Adjusted carrying value, December of prior year (Line 6, prior year). Cumulative cash change (Section, Broker Name/Net Cash Deposits Footnote - Cumulative Cash Change Column). Add: Change in variation margin on open contracts - Highly effective hedges. Section, Column 5, current year minus. Section, Column 5, prior year Change in variation margin on open contracts - All other. Section, Column 8, current year minus.4 Section, Column 8, prior year. Add: Change in adjustment to basis of hedged item. Section, Column 7, current year to date minus. Section, Column 7, prior year Change in amount recognized. Section, Column 9, current year to date minus.4 Section, Column 9, prior year. Subtotal (Line. minus Line.) 4. Cumulative variation margin on terminated contracts during the year (Section, Column 5) 4. Less: 4. Amount used to adjust basis of hedged item (Section, Column 7) 4. Amount recognized (Section, Column 6) 4. Subtotal (Line 4. minus Line 4.) 5. Dispositions gains (losses) on contracts terminated in prior year: 5. Total gain (loss) recognized for terminations in prior year 5. Total gain (loss) adjusted into the hedged item(s) for terminations in prior year 6. Book/Adjusted carrying value at end of current period (Lines ) 7. Deduct total nonadmitted amounts 8. Statement value at end of current period (Line 6 minus Line 7) SI

133 Number ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE DB - PART C - SECTION Replication (Synthetic Asset) Transactions Open as of December of Current Year Replication (Synthetic Asset) Transactions Components of the Replication (Synthetic Asset) Transactions Derivative Instrument(s) Open Cash Instrument(s) Held NAIC NAIC Designation or Book/Adjusted Book/Adjusted Designation or Other Notional Carrying Effective Maturity Carrying Other Description Description Amount Value Fair Value Date Date Description Value Fair Value CUSIP Description Description 5 Book/Adjusted Carrying Value 6 Fair Value NONE SI Totals XXX XXX XXX XXX XXX XXX

134 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE DB - PART C - SECTION Replication (Synthetic Asset) Transactions Open Number of Positions First Quarter Second Quarter Third Quarter Fourth Quarter Year To Date Total Replication Total Replication Total Replication Total Replication (Synthetic Asset) Number (Synthetic Asset) Number (Synthetic Asset) Number (Synthetic Asset) Number Transactions of Transactions of Transactions of Transactions of Statement Value Positions Statement Value Positions Statement Value Positions Statement Value Positions 0 Total Replication (Synthetic Asset) Transactions Statement Value. Beginning Inventory. Add: Opened or Acquired Transactions. Add: Increases in Replication (Synthetic Asset) Transactions Statement Value XXX XXX XXX XXX XXX 4. Less: Closed or Disposed of Transactions 5. Less: Positions Disposed of for Failing Effectiveness Criteria SI 6. Less: Decreases in Replication (Synthetic Asset) Transactions Statement Value XXX XXX XXX XXX XXX 7. Ending Inventory

135 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE DB - VERIFICATION Verification of Book/Adjusted Carrying Value, Fair Value and Potential Exposure of all Open Derivative Contracts Book/Adjusted Carrying Value Check. Part A, Section, Column 4. Part B, Section, Column 5 plus Part B, Section Footnote - Total Ending Cash Balance. Total (Line plus Line ) 4. Part D, Section, Column 5 5. Part D, Section, Column 6 6. Total (Line minus Line 4 minus Line 5) Fair Value Check 7. Part A, Section, Column 6 8. Part B, Section, Column 9. Total (Line 7 plus Line 8) 0. Part D, Section, Column 8. Part D, Section, Column 9 Total (Line 9 minus Line 0 minus Line ) Potential Exposure Check. Part A, Section, Column 4. Part B, Section, Column 0 5. Part D, Section, Column 6. Total (Line plus Line 4 minus Line 5) SI4

136 ANNUAL STATEMENT FOR THE YEAR 0 OF THE SCHEDULE E - VERIFICATION BETWEEN YEARS (Cash Equivalents) Total Bonds Other (a). Book/adjusted carrying value, December of prior year. Cost of cash equivalents acquired. Accrual of discount 4. Unrealized valuation increase (decrease) 5. Total gain (loss) on disposals 6. Deduct consideration received on disposals 7. Deduct amortization of premium 8. Total foreign exchange change in book/adjusted carrying value 9. Deduct current year s other than temporary impairment recognized 0. Book/adjusted carrying value at end of current period (Lines ). Deduct total nonadmitted amounts. Statement value at end of current period (Line 0 minus Line ) (a) Indicate the category of such assets, for example, joint ventures, transportation equipment: SI5