blanks (e) working groupcontent.naic.org/sites/default/files/call_materials/bwg 5.28.2020...

© 2020 National Association of Insurance Commissioners 1

Date: 5/15/20

Conference Call

BLANKS (E) WORKING GROUP Thursday, May 28, 2020 11:00 a.m. – 12:00 p.m.

ROLL CALL

Jake Garn, Chair Utah Patricia Gosselin New Hampshire Kim Hudson, Vice Chair California John Sirovetz New Jersey Jeffery Bethel Alaska Tracy Snow Ohio William Arfanis Connecticut Diane Carter Oklahoma Dave Lonchar Delaware Ryan Keeling Oregon N. Kevin Brown District of Columbia Joe DiMemmo Pennsylvania Carolyn Morgan Florida Trey Hancock Tennessee Roy Eft Indiana Shawn Frederick Texas Daniel Mathis Iowa Steve Drutz Washington Dan Schaefer Michigan Jamie Taylor West Virginia Debbie Doggett Missouri Randy Milquet Wisconsin Lindsay Crawford/Justin Schrader Nebraska NAIC Support Staff: Mary Caswell/Calvin Ferguson/Julie Gann

AGENDA

1. Consider Adoption of its Dec. 17, 2019, Minutes—Jake Garn (UT) Attachment A

2. Discuss Items Previously Exposed—Jake Garn (UT)

a) 2019-25BWG Modified – Modify the instructions for Column 10 (Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement) removing the instructions to exclude adjusting and other reserves from the column and add instructions to include those reserves with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

Attachment B

b) 2019-28BWG – Modify the instructions for Supplemental Investment Risk Interrogatories

Lines 13.02 through 13.11 clarifying when to identify the actual equity interests within a fund and aggregate those equity interests for determination of the ten largest equity interests.

Attachment C

c) 2019-29BWG – Modify the instructions and blank for Supplemental Investment Risk Interrogatories Question 14.01.

Attachment D

d) 2019-30BWG Modified – Add a category and instructions for Reciprocal Jurisdiction

Companies in Schedule S for the life/fraternal and health blanks and to Schedule F for the property and title blanks. Add a list of identification numbers in the instructions of Schedule Y, Part 1A; Schedule Y, Part 2; and Schedule D, Part 6, Section 1 for Reciprocal Jurisdiction Companies. Add a reference to Reciprocal Jurisdiction Companies in the Trusteed Surplus Statement instructions for life/fraternal, health and property statements.

Attachment E

e) 2020-01BWG – Add crosschecks to Lines 13 and 14 of the Exhibit of Premiums, Enrollment

and Utilization (State Page) to Lines 10 and 11 of the Underwriting and Investment Exhibit, Part 1 in the health blank. Add crosschecks to Lines 9, 10 and 11 of the Underwriting and Investment Exhibit, Part 1 and Schedule T, Line 61.

Attachment F


f) 2020-02BWG Modified – Modify the instructions and illustration for Note 10L to reflect the

disclosure changes for SSAP No. 97—Investments in Subsidiary, Controlled, and Affiliated Entities being adopted by the Statutory Accounting Principles (E) Working Group.

Attachment G

g) 2020-03BWG Modified – Modify the instructions and illustration for 13(11) to the Notes to

Financial Statement. Change the numbering from 1 through 13 to A through M to reflect the disclosure addition for SSAP No. 41R—Surplus Notes being adopted by the Statutory Accounting Principles (E) Working Group (SAPWG 2019-37).

Attachment H

h) 2020-04BWG – Modify the instructions and illustration for Note 23A – Unsecured Reinsurance Recoverables to reflect the disclosure addition for SSAP No. 62R—Property and Casualty Reinsurance adopted by the Statutory Accounting Principles (E) Working Group (SAPWG 2019-48).

Attachment I

i) 2020-05BWG Modified – Modify the instructions and illustration for Note 2 – Accounting Changes and Correction of Errors to reflect the disclosure addition for SSAP No. 3—Accounting Changes and Corrections of Errors and SSAP No. 51R—Life Contracts being adopted by the Statutory Accounting Principles (E) Working Group (SAPWG 2019-47).

Attachment J

j) 2020-06BWG Modified – Modify the instruction and illustration for Note 19 on MGAs and TPAs to reflect the disclosure addition for SSAP No. 51RLife Contracts, SSAP No. 53—Property Casualty Contracts—Premiums, SSAP No. 54R—Individual and Group Accident and Health Contracts, and SSAP No. 59—Credit Life and Accident and Health Insurance Contracts being adopted by the Statutory Accounting Principles (E) Working Group (SAPWG 2019-36).

Attachment K

k) 2020-07BWG – Add new disclosure Note 23 – Reinsurance for reinsurance credit (23H – Life/Fraternal, 23E Health and 23K Property) to reflect the disclosure additions for SSAP No. 61R—Life, Deposit-Type Contracts and Accident and Health Contracts Reinsurance adopted by the Statutory Accounting Principles (E) Working Group.

Attachment L

l) 2020-08BWG Modified – Add a disclosure instruction for 10C to the Notes to Financial Statement for related party transactions not captured on Schedule Y to reflect the disclosure addition for SSAP No. 25—Affiliates and Other Related Parties adopted by the Statutory Accounting Principles (E) Working Group (SAPWG 2019-33). Combine existing 10C into 1B instructions and illustration narrative.

Attachment M

m) 2020-09BWG – Modify the Annual Statement Instructions for Schedule F, Part 3 to reflect the

factors for all uncollateralized reinsurance recoverable from unrated reinsurers be the same for authorized, unauthorized, certified, and reciprocal reinsurance.

Attachment N

n) 2020-10BWG – Revise the column 10 header in the Variables Annuities Supplement blank to

be Contract Level Reserves Less Cash Surrender Value. Revise the line descriptions in Lines 1 through 3 in the footer and add a line for the Reserve Credit from Other Reinsurance and for Post-Reinsurance Ceded Aggregate Reserve. Adjust the instructions to correspond with changes made to the blanks as well as changes in the 2020 Valuation Manual for the new Variable Annuities Framework.

Attachment O

o) 2020-11BWG – For the VM-20 Reserves Supplement Blank, split Part 1 into Part 1A and Part

1B. For Part 1A: change the description header for column 3 to “Due and Deferred Premium Asset” to match the instructions. Add “XXX” in the two places needed to indicate that a due and deferred premium asset does not need to be reported in the lines shown for Total Reserves. Change the reporting units for all columns to be in dollars rather than in thousands. Expand all columns to allow room for a number as large as 999,999,999,999. Change the product labels for clarity. For Part 1B: change the reporting units for the reserve columns to be in dollars rather than in thousands. Expand the reserve columns to allow room for a number as large as 999,999,999,999. Expand the face amount columns to allow room for a number as large as

Attachment P


9,999,999,999. Change the product labels for clarity. Remove Part 2 and re-number the remaining Parts. Adjust the instructions according to the changes made to the blanks. Clarify instructions and add examples for Parts 1A and 1B.

p) 2020-12BWG – The proposal will require appointed actuaries to attest to meeting Continuing

Education (CE) requirements and participate in the CAS/SOA CE review procedures, if requested. These proposed changes were adopted by the Task Force on Jan. 28, 2020.

Attachment Q

q) 2020-13BWG Modified – Remove Line 24.04 from the General Interrogatories, Part 1 and renumber remaining lines for Interrogatory Question 24. Modify Lines 24.05 and 24.06 to require reporting amounts for conforming and non-conforming collateral programs.

Attachment R

r) 2020-14BWG Modified – Modify the columns and rows on the blank pages for the Long-Term

Care Experience Reporting Forms 1 through 5 and make appropriate changes to the instructions for those forms.

Attachment S

s) 2020-15BWG Modified – A new Private Flood Insurance Supplement collecting residential

and commercial private flood insurance data and revisions to the Credit Insurance Experience Exhibit (CIEE) to collect lender-placed flood coverages.

Attachment T

t) 2020-16BWG Modified – Modify Questions 3.1 and 3.2 of General Interrogatories Part 2 and

provide instructions for the questions. Attachment U

u) 2020-17BWG – Adjust the AVR presentation to include separate lines for each of the expanded

bond designation categories. Attachment V

v) 2020-18BWG Modified – Clarify the instructions to indicate which funds reported on Schedule

D, Part 2, Section 2 (annual filing) and Schedules D, Part 3 and 4 (quarterly filing) must have an NAIC Designation, NAIC Designation Modifier, and SVO Administrative Symbol. Modify the reference to the Purposes and Procedures Manual of the NAIC Investment Analysis Office found in the following investment instructions.

Attachment W

w) 2020-19BWG Modified – Add a code of “%” to the code column for all investments which

have been reported Schedule DA, Part 1 and Schedule E, Part 2 for more than one consecutive year. Add certification to the General Interrogatories, Part 1 inclusion of these investments on Schedule DA, Part 1 and Schedule E, Part 2 (SAPWG 2019-20).

Attachment X

x) 2020-20BWG Modified – For Schedule D, Part 1, add code “10” to Column 26 – Collateral

Type for ground lease financing. Renumber “Other” code to “11”. Attachment Y

y) 2020-21BWG Modified – Add new Line 4.05 for valuation allowance for mortgage loans to

the Summary Investment Schedule and renumber existing Line 4.05 to 4.06. Modify the instructions to include a crosscheck for new Line 4.05 back to Schedule B – Verification Between years. Clarify the instructions for 4.01-4.04 to explicitly show crosschecking to Column 8 of Schedule B, Part 1.

Attachment Z

z) 2020-22BWG Modified – Modify the instructions and illustration for Note 3A and a new Note

3E with instructions and illustrations to be data captured. Modify the blank and instructions for Schedule D, Part 6, Sections 1 and 2 (SAPWG 2020-03).

Attachment AA

aa) 2020-23BWG Modified – Add footnote to Exhibit 5 (life/fraternal & health – life supplement)

and Exhibit 3 separate accounts to disclose cases when a mortality risk is no longer present or a significant factor – i.e. due to a policyholder electing a payout benefit (SAPWG 2019-08).

Attachment BB


w:\qa\blanksproposals\web postings\2020-05\1-before meeting\01 preliminary agenda\bwg 5.28.2020 agenda.docx

3. Discuss New Items—Jake Garn (UT)

a) 2020-24BWG – Remove questions 29, 30, 31 and 32 from the Supplemental Exhibits and Schedules Interrogatories. Renumber the remaining questions.

Attachment CC

b) 2020-25BWG – Add a new Column 5 to the blank for Schedule T with instructions to

specifically capture the CHIP premium. Existing columns after the new Column 5 will be renumbered.

Attachment DD

c) 2020-26BWG – Add a new Column 5 to Schedule DB, Part D, Section 1 and renumber the remining columns. Add instruction for the new Column 5, add the column reference to Column 7, and adjust other column references in crosschecks. Correct column references for this schedule on the Liability Page, Asset Page and Schedule DB Verification. Modify instruction language for the disclosure Note 8A(8).

Attachment EE

4. Consider Adoption of Editorial Listing—Jake Garn (UT) Attachment FF

5. Discuss Any Other Matters Brought Before the Working Group—Jake Garn (UT)

a) Electronic Blanks and Instructions Publications

6. Adjournment The following documents are being provided as reference materials: Summary of Comment Letters Attachment GG Comment Letters Attachment HH

Attachment A


Draft: 1/3/20 Blanks (E) Working Group

Conference Call December 17, 2019

The Blanks (E) Working Group of the Accounting Practices and Procedures (E) Task Force met via conference call Dec. 17, 2019. The following Working Group members participated: Jake Garn, Chair (UT); Kim Hudson, Vice Chair (CA); William Arfanis (CT); N. Kevin Brown (DC); Adrienne Lupo (DE); Virginia Christy, Carolyn Morgan and Jason Reynolds (FL); Carrie Mears and Daniel Mathis (IA); Roy Eft (IN); Dan Schaefer (MI); Debbie Doggett (MO); Justin Schrader (NE); Patricia Gosselin (NH); John Sirovetz (NJ); Dale Bruggeman and Tracy Snow (OH); Eli Snowbarger and Joel Sander (OK); Joe DiMemmo (PA); Trey Hancock and Hui Wattanaskolpant (TN); Shawn Frederick (TX); Steve Drutz (WA); Randy Milquet (WI); and Jamie Taylor (WV). 1. Adopted its Oct. 22 Minutes Mr. Eft made a motion, seconded by Mr. Sander, to adopt the Working Group’s Oct. 22 minutes (see NAIC Proceedings – Fall 2019, Accounting Practices and Procedures (E)_Task Force, Attachment Two). The motion passed unanimously. 2. Adopted Items Previously Exposed

a. Add Instructions and Crosschecks for Line 34 on the Analysis of Operations by Lines of Business – Summary. Add

Instructions for Column 5 – Indexed Life on the Analysis of Operations by Lines of Business – Individual Life. Add Clarifying Instructions to the Analysis of Operations by Lines of Business for Individual Life and Group Life Regarding Reporting Consistent with Policy Type Language in the Contract and Reporting of Policies Issued with Secondary Guarantees That Have Expired (2019-26BWG) Effective Dec. 31, 2020

Mr. Schrader stated that this proposal adds clarifying instructions to address questions that have been received regarding the new Analysis of Operations by Lines of Business on the life and health blank. The proposal adds instructions and crosschecks for line 34 on the Analysis of Operations by Lines of Business – Summary. It adds instructions for column 5 for indexed life on the Analysis of Operations by Lines of Business for individual life. It adds clarifying instructions to the Analysis of Operations by Lines of Business for individual life and group life, indicating that the reporting should be consistent with policy type language in the contract and the reporting of policies issued with secondary guarantees that have expired. Mr. Schrader stated that interested parties have some concerns with crosscheck references which have been addressed and highlighted as modifications within the proposal. Mr. Schrader made a motion, seconded by Mr. Eft, to adopt the modifications to the proposal. The motion passed unanimously. Mr. Schrader made a motion, seconded by Mr. Snow, to adopt the modified proposal (Attachment 1). The motion passed unanimously. Connie Jasper Woodroof (Sapiens) requested that the adopted proposal language be posted on the Blanks (E) Working Group web page as guidance to assist the life, accident & health/fraternal blank filers with the 2019 annual statement reporting of the Analysis of Operations by Lines of Business. The Working Group members agreed to posting the guidance document.

b. Remove the Alphabetic Index from Inclusion at the Back of the Annual Statement Blank, Instructions, and Blanks (E) Working Group Web page (2019-27BWG) Effective Dec. 31, 2020

Mr. Hudson stated that this proposal requests the removal of the alphabetic index from inclusion at the back of the annual statement blank, instructions, and the Blanks (E) Working Group web page. Interested parties indicated that the alphabetic index reference should be deleted from the vendor electronic filing submission directive. Staff will make those changes when updating the directive for the 2019 filing period. The Working Group does not need to take an action on that change. Mr. Hudson made a motion, seconded by Ms. Gosselin, to adopt the proposal (Attachment 2). The motion passed unanimously. 3. Exposed its Procedures Mr. Garn stated that there have been changes incorporated into the procedures document and even more recent changes related to dates and timing. For example, moving the final adoption date to June 1 rather than “June” or what may have been presumed to be June 30. The proposed procedures include a deadline of April 15 for exposure of proposals with an annual statement effective date. Mary Caswell (NAIC) stated that one recent suggested change was to change the word “may” to “can be technically” in the “subsequent requests” paragraph. The sentence would read, “[a]ny proposal which includes data capture

Attachment A


elements will be evaluated individually as to whether the data capture can be technically accommodated in that year.” Mr. Bruggeman stated that he agreed with designating specific dates for exposures and adoptions. He also said allowing for exceptions if technically possible makes it easier to understand the timing. John Bauer (Prudential Financial) agrees with the change of “can be technically” language to be incorporated as indicated. Mr. Hudson made a motion, seconded by Mr. DiMemmo, to adopt the procedures with the minor word modifications as indicated. The motion passed unanimously. Mr. Garn stated that interested parties had requested one in-person meeting to be held. Since the procedures reference “meetings,” there is no need to specifically reference “in-person” or a specific time period for that meeting in the procedures document. The 2020 Spring National Meeting has been suggested for an in-person meeting. The Meetings Department will perform the scheduling and avoid conflicts with any Financial Condition (E) Committee, Financial Regulation Standards and Accreditation (F) Committee, or International Insurance Relations (G) Committee groups. 4. Exposed Proposals

a. Modify the Instructions for Column 10, Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-Out Supplement, Removing Instruction to Exclude Adjusting Other Reserves from the Column. Add Instructions to Include Those with the Defense and Cost Containment Reserves. Add a New Instruction for Column 12 for the Same Schedules. Add Crosschecks to Schedule P, Part 1 (2019-25BWG)

Mr. Snow stated that this proposal modifies the instructions for Column 10, Schedule F, Part 3 – Property and the Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement, removing instructions to exclude adjusting and other reserves from the column. It adds instructions to include those with the defense and cost containment reserves. It adds a new instruction for Column 12 for the same schedules. It adds crosschecks to Schedule P, Part 1. Mr. Snow stated that interested parties had a minor modification to add the word “and” that was missing from the reference to “adjusting and other.” Mr. Snow stated that interested parties also ask for a wording clarification to address companies that might fail crosschecks because of pooling arrangements. Since the proposal is not effective until the annual 2020 filing, there is time to clarify the language and re-expose the proposal. Mr. Snow made a motion, seconded by Mr. Drutz, to re-expose the proposal with the minor modification adding the word “and,” as well as adding clarifying crosscheck language to address companies involved in pooling. The motion passed unanimously. Mr. Bauer expressed support for re-exposing the proposal with the clarifying language to address the application of crosschecks for companies involved in pooling. Ms. Caswell stated that, with the approval of the Working Group, staff could add language to the crosscheck reference to indicate that it “does not apply to companies with inter-company pooling participation arrangements having amounts reported in Sch P, Part 1, Column 34.” Staff would set up the crosscheck to test any crosscheck failures to see if amounts are recorded in the pooling column of Schedule P, Part 1, Column 34 and pass the crosscheck. It would be set up like an “if-then” statement test.

b. Modify the Instruction for SIRI Lines 13.02 Through 13.11 Clarifying When to Identify the Actual Equity Interests Within a Fund and Aggregate Those Equity Interests for Determination of the Ten Largest Equity Interests (2019-28BWG)

Mr. Bruggeman stated that the purpose of this proposal is to clarify when to identify the actual equity interests within a fund like an exchange-traded fund (ETF) or a mutual fund and aggregate those equity interests for determination of the 10 largest equity interests. The proposal modifies the instruction for Supplemental Investment Risk Interrogatories (SIRI) lines 13.02 through 13.11. The Statutory Accounting Principles (E) Working Group adopted this application at the 2019 Fall National Meeting. This proposal has an annual 2020 effective date. The clarification indicates that the company must look through a non-diversified fund to aggregate exposures in the top 10 equity interest, but a look through is not required with diversified funds. Hearing no state insurance regulator objection, the proposal was exposed for a public comment period ending Feb. 21, 2020.

c. Modify the Instruction and Blank for Supplemental Investment Risk Interrogatories Question 14.01 (2019-29BWG) Mr. Bruggeman stated that this proposal is to clarify that interrogatories 14.06 through 14.15 in the blank are to be completed regardless of the answer to SIRI question 14.01. This item was adopted by the Statutory Accounting Principles (E) Working Group at the 2019 Spring National Meeting and adopted by the Blanks (E) Working Group. This proposal is a clarification of that previous proposal. Hearing no objection, the proposal was exposed for a public comment period ending Feb. 21, 2020.

Attachment A


d. Add a Category and Instructions for Reciprocal Jurisdiction Companies in Schedule S for the Life/Fraternal and Health

Blanks and Schedule F for the Property and Title Blanks. Add a List of Identification Numbers in Instruction to Schedule Y, Part 1A; Schedule Y, Part 2; and Schedule D, Part 6, Section 1 for Reciprocal Jurisdiction Companies. Add a Reference to Reciprocal Jurisdiction Companies in the Trusteed Surplus Statement Instructions for Life/Fraternal, Health and Property Statements (2019-30BWG)

Jake Stultz (NAIC) stated that this proposal relates to work of the Reinsurance (E) Task Force with regards to the “Bilateral Agreement Between the United States of America and the European Union on Prudential Measures Regarding Insurance and Reinsurance” (Covered Agreement) and the creation of a reciprocal jurisdiction. The intent of this proposal is to set up annual reporting blanks to allow companies to report reinsurance with reciprocal jurisdiction reinsurers as soon as the states enact the 2019 revisions to the Credit for Reinsurance Model Law (#785) and the Credit for Reinsurance Model Regulation (#786). This is similar to the process used to implement the certified reinsurer provision in 2011. The Reinsurance (E) Task Force exposed this change during the 2019 Fall National Meeting for a concurrent exposure with the Blanks (E) Working Group. Hearing no objection, the proposal was exposed for a public comment period ending Feb. 21, 2020. 5. Adopted the Editorial Listing Mr. Hudson made a motion, seconded by Mr. Snow, to adopt the editorial listing (Attachment 3). The motion passed unanimously. Having no further business, the Blanks (E) Working Group adjourned. w:\national meetings\2020\spring\tf\app\blankswg\bwg 12.17.19 minutes.docx

This page intentionally left blank.

© 2020 National Association of Insurance Commissioners 2019-25BWG_Modified.doc 1

NAIC BLANKS (E) WORKING GROUP

Blanks Agenda Item Submission Form

DATE: 09/24/2019

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:

NAME: Tracy Snow

TITLE: Chief, Captive Insurance

AFFILIATION: Ohio Department of Insurance

ADDRESS: 50 W Town St, 3rd Fl, Ste 300

Columbus, OH 43215

FOR NAIC USE ONLY Agenda Item # 2019-25BWG MOD Year 2020Changes to Existing Reporting [ X ] New Reporting Requirement [ ]

REVIEWED FOR ACCOUNTING PRACTICES AND PROCEDURES IMPACT

No Impact [ X ] Modifies Required Disclosure [ ]

DISPOSITION

[ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ X ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)

BLANK(S) TO WHICH PROPOSAL APPLIES

[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)

Anticipated Effective Date: Annual 2020

IDENTIFICATION OF ITEM(S) TO CHANGE

Modify the instruction for Column 10 (Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement) to remove instruction to exclude adjusting and other reserves from the column and add instruction include along with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE**

The purpose of this proposal is ensure adjusting other and defense and cost containment reserves are reported properly as Known Case LAE Reserves or IBNR LAE Reserves.

NAIC STAFF COMMENTS

Comment on Effective Reporting Date:

Other Comments:

___________________________________________________________________________________________________ ** This section must be completed on all forms. Revised 7/18/2018

Attachment B


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY

SCHEDULE F – PART 3

CEDED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR

Detail Eliminated to Conserve Space

Column 9 – Known Case Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 2A, Line 35, Column 3.

Column 10 – Known Case LAE Reserves

Include: Defense and Cost Containment from Schedule P, Part 1, Columns 18

Adjusting and Other from Schedule P, Part 1, Column 22, in part

The sum of Schedule F, Part 3, Columns 10 and 12 should equal the sum of Schedule P, Part 1, Columns 18, 20 and 22. (Note: This crosscheck doesn’t apply to those companies participating in inter-company pooling participation arrangements where the participation percentage in Schedule P, Part 1, Column 34 is not equal to zero.)

Exclude: Adjusting & Other Expense Reserves.

Column 11 – IBNR Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 2A, Line 35, Column 7.

Column 12 – IBNR LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part Column 13 – Unearned Premiums

Total multiplied by 1000 should equal Page 3, Line 9 parenthetical amount.


Attachment B


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL

WORKERS’ COMPENSATION CARVE-OUT SUPPLEMENT



CEDED REINSURANCE


Column 9 – Known Case Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 4, Column 2. Column 10 – Known Case LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part

The sum of Schedule F, Part 2, Columns 10 and 12 should equal the sum of Schedule P, Part 1, Columns 18, 20 and 22. (Note: This crosscheck doesn’t apply to those companies participating in inter-company pooling participation arrangements where participation the percentage in Schedule P, Part 1, Column 34 is not equal to zero.)

Exclude: Adjusting and other Expense reserves.

Column 11 – IBNR Loss Reserves

Total multiplied by 1000 should agree with Underwriting and Investment Exhibit, Part 4, Column 5. Column 12 – IBNR LAE Reserves


Adjusting and Other from Schedule P, Part 1, Column 22, in part Column 14 – Contingent Commissions

Include: Contingent commissions receivable from a reinsurer. Regular commissions should be netted with ceded balances payable in Column 16.


W:\QA\BlanksProposals\2019-25BWG_Modified.doc

Attachment B



Attachment B

© 2020 National Association of Insurance Commissioners 2019-28BWG.doc 1



DATE: 11/12/2019

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:

NAME: Dale Bruggeman

TITLE: Chair SAPWG


ADDRESS: 50W. Town St., 3rd Fl., Ste. 300

Columbus, OH 43215

FOR NAIC USE ONLY Agenda Item # 2019-28BWG Year 2020Changes to Existing Reporting [ X ] New Reporting Requirement [ ]



DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)



Modify the instruction for Supplemental Investment Risk Interrogatories Lines 13.02 through 13.11 clarifying when to identify the actual equity interests within a fund and aggregate those equity interests for determination of the ten largest equity interests.


The purpose of this proposal is to clarify when reporting entities are required to identify actual equity interests within a fund and aggregate those equity interests to determine their ten largest equity interests.

NAIC STAFF COMMENTS


Other Comments:


Attachment C


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES


Line 13.02 through 13.11 – Report the amounts and percentages of admitted assets held in the ten largest equity interests

(including equity funds that qualify individually as one of the largest equity interests and a look-through of investments in the shares of non-diversified mutual funds and ETFs, preferred stocks, publicly traded equity securities, and other equity securities (including Schedule BA equity interests), and excluding money market and bond mutual funds listed in Part Six, Sections 2(f) and (g) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office as exempt or NAIC 1). Equity interests in all funds that are diversified in accordance with the Investment Company Act of 1940 do not need to be individually assessed and aggregated to determine the ten largest equity interests. For funds that are not diversified within the meaning of the Investment Company Act of 1940, insurance reporting entities are required to identify actual equity interests within the fund and aggregate those equity interests to determine their ten largest equity interests.

Determine the ten largest equity interests by first aggregating investments included in this line by issuer. For example, the reporting entity owns preferred stock of the XYZ Company of $600,000, and common stock of the XYZ Company of $300,000 and $50,000 of XYZ identified through a look-through of a non-diversified stock closed-end fund reported on Schedule D-2-2. The total is $9500,000 ($600,000+$300,000+50,000). The reporting entity also owns bonds issued by the XYZ Company of $500,000 that are excluded from this calculation because bonds are debt instruments. The reporting entity may also have exposure to equity interests in XYZ through mutual funds that are excluded from this calculation as the funds are diversified within the meaning of the Investment Company Act of 1940. Other equity securities include partnerships and Limited Liability Companies (LLC) and any other investments reported in Schedule BA classified as equity.

The following funds shall also be excluded from aggregation as equity interests: SVO-Identified U.S. Direct Obligations / Full Faith And Credit Exempt List of Money Market Mutual Funds, SVO-Identified Bond ETFs, SVO-Identified Bond Mutual Funds and SVO Identified fund investments with underlying characteristics of fixed-income instruments, which do not contain underlying equities and that are outlined within the Purposes and Procedures Manual of the NAIC Investment Analysis Office.


W:\QA\BlanksProposals\2019-28BWG.doc

Attachment C




DATE: 11/12/2019

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION







Modify the instruction and blank for Supplemental Investment Risk Interrogatories Question 14.01.


The purpose of this proposal is to clarify that Interrogatories 14.06 through 14.15 are to be completed regardless of the answer to Supplemental Investment Risk Interrogatories Question 14.01.

NAIC STAFF COMMENTS


Other Comments:


Attachment D





Line 14.06 through 14.15 – These lines should be completed even if the answer to Question 14.01 is “YES.”

Report the investments held in the ten largest fund managers, with allocation between funds that are diversified or non-diversified in accordance with the meaning of the Investment Company Act of 1940. This should include all “funds” regardless of the type of fund (private placement, mutual fund, exchange-traded fund, closed-end fund, money market mutual fund, etc), reporting schedule or underlying investments captured in a fund.


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

SUPPLEMENTAL INVESTMENT RISKS INTERROGATORIES For The Year Ended December 31, 2019

(To Be Filed by April 1)


14. Amounts and percentages of the reporting entity’s total admitted assets held in nonaffiliated, privately placed equities:

14.01 Are assets held in nonaffiliated, privately placed equities less than 2.5% of the reporting entity’s total admitted assets?

Yes [ ] No [ ]

If response to 14.01 above is yes, responses are not required for 14.02 through 14.05 the remainder of Interrogatory 14.



Attachment D




DATE: 11/14/2019

CONTACT PERSON: Jake Stultz

TELEPHONE: 816-783-8481

EMAIL ADDRESS: [email protected]

ON BEHALF OF:

NAME: Chlora Lindley-Myers

TITLE: Chair, Reinsurance (E) Task Force

AFFILIATION:

ADDRESS:




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ X ] Health (Life Supplement)



See next page for details.


See next page for details

NAIC STAFF COMMENTS


Other Comments:


Attachment E


REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE

On June 25, 2019, NAIC Executive (EX) Committee and Plenary adopted revisions to the Credit for Reinsurance Model Law (#785) and the Credit for Reinsurance Model Regulation (#786) to incorporate the relevant provisions from the “Bilateral Agreement Between the United States of America and the European Union on Prudential Measures Regarding Insurance and Reinsurance” (Covered Agreement). Under the revisions, credit for reinsurance is allowed for domestic ceding insurers for reinsurance that has been ceded to reinsurers from Reciprocal Jurisdictions, and that those reinsurers are not required to post collateral. As a result, it is necessary to consider revisions to the appropriate reinsurance schedules and instructions in order to collect the relevant information with respect to these reinsurance transactions.


Annual Statement Instructions

Life/Fraternal and Health

Schedule S General Instructions

Modify instructions to include section on numbers for Reciprocal Jurisdiction Companies.

Modify note on applying Reciprocal Jurisdiction.

Add Reciprocal Jurisdiction to the instruction for determining status.

Reference in certified reinsurer number paragraph.

Schedule S, Part 1, Section 1

Add Reciprocal Jurisdiction to list of type of reinsurers for Column 2.



Schedule S, Part 2



Add category lines for Reciprocal Jurisdiction Companies.





Schedule S, Part 4


Schedule S, Part 5


Life/Fraternal

Workers’ Compensation Cave-out Supplement

Schedule F General Instructions





Schedule F, Part 1


Attachment E


Schedule F, Part 2


Supplemental term and Universal Life Insurance Reinsurance Exhibit

Part 1


Part 2A


Part 2B


Trusteed Surplus Statement

Add instructions for Line 4.4 Reciprocal Jurisdiction Companies

Property






Schedule F, Part 1


Schedule F, Part 2


Schedule F, Part 3



Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 28 through 36.

Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 71 and 72.

Modify category lines references for the list of lines for Reciprocal Jurisdiction Companies for Columns 73 and 74.

Supplemental Schedule for Reinsurance Counterparty Reporting Acceptations – Asbestos and Pollution Contracts


Add Reciprocal Jurisdiction to list of type of reinsurers for Columns 1 and 5.

Notes to Financial Statement 23F(1)f

Add section to illustration for Reciprocal Jurisdiction Companies



Attachment E


Title






Schedule F, Part 1


Schedule F, Part 2



Schedule F, Part 3


Schedule F, Part 4


Operations and Investments Exhibit – Part 2B

For Line 2 remove the references to authorized, unauthorized and certified. Line is for all types of reinsurers sot specifying is not needed.

Notes to Financial Statement 23F(1)f

Add section to illustration for Reciprocal Jurisdiction Companies

Life/Fraternal, Health, Property, Title

Schedule Y, Part 1A

Add Reciprocal Jurisdiction to the list of ID numbers provided in Column 4

Schedule Y, Part 2


Schedule D, Part 6, Section 1


Quarterly Statement Instructions




Property



Attachment E



Schedule S


Modify instructions to include section on numbers for Reciprocal Jurisdiction Companies

Property and Title

Schedule F



Life/Fraternal, Health, Property, Title

Schedule Y, Part 1A

Add Reciprocal Jurisdiction to the list of ID numbers provided in Column 4.

Annual Statement Blank

Property

Schedule F, Part 3

Add the word Reciprocal Jurisdiction to the column descriptions for Columns 73, 74, and 75.

Title

Operations and Investments Exhibit – Part 2B

For Line 2 remove the references to authorized, unauthorized and certified. Line is for all types of reinsurers sot specifying is not needed.

Life/Fraternal and Property


Add Line 7.4 for Reciprocal Jurisdiction Companies

Quarterly Statement Blank

Life/Fraternal and Property


Add Line 7.4 for Reciprocal Jurisdiction Companies

Attachment E


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL AND HEALTH (INCLUDES HEALTH LIFE SUPPLEMENT)

SCHEDULE S – REINSURANCE These parts (except Part 1, which shows reinsurance assumed) provide an analysis by reinsurance carrier of reinsurance ceded data shown in total in various parts of the statement. Information is included on all reinsurance ceded to other entities authorized as well as unauthorized or certified in the state of domicile of the reporting entity. Additional data for unauthorized companies is displayed in Part 4; additional data for certified reinsurers is displayed in Part 5. NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule S. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for reciprocal jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Effective date as used in this schedule is the date the contract originally went into effect.


Index to Schedule S

Part 1, Section 1 – Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits

Part 1, Section 2 – Reinsurance Assumed Accident and Health Insurance

Part 2 – Reinsurance Recoverable on Paid and Unpaid Losses

Part 3, Section 1 – Reinsurance Ceded Life Insurance, Annuities, Deposit Funds and Other Liabilities Without Life or Disability Contingencies, and Related Benefits

Part 3, Section 2 – Reinsurance Ceded Accident and Health Insurance

Part 4 – Reinsurance Ceded to Unauthorized Companies

Part 5 – Reinsurance Ceded to Certified Reinsurers

Part 6 – Five-Year Exhibit of Reinsurance Ceded Business

Part 7 – Restatement of Balance Sheet to Identify Net Credit for Ceded Reinsurance ID Number

Most parts of Schedule S require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not to be listed, because Schedule S is intended to identify the risk-bearing entities.

A ceding insurer can have unauthorized reinsurance, certified reinsurance and reciprocal jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for reciprocal jurisdiction reinsurance.

Attachment E


Use of Federal Employer Identification Number

The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “ID Number” for other alien insurers even if the federal government has issued such a number.

Alien Insurer Identification Number (AIIN)

In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule S instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.

Newly assigned numbers are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC also provides this information to annual statement software vendors for incorporation into the software.

Pool and Association Numbers

In order to report transactions involving non-risk bearing pools or associations consisting of nonaffiliated companies correctly, the company must include on Schedule S the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Certified Reinsurer Identification Number (CRIN)

In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule S instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Reciprocal Jurisdiction Reinsurer Identification Number (RJIN)

In order to report transactions involving reciprocal jurisdiction reinsurers correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN, AIIN or CRIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment E


**************************************************

For 2020 Reporting Only Reinsurers that have met the requirements for reciprocal jurisdiction reinsurer status in your state of domicile should be reported in the appropriate reciprocal jurisdiction reinsurer category if the reporting entity has implemented the necessary system and reporting changes for 2020 annual reporting to identify and report those reinsurance transactions in the appropriate reciprocal jurisdiction reinsurer category. If the reporting entity has not been able to make the necessary system and reporting changes for 2020 annual reporting, the reporting entity may report those reinsurance transactions using the authorized reinsurer lines. Any crosschecks the reporting entity fails as a result of reporting reciprocal jurisdiction reinsurers on the authorized reinsurer lines should be explained.

************************************************** NAIC Company Code

Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the “Pool and Association Numbers” section above for details on assignment of Pool/Association Identification Numbers. Risk-bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk-bearing entity (e.g., risk-bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Determination of Authorized Status

The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule S shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment E


SCHEDULE S PART 1 – SECTION 1

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 31, CURRENT YEAR

This section should include data on all reinsurance assumed for life insurance, annuities, deposit fund and other liabilities without life or disability contingencies, and related benefits by reinsured company as of December 31, current year.


Column 2 – ID Number

Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) Certified Reinsurer Identification Number (CRIN) Pool/Association Identification Number


SCHEDULE S PART 1 – SECTION 2

REINSURANCE ASSUMED ACCIDENT AND HEALTH INSURANCE LISTED BY REINSURED COMPANY AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number:






Attachment E


SCHEDULE S PART 2

REINSURANCE RECOVERABLE ON PAID AND UNPAID LOSSES LISTED BY REINSURING COMPANY AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number:






Attachment E


SCHEDULE S PART 3 SECTION 1

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 31, CURRENT YEAR NOTE: This schedule is to include Exhibit 7 cessions. Include actual reinsurance ceded on group cases but exclude

jointly underwritten group contracts. If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number: Group or Category Line Number General Account

Authorized

Affiliates

U.S.

Captive ................................................................................................................ 0199999 Other .................................................................................................................. 0299999 Total .................................................................................................................... 0399999

Non-U.S.


Total Authorized Affiliates ................................................................................................ 0799999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 0899999 Non-U.S. Non-Affiliates .................................................................................................... 0999999 Total Authorized Non-Affiliates ........................................................................................ 1099999

Total General Account Authorized .................................................................................................. 1199999

Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates ............................................................................................ 1899999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 1999999 Non-U.S. Non-Affiliates .................................................................................................... 2099999 Total Unauthorized Non-Affiliates .................................................................................... 2199999

Total General Account Unauthorized ............................................................................................... 2299999

Attachment E


Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates .................................................................................................... 2999999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 3099999 Non-U.S. Non-Affiliates .................................................................................................... 3199999 Total Certified Non-Affiliates ............................................................................................ 3299999

Total General Account Certified .................................................................................................................... 3399999

Reciprocal Jurisdiction

Affiliates

U.S.


Non-U.S.


Total Reciprocal Jurisdiction Affiliates ............................................................................. 4099999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 4199999 Non-U.S. Non-Affiliates .................................................................................................... 4299999 Total Reciprocal Jurisdiction Non-Affiliates ..................................................................... 4399999

Total General Account Reciprocal Jurisdiction .............................................................................................. 4499999

Total General Account Authorized, Reciprocal Jurisdiction, Unauthorized and Certified............... 34999994599999

Separate Accounts

Authorized

Affiliates

U.S.

Captive ................................................................................................... 35999994699999 Other ..................................................................................................... 36999994799999 Total ....................................................................................................... 37999994899999

Non-U.S.


Total Authorized Affiliates .................................................................................. 41999995299999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 42999995399999 Non-U.S. Non-Affiliates ...................................................................................... 43999995499999 Total Authorized Non-Affiliates .......................................................................... 44999995599999

Total Separate Accounts Authorized .................................................................................. 45999995699999

Attachment E


Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates .............................................................................. 52999996399999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 53999996499999 Non-U.S. Non-Affiliates ...................................................................................... 54999996599999 Total Unauthorized Non-Affiliates ...................................................................... 55999996699999

Total Separate Accounts Unauthorized .............................................................................. 56999996799999

Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates ...................................................................................... 63999997499999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 64999997599999 Non-U.S. Non-Affiliates ...................................................................................... 65999997699999 Total Certified Non-Affiliates .............................................................................. 66999997799999

Total Separate Accounts Certified .................................................................................................... 67999997899999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total Separate Accounts Reciprocal Jurisdiction ........................................................................................... 8999999

Total Separate Accounts Authorized, Reciprocal Jurisdiction, Unauthorized and Certified ............ 68999999099999

Attachment E


Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2599999, 3099999, 37999993699999, 42999994199999, 4899999, 5399999, 5999999, 6499999, 7099999, 7599999, 8199999 and 64999998699999) ............................................................................................................................. 69999999199999

Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2899999, 3199999, 40999993999999, 43999994299999, 5199999, 5499999, 6299999, 6599999, 7399999, 7699999, 8499999 and 65999998799999) ............................................................................................................................. 70999999299999

Total (Sum of 3499999 4599999 and 68999999099999) ............................................................................................ 9999999 Column 2 – ID Number




Attachment E


SCHEDULE S PART 3 SECTION 2

REINSURANCE CEDED ACCIDENT AND HEALTH INSURANCE LISTED BY REINSURING COMPANY AS OF DECEMBER 31, CURRENT YEAR

Include actual reinsurance ceded on group cases but exclude jointly underwritten group contracts. If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number: Group or Category Line Number General Account

Authorized

Affiliates

U.S.


Non-U.S.


Total Authorized Affiliates ................................................................................................ 0799999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 0899999 Non-U.S. Non-Affiliates .................................................................................................... 0999999 Total Authorized Non-Affiliates ........................................................................................ 1099999

Total General Account Authorized .................................................................................................. 1199999

Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates ............................................................................................ 1899999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 1999999 Non-U.S. Non-Affiliates .................................................................................................... 2099999 Total Unauthorized Non-Affiliates .................................................................................... 2199999

Total General Account Unauthorized ............................................................................................... 2299999

Attachment E


Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates .................................................................................................... 2999999

Non-Affiliates

U.S. Non-Affiliates ............................................................................................................ 3099999 Non-U.S. Non-Affiliates .................................................................................................... 3199999 Total Certified Non-Affiliates ............................................................................................ 3299999

Total General Account Certified .................................................................................................................... 3399999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total General Account Reciprocal Jurisdiction .............................................................................................. 4499999

Total General Account Authorized, Reciprocal Jurisdiction, Unauthorized and Certified............... 34999994599999

Separate Accounts

Authorized

Affiliates

U.S.


Non-U.S.


Total Authorized Affiliates .................................................................................. 41999995299999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 42999995399999 Non-U.S. Non-Affiliates ...................................................................................... 43999995499999 Total Authorized Non-Affiliates .......................................................................... 44999995599999

Total Separate Accounts Authorized .................................................................................. 45999995699999

Attachment E


Unauthorized

Affiliates

U.S.


Non-U.S.


Total Unauthorized Affiliates .............................................................................. 52999996399999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 53999996499999 Non-U.S. Non-Affiliates ...................................................................................... 54999996599999 Total Unauthorized Non-Affiliates ...................................................................... 55999996699999

Total Separate Accounts Unauthorized .............................................................................. 56999996799999

Certified

Affiliates

U.S.


Non-U.S.


Total Certified Affiliates ...................................................................................... 63999997499999

Non-Affiliates

U.S. Non-Affiliates .............................................................................................. 64999997599999 Non-U.S. Non-Affiliates ...................................................................................... 65999997699999 Total Certified Non-Affiliates .............................................................................. 66999997799999

Total Separate Accounts Certified .................................................................................................... 67999997899999


Affiliates

U.S.


Non-U.S.



Non-Affiliates


Total Separate Accounts Reciprocal Jurisdiction ........................................................................................... 8999999

Total Separate Accounts Authorized, Reciprocal Jurisdiction, Unauthorized and Certified ............ 68999999099999

Attachment E


Total U.S. (Sum of 0399999, 0899999, 1499999, 1999999, 2599999, 3099999, 37999993699999, 42999994199999, 4899999, 5399999, 5999999, 6499999, 7099999, 7599999, 8199999 and 64999998699999) ............................................................................................................................. 69999999199999

Total Non-U.S. (Sum of 0699999, 0999999, 1799999, 2099999, 2899999, 3199999, 40999993999999, 43999994299999, 5199999, 5499999, 6299999, 6599999, 7399999, 7699999, 8499999 and 65999998799999) ............................................................................................................................. 70999999299999

Total (Sum of 3499999 4599999 and 68999999099999) ............................................................................................ 9999999





Attachment E


SCHEDULE S PART 4

REINSURANCE CEDED TO UNAUTHORIZED COMPANIES Contains data on life and accident and health insurance in force that is reinsured with companies not authorized in the state of domicile of the reporting insurance company. The purpose of this schedule is to display reinsurance ceded data used in the development of the liability for reinsurance in unauthorized companies. This liability serves to offset those assets and liability reductions that reflect the result of reinsurance ceded with unauthorized companies.






SCHEDULE S PART 5

REINSURANCE CEDED TO CERTIFIED REINSURERS NOTE: This schedule is to be completed by those reporting entities whose domiciliary state has enacted the Credit for

Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.



Enter one of the following as appropriateCRIN for the entity being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.



Attachment E



SCHEDULE F – REINSURANCE Index to Schedule F

Part 1 – Assumed Reinsurance

Part 2 – Portfolio Reinsurance

Part 3 – Ceded Reinsurance

Part 4 – Issuing or Confirming Banks for Letters of Credit from Schedule F, Part 3

Part 5 – Interrogatories for Schedule F, Part 3

Part 6 – Restatement of Balance Sheet to Identify Net Credit for Ceded Reinsurance NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule F. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for reciprocal jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Due Date

All parts of Schedule F are to be filed with the annual statement.

Please note that Parts 1, 3, 4 and 5 of this schedule are reported with thousands omitted. Parts 2 and 6 are reported in whole dollars.

ID Number

Most parts of Schedule F require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities.

A ceding insurer can have unauthorized reinsurance, certified reinsurance and reciprocal jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule F by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for reciprocal jurisdiction reinsurance.


The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “ID Number” for other alien insurers, even if the federal government has issued such a number.

Attachment E



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact with the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Alien pools and associations should be reported on Schedule F under the category “Other Non-U.S. Insurers” rather than under “Pools, Associations and Similar Facilities.” Pools and associations consisting of affiliated companies should be listed by individual company names rather than by pool or association identification.


In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule F instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN, Alien Insurer Identification Number (AIIN) or Certified Reinsurer Identification Number (CRIN). The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment E


**************************************************







The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment E



ASSUMED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR

If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number:



Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F General Instructions for more information on these identification numbers.




PREMIUM PORTFOLIO REINSURANCE EFFECTED OR (CANCELED) DURING CURRENT YEAR

This schedule should list by portfolio any original premiums and reinsurance premiums for portfolio reinsurance transactions affected or canceled during the year. Portfolio reinsurance is the transfer of the entire liability of a reporting entity for in force policies as respects a described segment of the reporting entity’s business. Column 1 – ID Number



Attachment E




If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:


Group or Category Line Number Total Authorized

Affiliates U.S. Intercompany Pooling ............................................................................................................. 0199999 U.S. Non-Pool

Captive .............................................................................................................................. 0299999 Other ................................................................................................................................. 0399999 Total .................................................................................................................................. 0499999

Other (Non-U.S.) Captive .............................................................................................................................. 0599999 Other ................................................................................................................................. 0699999 Total .................................................................................................................................. 0799999

Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999 Pools

Mandatory Pools*@ ........................................................................................................................ 1099999 Voluntary Pools*% ......................................................................................................................... 1199999

Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Protected Cells ............................................................................................................................................... 1399999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999 Total Unauthorized




Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Protected Cells ............................................................................................................................................... 2799999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment E


Total Certified Affiliates

U.S. Intercompany Pooling ............................................................................................................. 2999999 U.S. Non-Pool



Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Protected Cells ............................................................................................................................................... 4199999 Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and

4099999) ......................................................................................................................................... 4299999 Total Reciprocal Jurisdiction




Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Protected Cells ............................................................................................................................................... 5599999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999 Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of

1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999 Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999 Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * – Pools and Associations consisting of affiliated companies should be listed by individual company names.

@ – Include in Mandatory Pools all U.S. Government programs (e.g., National Flood Insurance, National Crop Insurance Corporation), all state residual market mechanisms, the Workers Compensation Reinsurance Pool, and the National Council on Compensation Insurance.

% – Include in Voluntary Pools all pool participation that is voluntary on the part of the reporting entity. Include participation in any state program for which participation is not mandatory.

# – Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.”

Attachment E






Ceded Reinsurance Credit Risk – Columns 28 Through 36 Only complete columns 28 through 36 for the following required groups, categories or subcategories (Line Numbers); otherwise leave blank. Group or Category Line Number Total Authorized

Affiliates Other (Non-U.S.)


Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999

Pools Voluntary Pools*% ......................................................................................................................... 1199999

Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999

Total Unauthorized



Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment E


Total Certified



Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999


Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and

4099999) ......................................................................................................................................... 4299999

Total Reciprocal Jurisdiction



Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999

Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of 1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999

Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999


Provision for Certified Reinsurance – Columns 54 Through 69 NOTE: Columns 54 through 69 are to be completed by those reporting entities whose domiciliary state has enacted the

Credit for Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.

Only complete columns 54 through 69 for the following required groups, categories, or subcategories (Line Numbers); otherwise leave blank. Group or Category Line Number

Total Certified

Affiliates



Attachment E



Total Certified – Affiliates .............................................................................................................. 3699999

Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999

Pools Mandatory Pools*@ ........................................................................................................................ 3899999 Voluntary Pools*% ......................................................................................................................... 3999999

Other Non-U.S. Insurers# .............................................................................................................................. 4099999 Protected Cells ............................................................................................................................................... 4199999

Total Certified Excluding Protected Cells (Sum of 3699999, 3799999, 3899999, 3999999 and 4099999) ......................................................................................................................................... 4299999


Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999

Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999


Provision for Unauthorized Reinsurance – Columns 71 and 72 Only complete columns 71 and 72 for the following required groups, categories or subcategories (Line Numbers); otherwise enter zero. Group or Category Line Number

Total Unauthorized

Affiliates




Total Unauthorized – Affiliates ....................................................................................................... 2299999 Other U.S. Unaffiliated Insurers .................................................................................................................... 2399999


Other Non-U.S. Insurers# .............................................................................................................................. 2699999 Protected Cells ............................................................................................................................................... 2799999 Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and

2699999) ......................................................................................................................................... 2899999

Attachment E



Total Protected Cells (Sum of 1399999, 2799999, and 4199999 and5599999) ............................................. 44999995899999

Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 Provision for Overdue Authorized and Reciprocal Jurisdiction Reinsurance – Columns 73 and 74 Only complete columns 73 and 74 for the following required groups, categories or subcategories (Line Numbers); otherwise enter zero. Group or Category Line Number Total Authorized

Affiliates




Total Authorized – Affiliates .......................................................................................................... 0899999 Other U.S. Unaffiliated Insurers .................................................................................................................... 0999999


Other Non-U.S. Insurers# .............................................................................................................................. 1299999 Protected Cells ............................................................................................................................................... 1399999 Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and

1299999) ......................................................................................................................................... 1499999


Affiliates

U.S. Intercompany Pooling ............................................................................................................. 4399999

U.S. Non-Pool Captive .............................................................................................................................. 4499999 Other ................................................................................................................................. 4599999 Total .................................................................................................................................. 4699999


Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999



Other Non-U.S. Insurers# .............................................................................................................................. 5499999

Protected Cells ............................................................................................................................................... 5599999

Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999, 5399999 and 5499999) .................................................................................................................... 5699999

Attachment E




Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999

Columns 73 & 74 – Provisions for Overdue Authorized Reinsurance

Amounts reported in the detail lines cannot be less than 0. If the calculated amounts are less than 0, then enter 0.

Columns 75 through 78 – Total Provisions for Reinsurance

Amounts reported in the detail lines cannot be less than 0. If the calculated amounts are less than 0, then enter 0.

Attachment E


SUPPLEMENTAL SCHEDULE FOR REINSURANCE COUNTERPARTY REPORTING EXCEPTION – ASBESTOS AND POLLUTION CONTRACTS

DETAIL OF ORIGINAL REINSURERS AGGREGATED ON SCHEDULE F AS OF DECEMBER 31, CURRENT YEAR


Group or Category Line Number Total Authorized

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 0299999

Other ................................................................................................................................. 0399999

Total .................................................................................................................................. 0499999

Other (Non-U.S.)

Captive .............................................................................................................................. 0599999

Other ................................................................................................................................. 0699999

Total .................................................................................................................................. 0799999

Total Authorized – Affiliates .......................................................................................................... 0899999


Pools

Mandatory Pools*@ ........................................................................................................................ 1099999

Voluntary Pools*% ......................................................................................................................... 1199999


Protected Cells ............................................................................................................................................... 1399999

Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and 1299999) ......................................................................................................................................... 1499999

Total Unauthorized

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 1699999

Other ................................................................................................................................. 1799999

Total .................................................................................................................................. 1899999

Other (Non-U.S.)

Captive .............................................................................................................................. 1999999

Other ................................................................................................................................. 2099999

Total .................................................................................................................................. 2199999

Total Unauthorized – Affiliates ....................................................................................................... 2299999

Attachment E



Pools

Mandatory Pools*@ ........................................................................................................................ 2499999

Voluntary Pools*% ......................................................................................................................... 2599999


Protected Cells ............................................................................................................................................... 2799999

Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and 2699999) ......................................................................................................................................... 2899999

Total Certified

Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 3099999

Other ................................................................................................................................. 3199999

Total .................................................................................................................................. 3299999

Other (Non-U.S.)

Captive .............................................................................................................................. 3399999

Other ................................................................................................................................. 3499999

Total .................................................................................................................................. 3599999

Total Certified – Affiliates .............................................................................................................. 3699999


Pools

Mandatory Pools*@ ........................................................................................................................ 3899999

Voluntary Pools*% ......................................................................................................................... 3999999


Protected Cells ............................................................................................................................................... 4199999



Affiliates


U.S. Non-Pool

Captive .............................................................................................................................. 4499999

Other ................................................................................................................................. 4599999

Total .................................................................................................................................. 4699999

Other (Non-U.S.)

Captive .............................................................................................................................. 4799999

Other ................................................................................................................................. 4899999

Total .................................................................................................................................. 4999999

Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999


Attachment E


Pools

Mandatory Pools*@ ........................................................................................................................ 5299999

Voluntary Pools*% ......................................................................................................................... 5399999


Protected Cells ............................................................................................................................................... 5599999

Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999, 5399999 and 5499999) .................................................................................................................... 5699999



Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * – Pools and Associations consisting of affiliated companies should be listed by individual company names.

@ – Include in Mandatory Pools all U.S. Government programs (e.g., National Flood Insurance, National Crop Insurance Corporation), all state residual market mechanisms, the Workers Compensation Reinsurance Pool, and the National Council on Compensation Insurance.

% – Include in Voluntary Pools all pool participation that is voluntary on the part of the reporting entity. Include participation in any state program for which participation is not mandatory.

# – Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” Column 1 – ID Number (Original Reinsurer)




Column 5 – ID Number (Retroactive Reinsurer)




Attachment E


ANNUAL STATEMENT INSTRUCTIONS – TITLE

SCHEDULE F – REINSURANCE Index to Schedule F


Part 2 – Ceded Reinsurance

Part 3 – Provision for Unauthorized Reinsurance

Part 4 – Provision for Reinsurance Ceded to Certified Reinsurers NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule F. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. This will also be the case for reciprocal jurisdiction reinsurance, which may have been classified as certified reinsurance prior to the enactment of the 2019 revisions to the Credit for Reinsurance Models by the domiciliary state of the ceding entity. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Due Date

All parts of Schedule F are to be filed with the annual statement.

Please note that Parts 1, 2, 3 and 4 of this schedule are reported with thousands omitted. ID Number

Schedule F require that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities. A ceding insurer can have unauthorized reinsurance, certified reinsurance and reciprocal jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for reciprocal jurisdiction reinsurance.



Attachment E



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst. at [email protected] for numbers assigned since the last publication or information for on having a number assigned.



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.







In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN, Alien Insurer Identification Number (AIIN) or Certified Reinsurer Identification Number (CRIN). The RJIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment E


**************************************************







The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting entity’s state of domicile.


Attachment E



ASSUMED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number:







CEDED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number: Group or Category Line Number Total Authorized

Affiliates

U.S. Intercompany Pooling ................................................................................................................. 0199999

U.S. Non-Pool

Captive .................................................................................................................................. 0299999 Other ..................................................................................................................................... 0399999 Total ...................................................................................................................................... 0499999

Other (Non-U.S.)


Total Authorized – Affiliates .............................................................................................................. 0899999

Attachment E


Other U.S. Unaffiliated Insurers ........................................................................................................................ 0999999

Pools

Mandatory Pools* ............................................................................................................................... 1099999 Voluntary Pools* ................................................................................................................................. 1199999

Other Non-U.S. Insurers# .................................................................................................................................. 1299999

Total Authorized ................................................................................................................................................ 1399999

Total Unauthorized

Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Unauthorized – Affiliates ........................................................................................................... 2199999


Pools

Mandatory Pools* ............................................................................................................................... 2399999 Voluntary Pools* ................................................................................................................................. 2499999

Total Unauthorized – Other Non-U.S. Insurers# ............................................................................................... 2599999

Total Unauthorized ............................................................................................................................................ 2699999

Total Certified

Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Certified – Affiliates .................................................................................................................. 3499999


Pools Mandatory Pools*@ ............................................................................................................................ 3699999 Voluntary Pools*% ............................................................................................................................. 3799999


Total Certified .................................................................................................................................................................. 3999999

Attachment E



Affiliates


U.S. Non-Pool


Other (Non-U.S.)


Total Reciprocal Jurisdiction – Affiliates............................................................................................ 4799999


Pools Mandatory Pools*@ ............................................................................................................................ 4999999 Voluntary Pools*% ............................................................................................................................. 5099999


Total Reciprocal Jurisdiction ........................................................................................................................................... 5299999

Totals ............................................................................................................................................................................... 9999999 * Pools and Associations consisting of affiliated companies should be listed by individual company names.

# Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” NOTE: Disclosure of the five largest provisional commission rates should exclude mandatory pools and joint underwriting

associations. Column 1 – ID Number




Attachment E



PROVISION FOR UNAUTHORIZED REINSURANCE AS OF DECEMBER 31, CURRENT YEAR If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, category, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:







PROVISION FOR REINSURANCE CEDED TO CERTIFIED REINSURERS AS OF DECEMBER 31, CURRENT YEAR

NOTE: This schedule is to be completed by those reporting entities whose domiciliary state has enacted the Credit for

Reinsurance Model Law (#785) and/or Credit for Reinsurance Model Regulation (#786) with the defined certified reinsurer provisions.



Enter one of the following as appropriateCRIN for the entity being reported on the schedule. See the Schedule F General Instructions for more information on these identification numbers.



Attachment E


OPERATIONS AND INVESTMENT EXHIBIT

PART 2B – UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES This schedule reports unpaid loss and loss adjustment expenses on direct and agency operations. Affiliated agencies are those that meet the affiliation standards defined by SSAP No. 25—Affiliates and Other Related Parties. Refer to SSAP No. 57—Title Insurance, paragraphs 8–13, for accounting guidance.


Line 2 – Reinsurance Recoverable from Authorized, Unauthorized and Certified Companies

The amounts shown on this line represents reinsurance ceded recoverables (from authorized, unauthorized and certified companies) on unpaid losses of which notice has been received. This can be done through reinsurance ceded treaties, facultative reinsurance assumed agreements, or under transfer and assumption agreements.

The amounts shown on this line should reconcile to amounts reported in Schedule F, Part 2, Column 9, Total.

The amount shown in Column 1 should agree to Schedule P, Part 1A, Column 19, Line 12.

The amount shown in Column 2 plus the amount shown in Column 3 should as agree to Schedule P, Part 1B, Column 19, Line 12.


Attachment E



WORKERS’ COMPENSATION CARVE-OUT SUPPLEMENT The Workers’ Compensation Carve-out Supplement shall be completed by those reporting entities that assume or cede workers’ compensation carve-out business. Workers’ compensation carve-out business is 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 employer’s liability exposures, of business originally written as workers compensation insurance.


SCHEDULE F – REINSURANCE NOTE: Certified reinsurer status applies on a prospective basis and is determined by the state of domicile of the ceding

insurer. Reciprocal jurisdiction reinsurer status applies on a prospective basis and is for reinsurance agreements entered into, amended, or renewed on or after the effective date of the domiciliary state of the ceding entity enacting the 2019 revisions to the Credit for Reinsurance Models, and only with respect to losses incurred and reserves reported on or after the later of (i) the date on which the assuming insurer has met all eligibility requirements, and (ii) the effective date of the new reinsurance agreement, amendment, or renewal. As such, it is possible that a ceding insurer will report reinsurance balances applicable to a single assuming insurer under multiple classifications within Schedule FS. For example, with respect to a certified reinsurer that was considered unauthorized prior to certification, balances attributable to contracts entered into prior to the assuming insurer’s certification would be reported in the unauthorized classification, while balances attributable to contracts entered into or renewed on or after the assuming insurer’s certification would be reported in the certified classification. Proper classification of such balances is essential to ensure accurate reporting of collateral requirements applicable to specific balances and the corresponding calculation of the liability for unauthorized and/or certified reinsurance.

Index to Schedule F


Part 2 – Ceded Reinsurance ID Number

Schedule F requires that the “ID Number” be reported for assuming or ceding entities.

Reinsurance intermediaries should not be listed, because Schedule F is intended to identify only risk-bearing entities.

A ceding insurer can have unauthorized reinsurance, certified reinsurance and reciprocal jurisdiction reinsurance with the same reinsurer, based on when the contract became effective. It is important that the ceding insurer report all types correctly. The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for reciprocal jurisdiction reinsurance.



Attachment E



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Pools and Association Numbers

In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The NAIC Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.







In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule F instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.


Attachment E


**************************************************



Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the “Pool and Association Numbers” section above for details on assignment of Pool/Association Identification Numbers. Risk-bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.




The determination of the authorized, reciprocal jurisdiction, unauthorized or certified status of an insurer or reinsurer listed in any part of Schedule F shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.


Attachment E



ASSUMED REINSURANCE If a reporting entity has any detail lines reported for any of the following required groups, categories, or subcategories, it shall report the subtotal of the corresponding group, category, or subcategory, with the specified subtotal line appearing in the same manner and location as the pre-printed total or grand total line and number.







CEDED REINSURANCE If a reporting entity has amounts reported for any of the following required groups, categories, or subcategories, it shall report the subtotal amount of the corresponding group, categories, or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total line and number. Group or Category Line Number Total Authorized

Affiliates

Affiliates – U.S. Intercompany Pooling ......................................................................................... 0199999 U.S. Non-Pool



Total Authorized – Affiliates .......................................................................................................... 0899999


Attachment E


Pools

Mandatory Pools* ........................................................................................................................... 1099999 Voluntary Pools* ............................................................................................................................. 1199999


Total Authorized Excluding Protected Cells (Sum of 0899999, 0999999, 1099999, 1199999 and 1299999) ......................................................................................................................................... 1499999

Total Unauthorized

Affiliates




Total Unauthorized – Affiliates ...................................................................................................... 2299999


Pools

Mandatory Pools* ........................................................................................................................... 2499999 Voluntary Pools* ............................................................................................................................. 2599999


Total Unauthorized Excluding Protected Cells (Sum of 2299999, 2399999, 2499999, 2599999 and 2699999) ......................................................................................................................................... 2899999

Total Certified

Affiliates




Total Certified – Affiliates .............................................................................................................. 3699999 Other U.S. Unaffiliated Insurers .................................................................................................................... 3799999




Attachment E


Total Reciprocal Jurisdiction Affiliates




Total Reciprocal Jurisdiction – Affiliates........................................................................................ 5099999 Other U.S. Unaffiliated Insurers .................................................................................................................... 5199999 Pools


Other Non-U.S. Insurers# .............................................................................................................................. 5499999 Protected Cells ............................................................................................................................................... 5599999 Total Reciprocal Jurisdiction Excluding Protected Cells (Sum of 5099999, 5199999, 5299999,

5399999 and 5499999) .................................................................................................................... 5699999 Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of

1499999, 2899999, 4299999 and 42999995699999) ....................................................................... 43999995799999 Total Protected Cells (Sum of 1399999, 2799999, 4199999 and 41999995599999) ..................................... 44999995899999 Totals (Sum of 4399999 5799999 and 44999995899999) ........................................................................................... 9999999 * Pools and Associations consisting of affiliated companies should be listed by individual company names.

# Alien Pools and Associations should be reported on Schedule F under the category “Other Non-U.S. Insurers.” Column 1 – ID Number




Attachment E


SUPPLEMENTAL TERM AND UNIVERSAL LIFE INSURANCE REINSURANCE EXHIBIT

PART 1 – ALL CESSIONS OF TERM AND UNIVERSAL LIFE INSURANCE WITH SECONDARY GUARANTEES



Enter one of the following as appropriate for the assuming insurer reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) Certified Reinsurer Identification Number (CRIN)



PART 2A – TRANSACTIONS SUBJECT TO PART 2 DISCLOSURE (GRANDFATHERED OR SPECIAL EXEMPTION)

Column 1 – Cession ID

Enter a unique Cession ID for each line (01 – 99). Column 2 – NAIC Company Code

Provide the NAIC code of the assuming insurer. Column 3 – ID Number

Enter one of the following as appropriate for the assuming insurer being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.



Attachment E



PART 2B – TRANSACTIONS SUBJECT TO PART 2 DISCLOSURE (NON-GRANDFATHERED)

Column 1 – Cession ID

Enter a unique Cession ID for each line (01 – 99).

To differentiate between cessions that contain risks subject to the provisions of AG48 and those that contain risks subject to the provisions of a state regulation equivalent to Model #787, append an A or B after the cession ID.

In the event that a cession contains risks subject to both the provisions of AG48 and the provisions of a state regulation equivalent to Model #787, the reporting of the cession shall be bi-furcated accordingly and listed on two distinct lines.

Use “A” for cessions that contain risks subject to the provisions of AG48.

Use “B” for cessions that contain risks subject to the provisions of a state regulation.

Column 2 – NAIC Company Code

Provide the NAIC code of the assuming insurer. Column 3 – ID Number

Enter one of the following as appropriate for the assuming insurer being reported on the schedule. See the Schedule S General Instructions for more information on these identification numbers.



Attachment E


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY AND TITLE

NOTES TO FINANCIAL STATEMENTS Notes to the Annual Statement are to be filed on March 1.


23. Reinsurance

Instruction:

A. Unsecured Reinsurance Recoverables

If the company has with any individual reinsurers (authorized, reciprocal jurisdiction, unauthorized or certified), an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses, and unearned premium that exceeds 3% of the company’s policyholder surplus, list each individual reinsurer and the unsecured aggregate recoverable pertaining to that reinsurer. If the individual reinsurer is part of a group, list the individual reinsurers, each of its related group members having reinsurance with the reporting company, and the total unsecured aggregate recoverables for the entire group.

Include: The NAIC group code number, where appropriate, and the Federal Employer

Identification Number for each individual company.


F. Retroactive Reinsurance (1) Provide the following information for all retroactive reinsurance agreements that transfer liabilities

for losses that have already occurred and that will generate special surplus transactions:


f. List the total Paid Loss/LAE amounts recoverable (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers), any amounts more than 90 days overdue (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers) and for amounts recoverable the collateral held (for unauthorized and certified reinsurers).

The insurer (assuming or ceding) shall assign a unique number to each retroactive reinsurance agreement and shall utilize this number for as long as the agreement exists. Do not report transactions utilizing deposit accounting in this note.


Attachment E


Illustration:


The Company does not have an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses and unearned premium with any individual reinsurers, authorized or unauthorized, that exceeds 3% of the Company’s policyholder surplus.


THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION.

F. Retroactive Reinsurance

(1) Reported Company


f. Total Paid Loss/LAE amounts recoverable (for authorized, reciprocal jurisdiction,

unauthorized and certified reinsurers), any amounts more than 90 days overdue (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers), and for amounts recoverable the collateral held (for authorized, reciprocal jurisdiction, unauthorized and certified reinsurers) as respects amounts recoverable from authorized, reciprocal jurisdiction, unauthorized and certified reinsurers:

1. Authorized Reinsurers

Total Paid/Loss/LAE Amounts Over 90 Company Recoverable Days Overdue $ $ Total $ $

2. Unauthorized Reinsurers

Total Amounts Paid/Loss/LAE Over 90 Collateral Company Recoverable Days Overdue Held

$ $

Total $ $ $

Attachment E


3. Certified Reinsurers


$ $

Total $ $ $

4. Reciprocal Jurisdiction Reinsurers


$ $

Total $ $ $


Attachment E


ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH, PROPERTY & TITLE

SCHEDULE Y

PART 1A – DETAIL OF INSURANCE HOLDING COMPANY SYSTEM All insurer and reporting entity members of the holding company system shall prepare a schedule for inclusion in each of the individual annual statements that is common for the group with the exception of Column 10, Relationship to Reporting Entity.



Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) General Instructions for more information on these identification numbers.

Federal Employer Identification Number (FEIN) Alien Insurer Identification Number (AIIN) * Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) * Certified Reinsurer Identification Number (CRIN) *

* RJIN, AIINs or CRINs are only reported if the entity in Column 8 is a reinsurer that has had

an RJIN, AIIN or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another entity regardless of whether the entity in Column 8 is part of reporting entity’s group.

If not applicable for the entity in Column 8, leave blank.


Attachment E



SCHEDULE Y

PART 2 – SUMMARY OF INSURER’S TRANSACTIONS WITH ANY AFFILIATES This schedule was designed to provide an overview of transactions among insurance holding company system members. It is intended to demonstrate the scope and direction of major fund and/or surplus flows throughout the system. This schedule should be prepared on an accrual basis.





* RJIN, AIIN or CRIN numbers are only reported if the entity in Column 3 is a reinsurer that

has had an RJIN, AIIN or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another entity regardless of whether the entity in Column 3 is part of reporting entity’s group or not.

If not applicable for the entity in Column 3, leave blank.


Attachment E


SCHEDULE D – PART 6 – SECTION 1

VALUATION OF SHARES OF SUBSIDIARY, CONTROLLED OR AFFILIATED COMPANIES If a reporting entity has any common stock or preferred stock reported for any of the following required categories or subcategories, it shall report the subtotal amount of the corresponding category or subcategory, with the specified subtotal line number appearing in the same manner and location as the pre-printed total or grand total line and number:





* RJIN, AIINs or CRINs are only reported if the entity is a reinsurer that has had an RJIN, AIIN

or CRIN number assigned or should have one assigned due to transactions being reported on Schedule F (Property and Title) or Schedule S (Life, Health and Fraternal) of another reporting entity.

If not applicable for the entity, leave blank.


Attachment E



TRUSTEED SURPLUS STATEMENT


Page 3 Line 1 – Total Liabilities

Should agree with the amount reported on Page 3, Line 28 of the annual statement.


Line 4 – Amounts Recoverable From Reinsurers

Line 4.1 – Authorized Companies

Include: Any reinsurance recoverable on paid losses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.

Line 4.2 – Unauthorized Companies

Include: Any reinsurance recoverables on paid losses from unauthorized

companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.

Line 4.3 – Certified Companies

Include: Any reinsurance recoverable on paid losses from certified companies

that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.

Line 4.4 – Reciprocal Jurisdiction Companies

Include: Any reinsurance recoverable on paid losses from reciprocal

jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.


Attachment E






Should agree with the amount reported on Page 3, Line 28 of the annual statement.


Line 7 – Reinsurance Recoverable on Paid Losses and Loss Adjustment Expenses


Include: Any reinsurance recoverables on paid losses and loss adjustment expenses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.


Include: Any reinsurance recoverables on paid losses and loss adjustment

expenses from unauthorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.



expenses from certified companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.



expenses from reciprocal jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the annual statement.


Attachment E


ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL




Should agree with the amount reported on Page 3, Line 28 of the quarterly statement.


Line 4 – Amounts Recoverable From Reinsurers


Include: Any reinsurance recoverable on paid losses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Include: Any reinsurance recoverables on paid losses from unauthorized

companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Include: Any reinsurance recoverable on paid losses from certified companies

that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Include: Any reinsurance recoverable on paid losses from reciprocal

jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Attachment E


ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS – PROPERTY




Should agree with the amount reported on Page 3, Line 28 of the quarterly statement.


Line 7 – Reinsurance Recoverable on Paid Losses and Loss Adjustment Expenses


Include: Any reinsurance recoverables on paid losses and loss adjustment expenses from authorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.



expenses from unauthorized companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.



expenses from certified companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.



expenses from reciprocal jurisdiction companies that are included in the asset on Page 2, Line 16.1, Column 3 of the quarterly statement.


Attachment E


QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL AND HEALTH

SCHEDULE S – CEDED REINSURANCE

SHOWING ALL NEW REINSURANCE TREATIES – CURRENT YEAR TO DATE



Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the instruction for Column 2 for details on assignment of Pool/Association Identification Numbers. Risk bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk bearing entity (e.g., risk bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule S General Instructions in the annual statement instructions for more information on these identification numbers.


Federal ID Number (FEIN)

The Federal Employer Identification Number (FEIN) must be reported for each U.S.-domiciled insurer and U.S. branch of an alien insurer. The FEIN should not be reported as the “Federal ID Number” for other alien insurers even if the federal government has issued such a number.


In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule S instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.

Newly assigned numbers are incorporated in revised editions of the NAIC Listing of Companies, which are available semiannually. The NAIC provides this information to annual statement software vendors for incorporation into the software.

Attachment E



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule S the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule S instead of the FEIN, or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



Column 7 – Type of Reinsurer

The determination of the authorized, certified or unauthorized status of an insurer or reinsurer shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.

Enter “Authorized” “Reciprocal Jurisdiction” “Certified” or “Unauthorized” to indicate the type of reinsurer.


Attachment E


QUARTERLY STATEMENT INSTRUCTIONS – PROPERTY AND TITLE

SCHEDULE F – CEDED REINSURANCE

SHOWING ALL NEW REINSURERS – CURRENT YEAR TO DATE



Company codes are assigned by the NAIC and are listed in the NAIC Listing of Companies. The NAIC does not assign a company code to insurers domiciled outside of the U.S. or to non-risk bearing pools or associations. The “NAIC Company Code” field should be zero-filled for those organizations. Non-risk bearing pools or associations are assigned a Pool/Association Identification Number. See the instruction for Column 2 for details on assignment of Pool/Association Identification Numbers. Risk bearing pools or associations are assigned a company code. If a reinsurer or reinsured has merged with another entity, report the company code of the surviving entity.

If a risk bearing entity (e.g., risk bearing pools or associations) does not appear in the NAIC Listing of Companies, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned. Newly assigned company codes are incorporated in revised editions of the NAIC Listing of Companies, which are available semi-annually. The NAIC provides this information to annual statement software vendors for incorporation into the software.


Enter one of the following as appropriate for the entity being reported on the schedule. See the Schedule F General Instructions in the annual statement instructions for more information on these identification numbers.


Federal ID Number (FEIN)



In order to report transactions involving alien companies correctly, the appropriate Alien Insurer Identification Number (AIIN) must be included on Schedule F instead of the FEIN. The AIIN number is assigned by the NAIC and is listed in the Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.


Attachment E



In order to report transactions involving non-risk bearing pools or associations consisting of non-affiliated companies correctly, the company must include on Schedule F the appropriate Pool/Association Identification Number. These numbers are listed in the NAIC Listing of Companies. The Pool/Association Identification Number should be used instead of any FEIN that may have been assigned. If a pool or association does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving certified reinsurers correctly, the appropriate Certified Reinsurer Identification Number (CRIN) must be included on Schedule F instead, of the FEIN or Alien Insurer Identification Number (AIIN) or Reciprocal Jurisdiction Reinsurer Identification Number (RJIN). The CRIN is assigned by the NAIC and is listed in the NAIC Listing of Companies. If a certified reinsurer does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or information on having a number assigned.



In order to report transactions involving alien companies correctly, the appropriate Reciprocal Jurisdiction Reinsurer Identification Number (RJIN) must be included on Schedule S instead of the FEIN. The RJIN number is assigned by the NAIC and is listed in the NAIC Listing of Companies. If an alien company does not appear in that publication, contact the NAIC Financial Systems and Services Department, Company Demographics Analyst at [email protected] for numbers assigned since the last publication or for information on having a number assigned.



Column 5 – Type of Reinsurer

The determination of the authorized, certified or unauthorized status of an insurer or reinsurer shall be based on the status of that insurer or reinsurer in the reporting company’s state of domicile.

Enter “Authorized” “Reciprocal Jurisdiction” “Certified” or “Unauthorized” to indicate the type of reinsurer.


Attachment E


ANNUAL STATEMENT BLANK – PROPERTY

SCHEDULE F – PART 3 (Continued) Ceded Reinsurance as of December 31, Current Year ($000 Omitted)

(Total Provision for Reinsurance)

70 Provision for Unauthorized Reinsurance Provision for Overdue Authorized and Reciprocal

Jurisdiction Reinsurance Total Provision for Reinsurance

ID Number From Col. 1

Name of Reinsurer From Col. 3

20% of Recoverable on Paid Losses & LAE Over

90 Days Past Due Amounts Not in Dispute

(Col. 47 * 20%)

71

Provision for Reinsurance with

Unauthorized Reinsurers Due to

Collateral Deficiency (Col. 26)

72

Provision for Overdue Reinsurance from

Unauthorized Reinsurers and Amounts in Dispute

(Col. 70 + 20% of the Amount in Col. 16)

73 Complete if

Col. 52 = "Yes"; Otherwise Enter 0

20% of Recoverable on Paid Losses &

LAE Over 90 Days Past Due Amounts

Not in Dispute + 20% of Amounts in

Dispute ([Col. 47 * 20%] + [Col. 45 * 20%])

74 Complete if

Col. 52 = "No"; Otherwise Enter 0

Greater of 20% of Net

Recoverable Net of Funds Held &

Collateral, or 20% of Recoverable on Paid

Losses & LAE Over 90 Days Past Due

(Greater of Col 26 * 20% or

[Cols. 40 + 41] * 20%)

75

Provision for Amounts Ceded to Authorized

and Reciprocal Jurisdiction Reinsurers

(Cols. 73 + 74)

76

Provision for Amounts Ceded to Unauthorized

Reinsurers (Cols. 71 + 72 Not in Excess

of Col. 15)

77

Provision for Amounts Ceded to Certified

Reinsurers (Cols. 64 + 69)

78

Total Provision for Reinsurance

(Cols. 75 + 76 +77) ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ ....................... .............................................. ................................................ ..................................... ....................................... ................................... ..................................... ............................................ ............................................ ............................................ ........................................ 9999999 Totals

Attachment E


ANNUAL STATEMENT BLANK – TITLE

OPERATIONS AND INVESTMENT EXHIBIT PART 2B – UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES

1 Agency Operations 4 5

Direct

Operations

2 Non-Affiliated

Agency Operations

3 Affiliated Agency

Operations

Total Current

Year (Cols. 1+2+3)

Total Prior Year

1. Loss and allocated LAE reserve for title and other losses of which notice has been

received:

1.1 Direct (Schedule P, Part 1, Line 12, Col. 17) ........................................................

1.2 Reinsurance assumed (Schedule P, Part 1, Line 12, Col. 18) ...............................

...................

...................

...........................

...........................

.......................

.......................

.........................

.........................

............

............

2. Deduct reinsurance recoverable from authorized, unauthorized and certified

companies (Schedule P, Part 1, Line 12, Col. 19) ...........................................................

3. Known claims reserve net of reinsurance (Line 1.1 plus Line 1.2 minus Line 2) ........... ................... ........................... ....................... ......................... ............

4. Incurred But Not Reported:

4.1 Direct (Schedule P, Part 1, Line 12, Col. 20) ........................................................

4.2 Reinsurance assumed (Schedule P, Part 1, Line 12, Col. 21) ...............................

4.3 Reinsurance ceded (Schedule P, Part 1, Line 12, Col. 22) ....................................

...................

...................

...........................

...........................

.......................

.......................

.........................

.........................

............

............

4.4 Net incurred but not reported (Line 4.1 plus Line 4.2 minus Line 4.3) ................

5. Unallocated LAE reserve (Schedule P, Part 1, Line 12, Col. 23)....................................

...................

...................

...........................

......................

.......................

.......................

.........................

.........................

............

............

6. Less discount for time value of money, if allowed (Schedule P, Part 1, Line 12,

Col. 33) .............................................................................................................................

XXX

XXX

XXX

7. Total Schedule P reserves (Lines 3 + 4.4 + 5 - 6) (Schedule P, Part 1, Line 12,

Col. 34) .............................................................................................................................

XXX

XXX

XXX

.........................

............

8. Statutory premium reserve at year end (Part 1B, Line 2.6) ............................................. XXX XXX XXX ......................... ............

9. Aggregate of other reserves required by law (Page 3, Line 3) ........................................ XXX XXX XXX

10. Supplemental reserve (a) (Lines 7 - (3 + 8 + 9) XXX XXX XXX

(a) If the sum of Lines 3 + 8 + 9 is greater than Line 7, place a "0" in this Line.

Attachment E


ANNUAL AND QUARTERLY STATEMENT BLANK – LIFE/FRATERNAL

TRUSTEED SURPLUS STATEMENT LIABILITIES AND TRUSTEED SURPLUS

1

Current Quarter 1. Total Liabilities ..................................................................................................................................................................... ...................................... ADDITIONS TO LIABILITIES: 2. Aggregate write-ins for additions to liabilities .....................................................................................................................

......................................

3. Total (Lines 1 + 2) ................................................................................................................................................................ ...................................... DEDUCTIONS FROM LIABILITIES: 4. Amounts Recoverable From Reinsurers:

4.1 Authorized Companies ............................................................................................. ........................................... 4.2 Unauthorized Companies ......................................................................................... ........................................... 4.3 Certified Companies ................................................................................................. ........................................... 4.4 Reciprocal Jurisdiction Companies .......................................................................... ........................................... 5. Special State Deposits, not exceeding net liabilities carried: 5.1 Special State Deposits (submit schedule) ................................................................ ........................................... 5.2 Accrued interest on special state deposits ................................................................ ........................................... 6. Life insurance premiums and annuity considerations deferred and uncollected ............... ........................................... 7. Accident and health premiums due and unpaid ................................................................. ........................................... 8. Contract loans and premium notes: 8.1 Contract loans not exceeding reserves carried on such policies .............................. ........................................... 8.2 Premium notes .......................................................................................................... ........................................... 8.3 Interest due and accrued on contract loans and premium notes .............................. ........................................... 9. Aggregate write-ins for other deductions from liabilities .................................................. 10. Total Deductions (Lines 4.1 thru 9) ..................................................................................................................................... 11. Total Adjusted Liabilities (Line 3 minus Line 10) ............................................................................................................... 12. Trusteed Surplus ................................................................................................................................................................... 13. Total

DETAILS OF WRITE-INS 0201. .............................................................................................................................................................................................. ...................................... 0202. .............................................................................................................................................................................................. ...................................... 0203. .............................................................................................................................................................................................. ...................................... 0298. Summary of remaining write-ins for Line 2 from overflow page ........................................................................................ ...................................... 0299. Totals (Lines 0201 thru 0203 plus 0298) (Line 2 above) 0901. .............................................................................................................................................................................................. ...................................... 0902. .............................................................................................................................................................................................. ...................................... 0903. .............................................................................................................................................................................................. ...................................... 0998. Summary of remaining write-ins for Line 9 from overflow page ........................................................................................ ...................................... 0999. Totals (Lines 0901 thru 0903 plus 0998) (Line 9 above)

INTERROGATORIES:

1.1 Have there been any changes made to any of the trust indentures during the period? Yes [ ] No [ ]

1.2 If yes, has the domiciliary or entry state approved the change? Yes [ ] No [ ]

Attachment E


ANNUAL AND QUARTERLY STATEMENT BLANK – PROPERTY

TRUSTEED SURPLUS STATEMENT LIABILITIES AND TRUSTEED SURPLUS

1

Current Quarter 1. Total Liabilities ..................................................................................................................................................................... ...................................... ADDITIONS TO LIABILITIES: 2. Ceded Reinsurance Balances Payable ..............................................................................

3. Agents' Credit Balances .................................................................................................... 4. Aggregate Write-ins For Other Additions to Liabilities .................................................. 5. Total Additions (Lines 2 + 3 + 4) ......................................................................................................................................... 6. Total (Lines 1 + 5) ................................................................................................................................................................ DEDUCTIONS FROM LIABILITIES: 7. Reinsurance Recoverable on Paid Losses and Loss Adjustment Expenses:

7.1 Authorized Companies ........................................................................................... ........................................... 7.2 Unauthorized Companies ....................................................................................... ........................................... 7.3 Certified Companies ............................................................................................... 7.4 Reciprocal Jurisdiction Companies ........................................................................ 8. Special State Deposits, not exceeding net liabilities carried in this statement on business

in each respective state:

8.1 Special State Deposits (submit schedule) .............................................................. ........................................... 8.2 Accrued interest on Special State Deposits............................................................ ........................................... 9. Agents' balances or uncollected premiums not more than ninety days past due, not exceeding unearned premium reserves carried thereon ...................................................

10. Unpaid Reinsurance Premiums Receivable, not exceeding losses and loss adjustment expenses due to reinsured:

10.1 Authorized Companies ........................................................................................... ........................................... 10.2 Unauthorized Companies ....................................................................................... ........................................... 11. Aggregate write-ins for other deductions from liabilities ................................................ 12. Total Deductions (Lines 7 thru 11) ...................................................................................................................................... 13. Total Adjusted Liabilities (Line 6 minus Line 12) ............................................................................................................... 14. Trusteed Surplus ................................................................................................................................................................... 15. Total

DETAILS OF WRITE-INS 0401. . ............................................................................................................................................................................................. ...................................... 0402. .............................................................................................................................................................................................. ...................................... 0403. .............................................................................................................................................................................................. ...................................... 0498. Summary of remaining write-ins for Line 4 from overflow page ........................................................................................ ...................................... 0499. Totals (Lines 0401 thru 0403 plus 0498) (Line 4 above) 1101. .............................................................................................................................................................................................. ...................................... 1102. .............................................................................................................................................................................................. ...................................... 1103. .............................................................................................................................................................................................. ...................................... 1198. Summary of remaining write-ins for Line 11 from overflow page ...................................................................................... ...................................... 1199. Totals (Lines 1101 thru 1103 plus 1198) (Line 11 above)


Attachment E



Attachment E




DATE: 12/11/2019

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:

NAME: Patricia Gosselin

TITLE:

AFFILIATION: New Hampshire Insurance Department

ADDRESS: 215 S. Fruit St., Ste. 14

Concord, NH 03301




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ ] BLANK

[ ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)



Add crosschecks to Lines 13 and 14 of the State Page to Lines 10 and 11 of the Underwriting and Investment Exhibit, Part 1. Also add crosschecks to Lines 9, 10 and 11 of the Underwriting and Investment Exhibit, Part 1 and Schedule T, Line 61.


The purpose of this proposal is to add additional crosschecks between the State Page, Schedule T and Underwriting and Investment Exhibit, Part 1 for the direct written premium for the Health, Life and Property business.

NAIC STAFF COMMENTS


Other Comments:


Attachment F


ANNUAL STATEMENT INSTRUCTIONS – HEALTH

EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION


Line 12 – Health Premiums Written

Include: Direct premiums written.

Amount Column 1 should agree withequal Underwriting and Investment Exhibit, Part 1, Column 1, Line 9.

Line 13 – Life Premiums Direct

Include: Direct premiums and annuity considerations for life contracts excluding reinsurance assumed and without deduction of reinsurance ceded.

Column 1 should equal Underwriting and Investment Exhibit, Part 1, Column 1, Line 10.

Line 14 – Property/Casualty Premiums Written

Include: Direct premiums for property and casualty lines of business excluding reinsurance assumed and without deduction of reinsurance ceded.

Column 1 should equal Underwriting and Investment Exhibit, Part 1, Column 1, Line 11.


Attachment F


UNDERWRITING AND INVESTMENT EXHIBIT

PART 1 – PREMIUMS


Line 8 – Other Health

Include: Other health revenues not included in any other column, including stop loss, disability income and long-term care. Policies providing stand alone Medicare Part D Prescription Drug Coverage.

Exclude: ASO (administrative services only) contracts and ASC (administrative service

contracts). Refer to SSAP No. 47—Uninsured Plans for accounting guidance. Policies providing Medicare Part D Prescription Drug Coverage through a Medicare Advantage product.

Line 9 – Health Subtotal

Column 1 should equal Schedule T, Line 61 sum of Columns 2, 3, 4 and 5. Line 10 – Life

Include: Revenue for life insurance.

Column 1 should equal Schedule T, Line 61, Column 6. Line 11 – Property/Casualty

Include: Revenue for property/casualty insurance.

Column 1 should equal Schedule T, Line 61, Column 7.



Attachment F



Attachment F




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ ] BLANK




Modify the instruction and illustration for Note 10L. The illustration will not be data captured.


The purpose of this proposal is to reflect the disclosure changes for SSAP No. 97—Investments in Subsidiary, Controlled, and Affiliated Entities being adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:

Proposal is being exposed concurrently with the changes being considered by the Statutory Accounting Principles (E) Working Group


Attachment G



NOTES TO FINANCIAL STATEMENTS


10. Information Concerning Parent, Subsidiaries, Affiliates and Other Related Parties

Instruction:


L. If a reporting entity holds an investment in a downstream noninsurance holding company, the reporting entity may look-through the downstream noninsurance holding company to the value of (i) SCA entities having audited financial statements and/or (ii) joint ventures, partnerships, and/or limited liability companies having audited financial statements in which the downstream noninsurance holding company has a minor ownership interest or otherwise lacks control, i.e., ownership interest is less than 10% in lieu of obtaining an audit of the financial statements of the downstream noninsurance holding company (provided the limited exception to the audited financial statements requirement contained in SSAP No. 97—Investments in Subsidiary, Controlled, and Affiliated Entities applies).

If a reporting entity utilizes the look-through approach for the valuation of the downstream noninsurance holding company instead of obtaining audited financial statements of the downstream noninsurance holding company, the financial statements of the reporting entity shall include the following disclosures for each noninsurance holding company in which the look-through approach is utilized:

Information that details The the name of the downstream noninsurance holding company (including

whether the reporting entity has looked-through more-than-one holding companies) along with details on the carrying value, goodwill and admitted value of the holding company.

The carrying value of the investment in the downstream non insurance holding company.

The fact that the financial statements of the downstream noninsurance company are not audited.

The fact that the reporting entity has limited the value of its investment in the downstream

noninsurance holding company to the value contained in the audited financial statements, including adjustments required by this statement, of SCA entities and/or non-SCA SSAP No. 48 entities owned by the downstream noninsurance holding company and valued in accordance with SSAP No. 97—Investments in Subsidiary, Controlled, and Affiliated Entities.

The fact that all liabilities, commitments, contingencies, guarantees or obligations of the downstream

noninsurance holding company, which are required to be recorded as liabilities, commitments, contingencies, guarantees or obligations under applicable accounting guidance, are reflected in the reporting entity’s determination of the carrying value of the investment in the downstream noninsurance holding company, if not already recorded in the financial statements of the downstream noninsurance holding company.


Attachment G


Illustration:


L. XYZ Company utilizes the look-through approach in valuing its investment in ABC Company at $______. ABC Company’s financial statements are not audited and XYZ Company has limited the value of its investment in ABC Company to the value contained in the audited financial statements, including adjustments required by SSAP No. 97, of SCA entities and/or non-SCA SSAP No. 48 entities owned by the ABC Company and valued in accordance with paragraphs SSAP No. 97. All liabilities, commitments, contingencies, guarantees or obligations of the ABC Company, which are required to be recorded as liabilities, commitments, contingencies, guarantees or obligations under applicable accounting guidance, are reflected in XYZ Company’s determination of the carrying value of the investment in ABC Company, if not already recorded in the financial statements of ABC Company.For the year-end 2018 financial statements, the reporting entity reported the value of a downstream holding company using the look-through approach permitted in SSAP No. 97 as the downstream holding company was not supported by audited financial statements. Pursuant to the provisions in SSAP No. 97, the look-through approach is only permitted when the downstream noninsurance entity is an 8.b.iii entity, and the downstream holding company does not own any other assets which are material to the downstream holding company other than the audited/non-audited entities held by the downstream holding company. Additionally, the downstream noninsurance holding company is not subject to liabilities, commitments, contingencies, guarantees or obligations which are materials to the downstream holding company.

In accordance with the provisions of SSAP No. 97, the investment of the downstream holding company has been limited to the value contained in the audited financial statements, including adjustments required by SSAP No. 97, of the SCA entities (and SSAP No. 48 entities) owned by the downstream noninsurance holding company pursuant to the valuation requirements detailed in SSAP No. 97, paragraphs 22-25. Detail of how the reported investment of the downstream holding company was determined using the look-through approach is shown below:

Downstream Holding Company Look-Through

Downstream Holding Company: Carrying Value Goodwill Total Admitted

Value SSAP No. 97 Adjustments

Total Nonadmitted

ABC Downstream** $3,000,000 $250,000 $2,712,500 $0 $287,500

Downstream Holding Company: Carrying Value Goodwill

Total (Carrying Value +

Goodwill) Total Admitted

Value Total

Nonadmitted ABC Downstream** $3,000,000 $250,000 $3,250,000 $2,712,500 $287,500

Name of Look-Through Entity

Audited F/S (Yes/No)

Carrying Value Assigned Goodwill %*

Assigned Goodwill

SSAP No. 97 Adjustments

Admitted Value

XYZ Entity Yes 2,500,000 85% $212,500 $0 $2,712,500 QRS Entity No 400,000 10% $25,000 $0 $0 MNO Entity No 100,000 5% $12,500 $0 $0 Total $3,000,000 100% $250,000 $0 2,712,500

* Goodwill assignment occurred at original acquisition of the downstream holding company on the basis of the percentage of the carrying value of each look-through entity to the total carrying value.

** ABC Downstream holding company is owned by DEF nonaudited downstream holding company. The reporting entity has conducted a “more-than-one” holding company look-through as both downstream companies qualify for look-through under SSAP No. 97 as they are 8.b.iii entities holding no materials assets or liabilities in accordance with SSAP No. 97, paragraphs 26-27.



Attachment G



Attachment G




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION







Modify the instruction and illustration for 13(11) to the Notes to Financial Statement. Change the numbering from 1 through 13 to A through M.


The purpose of this proposal is to reflect the disclosure addition for SSAP No. 41R—Surplus Notes being adopted by the Statutory Accounting Principles (E) Working Group and correct the instruction.

NAIC STAFF COMMENTS


Other Comments:

Proposal is being exposed concurrently with the changes being considered by the Statutory Accounting Principles (E) Working Group.


Attachment H





13. Capital and Surplus, Dividend Restrictions and Quasi-Reorganizations

Instruction:

Disclose the following information related to capital and surplus, shareholder’s dividend restrictions and quasi-reorganizations.

(1)A. The number of shares of each class of capital stock authorized, issued and outstanding as of the balance

sheet date and the par value or stated value of each class.

(2)B. The dividend rate, liquidation value and redemption schedule (including prices and dates) of any preferred stock issues.

(3)C. Dividend restrictions, if any, and an indication if the dividends are cumulative.

(4)D. The dates and amounts of dividends paid. Note for each payment whether the dividend was ordinary or

extraordinary.

(5)E The portion of the reporting entity’s profits that may be paid as ordinary dividends to stockholders.

(6)F A description of any restrictions placed on the unassigned funds (surplus), including for whom the surplus is being held.

(7)G For mutual reciprocals, and similarly organized entities, the total amount of advances to surplus not repaid,

if any.

(8)H The total amount of stock held by the reporting entity, including stock of affiliated entities, for special purposes such as:

a. Conversion of preferred stock

b. Employee stock options

c. Stock purchase warrants

(9)I A description of the reasons for changes in the balances of any special surplus funds from the prior period.

(10)J The portion of unassigned funds (surplus) represented or reduced by cumulative unrealized gains and losses.

(11)K Surplus Notes

For each surplus debenture or similar obligation, except those surplus notes required or those that are a prerequisite for purchasing an insurance policy and are held by the policyholder, furnish the following information:

a. Date issued

b. Description and fair value of the assets received

c. Holder of the note or, if public, the names of the underwriter and trustee with identification on whether the holder of the surplus note is a related party per SSAP No. 25

Attachment H


Original issue amount of note

d. Par Value (Face Amount of Note)

e. Carrying value of note (current year and prior year)

f. The rate at which interest accrues

g. Maturity dates or repayment schedules, if stated

h. Unapproved interest and/or principal

i. Interest and/or principal paid in the current year

j. Total interest and/or principal paid on surplus notes

Approved interest recognized and principal paid Ccurrent year and life-to-date:

Approved interest and/or principal recognized as “paid”

Amount of approved interest and/or principal remitted to the holder of the surplus note (actual transfer of cash / assets) and

The amount of approved interest and/or principal not remitted to the holder of the surplus note (no transfer of cash / assets).

Life-to-date:

Amount of approved interest and/or principal remitted to the holder of the surplus note (actual transfer of cash / assets)

Information regarding a 3rd party liquidity source including:

Name

Identification if a related party

Cost of the liquidity guarantee and

Maximum amount available should a triggering event occur.

Percentage of offset interest payments offset through administrative offsetting (not inclusive of amounts paid to a 3rd party liquidity provider). I.E. if $100 in interest was recognized through the year, $10 of which was remitted to a 3rd party liquidity provider and the reminder $90 was offset, the reporting entity shall report 100% as offset.

Disclosure of whether the surplus note was issued as part of a transaction with any of the following attributes:

Do surplus note/associated asset terms negate or reduce cash flow exchanges, and/or are amounts payable under surplus note and amounts receivable under other agreements contractually linked (For example, the asset provides interest payments only when the surplus note provides interest payments).

Are any amounts due under surplus notes and associated assets netted or offset (partially or in full) thus eliminating or reducing the exchange of cash or assets that would normally occur throughout the duration, or at maturity, of the agreement (This may be referred to as administrative offsetting.)

Were the proceeds from the issuance of a surplus note used to purchase an asset directly or indirectly from the holder of the surplus note.

Attachment H


If a reporting entity has ceded business to a surplus note issuer that is a related party as part of a reinsurance transaction in which the surplus note meets any of the criteria above, the ceding entity shall provide a description of the transaction, including whether the criteria above were met with respect to the surplus note issuance, as long as the reinsurance agreement remains in force.

The ceding entity should provide a description of the risks reinsured, the related party reinsurer, any guarantees or support agreements and the amount of notes outstanding.

If the proceeds from the issuance of a surplus note used to purchase an asset directly or indirectly from the holder of the surplus note, the following information shall be disclosed regarding the assets received:

Identification of asset, including the investment schedule where the asset is reported and reported NAIC designation;

Book/ adjusted carrying value of asset as of the current reporting date.

A description of terms under which liquidity would be provided should a triggering event occur.

Principal amount value of assets received upon Surplus Note issuance, if applicable.

k. Subordination terms

l. Liquidation preference to the reporting entity’s common and preferred shareholders

m. The repayment conditions and restrictions

Information about any guarantees, support agreements, or related party transactions associated with the surplus note issuance, and whether payments have been made under such agreements.

If a reporting entity has ceded business to a surplus note issuer that is a related party as part of a reinsurance transaction in which the surplus note meets any of the criteria above, the ceding entity shall provide a description of the transaction, including whether the criteria above were met with respect to the surplus note issuance, as long as the reinsurance agreement remains in force.

The ceding entity should provide a description of the risks reinsured, the related party reinsurer, any guarantees or support agreements and the amount of notes outstanding.

If the proceeds from the issuance of a surplus note used to purchase an asset directly or indirectly from the holder of the surplus note, the following information shall be disclosed regarding the assets received:

Identification of asset, including the investment schedule where the asset is reported and reported NAIC designation;

Book/ adjusted carrying value of asset as of the current reporting date.

A description of terms under which liquidity would be provided should a triggering event occur.

n. In addition to the above, a reporting entity shall identify all affiliates that hold any portion of a surplus debenture or similar obligation (including an offering registered under the Securities Act of 1933 or distributed pursuant to Rule 144A under the Securities Act of 1933), and any holder of 10% or more of the outstanding amount of any surplus note registered under the Securities Act of 1933 or distributed pursuant to Rule 144A under the Securities Act of 1933.

NOTE: For the table illustrated for the disclosures above provide an “Item Number” (4 digits) to

identify each surplus note being disclosed and should remain the same between year..

(12)L The impact of the restatement in a quasi-reorganization as long as financial statements for the period of the reorganization are presented.

(13)M The effective date of a quasi-reorganization for a period of ten years following the reorganization.

Attachment H


Illustration:

(1)A The Company has ________ shares authorized, ________ shares issued and ________ shares outstanding. All shares are Class A shares.

(2)B The Company has no preferred stock outstanding.

(3)C Without prior approval of its domiciliary commissioner, dividends to shareholders are limited by the laws

of the Company’s state of incorporation, _________, to $_________, an amount that is based on restrictions relating to statutory surplus.

(4)D An ordinary dividend in the amount of $ _________ on _________ was paid by the Company.

(5)E Within the limitations of (3) above, there are no restrictions placed on the portion of Company profits that

may be paid as ordinary dividends to stockholders.

(6)F There were no restrictions placed on the Company’s surplus, including for whom the surplus is being held.

(7)G The total amount of advances to surplus not repaid is $_________.

(8)H The amounts of stock held by the Company, including stock of affiliated companies, for special purposes are:

a. For conversion of preferred stock: ________ shares

b. For employee stock options: __________ shares

c. For stock purchase warrants: _________ shares

(9)I Changes in balances of special surplus funds from the prior year are due to: ________________________ _____________________________________________________________________________________

(10)J The portion of unassigned funds (surplus) represented or reduced by cumulative unrealized gains and losses

is $ ___________ THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION. (NOTE: THIS DOES NOT INCLUDE THE ENDING NARRATIVE.)

(11)K The Company issued the following surplus debentures or similar obligations:

1 2 3 4 5 6 7 8

Item Number Date Issued

Interest Rate

Original Issue Amount of Note

Is Surplus Note Holder

a Related Party (Y/N)

Carrying Value of Note Prior Year

Carrying Value of Note Current Year *

Unapproved Interest And/Or Principal

00001 ........................ ............... $ ........................... ......................... $ .......................... $ ........................... $ ........................... .............. ........................ ............... ........................... ......................... .......................... ........................... ........................... .............. ........................ ............... ........................... ......................... .......................... ........................... ........................... Total XXX XXX $ XXX $ $ $

* Total should agree with Page 3, Line 32.

1 9 10 11 12 13 14

Item Number

Current Year Interest Expense

Recognized

Life-To-Date Interest Expense

Recognized

Current Year Interest Offset Percentage (not

including amounts paid to a 3rd party

liquidity provider). Current Year Principal Paid

Life-To-Date Principal Paid Date of Maturity

00001 $ ........................... $ ........................... ................................. $ .......................... $ ........................... ................................ .............. 999,999,999,999 999,999,999,999 100.0 ........................ 999,999,999,999 999,999,999,999 XX/XX/XXXX ....... .............. ........................... ........................... ................................. .......................... ........................... ................................ Total $ $ XXX $ $ XXX

Attachment H


1 15 16 17 18 19

Item Number

Are Surplus Note payments contractually linked? (Y/N)

Surplus Note payments subject to

administrative offsetting

provisions? (Y/N)

Were Surplus Note proceeds

used to purchase an asset directly

from the holder of the surplus note? (Y/N)

Is Asset Issuer a Related

Party (Y/N) Type of Assets

Received Upon Issuance 00001 ........................ ......................... ......................... ......................... ........................................................................................................... .............. ........................ ......................... ......................... ......................... ........................................................................................................... .............. ........................ ......................... ......................... ......................... ........................................................................................................... Total XXX XXX XXX XXX XXX

1 20 21 22

Item Number

Principal Amount of Assets Received Upon Issuance

Book/Adjusted Carry Value of

Assets

Is Liquidity Source a Related

Party to the Surplus Note

Issuer? (Y/N)

00001 $ ........................... $ .......................... ..................... .............. ........................... .......................... ..................... .............. ........................... .......................... ..................... Total $ $ XXX

1 2 3 4 5 6 7

Item Number Date Issued

Date of Maturity

Interest Rate

Type of Assets Received Upon Issuance

Original Issue Amount of Note

Fair Value of Assets Received Upon Issuance

00001 ........................ .......................... ........... .......................................................................................... $ ........................... $ .......................... .............. ........................ .......................... ........... .......................................................................................... ........................... .......................... .............. ........................ .......................... ........... .......................................................................................... ........................... .......................... Total XXX XXX XXX XXX $ $

1 8 9 10 11 12 13

Item Number

Carrying Value of Note Prior Year

Carrying Value of Note Current Year *

Unapproved Interest And / Or Principal

Approved Interested Recognized Current

Year

Life-To-Date Interest Remitted

(Actual Transfer of Cash/Assets)

Life-To-Date Principal (Actual

Transfer of Cash/Assets)

Remitted 00001 $ ........................... $ ........................... $ .......................... $ .......................... $ ........................... $ ........................... .............. ........................... ........................... .......................... .......................... ........................... ........................... .............. ........................... ........................... .......................... .......................... ........................... ........................... Total $ $ $ $ $ $


1 14 15 16 17 18 19 20

Item Number

Current Year Approved Interested

Remitted (Actual Transfer of

Cash/Assets)

Current Year Approved Principal Remitted (Actual


Current Year Approved Interest

Not Remitted Since Issuance (No Transfer of

Cash/Assets) *

Current Year Approved Principal Not Remitted Since

Issuance (No Transfer of

Cash/Assets) *

Is Non-Remitted Interest or

Principal Offset with Amounts

Owed from Surplus Note

Holder? (Yes/No)

Does Remitted Interest or Principal

Payments Result with Acquisition

of a Source of Liquidity

Through the Surplus Note

Holder? (Yes/No)

Is Surplus Note Holder a

Related Party (Yes/No)

00001 $ ........................... $ ........................... $ .......................... $ .......................... .......................... .......................... .......................... .............. ........................... ........................... .......................... .......................... .......................... .......................... .......................... .............. ........................... ........................... .......................... .......................... .......................... .......................... .......................... Total $ $ $ $ XXX XXX XXX

1 21 22 23 24

Item Number Name of 3rd Party Liquidity Source Acquired

Is Liquidity Source a Related

Party to the Surplus Note

Issuer?

Current Year Total Cost of Liquidity

Source

Current Year Cost of Liquidity Source Reported as Surplus

Note Interest 00001 ......................................................................................................................... ..................... $ .......................... $ ........................... .............. ......................................................................................................................... ..................... .......................... ........................... .............. ......................................................................................................................... ..................... .......................... ........................... Total XXX XXX $ $

Attachment H


1 25 26 27

Item Number

Total Cost of Liquidity Source Since Acquisition

Total Cost of Liquidity Source

Reported as Surplus Note Interest Since

Acquisition

Maximum Amount Surplus Note Issuer Can Receive from Liquidity Source

00001 $ ........................... $ ........................... $ .......................... .............. ........................... ........................... .......................... .............. ........................... ........................... .......................... Total $ $ $

Date Issued

Interest Rate

Par Value (Face Amount

of Notes)

Carrying Value of

Note

Interest And/Or Principal Paid Current Year

Total Interest And/Or

Principal Paid

Unapproved Interest And/Or

Principal Date of

Maturity 1311999 Total * XXX


The surplus note in the amount of $______, listed as item _______ in the above table, was issued to _____________________ (parent) in exchange for ___________________________.

The surplus note, in the amount of $_____, listed as item _______ in the above table, was issued pursuant to Rule 144A under the Securities Act of 1933, underwritten by ____________________, and is administered by _____________________ as trustee.

The surplus note has the following repayment conditions and restrictions: (e.g., Each payment of interest on and principal of the surplus notes may be made only with the prior approval of the Commissioner of Insurance of the State and only to the extent the Company has sufficient surplus earnings to make such payment).

The surplus note has the following subordination terms: (e.g., The Notes will rank pari passu with any other future surplus notes of the Parent and with all other similarly subordinated claims).

The liquidation preference to the insurer's common and preferred shareholders are as follows: (e.g., In the event that the Parent is subject to such a proceeding, holders of Indebtedness, Policy Claims and Prior Claims would be afforded a greater priority under the Liquidation Act and the terms of the Notes and, accordingly, would have the right to be paid in full before any payments of interest or principal are made to Note holders).

The surplus debenture in the amount of $ , listed as item _______ in above table, is held by _______________________________(an affiliate).

The surplus debenture in the amount of $_____________, listed as item ________ in above table, was issued pursuant to Rule 144A under the Securities Act of 1933, and is held by _____________________ in the following ownership percentage _________________________ (10% or more).

The _____ (an affiliate) holds $ __________ or __________% of the surplus debenture listed as item ________in the above table.

The Company has outstanding $__________ of __________% debentures due in 20___ issued on __/__/20__. The carrying amount of the debt is $______ with an effective rate of ____%. The debentures are not redeemable prior to 20___. The Company is required to make annual sinking fund payments of $__________ that will provide sufficient funds for the retirement of debentures at maturity. Interest paid during 20__ was $______.

Attachment H


The Company has an outstanding liability for borrowed money in the amount of $_______ due to __________on __/__/20__. The principal amount is due 20__. At the option of the Company, early repayment may be made. Interest at ___% is required to be paid annually. Interest paid during 20___ was $______. The Company is required to maintain a collateral security deposit with the lender. Assets in such security deposit are required to be maintained in a fair value amount at least equal to the outstanding principal. At December 31, 20__, assets having an admitted value of $__________ and a fair value of $_______ were on deposit with the lender.

THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION.

(12)L The impact of any restatement due to prior quasi-reorganizations is as follows: Change in Change in Gross Paid-in Year Surplus and Contributed Surplus

2008 $ ____________ $ ____________

2007 $ ____________ $ ____________

2006 $ ____________ $ ____________

etc.

(13)M The effective date(s) of all quasi-reorganizations in the prior 10 years is/are __________.



Attachment H




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION




[ ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)



Modify the instruction and illustration for Note 23A – Unsecured Reinsurance Recoverables.


The purpose of this proposal is to reflect the disclosure addition for SSAP No. 62R—Property and Casualty Reinsurance being adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:



Attachment I


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY AND TITLE



23. Reinsurance

Instruction:


If the company has with any individual reinsurers (authorized, reciprocal jurisdiction, unauthorized or certified), an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses, and unearned premium that exceeds 3% of the company’s policyholder surplus, list each individual reinsurer and the unsecured aggregate recoverable pertaining to that reinsurer. If the individual reinsurer is part of a group, list the individual reinsurers, each of its related group members having reinsurance with the reporting company, and the total unsecured aggregate recoverables for the entire group.

Include: The NAIC group code number, where appropriate, and the Federal Employer

Identification Number for each individual company.


Illustration:


The Company does not have an unsecured aggregate recoverable for losses, paid and unpaid including IBNR, loss adjustment expenses and unearned premium with any individual reinsurers, authorized or unauthorized, that exceeds 3% of the Company’s policyholder surplus.

DRAFTING NOTE: The tables below will not be data captured

Individual Reinsurers with Unsecured Reinsurance Recoverables Exceeding 3% of Policyholder Surplus

Individual Reinsurers Who Are Not Members of a Group

FEIN Reinsurer Name Unsecured Amount

.............................. .............................................................................................................. $ .............................. .............................. .............................................................................................................. $ .............................. .............................. .............................................................................................................. $ .............................. .............................. .............................................................................................................. $ .............................. .............................. .............................................................................................................. $ ..............................

Individual Reinsurers Who Are Members of a Group

Group Code FEIN Reinsurer Name Unsecured Amount

.......... .............................. ........................................................................................................ $ ............................... .......... .............................. ........................................................................................................ $ ............................... .......... .............................. ........................................................................................................ $ ............................... .......... .............................. ........................................................................................................ $ ............................... .......... .............................. ........................................................................................................ $ ...............................

Attachment I


All Members of the Groups Shown above with Unsecured Reinsurance Recoverables

Group Code FEIN Reinsurer Name Unsecured Amount

123 .............................. ........................................................................................................ XXX 123 .............................. ........................................................................................................ XXX 123 XXX Total 123 $ ............................... 456 .............................. ........................................................................................................ XXX 456 XXX Total 456 $ ............................... 789 .............................. ........................................................................................................ XXX 789 .............................. ........................................................................................................ XXX 789 .............................. ........................................................................................................ XXX 789 XXX Total 789 $ ...............................



Attachment I



Attachment I




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION

[ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)



[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)



Modify the instruction and illustration for Note 2 – Accounting Changes and Correction of Errors.


The purpose of this proposal is to reflect the disclosure addition for SSAP No. 3—Accounting Changes and Corrections of Errors and SSAP No. 51R—Life Contracts being adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:



Attachment J





2. Accounting Changes and Corrections of Errors

Instruction:

Describe material changes in accounting principles and/or correction of errors. Include:

A brief description of the change, encompassing a general disclosure of the reason and justification for the change or correction.

The impact of the change or correction on net income, surplus, total assets and total liabilities for the two years

presented in the financial statements (i.e., the balance sheet and statement of income).

The effect on net income of the current period for a change in estimate that affects several future periods, such as a change in the service lives of depreciable assets or actual assumptions affecting pension costs. Disclosure of the effect on those income statement amounts is not necessary for estimates made each period in the ordinary course of accounts for items such as uncollectible accounts. However, disclosure is recommended if the effect of a change in the estimate is material.

Changes in accounting that are changes in reserve valuation basis as described in SSAP No. 51R—Life

Contracts which have elected gradephase-in provided for in the Valuation Manual section VM-21or other optional application features, shall also include in the change in accounting disclosures information regarding the application of any phasegrade-in as provided for in SSAP No. 51R.

Reporting entities shall provide disclosure of the following:

The phasegrade-in period being applied, and the remaining time period of the grade in.

Any adjustments to the phasegrade-in period.

Amount of change in valuation basis phasegrade-in, which has been recognized in unassigned

funds.

The remaining amount to be phasegraded-in. (reflected in special surplus if the ungraded-in amount represents an increase in reserving)

When subsequent financial statements are issued containing comparative restated results as a result of the filing

of an amended financial statement, the reporting entity shall disclose that the prior period has been restated and the nature and amount of such restatement.

Attachment J


Illustration:

During the current year’s financial statement preparation, the Company discovered an error in the compiling and reporting of investment income from an affiliate for the prior year. In the prior year, common stocks (Assets Page, Line _____) and investment income earned from affiliates (included in Summary of Operation, Line ____) were understated by $________. Line _____ on the Assets Page and Line ____ on the Gains and Losses section of the Summary of Operations have been adjusted in the current year to correct for this error.

In 2020, the Company elected a phasegrade-in period of three years of a change in reserve valuation basis as described in SSAP No. 51R—Life Contracts for its variable annuity reserves. This change in valuation basis, which impacts annuities reserves written from 1981 to 2019 is permitted under the revisions to the Commissioners Annuity Reserve Valuation Method (CARVM) adopted in Valuation Manual Requirements for Principle-Based Reserves for Variable Annuities (VM-21), and Actuarial Guideline 43 CARVM for variable annuities (AG 43). There have been no adjustments to the phasegrade-in period. The amount of grade-in, which has been recognized in unassigned funds is $________. and tThe remaining amount to be graded-in reflected in special surplus is $________.



Attachment J



Attachment J




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION







Modify the instruction and illustration for Note 19 on MGAs and TPAs.


The purpose of this proposal is to reflect the disclosure addition for SSAP No. 51R—Life Contracts, SSAP No. 53—Property Casualty Contracts—Premiums, SSAP No. 54R—Individual and Group Accident and Health Contracts and SSAP No. 59—Credit Life and Accident and Health Insurance Contracts being adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:



Attachment K





19. Direct Premium Written/Produced by Managing General Agents/Third-Party Administrators

Instruction:

Disclosures should be completed regarding the aggregate amount of direct premiums written through following managing general agents (MGAs) or third-party administrators (TPAs) that write direct policies or provide claims adjusting or other services. For purposes of this disclosureinstruction, a managing general agent means the same as referenced in Appendix A-225 of the Accounting Practices and Procedures Manual. For purposes of this disclosure a third-party administrator is consistent with NAIC Model Guideline, VI-1090 Registration and Regulation of Third-Party Administrators (TPAs). If this the premium written amount is equal to or greater than 5% of surplus or if the total count of claims processed by the TPA or MGAclaims adjusting services are greater than 5% of the total count of claims processedannual average claims volume, provide the following information for each managing general agent and third-party administrator:

Disclose the aggregate amount of direct premiums written through the MGA or TPA and the total premium

written by those MGAs or TPAs.

Disclose the aggregate amount of claims payments processed by agent or administrator and the total claims processed by such agents or administrators.

Licensed Name name and address of managing general agent or third-party administrator.

Federal Employer Identification Number.

Whether such person holds an exclusive contract.

Types of business written.

Type of authority granted and/or services provided (i.e., underwriting, claims payment, etc.).

Whether the MGA or TPA is affiliated, a non-affiliate related party or unaffiliated.

Whether the MGA or TPA is independently audited, and/or bonded.

Total direct premiums written/produced by managing general agents or third party administrators.

Illustration: THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLES BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION. Name and Address of Total Managing General Types of Types of Direct Agent or Third FEIN Exclusive Business Authority Premium Written/ Party Administration Number Contract Written Granted Produced By

XYZ U $

XYX B $

Total $

Attachment K


A. Managing General Agents (MGA) and Third-Party Administrators (TPA) Whose Premium Written Amount Is Equal to or GreaterWho Either Write More Than 5% of PremiumSurplus or Total Count of Claims Processed by the TPA/MGA Are Process Greater Than 5% of the Total Count of Claims Processed

Licensed Name

Address (City and State Only) of Managing General Agent or Third-Party Administration FEIN Number

Exclusive Contract (Yes/No) Type of Business Written

Type of Authority

and/or Service Granted*

Independently Audited (Yes/No)

Bonded Status

(Yes/No) XYZ ....................................................... ............................... ................ ................................................. ........................ ....................... ................ .................................................. ....................................................... ............................... ................ ................................................. ........................ ....................... ................ .................................................. ....................................................... ............................... ................ ................................................. ........................ ....................... ................ .................................................. ....................................................... ............................... ................ ................................................. ........................ ....................... ................ .................................................. ....................................................... ............................... ................ ................................................. ........................ ....................... ................

* Authority Codes Sample Listing (Multiple Codes Allowed):

C – Claims Payment

CA – Claims Adjustment

R – Reinsurance Ceding

B – Binding Authority

P – Premium Collection

U – Underwriting

O – Other (Write-in). If other, explain in the table below

Independent Audit – Subject to annual independent audit Bonded – The work of the entity is bonded by either a fiduciary or surety bond

B. Explanation of Other Code

Licensed NameLegal Name Explanation of Other Codes Regarding Type of Authority Granted

XYZ ........................................................................................................................................................................................ ........................................................................................ ........................................................................................................................................................................................ ........................................................................................ ........................................................................................................................................................................................ ........................................................................................ ........................................................................................................................................................................................ ........................................................................................ ........................................................................................................................................................................................ ........................................................................................ ........................................................................................................................................................................................

C. Information Regarding Independent Audit or Bonded Status:

Licensed Name FEIN Number

Affiliated, Non-Affiliate Related Party,

or Unaffiliated Direct Written Premium

Written / Produced

Claims Payments Processed by Agent or

Administrator XYZ .......................... ..................................... S .................................. S .................................. ........................................................................................ .......................... ..................................... .................................. .................................. ........................................................................................ .......................... ..................................... .................................. .................................. ........................................................................................ .......................... ..................................... .................................. .................................. Total XXX XXX $ $

Independent Audit – Subject to annual independent audit Bonded – The work of the entity is bonded by either a fiduciary or surety bond



Attachment K



Attachment K




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION




[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)



Add new disclosure Note 23 – Reinsurance for reinsurance credit (23H – Life/Fraternal, 23E Health and 23K Property).


The purpose of this proposal is to reflect the disclosure additions for SSAP No. 61R—Life, Deposit-Type Contracts and Accident and Health Contracts Reinsurance adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:


Attachment L





23. Reinsurance

Instruction:


H. Reinsurance Credit

(1) Disclose any reinsurance contracts (or multiple contracts with the same reinsurer or its affiliates) subject to A-791 that includes a provision, which limits the reinsurer’s assumption of significant risks identified as in A-791. Examples of risk limiting features include provisions such as a deductible, a loss ratio corridor, a loss cap, an aggregate limit or similar effect. If true, indicate the number of reinsurance contracts to which such provisions apply. For contracts subject to A-791, indicate if deposit accounting was applied for all contracts, which limit significant risks.

(2) Disclose any reinsurance contracts (or multiple contracts with the same reinsurer or its affiliates)

not subject to A-791, for which reinsurance accounting was applied and includes a provision that limits the reinsurer’s assumption of risk. Examples of risk limiting features include provisions such as a deductible, a loss ratio corridor, a loss cap, an aggregate limit or similar effect. If true, indicate the number of reinsurance contracts to which such provisions apply. If affirmative, indicate if the reinsurance credit was reduced for the risk limiting features.

(3) Disclose if any reinsurance contracts contain features (except reinsurance contracts with a federal

or state facility) described below which result in delays in payment in form or in fact:

Provisions which permit the reporting of losses, or settlements are made, less frequently than quarterly or payments due from the reinsurer are not made in cash within ninety (90) days of the settlement date (unless there is no activity during the period).

Payment schedule, accumulating retentions from multiple years or any features inherently

designed to delay timing of the reimbursement to the ceding entity.

(4) Disclose if the reporting entity has reflected reinsurance accounting credit for any contracts not subject to Appendix A-791 and not yearly renewable term, which meet the risk transfer requirements of SSAP No. 61R and identify the type of contracts and the reinsurance contracts.

Assumption Reinsurance – new for the reporting period.

Non-proportional reinsurance, which does not result in significant surplus relief. If yes,

indicate if the insured event(s) triggering contract coverage has been recognized.

Attachment L


(5) Disclose if the reporting entity ceded any risk which is not subject to A-791 and not yearly renewable term reinsurance, under any reinsurance contract (or multiple contracts with the same reinsurer or its affiliates) during the period covered by the financial statement, and either:

Accounted for that contract as reinsurance under statutory accounting principles (“SAP”) and

as a deposit under generally accepted accounting principles (“GAAP”); or

Accounted for that contract as reinsurance under GAAP and as a deposit under SAP.

(6) If affirmative disclosure is required for Paragraph 23H(5) above, explain why the contract(s) is treated differently for GAAP and SAP.

Illustration:


ANNUAL STATEMENT INSTRUCTIONS –HEALTH



23. Reinsurance

Instruction:


E. Reinsurance Credit




Attachment L


(3) Disclose if any reinsurance contracts contain features (except reinsurance contracts with a federal or state facility) described below which result in delays in payment in form or in fact:

Provisions which permit the reporting of losses, or settlements are made, less frequently than

quarterly or payments due from the reinsurer are not made in cash within ninety (90) days of the settlement date (unless there is no activity during the period).











(6) If affirmative disclosure is required for Paragraph 23E(5) above, explain why the contract(s) is treated differently for GAAP and SAP.

Illustration:


Attachment L





23. Reinsurance

Instruction:


K. Reinsurance Credit

The disclosures below apply to reinsurance contracts covering health business.




(3) Disclose if any reinsurance contracts contain features (except reinsurance contracts with a federal

or state facility) described below which result in delays in payment in form or in fact:

Provisions which permit the reporting of losses, or settlements are made, less frequently than quarterly or payments due from the reinsurer are not made in cash within ninety (90) days of the settlement date (unless there is no activity during the period).







Attachment L






(6) If affirmative disclosure is required for Paragraph 23K(5) above, explain why the contract(s) is treated differently for GAAP and SAP.

Illustration:



Attachment L




DATE: 01/14/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION







Add a disclosure instruction for 10C to the Notes to Financial Statement for related party transactions not captured on Schedule Y. Combine existing 10C into 1B instructions and illustration narrative.


The purpose of this proposal is to reflect the disclosure addition for SSAP No. 25—Affiliates and Other Related Parties being adopted by the Statutory Accounting Principles (E) Working Group.

NAIC STAFF COMMENTS


Other Comments:



Attachment M





10. Information Concerning Parent, Subsidiaries, Affiliates and Other Related Parties

Instruction:

The financial statements shall include disclosures of all material related party transactions. In some cases, aggregation of similar transactions that on a stand-alone basis are not material may be appropriate. Sometimes, the effect of the relationship between the parties may be so pervasive that disclosure of the relationship alone will be sufficient. If necessary, to the understanding of the relationship, disclose the name of the related party. Transactions shall not be purported to be arm’s-length transactions unless there is demonstrable evidence to support such statement. Note 10 is primarily for SCAs under SSAP No. 97, but the disclosure for 10O should also be completed of SSAP No. 48 entities. The disclosures shall include:

A. The nature of the relationship involved.

B. A description of the transactions for each of the periods for which financial statements are presented, and

such other information considered necessary to obtain an understanding of the effects of the transactions on the financial statements. Exclude reinsurance transactions, any non-insurance transactions that are less than ½ of 1% of the total admitted assets of the reporting entity, and cost allocation transactions. The following information shall be provided if applicable:

(1) Date of transaction;

(2) Explanation of transaction;

(3) Name of reporting entity;

(4) Name of affiliate;

(5) Description of assets received by reporting entity;

(6) Statement value of assets received by reporting entity;

(7) Description of assets transferred by reporting entity; and

(8) Statement value of assets transferred by reporting entity.

C. The dollar amounts of transactions for each of the periods for which financial statements are presented and the effects of any change in the method of establishing the terms from that used in the preceding period.

C. Transactions with related parties who are not reported on Schedule Y

A reference number should be provided for each transaction with the related party to be used in the tables for the disclosures below. In each disclosure the transaction for each related party should be reported contiguously together and not separated by other transactions with other related parties. (Multiple transactions with the same related party shall not be aggregated into a single row.)

Example: Company A has three separate transaction with Related Party B. All of transactions with

Related Party B would be reported together on three consecutive rows of the disclosure table before reporting transaction with the next related party.)

Attachment M


(1) Detail of material related party transactions

Date of transaction

Name of related party

Nature of relationship

Options for type of transaction:

Loan

Exchange of assets or liabilities (e.g., buys, sells and secured borrowing transactions)

Management services

Cost-sharing agreement

Other transactions involving services

Guarantee (e.g., guarantees to related parties, on behalf of, and when beneficiary is related party)

Other

Type of transaction

Options for type of transaction:

Loan

Exchange of assets or liabilities (e.g., buys, sells and secured borrowing transactions)

Management services

Cost-sharing agreement

Other transactions involving services

Guarantee (e.g., guarantees to related parties, on behalf of, and when beneficiary is related party)

Other

Written agreement (Yes/No)

Due date

Reporting period date amount due from (to)

(2) Detail of material related party transactions involving services


Overview description

Amount charged

Amount based on allocation of costs or market rates

Amount charged modified or waived (Yes/No)

Attachment M


(3) Detail of material related party transactions involving exchange of assets and liabilities


Overview description

Description of assets received

Description of assets transferred

Statement value of assets received

Statement value of assets transferred

Have terms changed from preceding period? (Yes/No)

(4) Detail of amounts owed to/from a related party


Aggregate reporting period amount due from

Aggregate reporting period amount due to

Amount offset in financial statement (if qualifying)

Net amount recoverable/(payable) by related party

Admitted recoverable

D. Amounts due from or to related parties as of the date of each balance sheet presented and, if not otherwise apparent, the terms and manner of settlement.

E. Any guarantees or undertakings, written or otherwise, shall be disclosed in Note 14, Liabilities,

Contingencies and Assessments, in accordance with the requirements of SSAP No. 5R—Liabilities, Contingencies and Impairments of Assets. In addition, the nature of the relationship to the beneficiary of the guarantee or undertaking (affiliated or unaffiliated) shall also be disclosed.

FE. A description of material management or service contracts and cost-sharing arrangements involving the

reporting entity and any related party. This shall include, but is not limited to, sale lease-back arrangements, computer or fixed asset leasing arrangements, and agency contracts that remove assets that may otherwise be recorded (and potentially nonadmitted) on the reporting entity’s financial statements.

F. Any guarantees or undertakings, written or otherwise, shall be disclosed in Note 14, Liabilities,

Contingencies and Assessments, in accordance with the requirements of SSAP No. 5R—Liabilities, Contingencies and Impairments of Assets. In addition, the nature of the relationship to the beneficiary of the guarantee or undertaking (affiliated or unaffiliated) shall also be disclosed.

G. The nature of the control relationship whereby the reporting entity and one or more other enterprises are

under common ownership or control and the existence of that control could result in operating results or financial position of the reporting entity being significantly different from those that would have been obtained if the enterprises were autonomous. Disclose the relationship even though there are no transactions between the enterprises.


Attachment M


Illustration:

A., B. B.& C. The Company paid common stock dividends to the Parent Company, The ABC Insurance Company, on

July 15, 20____, totaling $__________. THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLES BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION.

C Transactions with related party who are not reported on Schedule Y

(1) Detail of Material Related Party Transactions

Ref # Date of

Transaction Name of Related Party Nature of Relationship Type of Transaction

Written Agreement (Yes/No) Due Date

Reporting Period Date Amount Due From (To)

Options for Type of Transaction:

Loan Exchange of Assets or Liabilities (e.g., buys, sells and secured borrowing transactions) Management Services Cost-Sharing Agreement Other Transactions Involving Services Guarantee (e.g., guarantees to related parties, on behalf of, and when beneficiary is related party) Other

(2) Detail of Material Related Party Transactions Involving Services

Ref # Name of Related Party Overview Description Amount Charged

Amount Based on Allocation of

Costs or Market Rates

Amount Charged

Modified or Waived

(Yes/No) Total

(3) Detail of Material Related Party Transactions Involving Exchange of Assets and Liabilities

a. Description of Transaction

Ref # Name of Related Party Overview Description

Have Terms Changed from

Preceding Period?

(Yes/No)

b. Assets Received

Ref # Name of Related Party Description of Assets Received

Statement Value of Assets Received

Total

Attachment M


c. Assets Transferred

Ref # Name of Related Party Description of Assets Transferred

Statement Value of Assets

Transferred Total

(4) Detail of Amounts Owed To/From a Related Party

Ref # Name of Related Party

Aggregate Reporting Period

Amount Due From

Aggregate Reporting Period (Amount Due To)

Amount Offset in Financial Statement

(if qualifying)

Net Amount Recoverable / (Payable) by Related Party

Admitted Recoverable

Total XXX

D. At December 31, 20____, the Company reported $_________ as amounts due to the Parent Company, The

ABC Insurance Company. The terms of the settlement require that these amounts be settled within 30 days.

E. The Company has given XYZ Inc., an affiliated company, a standing commitment until January 1, 20____, in the form of guarantees in the event of a default of XYZ on various of its debt issues as disclosed in Note 14.

FE. The Company has agreed to provide the Parent Company, The ABC Insurance Company, certain actuarial

investment services with respect to the administration of certain large group insurance contracts that are subject to group experience rating procedures.

F. The Company has given XYZ Inc., an affiliated company, a standing commitment until January 1, 20____,

in the form of guarantees in the event of a default of XYZ on various of its debt issues as disclosed in Note 14.

The Parent Company has agreed to provide collection services for certain contracts for the Company.

G. All outstanding shares of The Company are owned by the Parent Company, The ABC Insurance Company,

an insurance holding company domiciled in the State of ______________.



Attachment M




DATE: 02/07/2020

CONTACT PERSON: Eva Yeung

TELEPHONE: 816-783-8407


ON BEHALF OF: P/C RBC WG

NAME: Tom Botsko

TITLE: Chair


ADDRESS: 50 W. Town Street, Third Floor – Suite 300

Columnbus, OH 43215




DISPOSITION




[ ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)



Modify the Annual Statement Instructions for Schedule F, Part 3 to reflect the factors for all uncollateralized reinsurance recoverable from unrated reinsurers be the same for authorized, unauthorized, certified, and reciprocal reinsurance.


1. The factor for reinsurance recoverable from uncollateralized, unrated reinsurers is being updated by PCRBC WG to movetowards a charge that is more aligned with risk-indicated factors used by the ratings agencies.

2. With respect to the broader implementation of the Covered Agreement, the PCRBC WG identified the need to eliminatethe different treatment of uncollateralized reinsurance recoverable from authorized versus unauthorized, unrated reinsurers.

NAIC STAFF COMMENTS


Other Comments:


Attachment N






Column 34 – Reinsurer Designation Equivalent

Following is a listing of the valid codes.

1 2 3 4 5 6 7

Utilize the table below and report a reinsurer designation equivalent code of 1 through 6 (where 6 represented vulnerable 6 or unrated) or 7 (for unrated authorized reinsurers). The equivalent designation category assigned will correspond to a current financial strength rating received from an approved rating agency as outlined in the table below. Ratings shall be based on interactive communication between the rating agency and the assuming insurer and shall not be based solely on publicly available information. If the reinsurer is unauthorized and does not have at least one financial strength rating, it should be assigned the “Vulnerable 6 or Unrated Unauthorized Reinsurers” equivalent rating. If the reinsurer is authorized and does not have at least one financial strength rating, it should be assigned the “Unrated Authorized Reinsurers” equivalent rating. Amounts recoverable from unrated voluntary pools should be assigned the “reinsurer equivalent code of 3.” Anauthorizedassociation including incorporated and individual unincorporated underwriters or amemberthereofmay utilize the lowest financial strength group rating received from an approved rating agency.

Reinsurer Designation Equivalent Category

Code 1 2 3 4 5 6 7

Description Secure 1 Secure 2 Secure 3 Secure 4 Secure 5

Vulnerable 6 or Unrated

Unauthorized Reinsurers

Unrated Authorized Reinsurers

Best A++ A+ A A- B++, B+ B, B-, C++, C+, C, C-, D, E, F ..................

S&P AAA AA+, AA, AA-

A+, A A- BBB+, BBB, BBB-

BB+, BB, BB-, B+, B, B-, CCC, CC, C, D, R ..................

Moody's Aaa Aa1, Aa2, Aa3

A1, A2 A3 Baa1, Baa2, Baa3

Ba1, Ba2, Ba3, B1, B2, B3, Caa, Ca, C ..................

Fitch AAA AA+, AA, AA-

A+, A A- BBB+, BBB, BBB-

BB+, BB, BB-, B+, B, B-, CCC, CC, C, D, R ..................

Attachment N


Column 35 – Credit Risk on Collateralized Recoverables

Following is a table of factors applicable to the respective reinsurer designation equivalent categories in Column 34

Code 1 2 3 4 5 6 7

Factor 3.6% 4.1% 4.8% 5.0% 5.0% 5.0% 5.0%

Column 36 – Credit Risk on Uncollateralized Recoverables

Following is a table of factors applicable to the respective reinsurer designation equivalent categories in Column 34

Code 1 2 3 4 5 6 7

Factor 3.6% 4.1% 4.8% 5.3% 7.1% 14.0%14.0% 10.0%



Attachment N



Attachment N




DATE: 02/21/2020

CONTACT PERSON: Pat Allison

TELEPHONE: 816-783-8528


ON BEHALF OF: LATF

NAME: Mike Boerner, Chair

TITLE:

AFFILIATION:

ADDRESS:




DISPOSITION







Variable Annuities Supplement Blank: Changing the header for Column 10 Changing Lines 1-3 and adding Line 4

Variable Annuities Supplement Instructions: Adjusting the instructions to correspond with changes made to the blanks as well as changes in the 2020 Valuation

Manual for the new VA Framework.


The new VA Framework is effective for 2020.

NAIC STAFF COMMENTS


Other Comments:


Attachment O



VARIABLE ANNUITIES SUPPLEMENT PARTS 1 AND 2

This supplement is to be filed on or before April 1. Complete this supplement for contracts and certificates subject to VM-21 or AG 43. A separate chart shall be prepared for individual contracts and for group contracts with individual certificates. For variable annuities (VAs) with guaranteed benefits, disclose the type(s) of guaranteed benefit(s), the number of contracts or certificates with those benefits, the amount of the benefit base related to each type of benefit, the net amount at risk for death benefits and the guaranteed annual payout for income and withdrawal benefits, the gross amount of the reserve for the guaranteed benefit(s), the portion of the contract/certificate account value related to contract/certificate funds in the General Account or the Separate Account, and the percent of the guaranteed benefit reinsured. Column 1 & Column 2 – Type of Guaranteed Benefit

For purposes of this supplement, a Guaranteed Death Benefit is defined in accordance with the term “Guaranteed Minimum Death Benefit” in VM-21, and a Guaranteed Living Benefit (GLB) is defined in accordance with the term “Variable Annuity Guaranteed Living Benefits” in VM-01. “Type” shall include a summary description of the type of benefit. Examples are provided in the table illustrated below. Descriptions that may apply when identifying “Type” for Column 2 include, “Guaranteed Minimum Accumulation Benefit” (GMAB), “Guaranteed Minimum Income Benefit” (GMIB), “Hybrid GMIB,” “Traditional GMIB,” “Guaranteed Minimum Withdrawal Benefit” (GMWB), “Lifetime GMWB,” “Non-Lifetime GMWB,” and “Guaranteed Payout Annuity Floor” (GPAF). These terms are defined in VM-01. For those guaranteed benefits that include waiting periods before any benefit can be realized, include the length of the original waiting period in the description.

A separate line shall be created for each combination of Guaranteed Death Benefit and Guaranteed Living Benefit.

o See the illustration in the table below for an example. o For a category with only one guarantee, show “None” in the other column. o For a category with no guaranteed benefit, show “None” in both columns.

Each contract/certificate shall be included in one and only one line. o For a contract with multiple living benefits, determine the most appropriate

classification.

A separate chart shall be prepared for individual contracts and for group contracts with individual certificates. In each chart, show the amount of any reinsurance reserve credit being taken separately for treaties with affiliated captive reinsurers and for other reinsurers. For purposes of this supplement, a Guaranteed Living Benefit (GLB) is defined as a contract/certificate, agreement or rider in which the insurance entity guarantees specified payouts during a defined period, which may include the lifetime of the insured(s). For VAs, these guaranteed payouts are typically made regardless of the performance of the contractual account value that is used to determine cash surrender values and/or withdrawal benefits. Column 3 – Number of Individual (Part 1) Contracts or Group (Part 2) Certificates

Attachment O


Column 4 – Benefit Base For Guaranteed Death Benefit (Col 1)

Report the Benefit Base (defined in the contract/certificate) as of the valuation date as the basis for the guaranteed value. If no guarantee exists, enter $0.

Column 5 – Benefit Base For Guaranteed Living Benefit (GLB) (Col 2)

Report the Benefit Base (defined in the contract/certificate) as of the valuation date as the basis for the guaranteed value. If no guarantee exists, enter $0.

Column 6 – Net Amount at Risk For Guaranteed Death Benefit (Col 1)

Death Benefit Net Amount at Risk (NAR) is defined as the greater of a) zero and b) the difference between the Guaranteed Death Benefit and the Account Value as of the valuation date. Report the sum of the NAR for all contracts/certificates.

Column 7 – Guaranteed Annual Income Amount For Guaranteed Living Benefit (GLB) (Col 2)

Report the total annual income/withdrawal benefits available if the income/withdrawal guarantees were elected on the valuation date. If no GLB/GMWB is available on the valuation date for a particular contract/certificate (e.g. due to a waiting period), use $0. Note, for GLB and GMWB previously elected, show the guaranteed amount based on the prior elections. For GMAB, use $0 since this is not an income benefit. Disclosures for GMAB shall be provided in the AG 43 Memorandum.

Column 8 – Account Value – General Account Column 9 – Account Value – Separate Account Column 10 – Reserve for Guaranteed Benefits (Total Reserve Less Base Adjusted Reserve)Contract-Level Reserves

Less Cash Surrender Value

Total gross reserve for guarantees as defined in AG-43 or VM 21 as applicable in excess of the base contract reserve. Reserves calculated according to AG-43 and VM-21 are allocated to individual contracts or certificates following the guidance of Appendix 6 of AG-43 or Section 8 of VM-21. Report in column 10 the excess of this per policy reserve over the base contract reserve. For base contract reserve, the company may use CSV or Base Adjusted Reserve (defined in Appendix 3, A.3.2D of AG-43 or Section 5, B.4. of VM-21) for that contract or certificate. For each contract/certificate, calculate the excess amount of the pre-reinsurance ceded contract-level reserve, defined in VM-21, over the contract’s cash surrender value. For each “Type” listed under Columns 1 and 2, report the sum of the excess amounts calculated for the associated contracts/certificates. For the Subtotal, report the sum of the excess amounts calculated for all contracts/certificates. The Subtotal should equal the excess of the aggregate reserve over the aggregate cash surrender value.

Column 11 & Column 12 – Percentage of Guaranteed Benefits Reinsured

Show percentage of the Guaranteed Benefit ceded to all reinsurers.

Line 1 – Aggregate Cash Surrender Value

Report the sum of the cash surrender values for all contracts/certificates.

Attachment O


Line 2 – Pre-Reinsurance Ceded Aggregate Reserve (Subtotal for Column 10 plus Line 1)

Report the sum of the pre-reinsurance ceded contract-level reserves for all contracts/certificates. This should equal the Subtotal Line for Column 10 plus Line 1.

Line 3 – Reserve Credit from affiliated captive reinsurance Line 4 – Reserve Credit from other reinsurance Line 3 5 – Total Net of ReinsurancePost-Reinsurance Ceded Aggregate Reserve

Line 3 Total Net of Reinsurance should equal the Subtotal Line for Column 10 minus the sum of Line 1 Reserve Credit from Affiliated Captive Reinsurance and Line 2 Reserve Credit from Other Reinsurance.Report the sum of the post-reinsurance ceded contract-level reserves for all contracts/certificates.

Illustration:

Type 3 Benefit Base 6 7 Account Value 10 Percentage of Guaranteed Benefits Reinsured

1

Guaranteed Death Benefit

2

Guaranteed Living Benefit

Number of Individual Contracts /

Group Certificates

4

For Guaranteed

Death Benefit (Col 1)

5

For Guaranteed Living Benefit (GLB) (Col 2)

Net Amount at

Risk For Guaranteed

Death Benefit (Col 1)

Guaranteed Annual Income

Amount For Guaranteed

Living Benefit (GLB) (Col 2)

8

General Account

9

Separate Account

Reserve for Guaranteed

Benefits (Total Reserve Less Base Adjusted Reserve)Contr

act-Level Reserves Less Cash Surrender

Value

11

Guaranteed Death

Benefit

12


Max Anniversary Value (MAV)*

GMAB - 110% of premium 957 $101.4 M $0 $5.7M $0 $2.7M $93.0M $1.5M 60% 40%

3% Roll-up

GMIB prem accum @3% w/10 yr waiting period 312 $32.6M $34.6M $1.4M $2.4M $0 $31.2M $1.0M 100% 100%

Greater of MAV & 5% Roll-up GMIB ROP, 10 yrs 482 $40.0M $35.0M $3.0M $0M $0M $37.0M $2.0M 0% 0%

Subtotal 1,751 $174.0M $69.6M $10.1M $2.4M $2.7M $161.2M $4.5M XXX XXX

1. Reserve credit from affiliated captive reinsuranceAggregate Cash Surrender Value

160.5M

2. Reserve credit from other reinsurancePre-Reinsurance Ceded Aggregate Reserve (Subtotal for Column 10 plus Line 1)

165.0M

3. Total net of reinsuranceReserve credit from affiliated captive reinsurance

20.0M

4. Reserve credit from other reinsurance 30.0M 5. Post-Reinsurance Ceded Aggregate Reserve 115.0M

Attachment O


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL

VARIABLE ANNUITIES SUPPLEMENT For Year Ended December 31, 20__

(To Be Filed by April 1) NAIC Group Code __________________ NAIC Company Code

PART 1 – INDIVIDUAL

Type 3

Number of Individual Contracts

Benefit Base

6

Net Amount at Risk For


(Col 1)

7 Guaranteed

Annual Income Amount For Guaranteed


Account Value

10 Reserve for Guaranteed

Benefits (Total Reserve Less Base Adjusted

Reserve)Contract-Level Reserves


Percentage of Guaranteed Benefits Reinsured

1


2


4

For Guaranteed Death Benefit

(Col 1)

5


8

General Account

9

Separate Account

11


12


.................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ....................... ......................... ......................... ......................... .................... ..................... Subtotal XXX XXX 1. Reserve credit from affiliated captive reinsuranceAggregate Cash

Surrender Value



4. Reserve credit from other reinsurance 5. Post-Reinsurance Ceded Aggregate Reserve

Attachment O


VARIABLE ANNUITIES SUPPLEMENT

PART 2 – GROUP CONTRACTS WITH INDIVIDUAL CERTIFICATES

Type 3

Number of Group

Certificates

Benefit Base

6

Net Amount at Risk For


(Col 1)

7 Guaranteed

Annual Income Amount For Guaranteed


Account Value

10 Reserve for Guaranteed

Benefits (Total Reserve Less Base Adjusted

Reserve)Contract-Level Reserves


Percentage of Guaranteed Benefits Reinsured

1


2


4

For Guaranteed Death Benefit

(Col 1)

5


8

General Account

9

Separate Account

11


12


.................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... .................................................. .................................................. ......................... ......................... ......................... ........................ ......................... ........................ ......................... ........................ .................... ..................... Subtotal XXX XXX 1. Reserve credit from affiliated captive reinsuranceAggregate Cash

Surrender Value



4. Reserve credit from other reinsurance 5. Post-Reinsurance Ceded Aggregate Reserve


Attachment O




DATE: 02/21/2020

CONTACT PERSON: Pat Allison

TELEPHONE: 816-783-8528


ON BEHALF OF: LATF

NAME: Mike Boerner, Chair

TITLE:

AFFILIATION:

ADDRESS:




DISPOSITION







See next page for details of changes to the VM-20 Reserves Supplement.


Changing the reporting units for reserves to attain consistency with other annual statement blanks. Clarifying the instructions to attain consistency in company reporting. Changes are based on findings from the 2018 review of company filings.

NAIC STAFF COMMENTS


Other Comments:


Attachment P


IDENTIFICATION OF ITEM(S) TO CHANGE VM-20 Reserves Supplement Blank:

Splitting Part 1 into Part 1A and Part 1B.

For Part 1A:

o Changing the description header for Column 3 to be “Due and Deferred Premium Asset” so that it matches the instructions.

o Adding “XXX” in two places to the indicate that a Due and Deferred Premium Asset does not need to be reported in the lines shown for Total Reserves.

o Changing the reporting units for all columns to be in dollars rather than in thousands.

o Expanding all columns to allow room for a number as large as 999,999,999,999.

o Changing the product labels for clarity.

For Part 1B:

o Changing the reporting units for the Reserve columns to be in dollars rather than in thousands.

o Expanding the Reserve columns to allow room for a number as large as 999,999,999,999.

o Expanding the Face Amount columns to allow room for a number as large as 9,999,999,999.

o Changing the product labels for clarity.

Removing Part 2 and re-numbering the remaining Parts.

VM-20 Reserves Supplement Instructions:

Adjusting the instructions according to the changes made to the blanks.

Clarifying instructions and adding examples for Parts 1A and 1B.

Attachment P



VM-20 RESERVES SUPPLEMENT – PART 1

Life Insurance Reserves Valued According to VM-20 by Product Type

($000 Omitted Except for Number of Policies) This Supplement provides information on the reserves required to be calculated by Section VM-20 of the Valuation Manual. This includes the Net Premium Reserve and, as applicable, the Deterministic Reserve and the Stochastic Reserve. This Supplement also provides information regarding business where VM-20 of the Valuation Manual is not required to be applied. Only business issued on or after Jan. 1, 2017, valued by the requirements of VM-20 should be reported in Part 1A and Part 1B. Part 1A and Part 1B are intended to aid regulators in the analysis of reserves as determined under Section VM-20 of the Valuation Manual for both the prior and current year. Companies that elect the three-year transition for some of their policies should not report those policies in this part. This Supplement also provides information regarding business where VM-20 of the Valuation Manual is not required to be applied. Companies that elect the three-year transition period for all of their business or are otherwise exempted from the requirements of Section VM-20 are not required to complete Part 1A or Part 1B of this Supplement pursuant to the instructions in Part 2 of this Supplement. but must complete Part 2 or Part 3 as applicable.

VM-20 RESERVES SUPPLEMENT – PART 1A

Life Insurance Reserves Valued According to VM-20 by Product Type Part 1A of this Supplement breaks out, by product type, the prior year and current year reported reserves on a Post-Reinsurance-Ceded and Pre-Reinsurance-Ceded basis as defined in Section 8.D of Section VM-20 of the Valuation Manual. The Due and Deferred Premium Asset for the current year is also shown.In addition, Part 1 of this Supplement shows, by product type for the current year, the Due and Deferred Premium Asset, the Net Premium Reserve (NPR), the Deterministic Reserve (DR) and the Stochastic Reserve (SR), where the NPR, DR and SR are as defined in Section VM-20 of the Valuation Manual. This Supplement is intended to aid regulators in the analysis of reserves as determined under Section VM-20 of the Valuation Manual for both the prior and current year. Section VM-20 of the Valuation Manual requires that the Post-Reinsurance-Ceded Reserve be determined by three product groupsVM-20 Reserving Categories: Term Insurance, Universal Life with Secondary Guarantees (ULSG) and all other. Term Insurance should be reported on line 1.1. ULSG, including Variable Universal Life with a secondary guarantee, Indexed life insurance with a secondary guarantee, regular Universal Life with a secondary guarantee, and ULSG policies with a non-material secondary guarantee as defined in Section VM-01 of the Valuation Manual, should be reported on line 1.2. Each of the other products reported in lines 1.3 – 1.8 should be determined as the sum of the policy reserves using the policy reserves determined following the allocation process of VM-20 Section 2. A similar process should be used for each of the pre-reinsurance-ceded reserves. Section A: Columns 4 through 8 are to be completed if each of the reserves in Columns 4 through 6 (NPR, DR, SR) is calculated according to the requirements of Section VM-20 of the Valuation Manual. Section B: Columns 9 through 12 are to be completed only if the reserves in Columns 9 and 10 (NPR, DR) are calculated according to the requirements of Section VM-20 of the Valuation Manual. Section C: Columns 13 through 15 are to be completed only if the reserve in Column 13 (NPR) is calculated according to the requirements of Section VM-20 of the Valuation Manual.

Attachment P


Columns 1 & 2 – Reported Reserve

Provide the reported reserve, in thousandswhole dollars, for the prior year and current year for each line item. Post-Reinsurance-Ceded is net of reinsurance ceded, and. Pre-Reinsurance-Ceded includes reinsurance assumed and excludes any reinsurance cededshould be prior to any reinsurance ceded and include reinsurance assumed. Sections 2 and 8 in the Valuation Manual further describe the required reserve and treatment of reinsurance. The reported reserve for the current year should reflect all policies in force as of the end of the current year. The reported reserve for the prior year should reflect all policies in force as of the end of the prior year.

Column 3 – Due and Deferred Premium Asset

Provide the due and deferred premium asset amount, in thousandswhole dollars, associated with the current year Reported Reserve from Column 2 and calculated in a manner consistent with lines 15.1 and 15.2 of the Annual Statement Assets page.

Example 1: A company reinsures a ULSG product using YRT reinsurance.

The ceding company reports their reserve on lines 1.2 and 3.2 for ULSG. The assuming company reports their reserve on lines 1.1 and 3.1 for Term.

Example 2: A company reinsures a Term product using YRT reinsurance.

The ceding company reports their reserve on lines 1.1 and 3.1 for Term. The assuming company reports their reserve on lines 1.1 and 3.1 for Term.

Attachment P


VM-20 RESERVES SUPPLEMENT – PART 1B

Life Insurance Reserves Valued According to VM-20 by Product Type

($000 Omitted for Face Amount) Part 1B of this Supplement provides details underlying the amounts shown in Part 1A. Section A: Columns 4 1 through 8 5 are to be completed if each of the reserves in Columns 4 1 through 6 3 (NPR, DR, SR) is calculated according to the requirements of Section VM-20 of the Valuation Manual. Section B: Columns 9 6 through 12 9 are to be completed only if the reserves in Columns 9 6 and 10 7 (NPR, DR) are calculated according to the requirements of Section VM-20 of the Valuation Manual. Section C: Columns 13 10 through 15 12 are to be completed only if the reserve in Column 13 10 (NPR) is calculated according to the requirements of Section VM-20 of the Valuation Manual. Column 41, 9 6 & 1310 – Net Premium Reserve (NPR)

Report the Post-Reinsurance-Ceded and Pre-Reinsurance-Ceded Net Premium Reserve for the each product type, in whole dollars. The Net Premium Reserve is defined in Section 3 in VM-20 of the Valuation Manual.

Column 5 2 & 107 – Deterministic Reserve

Report the Post-Reinsurance-Ceded and Pre-Reinsurance-Ceded Deterministic Reserve for each product type, in thousandswhole dollars. Report the amount whether it is positive or negative; do not floor the amount at zero if it is negative. The Deterministic Reserve calculation is defined in Section 4 in VM-20 of the Valuation Manual.

Column 63 – Stochastic Reserve

Report the Post-Reinsurance-Ceded and Pre-Reinsurance-Ceded Stochastic Reserve for each product type, in thousandswhole dollars. Report the amount whether it is positive or negative; do not floor the amount at zero if it is negative. The Stochastic Reserve calculation is defined in Section 5 in VM-20 of the Valuation Manual.

Column 74, 11 8 &1411 – Number of Policies

Report the number of individual life insurance policies by product type and by the required VM-20 methodology used as described in Section A, Section B and Section C above. The number of policies should be prior to any reinsurance ceded and include reinsurance assumed.

Column 85, 12 9 & 1512 – Face Amount

Report the face amount, in thousands, of individual life insurance by product type and by the required VM-20 methodology used as described in Section A, Section B and Section C above. The face amount should be prior to any reinsurance ceded and include reinsurance assumed.

Example: A company has Term business subject to VM-20, and there is no reinsurance. The Stochastic Exclusion Test was passed. The Deterministic Reserve at year-end was negative.

The company completes Section B. The Net Premium Reserve is reported in whole dollars in Column 6. The negative Deterministic Reserve is reported in whole dollars in Column 7. The Number of Policies is reported in Column 8. The Face Amount is reported in thousands in Column 9.

Attachment P


VM-20 RESERVES SUPPLEMENT – PART 2

Three Year-Transition Period

($000 Omitted Except for Number of Policies)

This section of the Supplement should be completed when a reporting entity has elected to apply the three-year transition provided in Section II, Sub-section C under Life Insurance Products of the Valuation Manual to some or all of its business.

This Part 2 should include the values requested for the business for which the three-year transition has been elected and should not include values for any policies valued based on VM-20. This Part 2 allows the company to establish minimum reserves according to applicable requirements stated in Appendix A (VM-A) and Appendix C (VM-C), in the Valuation

Manual, for business otherwise subject to VM-20 requirements and issued during the first three years following the Operative Date of the Valuation Manual. If a company does not elect this three-year transition, but elects to apply VM-20 to a block of business issued on and after the Operative Date, then such company must continue to apply the requirements of VM-20 to

this block of business, as well as future new issues of this type of business.

A company that elects to apply the three-year transition for all of its products within the scope of VM-20 does not have to complete Part 1 of the VM-20 Supplement. If a company applies VM-20 to a product or products, then Part 1 of this VM-20

Supplement will need to be completed.

VM-20 RESERVES SUPPLEMENT – PART 3 2

Life PBR Exemption This section of the Supplement should be completed by a company that has filed and been granted a Life PBR Exemption from its state of domicile. If a company has been granted a Life PBR Exemption, the company must indicate the source of the Life PBR Exemption, which could be defined in a state statute, a state regulation or in the NAIC-adopted Valuation Manual. If the source of the granted Life PBR Exemption is not the NAIC-adopted Valuation Manual, the company must disclose the criteria of the state’s Life PBR Exemption that the company has met, and the company must disclose the minimum reserve requirements that are required by the state of domicile. If the minimum reserve requirements of the state of domicile are the same as those specified in the NAIC-adopted Valuation Manual, the company may indicate: “Same as NAIC VM”. Companies whose individual ordinary life business is exempted from the requirements of VM-20 pursuant to a Life PBR Exemption are not required to complete Part 1 of this VM-20 Supplement.

VM-20 RESERVES SUPPLEMENT – PART 4 3

Other Exclusions from Life PBR Questions 1 and 2 of this section of the Supplement should be completed by a company that has filed and been granted a Single State Exemption from the reserve requirements of VM-20 by its state of domicile pursuant to requirements similar to the optional Section 15 of the NAIC Standard Valuation Law (# 820). The response to question 2 should be “Yes” if the company has any business assumed that relates to issues outside the state of domicile. Question 3 of this section of the Supplement should be completed by a company if all its life business is excluded from the requirements of VM-20 pursuant to Section II.B of the Valuation Manual. Companies responding “Yes” to question 1 are not required to complete Part 1 of this VM-20 Supplement if all of their individual ordinary life business was covered under the Single State Exemption. Companies responding “YES” to question 3 are not required to complete Part 1 of this VM-20 Supplement.

Attachment P



VM-20 RESERVES SUPPLEMENT – PART 1A Life Insurance Reserves Valued According to VM-20 by Product Type

For The Year Ended December 31, 20__ (To Be Filed by March 1)

($000 Omitted Except for Number of Policies) NAIC Group Code __________________ NAIC Company Code _________________

Prior Year Current Year 1

Reported Reserve

2

Reported Reserve

3 Deferred Premium

Asset

SECTION A SECTION B SECTION C 4 5 6 7 8 9 10 11 12 13 14 15

Net Premium

Reserve Deterministic

Reserve Stochastic Reserve

Number of Policies Face Amount

Net Premium Reserve

Deterministic Reserve


Net Premium Reserve


1. Post-Reinsurance-Ceded Reserve 1.1. Term Life Insurance ........................................ ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX XXX XXX XXX 1.2. Universal Life With Secondary Guarantee ...... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.3. Non-Participating Whole Life ......................... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.4. Participating Whole Life ................................. ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.5. Universal Life Without Secondary Guarantee. ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.6. Variable Universal Life ................................... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.7. Variable Life .................................................... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.8. Indexed Life ..................................................... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.9. Aggregate Write-Ins for Other Products XXX XXX XXX XXX XXX XXX 2. Total Post-Reinsurance-Ceded Reserve

(Sum of Lines 1.1 through 1.9) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 3. Pre-Reinsurance-Ceded Reserve 3.1. Term Life Insurance ........................................ ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... XXX ..................... ..................... 3.2. Universal Life With Secondary Guarantee ...... ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.3. Non-Participating Whole Life ......................... ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.4. Participating Whole Life ................................. ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.5. Universal Life Without Secondary Guarantee. ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.6. Variable Universal Life ................................... ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.7. Variable Life .................................................... ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.8. Indexed Life ..................................................... ...................... ...................... ........................ ..................... .................... ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.9. Aggregate Write-Ins for Other Products 4. Total Pre-Reinsurance-Ceded Reserve

(Sum of Lines 3.1 through 3.9) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 5. Total Reserves Ceded (Line 4 minus Line 2) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX

DETAILS OF WRITE-INS 1.901. . ........................................................................... ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.902. ............................................................................ ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.903. ............................................................................ ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.998. Summary of remaining write-ins for Line 1.9

from overflow page ............................................ ...................... ...................... ........................ ..................... .................... ..................... XXX XXX ..................... ..................... XXX XXX ..................... XXX XXX 1.999 Totals (Lines 1.901 through 1.903 plus 1.998)

(Line 1.9 above) XXX XXX XXX XXX XXX XXX 3.901. . ........................................................................... ...................... ...................... ........................ ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.902. ............................................................................ ...................... ...................... ........................ ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.903. ............................................................................ ...................... ...................... ........................ ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.998. Summary of remaining write-ins for Line 3.9

from overflow page ............................................ ...................... ...................... ........................ ..................... .................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... 3.999 Totals (Lines 3.901 through 3.903 plus 3.998)

(Line 3.9 above)

Attachment P



Reported Reserve

2

Reported Reserve

3 Due and Deferred

Premium Asset

1. Post-Reinsurance-Ceded Reserve 1.1. Term Life Insurance ................................................................................. ............................................................ ............................................................ ............................................................. 1.2. Universal Life With Secondary Guarantee .............................................. ............................................................ ............................................................ ............................................................. 1.3. Non-Participating Whole Life .................................................................. ............................................................ ............................................................ ............................................................. 1.4. Participating Whole Life .......................................................................... ............................................................ ............................................................ ............................................................. 1.5. Universal Life Without Secondary Guarantee ......................................... ............................................................ ............................................................ ............................................................. 1.6. Variable Universal Life Without Secondary Guarantee .......................... ............................................................ ............................................................ ............................................................. 1.7. Variable Life Without Secondary Guarantee ........................................... ............................................................ ............................................................ ............................................................. 1.8. Indexed Life Without Secondary Guarantee ............................................ ............................................................ ............................................................ ............................................................. 1.9. Aggregate Write-Ins for Other Products 2. Total Post-Reinsurance-Ceded Reserve (Sum of Lines 1.1 through 1.9) XXX 3. Pre-Reinsurance-Ceded Reserve 3.1. Term Life Insurance ................................................................................... ............................................................ ............................................................ ............................................................. 3.2. Universal Life With Secondary Guarantee ................................................ ............................................................ ............................................................ ............................................................. 3.3. Non-Participating Whole Life .................................................................... ............................................................ ............................................................ ............................................................. 3.4. Participating Whole Life ............................................................................ ............................................................ ............................................................ ............................................................. 3.5. Universal Life Without Secondary Guarantee ........................................... ............................................................ ............................................................ ............................................................. 3.6. Variable Universal Life Without Secondary Guarantee ............................ ............................................................ ............................................................ ............................................................. 3.7. Variable Life Without Secondary Guarantee ............................................. ............................................................ ............................................................ ............................................................. 3.8. Indexed Life Without Secondary Guarantee .............................................. ............................................................ ............................................................ ............................................................. 3.9. Aggregate Write-Ins for Other Products 4. Total Pre-Reinsurance-Ceded Reserve (Sum of Lines 3.1 through 3.9) XXX 5. Total Reserves Ceded (Line 4 minus Line 2) XXX DETAILS OF WRITE-INS 1.901. . .................................................................................................................................... ............................................................ ............................................................ ............................................................. 1.902. ..................................................................................................................................... ............................................................ ............................................................ ............................................................. 1.903. ..................................................................................................................................... ............................................................ ............................................................ ............................................................. 1.998.Summary of remaining write-ins for Line 1.9 from overflow page ................................ ............................................................ ............................................................ ............................................................. 1.999 Totals (Lines 1.901 through 1.903 plus 1.998) (Line 1.9 above) 3.901. . .................................................................................................................................... ............................................................ ............................................................ ............................................................. 3.902. ..................................................................................................................................... ............................................................ ............................................................ ............................................................. 3.903. ..................................................................................................................................... ............................................................ ............................................................ ............................................................. 3.998.Summary of remaining write-ins for Line 3.9 from overflow page ............. ............................................................ ............................................................ ............................................................. 3.999 Totals (Lines 3.901 through 3.903 plus 3.998) (Line 3.9 above)

Attachment P


VM-20 RESERVES SUPPLEMENT – PART 1B Life Insurance Reserves Valued According to VM-20 by Product Type


($000 Omitted for Face Amount)

Current Year SECTION A SECTION B SECTION C 1 2 3 4 5 6 7 8 9 10 11 12

Net Premium

Reserve Deterministic

Reserve Stochastic Reserve


Net Premium Reserve

Deterministic Reserve


Net Premium Reserve


1. Post-Reinsurance-Ceded Reserve 1.1. Term Life Insurance ......................................................................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX XXX XXX XXX 1.2. Universal Life With Secondary Guarantee ....................................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.3. Non-Participating Whole Life .......................................................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.4. Participating Whole Life .................................................................. ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.5. Universal Life Without Secondary Guarantee .................................. ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.6. Variable Universal Life Without Secondary Guarantee ................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.7. Variable Life Without Secondary Guarantee ................................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.8. Indexed Life Without Secondary Guarantee .................................... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.9. Aggregate Write-Ins for Other Products XXX XXX XXX XXX XXX XXX 2. Total Post-Reinsurance-Ceded Reserve (Sum of Lines 1.1 through 1.9) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 3. Pre-Reinsurance-Ceded Reserve 3.1. Term Life Insurance ......................................................................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ XXX .......................... ............................ 3.2. Universal Life With Secondary Guarantee ....................................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.3. Non-Participating Whole Life .......................................................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.4. Participating Whole Life .................................................................. ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.5. Universal Life Without Secondary Guarantee .................................. ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.6. Variable Universal Life Without Secondary Guarantee ................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.7. Variable Life Without Secondary Guarantee ................................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.8. Indexed Life Without Secondary Guarantee .................................... ..................................... ...................................... ...................................... ........................ ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.9. Aggregate Write-Ins for Other Products 4. Total Pre-Reinsurance-Ceded Reserve (Sum of Lines 3.1 through 3.9) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 5. Total Reserves Ceded (Line 4 minus Line 2) XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX

DETAILS OF WRITE-INS 1.901. . ............................................................................................................ ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.902. ............................................................................................................. ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.903. ............................................................................................................. ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.998. Summary of remaining write-ins for Line 1.9 from overflow page ..... ..................................... ...................................... ...................................... XXX XXX ..................................... ...................................... XXX XXX ..................................... XXX XXX 1.999 Totals (Lines 1.901 through 1.903 plus 1.998) (Line 1.9 above) XXX XXX XXX XXX XXX XXX 3.901. . ............................................................................................................ ..................................... ...................................... ...................................... ......................... ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.902. ............................................................................................................. ..................................... ...................................... ...................................... ......................... ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.903. ............................................................................................................. ..................................... ...................................... ...................................... ......................... ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.998. Summary of remaining write-ins for Line 3.9 from overflow page ..... ..................................... ...................................... ...................................... ......................... ............................ ..................................... ...................................... ......................... ............................ ..................................... .......................... ............................ 3.999 Totals (Lines 3.901 through 3.903 plus 3.998) (Line 3.9 above)

Attachment P


VM-20 RESERVES SUPPLEMENT – PART 2 Reserves for Policies Not Based on VM-20 as a

Result of the Three-Year Transition Period For The Year Ended December 31, 20__

(To Be Filed by March 1) ($000 Omitted Except for Number of Policies)

Three-Year Transition Period


Gross Reserve 2

Net Reserve 3

Gross Reserve 4

Net Reserve 5

Number of Policies 6

Face Amount

1. Life Insurance Reserves

1.1. Term Life .................................................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.2. Universal Life With Secondary Guarantee ................................................. ............................ ........................... ............................ ............................ ........................... ............................ 1.3. Non-Participating Whole Life .................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.4. Participating Whole Life ............................................................................. ............................ ........................... ............................ ............................ ........................... ............................ 1.5. Universal Life Without Secondary Guarantee ............................................ ............................ ........................... ............................ ............................ ........................... ............................ 1.6. Variable Universal Life .............................................................................. ............................ ........................... ............................ ............................ ........................... ............................ 1.7. Variable Life ............................................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.8. Indexed Life ................................................................................................ ............................ ........................... ............................ ............................ ........................... ............................ 1.9. Aggregate Write-Ins for Other Products 2. Total Life Insurance Reserves (Sum of Lines 1.1 through 1.9)

DETAILS OF WRITE-INS 1.901 . ...................................................................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.902. ....................................................................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.903. ....................................................................................................................... ............................ ........................... ............................ ............................ ........................... ............................ 1.998. Summary of remaining write-ins for Line 1.9 from overflow page .............. ............................ ........................... ............................ ............................ ........................... ............................ 1.999 Totals (Lines 1.901 through 1.903 plus 1.998) (Line 1.9 above).

VM-20 RESERVES SUPPLEMENT – PART 3 2 Life PBR Exemption


Life PBR Exemption as defined in the NAIC adopted Valuation Manual (VM)

1. Has the company filed and been granted a Life PBR Exemption from the reserve requirements of VM-20 of the Valuation Manual by their state of domicile? Yes [ ] No [ ] 2. If the response to Question 1 is "Yes", then check the source of the granted “Life PBR Exemption” definition? (Check either 2.1, 2.2 or 2.3)

2.1 NAIC Adopted VM [ ]

2.2 State Statute (SVL) [ ] Complete items “a” and “b”, as appropriate.

a. Is the criteria in the State Statute (SVL) different from the NAIC adopted VM? Yes [ ] No [ ]

b. If the answer to “a” above is “Yes”, provide the criteria the state has used to grant the Life PBR Exemption (e.g., Group/Legal Entity criteria) and the minimum reserve requirements that are required by the state of domicile (if the minimum reserve requirements are the same as the Adopted VM, write SAME AS NAIC VM:

....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................................................

2.3 State Regulation [ ] Complete items “a” and “b”, as appropriate.

a. Is the criteria in the State Regulation different from the NAIC adopted VM? Yes [ ] No [ ]

b. If the answer to “a” above is “Yes”, provide the criteria the state has used to grant the Life PBR Exemption (e.g., Group/Legal Entity criteria) and the

minimum reserve requirements that are required by the state of domicile (if the minimum reserve requirements are the same as the Adopted VM, write SAME AS NAIC VM:

....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................................................

Attachment P


VM-20 RESERVES SUPPLEMENT – PART 4 3 Other Exclusions from Life PBR For The Year Ended December 31, 20__

(To Be Filed by March 1)

1A. Has the company filed and been granted a Single State Exemption from the reserve requirements of VM-20 of the Valuation Manual by their state of domicile? Yes [ ] No [ ] 1B. If the answer to question 1A is “Yes” please discuss any business not covered under the Single State Exemption.

___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________

2A. If the answer to question 1A is "Yes", does the company have risks for policies issued outside its state of domicile? Yes [ ] No [ ] 2B. If the answer to question 2A is “Yes” please discuss the risks for policies issued outside the state of domicile, how those risks came to be a responsibility of the

company, and why the company would still be considered a Single State Company with such risks. ___________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________

3. Is all of the company’s individual ordinary life insurance business excluded from the requirements of VM-20 pursuant to Section II.B of the Valuation Manual? Yes [ ] No [ ]


Attachment P



Attachment P




DATE: 02/21/2020

CONTACT PERSON: Kris DeFrain

TELEPHONE: 816-783-8229

EMAIL ADDRESS: [email protected] ON BEHALF OF: Phil Vigliaturo, Chair, Casualty Actuarial and Statistical (C) Task Force

TITLE: Director, Research and Actuarial Dept.

AFFILIATION: NAIC

ADDRESS: NAIC Central Office

FOR NAIC USE ONLY Agenda Item # 2020-12BWG Year 2020 Changes to Existing Reporting [ X ] New Reporting Requirement [ ]



DISPOSITION [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ X ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)





IDENTIFICATION OF ITEM(S) TO CHANGE The proposal will require appointed actuaries to attest to meeting Continuing Education (CE) requirements and participate in the CAS/SOA CE review procedures, if requested. These proposed changes were adopted by the Task Force on Jan. 28, 2020.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** As charged by the Property and Casualty Insurance (C) Committee to ensure continued competence of appointed actuaries, the revisions would implement the CAS and SOA P/C Appointed Actuary Continuing Education Verification Process.

NAIC STAFF COMMENTS Comment on Effective Reporting Date: Other Comments: ___________________________________________________________________________________________________ ** This section must be completed on all forms. Revised 7/18/2018

Attachment Q


ACTUARIAL OPINION 1. There is to be included with or attached to Page 1 of the Annual Statement the statement of the Appointed Actuary,

entitled “Statement of Actuarial Opinion” (Actuarial Opinion), setting forth his or her opinion relating to reserves specified in the SCOPE paragraph. The Actuarial Opinion, both the narrative and required Exhibits, shall be in the format of and contain the information required by this section of the Annual Statement Instructions – Property and Casualty.

Upon initial engagement, the Appointed Actuary must be appointed by the Board of Directors by Dec. 31 of the calendar year for which the opinion is rendered. The Company shall notify the domiciliary commissioner within five business days of the initial appointment with the following information:

a. Name and title (and, in the case of a consulting actuary, the name of the firm).

b. Manner of appointment of the Appointed Actuary (e.g., who made the appointment and when).

c. A statement that the person meets the requirements of a Qualified Actuary (or was approved by the domiciliary commissioner) and that documentation was provided to the Board of Directors.

Once this notification is furnished, no further notice is required with respect to this person unless the Board of Directors takes action to no longer appoint or retain the actuary or the actuary no longer meets the requirements of a Qualified Actuary.

If subject to the U.S. Qualification Standards, the Appointed Actuary shall annually attest to having met the continuing education requirements under Section 3 of the U.S. Qualification Standards for issuing Actuarial Opinions. As agreed with the actuarial organizations, the Casualty Actuarial Society (CAS) and Society of Actuaries (SOA) will determine the process for receiving the attestations for their respective members and make available the attestations to the public. An Appointed Actuary subject to the U.S. Qualification Standards and not a member of the CAS or SOA shall select one of the above organizations to submit their attestation.

In accordance with the CAS and SOA’s continuing education review procedures, an Appointed Actuary who is subject to the U.S. Qualification Standards and selected for review shall submit a log of their continuing education in a form determined by the CAS and SOA. The log shall include categorization of continuing education approved for use by the Casualty Actuarial and Statistical Task Force. As agreed with the actuarial organizations, the CAS and SOA will provide an annual consolidated report to the NAIC identifying the types and subject matter of continuing education being obtained by Appointed Actuaries. An Appointed Actuary subject to the U.S. Qualification Standards and not a member of the CAS or SOA shall follow the review procedures for the organization in which they submitted their attestation.

The Appointed Actuary shall provide to the Board of Directors qualification documentation on occasion of their appointment, and on an annual basis thereafter, directly or through company management. The documentation should include brief biographical information and a description of how the definition of “Qualified Actuary” is met or expected to be met (in the case of continuing education) for that year. The documentation should describe the Appointed Actuary’s responsible experience relevant to the subject of the Actuarial Opinion. The Board of Directors shall document the company’s review of those materials and any other information they may deem relevant, including information that may be requested directly from the Appointed Actuary. The qualification documentation shall be considered workpapers and be available for inspection upon regulator request or during a financial examination.



Attachment Q




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF: Capital Adequacy (E) Task Force

NAME: Tom Botsko

TITLE: Chief P & C Actuary

AFFILIATION: Ohio Dept. of Insurance

ADDRESS:




DISPOSITION







Remove Line 24.04 from the General Interrogatories, Part 1 and renumber remaining lines for Interrogatory Question 24. Modify Lines 24.05 and 24.06 to require reporting amounts for conforming and non-conforming collateral programs.


Interrogatory Questions 24.05 and 24.06 are completed dependent on the answer to Question 24.04 which works for companies that have either all conforming or all non-conforming collateral programs. When a company has both, only the collateral amount of the conforming programs is captured. This proposal allows the capture of the amount of collateral for both conforming and non-conforming collateral programs when a company has both.

NAIC STAFF COMMENTS


Other Comments:


Attachment R



GENERAL INTERROGATORIES

PART 1 – COMMON INTERROGATORIES


INVESTMENT 24. For the purposes of this interrogatory, “exclusive control” means that the company has the exclusive right to

dispose of the investment at will, without the necessity of making a substitution thereof. For purposes of this interrogatory, securities in transit and awaiting collection, held by a custodian pursuant to a custody arrangement or securities issued subject to a book entry system are considered to be in actual possession of the company.

If bonds, stocks and other securities owned December 31 of the current year, over which the company has exclusive control are: (1) securities purchased for delayed settlement, or (2) loaned to others, the company should respond “NO” to 24.01 and “YES” to 25.1.

24.03 Describe the company’s securities lending program, including value for collateral and amount of loaned

securities, and whether the collateral is held on- or off-balance sheet. Note 17 of Notes to Financial Statement provides a full description of the program.

24.04 A company with a conforming securities lending program as defined in the risk-based capital instructions

should respond “YES.” 24.045 Report amount of collateral for conforming programs as outlined in the Risk-Based Capital Instructions (24.04

answer is “YES”). 24.056 Report amount of collateral for other programs (24.04 answer is “NO”). 24.1091 The fair value amount reported should equal the grand total of Schedule DL, Part 1, Column 5 plus

Schedule DL, Part 2, Column 5.

The fair value amount reported amount should also equal the fair value amount reported in Note 5E(5)a1(m). 24.1092 The book adjusted/carrying value amount reported should equal the grand total of Schedule DL, Part 1,

Column 6 plus Schedule DL, Part 2, Column 6. 24.1093 The payable for securities lending amount reported should equal current year column for payable for securities

lending line on the liability page.


Attachment R






INVESTMENT

24.01 Were all the stocks, bonds and other securities owned December 31 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 24.03) Yes [ ] No [ ]

24.02 If no, give full and complete information, relating thereto .................................................................................................................................

24.03 For securities 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 17 where this information is also provided)

.............................................................................................................................................................................................................................

24.04 Does the company's security lending program meet the requirements for a conforming program as outlined in the Risk-Based Capital Instructions?

24.045 If answer to 24.04 is yes, report For the reporting entity’s securities lending program, report amount of collateral for conforming programs as outlined in the Risk-Based Capital Instructions.

24.056 If answer to 24.04 is no, report For the reporting entity’s securities lending program, report amount of collateral for other programs.

Yes [ ] No [ ] N/A [ ] $ ______________________

$ ______________________

24.067 Does your securities lending program require 102% (domestic securities) and 105% (foreign securities) from the counterparty at the outset of the contract?

24.087 Does the reporting entity non-admit when the collateral received from the counterparty falls below 100%? 24.098 Does the reporting entity or the reporting entity’s securities lending agent utilize the Master Securities Lending Agreement (MSLA) to

conduct securities lending?

Yes [ ] No [ ] N/A [ ] Yes [ ] No [ ] N/A [ ] Yes [ ] No [ ] N/A [ ]

24.109 For the reporting entity’s security securities lending program, state the amount of the following as of December 31 of the current year:

24.1091 Total fair value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2 $ ______________________

24.1092 Total book adjusted/carrying value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2 $ ______________________

24.1093 Total payable for securities lending reported on the liability page $ ______________________



Attachment R



Attachment R




DATE: 02/21/2020

CONTACT PERSON: Eric King

TELEPHONE: 816-783-8234


ON BEHALF OF: Health Actuarial (B) Task Force

NAME: Perry Kupferman

TITLE: Chief Life Actuary

AFFILIATION: California Department of Insurance

ADDRESS:




DISPOSITION




[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)



Modify the columns and rows on the blank pages for the Long-Term Care Experience Reporting Forms 1 through 5 and make appropriate changes to the instructions for those forms.


Changes are proposed to provide more accurate and useful information to regulators and their customers, and to facilitate greater consistency among and ease of reporting by insurers.

NAIC STAFF COMMENTS


Other Comments:


Attachment S


ANNUAL STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH AND PROPERTY

LONG-TERM CARE INSURANCE EXPERIENCE REPORTING FORMS 1 THROUGH 5 These reporting forms must be filed with the NAIC by April 1 each year. The purpose of the Long-Term Care Insurance Experience Reporting Forms is to monitor the amount of such coverage and to provide data specific to this coverage on a nationwide basis. Long-term care expenses may be paid through life policies, annuity contracts and health contracts. When the long-term benefits portion of the contract is subject to rating rules based on the Long-Term Care Insurance Model Regulation (sections on required disclosure or rating practices to customers, loss ratio and premium rate increases), the adequacy of the pricing and reserve assumptions is critical to meeting the expectation of those sections. For life or annuity products where no portion is subject to these rating rules, the products are not being included in the reporting in these forms. Companies may use an assumption that long-term care benefits that are “incidental” regardless of the date of issue, may be excluded. Incidental means that the value of long-term care benefits provided is less than ten percent (10%) of the total value of the benefits provided over the life of the policy (measured as of the date of issue). If a policy form has had no policies in force and all claims on the policy form have been settled for more than one year, then the policy form is no longer reported on Forms 1, 2 and 4. Form 1 gives an overview of the stand-alone LTC business and claims experience for both individual and group policies. Form 2 focuses on the experience of individual policies broken down into three Primary Issue Periods: Prior to 2003, 2003-2010, and 2011 and later. Form 3 focuses on the adequacy of claims reserves by presenting experience based on incurred year over the next several years. Because prior-year values should already be available; this form should be completed for at least the current and past four years. If available, all prior years should be completed. Form 4 focuses on the experience of group business. Form 5 provides a location to report data at the state level and additionally asks for data related to hybrid life or annuity products with LTC extended and/or accelerated benefits. Form 1 focuses on the critical assumptions of morbidity and persistency while still presenting loss ratio data (without the level of detail in the original forms). As noted in the instructions specific to the form, prior-year values will be filled in over time. Only information as of 2009 and subsequent years is required on the forms, unless it was required on the previous Long-Term Care Insurance Experience Reporting Forms. Companies are not required to supply information for spaces on the forms corresponding to any year prior to adoption of the forms, unless that information was previously reported. Form 2 focuses on the developing level of funds from the issue age premium basis and compares this to the active life reserve. As noted in the instructions specific to the form, prior-year values will be filled in over time. Form 3 focuses on the adequacy of claims reserves by presenting experience based on incurred year over the next several years. Because prior-year values should already be available; this form should be completed for at least the current and past four years. If available, all prior years should be completed. Form 4 is to include life and annuity products that are not exempt as outlined in the Long-Term Care Insurance Model Regulation. Form 5, which replaces the LTC experience Form C, requires information at the state level. In addition to the considerable changes in the structure and purpose of the forms, the new forms are based on adding additional calendar years of experience to prior results. To more appropriately compare the actual results with expectations, the expected values are based on the exposure at the beginning of that year, not the original assumed sales distribution used when completing the original forms. Because of the relatively small claim rates and variable length and size of long-term care claims, the statistical credibility of long-term care insurance experience is lower than the amount of credibility assigned to similar amounts of experience on other types of health insurance. This should be taken into account when reviewing experience and assessing the adequacy of reserves and the critical assumptions underlying them. The Long-Term Care Insurance Experience Reporting Forms 1 through 5 should be filed whenever long-term care insurance has been sold, regardless of which annual statement has been filed. These forms are not only applicable to companies filing the life, accident and health annual statement. The list of the various annual statements is: life/fraternal, accident and health, property/casualty and health. Include under the Individual portion both Individual policies and Group certificates if the group is approved by the state under statutes similar to Section 4E(4) of the Long-Term Care Insurance Model Act. Include under the Group portion group certificates if the group is approved by the state under statutes similar to Section 4E(1), (2) or (3) of the model act.

Attachment S


Experience for LTC insurance should be reported separately by stand-alone LTC policy form or by rider where experience is to be reported by form. Reporting by rider is applicable only to riders having distinct premiums for LTC coverage that are attached to products other than stand-alone LTC policies. Experience under forms that provide substantially similar coverage and provisions, that are issued to substantially similar risk classes and that are issued under similar underwriting standards, may be combined. If this option is utilized, the forms combined should be identified in the column captioned “Policy Form.” Claims incurred will need to reflect the loss of future premiums. These will occur because of the waiver of premium provision in the contract, waiver due to spouse’s benefit status or other provisions in the contract that make it paid-up or not subject to collection of additional premiums for some future period. The claim incurred in each year will include the amount of the reserve established to reflect the loss of future expected premiums. The effect in future years will depend on the manner in which premiums from these policies are reported in following periods:. If the assumption is that the policy is paid-up (no future premiums to be collected), the reserve and experience fund would be the paid-up value and future incurred claims will be only for LTC benefits. If the assumption is that future premiums (gross or net) will be considered as “paid by waiver,” the reserve and experience fund will include in the reserve the present value of future premiums to be waived and the premium waived will be reported as both earned premium and a portion of the incurred claims.

(1) If the assumption is that future premiums (gross or net) will be considered as “paid by waiver,” the reserve will include in the reserve the present value of future premiums to be waived and the premium waived will be reported as both earned premium and a portion of the incurred claims.

(2) If the assumption is that the policy is paid-up (no future premiums to be collected), the reserve would be the paid-up

value and future incurred claims will be only for LTC benefits. Report using (1) above unless there are system limitations which require data to be entered under assumption (2). When reporting dollar amounts, report the amount in thousands ($000 omitted). For non-dollar values, do not truncate the amounts. Definition of Incurred Claims: The amount of developed claims incurred during the calendar year is equal to the present value of all claim payments during the year and any changes in claim reserves. The discount rate is the statutory valuation interest rate for case reserves.

Paid claims in the year of incurral are discounted one-quarter year.

Paid claims subsequent to the year of incurral are assumed to be paid mid-year and discounted back to the midpoint of the incurred year.

Outstanding claim reserves for a given incurred year plus transferred reserves from Part 3 of Form 3 are

discounted from the valuation date to the midpoint of the incurred year. If

iy = Incurred year

T = Report year – incurred year

v = Discount rate

tPaid Claimsiy = Paid claims during current or prior calendar year t from claims incurred in year iy

tCase Reserveiy = Case reserve at end of calendar year t from claims incurred in iy

tTransferred Reserveiy = Transferred reserve at end of calendar year t from claims incurred in iy and

Attachment S


t = iy, iy+1, iy+2, . . . , iy + T

then the Present Value of Incurred Claims for incurred year iy:

For T=0 iyPaid Claimsiy× v¼ + iyCase Reserveiy × v½ + iyIBNRiy × v½ + iyTransferred Reserveiy × v½

For T>0 iyPaid Claimsiy × v¼ + iy+1Paid Claimsiy × v1 + iy+2Paid Claimsiy × v2 + . . . + iy+TPaid Claimsiy × vT + iy+TCase Reserveiy × vT+½ + (iy+TIBNRiy× v T+½ ) + iy+TTransferred Reserveiy × vT+½

If a portion of the IBNR is held for years other than the current calendar year, the value in the parentheses should be used.

The total case reserves and IBNR equal the portion of the total direct liability attributable to LTC business from Exhibit 8, Part 2, Line 2.1 (life, accident & health and fraternal) plus the portion of the claim liabilities reported on Exhibit 6, Line 14 (life, accident & health\fraternal) attributable to LTC business for life, accident & health and fraternal only.

This amount includes accrued and unaccrued claims liabilities that are incurred but not yet paid, both reported and not reported.

Attachment S


INSTRUCTIONS FOR FORM 1 Stand-Alone LTC Only ($000 Omitted)

Long-Term Care Insurance Experience Reporting Form 1 is intended to track actual premium, claims, persistency, and reserves on a nationwide basis. Yearly and cumulative comparisons for direct, assumed, and ceded business are exhibited.

OVERVIEW Long-Term Care Insurance Experience Reporting Form 1 is intended to track actual claims and persistency against expected on a nationwide basis. Certain group business is reported separately from individual and some group business. (See Section 4(E) of the Long-Term Care Insurance Model Act.) Policy forms are grouped into three categories: comprehensive, institutional only or non-institutional. Yearly and cumulative comparisons are exhibited. Even though only policy form groupings are displayed, policy form level information should be kept. It may facilitate rating reviews by the regulators. If a policy form has had no policies in force and all claims on the policy form have been settled for more than one year, then the policy form is no longer reported on this form.

DEFINITIONS AND FORMULAS Comprehensive

Policy forms that provide a combination of institutional or facility and non-institutional coverage. These include institutional only policies with non-institutional riders.

Institutional Only

Policy forms that provide institutional coverage only. Non-Institutional Only

Policy forms that provide only non-institutional coverage. Current

Current calendar year of reporting.

Example: For a specific policy form category, the first year of issue was 2001. This Form 1 is required starting for the year 2009 and the reporting year is 2011. The current year would be 2011.

Prior

The year immediately prior to the year of reporting.

Example: 2010 2nd Prior

Two years prior to the year of reporting.

Example: 2009 3rd Prior

Three years prior to the year of reporting.

Example: Blank, because the first year of reporting is 2009.

Attachment S


4th Prior

Four years prior to the year of reporting.

Example: Blank, because the first year of reporting is 2009. 5th Prior

Five years prior to the year of reporting.

Example: Blank, because the first year of reporting is 2009. Form Inception-to-Date

Aggregate experience data since the adoption of this Form 1.

Example: Data from 2009 through 2011.

Actual and expected in force counts are sums of counts for all years since adoption of Form 1. Total Inception-to-Date

Aggregate experience data since issuance of policies.

Example: Data from 2001 through 2011. Assumed/Ceded Rows

Does not include YRT reinsurance transactions. For columns that are reported as “Number of” (count) rather than an amount, assumed/ceded business is only recorded here if the business is 100% coinsured.

Column 1 – Earned Premiums

Collected Premiums + Change in Due Premiums – Change in Advanced Premiums – Change in Unearned Premium Reserves.

Life, Accident & Health, Fraternal and Property/Casualty Only

Total earned premiums should equal direct earned premiums for LTC business from Schedule H, Part 1, Line 2.

Total earned premiums should equal Accident and Health Policy Experience Exhibit Column 1, Line 10.3 for Individual Business section and Line 12 Group Business section.

Column 2 – Incurred Claims

Developed claims incurred during the calendar year. Equal to the present value of all claim payments and any claim reserves. The discount rate is the statutory valuation interest rate for case reserves.

If iy = Incurred year

T = Report year – incurred year V = Discount rate tPaid Claimsiy = Paid claims during claim duration t from claims incurred

in year iy, t = 0, 1, 2, 3, . . . T

TCase Reserveiy = Case reserve at end of report year from claims incurred in iy

Attachment S


Incurred claims for incurred year iy :

For T=0

0Paid Claimsiy× v¼ + 0Case Reserveiy × v½ + 0IBNRiy × v½.

For T>0

0Paid Claimsiy × v¼ + 1Paid Claimsiy × v1 + 2Paid Claimsiy × v2 + . . . + TPaid Claimsiy × vT + TCase Reserveiy × vT+½ + (TIBNRiy × vT+½ )

This is the developed claim amounts for claims incurred during the specific calendar year. For each claim, the incurred claim equals the present values of all claim payments and the present value of any outstanding case reserve. This will be different from the reported financial incurred claims. The financial incurred claims, including the change in claim reserves that contains gain or loss due to reserve estimation different from actual payments for claims incurred in prior years.

For purposes of the present value calculation, assume all payments are made in the middle of the calendar year and the case reserve is at the end of the calendar year. The discount rate is the statutory valuation interest rate for case reserve. For the current calendar year, an Incurred But Not Reported (IBNR) reserve should be assigned. If a portion of the IBNR is held for years other than the current calendar year, the value in the parentheses should be used.

The total case reserves and IBNR equal the portion of the direct liability attributable to long-term care business from Exhibit 8, Part 2, Line 2.1 (life, accident & health and fraternal) plus the portion of the claim liabilities reported on Exhibit 6, Line 14 (life, accident & health) and Line 13 (fraternal) attributable to LTC business for life, accident & health and fraternal only. This amount includes accrued and unaccrued claims liabilities, which are incurred but not yet paid, both reported and not reported.

The incurred claims should be consistent with the claims exhibited on Form 3.

Column 3 – Number of Claims Opened

The number of claims that have at least one benefit payment made during the year after the elimination period but have no payments in previous years. If a claimant has prior claims, he or she should be counted if the current claim is considered as a new claim. For the purpose of including a claim in this count, payments that do not require satisfaction of the elimination period are excluded. A claim that has terminated by the end of the year should be included in the count.

Column 4 – Number of Claims Closed

Number of claims that had been opened, which became closed during the year due to recovery, exhaustion of benefits, or death.

Column 5 – Number of Claims Remaining Open

Open claims are all claims that have been opened at any date, but have not been closed as of the end of the year.

Column 6 – Number of Terminations

Total number of policy or certificate holders whose coverage ended during the year for any reason, including death, lapse, or benefit exhaustion.

Column 7 – Number of Policies/Certificates In-force at Year End

Total number of policies or certificates in force at the end of the year.

Attachment S


Column 8 – Number of Lives In-force at Year End

Total number of lives in force at the end of the year. Joint policies are to be counted as two lives. Column 9 – Active Life Reserves

Total amount of active life reserves held for policyholders, including those in non-forfeiture status. The amount reported in annual statement Exhibit 6, Line 2 for life, accident & health, and fraternal only.

The amount reported in annual statement Underwriting and Investment Exhibit 2D, line 2, less the premium deficiency reserve in footnote (a) of that exhibit.

Column 10 – Claim Reserves

Total amount of reserves held for payment of claims that have been incurred but not yet paid, including claims on policies in non-forfeiture status.

Column 11 – Other Reserves

Total amount of any other reserves associated with long-term care policies, including premium deficiency reserves, unearned premium reserves, and additional actuarial reserves. For the additional actuarial reserve, use the lesser of the aggregate additional reserve and a reserve calculated specifically for LTC business.

A reserve must be carried for any block of contracts for which future gross premiums when reduced by expenses for administration, commissions, and taxes will be insufficient to cover future claims or services.

Column 3 – Valuation Expected Incurred Claims

The expected claim cost for an individual covered under a policy in force1 at the beginning of the calendar year based on statutory active life reserve morbidity assumption. This is the interpolation of successive policy year expected claim cost for all coverages in force at the beginning of the year. Simple averaging is acceptable.

An acceptable approximation is the expected claim cost multiplied by an exposure adjustment, where expected claim cost is the sum of claim costs during the year based on the valuation morbidity assumption of each life in force at the beginning of the year. The valuation claim cost during the year is an interpolation of successive claim costs by policy year. Other approximations may also be acceptable. Any changes in method should be disclosed on the form.

The exposure adjustment is:

[Actual Number of Lives In Force at Beginning of Year – (Expected Deaths + Expected Lapses) ÷ 2] ÷ Actual Number of Lives In Force at Beginning of Year,

where Expected Deaths and Expected Lapses are based on valuation assumptions. They can be derived from a single average decrement rate combining deaths and lapses, or specific decrement rates applying to actual exposures. If there is no in force at the beginning of the year, the expected claim cost can be zero.

Column 4 – Actual to Expected Incurred Claims

Actual incurred claims as a percentage of valuation expected incurred claims. Column 5 – Open Claim Count

1 If active life reserves are not held for claimants, then exclude the claimants.

Attachment S


Number of claims that have at least one benefit payment made during the year after the elimination period. For the purpose of including a claim in this count, payments that do not require satisfaction of the elimination period are excluded. Examples are payments of caregiver training benefits and optional care coordination benefits. For these examples, if the amounts paid are included as benefits under the policy, they should be included in the claim amounts but excluded from the claim counts. A claim should be included in the count, even though it has terminated by the end of the year.

Column 6 – New Claim Count

Number of claims that have at least one benefit payment made during the year after the elimination period but have no payments in previous years. If a claimant has prior claims, he or she should be counted if the current claim is considered as a new claim. For the purpose of including a claim in this count, payments that do not require satisfaction of the elimination period are excluded. A new claim should be included in the count even though it has terminated by the end of the year.

Column 7 – Lives In Force End of Year

Actual number of lives in force at the end of the year. Joint policies should be counted by number of lives.

Column 8 – Expected Lives In Force End of Year

Expected number of lives in force at the end of the year:

Actual Number of Lives In Force at Beginning of Year + New Issue Lives – Expected Deaths – Expected Lapses,

where Expected Deaths and Expected Lapses are based on valuation assumptions. They can be derived from a single average decrement rate combining deaths and lapses or specific decrement rates applying to actual exposures. Joint policies should be counted by number of lives.

Column 9 – Actual to Expected Lives In Force

Actual number of lives in force as a percentage of expected number of lives in force at the end of the year.

NOTES 1. Form 1 applies to direct business only. 2. Prior years’ figures, except for incurred claims, should be the same as the figures from prior years’ Form 1. 3. Form Inception-to-Date figures, except for incurred claims, should be the corresponding figures from prior-year

Form 1 plus the figures for the current year. No interest discounting is required to determine Form Inception-to-Date and Total Inception-to-Date figures.

4. If Incurred But Not Reported reserves must be allocated by policy form, the allocation should be based on paid

claims and change in case reserves. 5. Use the valuation assumptions corresponding to the current reserves being held. They are not necessarily the original

reserve assumptions if strengthening or release of reserves has been made in the past. The assumptions for each year should be applied to the actual in-force (age, gender, plan distribution), not the distribution originally expected or issued.

6. An insurance company may use more refined methods in determining the required information than those described

in the definitions and instructions. Methods must be consistent from report year to report year.

Attachment S


INSTRUCTIONS FOR FORM 2 Direct Individual Experience – Stand-Alone Only ($000 Omitted)

Primary Issue Period Splits

Experience data for each policy should be aggregated in one of the three Primary Issue Year Periods shown on the experience form. It would be permissible for a company to include 100% of a policy form’s experience in just one of the three Primary Issue Year periods (using the issue year period where the majority of the policies were originally issued). It would also be permissible for a company to split a policy form’s experience by issue year into multiple Primary Issue Year periods shown in the form based upon policy issue year.

OVERVIEW

The purpose of Form 2 is to calculate a ratio of an experience reserve to the reported reserve by calendar year on a nationwide basis. Summary data by policy form is to be reported. Data for the current reporting year, as well as that reported in each of the prior two reporting years, is to be shown on Form 2. The following formulae specify data by calendar duration (t) and calendar year of issue (n). Data at this detail is required for the calculation of the experience reserve, although only totals by policy form are illustrated. Experience data is notated by a superscript E to distinguish from valuation assumptions. The experience reserve reported in column 13 is developed from: 1) the experience reserve at the end of the prior reporting year (t-1); 2) valuation net premiums and interest rates; and 3) experience incurred claims, earned premiums, and actual persistency. The valuation net premiums used are the actual net premiums used for that reporting year. As an example, if a factor file method is used, the valuation net premiums used to calculate the reserve factors would be used for Form 2. For 2009, the experience reserve (column 13) was calculated using the reported reserve as of the end of 2008 as the prior year’s reserve. Similarly, for acquired business, the experience reserve as of the year-end following acquisition is set equal to the reported reserve as of that date. The experience reserve as of subsequent periods is developed from the first experience reserve reported in this form. If a policy form has had no policies in force and all claims on the policy form have been settled for more than one year, then the policy form is no longer reported on this form. Experience and valuation data are reported by base policy form. Rider forms will be reported with the base forms to which they are attached. Only summary data by reporting year is illustrated. The reporting company should have detail by calendar duration available upon request.

DEFINITIONS AND FORMULAS Current

Current calendar year of reporting. Total Inception-to-Date

Aggregate experience data since issuance of policies. Comprehensive

Policies that provide a combination of institutional or facility and non-institutional coverage. These include institutional only policies with non-institutional riders.

Attachment S


Institutional Only

Policies that provide institutional coverage only. Non-Institutional Only

Policies that provide only non-institutional coverage. Column 1 – Calendar Year of Peak Issues

Calendar year in which the largest number of policies in the block were sold. When reporting figures for inception-to-date, include all policies ever sold in the block. For the current year, include only those policies that remain inforce as of 12/31.

Column 2 – Percent Male Lives Insured

Percentage of males within the block of policyholders. For example, a block consisting of 60% males would be reported as 60. When reporting figures for inception-to-date, include all policies ever sold in the block. For the current year, include only those policyholders that remain insured as of 12/31.

Column 3 – Average Attained Age

Arithmetic mean of the attained ages of all inforce policyholders in the block at year end. Column 4 – Earned Premium


Total earned premiums should equal Accident and Health Policy Experience Exhibit Column 1, Line 10.3 for Individual Business section and Line 12 Group Business section.


Developed claims incurred during the calendar year. Equal to the present value of all claim payments and any claim reserves. The discount rate is the statutory valuation interest rate for case reserves.

Column 6 – Number of Lives In-force Year End

Total number of lives in force at the end of the year. Joint policies are to be counted as two lives. Column 7 – Number of Terminations

Total number of policyholders whose coverage ended during the year for any reason including death, lapse, or benefit exhaustion.

Column 8 – Number of New Lives Insured

Total number of new lives issued LTC policies during the year. Values in rows that are labeled “inception-to-date” should be the sum of all new lives insured in each year during which the form was sold.

Attachment S


Column 3 – Last Year Issue

For closed blocks of business, report the last year a policy was issued for the policy form. For open blocks of business, leave blank.

Column 4 – Earned Premiums

tEPn = The direct earned premium in calendar duration t for all business of Calendar Year of Issue (CYI) n. Include earned premiums only for the reporting year. Total direct earned premiums should equal direct earned premiums for LTC business from Schedule H, Part 1, Line 2 for life, accident & health, fraternal and property/casualty only.


tICEn = The experience incurred claims of all business of CYI n in calendar duration t

for the reporting year.

tICEn = [t(Paid Claims)n] + [tCLiabE

n x (1+in)-1/2 – (t-1CLiabEn ) x (1+in)1/2]

Where:

t(Paid Claims)n = The paid claims of all business of CYI n in calendar duration t for the reporting

year. Paid claims is the total direct paid claims for LTC business from Exhibit 8, Part 2, Line 1.1 for life, accident & health and fraternal only.

in = The valuation interest rate for CYI n.

tCLiabE

n = The claim liability of all business of CYI n in calendar duration t for the reporting year. tCLiabE is the portion of the total direct claim liability attributable to LTC business from Exhibit 8, Part 2, Line 2.1 (life, accident & health and fraternal) plus the portion of the claim liabilities reported on Exhibit 6, Line 14 (life, accident & health) and Line 13 (fraternal) attributable to LTC business for life, accident & health, and fraternal only. This amount includes accrued and unaccrued claims liabilities, which are incurred but not yet paid, both reported and not reported.

t-1CLiabE

n = The claim liability of all business of CYI n in calendar duration t-1 for the prior reporting year. t-1CLiabE

n is the total direct claim liability for LTC business from Exhibit 8, Part 2, Line 4.1 (life, accident & health and fraternal) of the current year’s annual statement plus the portion of the claim liabilities reported on Exhibit 6, Line 14 (life, accident & health) and Line 13 (fraternal) attributable to LTC business on the prior year’s annual statement for life, accident & health and fraternal only. This amount includes accrued and unaccrued claims liabilities that were incurred but not paid at the prior year-end, both reported and not reported.

Column 6 – Loss Ratio

tLRn = The incurred claims loss ratio in calendar duration t for all business of CYI n.

tLRn = tICEn / tEPn

Column 6 = Column 5 / Column 4 x 100

Attachment S


Column 7 – Annual Net Premium/Annual Gross Premium

The ratio of annual net premium to annualized gross premium.

Annual Net Premium = ∑ (annual valuation net premiums for policies issued in calendar year n at the start of calendar duration t). Companies may report zero (0) for the net premiums during the Preliminary Term period.

Annual Gross Premium = ∑ (Annualized Premium In Force, including mode loadings for policies

issued in calendar year n at the start of calendar duration t).

For calendar duration 0, the net premiums and gross premiums at issue should be used. Column 8 – Current Year Net Premiums

tPn = The annual valuation net premium for all business of CYI n in calendar duration t.

tPn = tEPn x ∑ (annual valuation net premiums for policies issued in calendar year n at the start of calendar duration t)/ ∑ (Annualized Premium In Force for policies issued in calendar year n at the start of calendar duration t). At the detail level of CYI n and calendar duration t, Column 8 = Column 4 x Column 7.

Column 9 – In Force Count Beginning of Year

t-1IFn = The in force count in calendar duration t-1 for all business of CYI n at the end of the calendar year preceding the reporting year. In force Count Beginning of Years should equal in force end of prior year from the Exhibit of Number of Policies (Accident and Health Insurance, Line 1) for LTC business for life, accident & health and fraternal only.

Column 10 – New Issues Current Year

The new issues count during the reporting year. New Issues Current Year should equal issued during year from the Exhibit of Number of Policies (Accident and Health Insurance, Line 2) for LTC business for life, accident & health and fraternal only.

Column 11 – In Force Count End of Year

tIFn = The in force count in calendar duration t for all business of CYI n at the end of the reporting year. In Force Count End of Years should equal in force end of year from the Exhibit of Number of Policies (Accident and Health Insurance, Line 9) for LTC business for life, accident & health and fraternal only.

Column 12 – Persistency Rate

(Column 11 – .5 x Column 10) / (Column 9 + .5 x Column 10)

Attachment S


Column 13 – Experience Policy Reserves

tVE n = [(t-1VE n) + tPn] x (1+ in ) – tIC En x (1+ in )1/2

Where:

tVE n = The experience reserve as of the end of the reporting year for calendar duration t, and

CYI n.

t-1VE n = The experience reserve as of the end of the prior reporting year for calendar duration t-1,

and CYI n. For the first filing of this form, the experience reserve as of the second prior year is set equal to the reported reserve as of that date.

tPn = The annual valuation net premium for all business of CYI n in calendar duration t. The

total for the reporting year is the amount reported in Column (8).

in = The valuation interest rate for CYI n.

tIC En = The experience incurred claims for all business of CYI n in calendar duration t. The total amount for the reporting year is reported in Column (5).

Column 14 – Reported Policy Reserves

The amount reported in annual statement Exhibit 6, Line 2 for life, accident & health and fraternal only.

Column 15 – Experience: Reported Ratio

Column 15 = Column 13 / Column 14 x 100 Section C – Summary Line 1 – Total Current - Individual = Sum of each Section A, Line 1 (all policy forms)

Line 2 – Total Prior - Individual = Sum of each Section A, Line 2 (all policy forms)

Line 3 – Total 2nd Prior - Individual = Sum of each Section A, Line 3 (all policy forms)

Line 4 – Total Current - Group = Sum of each Section B, Line 1 (all policy forms)

Line 5 – Total Prior - Group = Sum of each Section B, Line 2 (all policy forms)

Line 6 – Total 2nd Prior - Group = Sum of each Section B, Line 3 (all policy forms)

Line 7 – Current Year Total = Section C, Line 1 + Section C, Line 4

Attachment S


INSTRUCTIONS FOR FORM 3 LTC Experience Development ($000 Omitted)

The purpose of this form is to test the adequacy of claim reserves held on long-term care policies. This form allows for the development of a seven-year trend of losses incurred by incurred calendar a specific year group of claimants. This form is to be prepared on a nationwide basis. Report all dollar amounts in thousands ($000 omitted). Part 1 – Total Amount Paid Policyholders Show paid claims by year paid and year incurred. Claims are on a direct basis, including transfers before any reinsurance. Claims incurred prior to the year shown on Line 2 should be included in Column 1. The “Prior” values in these sections will not be directly comparable to prior statements, as the current year’s statement will include an additional incurred year’s values. Transfer policies are defined as policies that are either purchased or sold, typically through assumption reinsurance. These policies will be recorded in these parts of this exhibit while the company owns them. Part 2 – Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year This section provides a claim cost development overview to show the adequacy of claim reserves for a particular incurral year at the end of that year and at the end of subsequent years. The entry in Line X and Column Y is the cumulative claims incurred during year X and paid through the end of year Y for claims incurred in year X, plus the reserve at the end of year Y for claims incurred in year X. Claims are on a direct basis including transfers before any reinsurance. Claims incurred prior to the year shown on Line 2 should be included in Line 1, Columns 1 through 8. The “Prior” values in these sections will not be directly comparable to prior statements, as the current year’s statement will include an additional incurred year’s values. Transfer policies are defined as policies that are either purchased or sold, typically through assumption reinsurance. These policies will be recorded in these parts of this exhibit while the company owns them. Part 3 – Transferred Reserves Claim reserves for transfer claims (acquired or sold) are shown here, by claim incurred year, starting from the year of transfer. For sold business, the entries are positive. For acquired business, the entries are negative. For years after the transfer year, the reserves are increased with interest. Claim reserves for the buyer are the reserves initially set by the buyer, not necessarily equal to the reserves for the seller. Part 4 – Present Value of Incurred Claims (Interest Adjusted Development of Incurred Claims) Because claim reserves for long-duration claims are generally discounted, the year-to-year comparison in Part 2 is misleading to the extent interest income on claim reserves is material. To show consistent values; paid claims; transferred reserves and claim reserves are discounted to a common point in time (assumed to be July 1 of the incurred year). The discount rate is the statutory valuation interest rate for case reserves.

Attachment S


Paid claims in the year of incurral are discounted one-quarter year.

Paid claims subsequent to the year of incurral are assumed to be paid mid-year and discounted back to the midpoint of the incurred year.

Outstanding claim reserves for a given incurred year plus transferred reserves from Part 3 are discounted from the

valuation date to the midpoint of the incurred year.

Negative results are possible for acquired business only. Negative results indicate downward development of ultimate claims.

If iy = Incurred year

T = Report year – incurred year v = Discount rate tPaid Claimsiy = Paid claims during current or prior calendar year t from

claims incurred in year iy tCase Reserveiy = Case reserve at end of calendar year t from claims

incurred in iy tTransferred Reserveiy = Transferred reserve at end of calendar year t from

claims incurred in iy and t = iy, iy+1, iy+2, . . . , iy + T

then the Present Value of Incurred Claims for incurred year iy:

For T=0

iyPaid Claimsiy× v¼ + iyCase Reserveiy × v½ + iyIBNRiy × v½ + iyTransferred Reserveiy × v½

For T>0

iyPaid Claimsiy × v¼ + iy+1Paid Claimsiy × v1 + iy+2Paid Claimsiy × v2 + . . . + iy+TPaid Claimsiy × vT + iy+TCase Reserveiy × vT+½ + (iy+TIBNRiy× v T+½ ) + iy+TTransferred Reserveiy × vT+½

If a portion of the IBNR is held for years other than the current calendar year, the value in the parentheses should be used. The total case reserves and IBNR equal the portion of the total direct liability attributable to LTC business from Exhibit 8, Part 2, Line 2.1 (life, accident & health and fraternal) plus the portion of the claim liabilities reported on Exhibit 6, Line 14 (life, accident & health) and Line 13 (fraternal) attributable to LTC business for life, accident & health and fraternal only. This amount includes accrued and unaccrued claims liabilities that are incurred but not yet paid, both reported and not reported.

Attachment S


INSTRUCTIONS FOR FORM 4 Direct Group Experience – Stand-Alone Only ($000 Omitted)

OVERVIEW

Long-Term Care Insurance Experience Reporting Form 4 is intended to track life insurance and annuity products that have long-term care benefits provided by acceleration of certain benefits within these products. Include only the products that are not exempt as outlined in the Long-Term Care Insurance Model Regulation (sections on required disclosure or rating practices to customers, loss ratio, and premium rate increases also defined as “incidental” at the beginning of these experience forms instructions). This form is not to include stand-alone LTC products. Individual and group business is separated in this form.


Current calendar year of reporting.

Example: For a specific policy form category, the first year of issue was 2001. This Form 4 is required starting for the year 2009 and the reporting year is 2010. The current year would be 2010.

Prior

The year immediately prior to the year of reporting.

Example: 2009 2nd Prior

Two years prior to the year of reporting.

Example: Blank, because the first year of reporting is 2009. Total Inception-to-Date

Aggregate experience data since issuance of policiescertificates.

Example: Data from 2001 through 2010. Comprehensive

Certificates that provide a combination of institutional or facility and non-institutional coverage. These include institutional only certificates with non-institutional riders.

Institutional Only

Certificates that provide institutional coverage only. Non-Institutional Only

Certificates that provide only non-institutional coverage. Column 1 – Calendar Year of Peak Issues

Calendar year in which the largest number of certificates in the block were distributed. When reporting figures for inception-to-date, include all certificates ever issued in the block. For the current year, include only those certificates that remain in force as of 12/31.

Column 2 – Third Party Funding

Attachment S


Indicate whether premiums are paid in whole or in part by a third party such as an employer.

Example: If the level of third-party funding is 25%, enter “25” in this column.

Calculate this in aggregate as [Third Party Premiums ÷ Total Premiums]

Column 3 – Average Attained Age

Arithmetic mean of the attained ages of all inforce certificate holders in the block at year end. Column 4 – Earned Premium



Developed claim amounts for claims incurred during the calendar year. Equal to the present value of all claim payments and any claim reserve. The discount rate is the statutory valuation interest rate for case reserve.


Total number of lives in force at the end of the year. Joint certificates are to be counted as two lives. Column 7 – Number of Terminations

Total number of certificate holders whose coverage ended during the year for any reason including death, lapse, or benefit exhaustion.


Total number of new lives issued LTC certificates during the year. Values in rows that are labeled “inception-to-date” should be the sum of all new lives insured in each year during which the form was sold.

Column 1 – Number of Policies In Force

The total number of policies in force as of end of calendar year. Column 2 – Number of Certificates

The total number of certificates as of end of calendar year. Column 3 – Death Claims

The total number of death claims for a calendar year. Column 4 – Long-Term Care Accelerated Claims

The total number of long-term care accelerated claims for a calendar year. Only the long-term claims that have been triggered due to acceleration should be totaled.

Column 5 – Total Reserves

The total amount of non-claim reserves for these life insurance or annuity products.

Attachment S


INSTRUCTIONS FOR FORM 5 Standalone and Hybrid Products – Direct State Reporting ($000 Omitted)

Form 5 provides LTC sales and claims experience on a state-by-state basis. These are the state’s portion of a number of statistics reported on a nationwide basis elsewhere in these experience forms. Form 5 also includes data on products that include extension of and/or acceleration of LTC benefits on life policies or annuity contracts.

OVERVIEW For long-term care insurance reported in the Long-Term Care Insurance Experience Reporting Form 1, Form 2 and Form 3, these lines are the state’s portion of the earned premium, incurred claims and number of in force count of lives at end of the year. A schedule must be prepared for each jurisdiction in which the company has long-term care direct earned premiums and/or has direct incurred claims. In addition, a schedule must be prepared that contains the grand total (GT) for the company.


Current calendar year of reporting. Total Inception-to-Date

Aggregate experience data since issuance of policies. Stand-alone LTC

An LTC product that is sold by itself, not as a rider on another type of insurance. Life/LTC Hybrid Accelerated Benefits Riders

Riders attached to life insurance or annuity products that allow for a benefit to be claimed upon the occurrence of a long-term care need at the cost of reduction in the death benefit or annuity payout benefit.

LTC Hybrid Extension ofExtended Benefit Riders

Riders attached to life insurance or annuity products that allow for a benefit to be claimed above and beyond the initial benefit amount in the event that all accelerated benefits have been claimed and the insured is still in need of long-term care services.


Total number of new lives issued LTC or hybrid policies during the year. Values in rows that are labeled “inception-to-date” should be the sum of all new lives insured in each year during which the form was sold.


Total number of lives in force at the end of the year. Joint policies are to be counted as two lives. Column 3 – Earned Premiums


If necessary, the premium may be derived as the gross premium of the policy with the inclusion of LTC coverage less the gross premium of that policy without LTC coverage.

Attachment S


Column 4 – Incurred LTC Claims

Developed claim amounts for LTC claims incurred during the calendar year including accelerated claims, but not including payments due to extension of benefits. Equal to the present value of all claim payments and any claim reserves. The discount rate is the statutory valuation interest rate for case reserves.

Column 5 – Incurred Extended Benefits Claims

Developed claim amounts for LTC claims incurred during the calendar year due to extension of benefits after exhaustion of accelerated benefits. Equal to the present value of all claim payments and any claim reserves. The discount rate is the statutory valuation interest rate for case reserves.

Column 6 – Number of Claims Remaining Open

Open claims are all claims that have been opened at any date but have not been closed as of the end of the year.

Column 7 – Number of Claims Opened

The number of claims that have at least one LTC benefit payment made during the year after the elimination period but have no payments in previous years. If a claimant has prior claims, he or she should be counted if the current claim is considered as a new claim. For the purpose of including a claim in this count, payments that do not require satisfaction of the elimination period are excluded. A claim that has terminated by the end of the year should be included in the count.

Column 8 – Number of New Extended Benefits Claims

The number of claims that have at least one benefit payment made during the year resulting from extension of benefits but have no extension of benefits payments in previous years. If a claimant has prior claims, he or she should be counted if the current claim is considered as a new claim. A claim that has terminated by the end of the year should be included in the count.

Column 9 – Accelerated Benefits Available

Maximum amount of death benefits available to be paid on an accelerated basis due to LTC Acceleration of Benefits riders on in force business.

Column 10 – Extended Benefits Available

Maximum amount of extended benefits available to policyholders with extension of benefit riders on in force business.

Policy forms should be grouped by individual and group and reported on Lines 1 and 2, respectively. The subtotals for these two classes (i.e., individual and group) must be provided. Line 3 is the sum of Lines 1 and 2. Column 1 – Earned Premiums

Earned premiums reported should be the state amount that is included in the current year of Form 2, Part C, Column 4.

Grand Total Page:

Line 1 should equal the amount in Form 2, Part C, Column 4, Line 1.



Attachment S


For Line 4 “Actual total reported experience through prior year”, the amount will be Line 5 from the previous year’s report.

For Line 5 “Actual total reported experience through statement year”: should be the state’s allocated earned premium for the current year (as reported on Line 3) added to the state’s cumulative experience through prior year (as reported on Line 4).


Incurred claims reported should be the state amount that is included in the current year of Form 2, Part C, Column 5. Incurred claims should be paid claims in the state plus a reasonable allocation of claim reserves less the reported allocated portion of the prior year’s claim reserve. The allocation method should be consistent from year-to-year when estimating reserves for each state.

Grand Total Page:




For Line 4 “Actual total reported experience through prior year”, the amount will be Line 5 from the previous year’s form.

For Line 5 “Actual total reported experience through statement year”: This should be the state’s allocated incurred claims for the current year (as reported on Line 3) added to the state’s cumulative experience through prior year (as reported on Line 4).

Column 3 – In Force Count End of Year

The In Force Count End of Year should be the state total used in calculating the In Force Count End of Year in Form 2, Part C, Column 11.

Grand Total Page:




Column 4 – Lives In force End of Year

Actual number of lives in force at the end of the year. Joint policies should be counted by number of lives. Once the state forms are completed, the Lives In force End of Year for all states (Grand Total State Page) LTC Form 5, Column 4, Line 01 should equal LTC Form 1, Column 7, Line A01 + A09 + A17 and Form 5, Line 02 should equal Form 1, Line B01 + B09 + B17. The number of lives for each state for individual policies should be based on the policies that were issued in that state. The number of lives for each state in group policies should be based on the certificates that were issued in that state.

Attachment S


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL, HEALTH AND PROPERTY

LONG-TERM CARE EXPERIENCE REPORTING FORM 1 STAND-ALONE LTC ONLY ($000 OMITTED)

ACTUAL VS. EXPECTED CLAIMS AND PERSISTENCY REPORTING YEAR 20__ (To Be Filed By April 1)

NAIC Group Code__________ NAIC Company Code

1 2 3 4 5 6 7 8 9 10 11

Earned Premiums

Incurred Claims

Number of Claims Opened

Number of Claims Closed

Number of Claims

Remaining Open

Number of Terminations

Number of Policies In force

Year End

Number of Lives

In-force Year End

Active Life Reserves

Claim Reserves

Other Reserves

Individual Direct 1. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... 2. Total Inception-to-date ......... .................... ................... .................... ................... XXX XXX XXX XXX XXX XXX XXX Assumed 3. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... Ceded 4. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... Net (Direct + Assumed - Ceded) 5 Current

1 2 3 4 5 6 7 8 9 10 11

Earned Premiums

Incurred Claims


Number of Claims Closed

Number of Claims

Remaining Open

Number of Terminations

Number of Policies Inforce

Year End

Number of Lives In-

force Year End

Active Life Reserves

Claim Reserves

Other Reserves

Group Direct 1. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... 2. Total Inception-to-date ......... .................... ................... .................... ................... XXX XXX XXX XXX XXX XXX XXX Assumed 3. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... Ceded 4. Current .................................. .................... ................... .................... ................... ................... ................... ................... ................... ................... ................... .................... Net (Direct + Assumed - Ceded) 5 Current

Indicate whether policies on claim that have triggered waiver of premium are considered paid-up or paid by waiver. [ } Paid by Waiver [ } Paid Up

Attachment S


1 2 3 4 5 6 7 8 9 Earned

Premiums Incurred Claims

Valuation Expected Incurred Claims

Actual to Expected Incurred Claims

Open Claim Count

New Claim Count

Lives In Force End of Year

Expected Lives In Force End of Year

Actual to Expected Lives In Force

A . Individual Comprehensive: 1. Current ..................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 2. Prior ......................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 3. 2nd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 4. 3rd Prior ................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 5. 4th Prior ................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 6. 5th Prior ................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 7. Form Inception-to-Date ........... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 8. Total Inception-to-Date ........... XXX XXX XXX XXX XXX XXX XXX Institutional Only: 9. Current .................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 10. Prior ........................................ ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 11. 2nd Prior ................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 12. 3rd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 13. 4th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 14. 5th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 15. Form Inception-to-Date .......... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 16. Total Inception-to-Date ........... XXX XXX XXX XXX XXX XXX XXX Non-Institutional Only: 17. Current .................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 18. Prior ........................................ ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 19. 2nd Prior ................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 20. 3rd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 21. 4th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 22. 5th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 23. Form Inception-to-Date .......... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 24. Total Inception-to-Date XXX XXX XXX XXX XXX XXX XXX B. Group Comprehensive: 1. Current ................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 2 Prior ....................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 3. 2nd Prior ................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 4. 3rd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 5. 4th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 6. 5th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 7. Form Inception-to-Date .......... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 8. Total Inception-to-Date ........... XXX XXX XXX XXX XXX XXX XXX Institutional Only: 9. Current .................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 10. Prior ........................................ ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 11. 2nd Prior ................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 12. 3rd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 13. 4th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 14. 5th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 15. Form Inception-to-Date .......... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 16. Total Inception-to-Date ........... XXX XXX XXX XXX XXX XXX XXX Non-Institutional Only: 17. Current .................................... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 18. Prior ........................................ ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 19. 2nd Prior ................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 20. 3rd Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 21. 4th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 22. 5th Prior .................................. ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 23. Form Inception-to-Date .......... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 24. Total Inception-to-Date XXX XXX XXX XXX XXX XXX XXX C. Summary 1. Form Inception-to-Date ........... ........................................ ................................. ................................................ ............................................... .............................................................. .............................................................. ....................................................... .......................................... ............................................. 2. Total Inception-to-Date XXX XXX XXX XXX XXX XXX XXX

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 2 DIRECT INDIVIDUAL EXPERIENCE - STAND-ALONE ONLY ($000 OMITTED)

EXPERIENCE RESERVE VS. REPORTED RESERVE BY CALENDAR YEAR REPORTING YEAR 20__ (To Be Filed By April 1)

NAIC Group Code_____________ NAIC Company Code

1 2 3 4 5 6 7 8

Calendar Year of Peak Issues

Percent Male Lives Insured

Average Attained Age

Earned Premium

Incurred Claims

Number of Lives In force

Year End Number of

Terminations

Number of New Lives

Insured Primarily 2002 and Prior Issue Years 1. Current (Comprehensive) .......................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 2. Total Inception-to-date (Comprehensive)................................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 3. Current (Institutional only) ....................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 4. Total Inception-to-date (Institutional only) .............................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 5. Current (Non-Institutional only) ............................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 6. Total Inception-to-date (Non-Institutional only) ...................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 7. Current (Grand Total) ............................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 8. Total Inception-to-date (Grand Total) ...................................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... Primarily 2003 to 2010 Issue Years 9. Current (Comprehensive) .......................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 10. Total Inception-to-date (Comprehensive)................................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 11. Current (Institutional only) ....................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 12. Total Inception-to-date (Institutional only) .............................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 13. Current (Non-Institutional only) ............................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 14. Total Inception-to-date (Non-Institutional only) ...................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 15. Current (Grand Total) ............................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 16. Total Inception-to-date (Grand Total) ...................................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... Primarily 2011 and Later Issue Years 17. Current (Comprehensive) .......................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 18. Total Inception-to-date (Comprehensive)................................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 19. Current (Institutional only) ....................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 20. Total Inception-to-date (Institutional only) .............................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 21. Current (Non-Institutional only) ............................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 22. Total Inception-to-date (Non-Institutional only) ...................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 23. Current (Grand Total) ............................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 24. Total Inception-to-date (Grand Total) ....................... ....................... XXX ....................... ....................... XXX XXX ......................

Indicate whether policies are assigned to a Primary Issue Period on a per-policy or per-policy form basis: [ } Policy [ } Policy Form

Attachment S


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Reporting Year

Policy Form

First Year Issue

Last Year Issue

Earned Premiums

Incurred Claims

Loss Ratio

Annual Net/ Annual Gross

Premiums

Current

Year Net Premiums

In Force Count

Beginning of Year

New Issues

Current Year

In Force Count End of Year

Persistency Rate

Experience

Policy Reserves

Reported

Policy Reserves

Experience/

Reported Ratio

A. Individual 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior ..................... .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior ..................... .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior B. Group 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior ..................... .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior ..................... .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 1. Current ........................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 2. Prior ............................ .................. ................... .................. ................... .................. .................. ................... .................. ................. .................. .................. .................. .................. ................... ...................... 3. 2nd Prior C. SUMMARY 1. Total Current-Individual ................................................................ 2. Total Prior-Individual .................................................................... 3. Total 2nd Prior-Individual ............................................................. 4. Total Current-Group ...................................................................... 5. Total Prior-Group .......................................................................... 6. Total 2nd Prior-Group ................................................................... 7. Current Year Total

................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX ................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX ................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX ................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX ................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX ................... .................. XXX XXX .................. ................. .................. .................. XXX .................. ................... XXX

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 3 LTC EXPERIENCE DEVELOPMENT ($000 OMITTED)

REPORTING YEAR 20__ (To Be Filed By April 1)

NAIC Group Code_____________ NAIC Company Code

1 2 3 4 5 6 7 8 Incurred Year 2013 2014 2015 2016 2017 2018 2019 2020

A. Individual PART 1 – Total (Direct and Transferred) Amount Paid Policyholders

1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................. ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 2 – Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 3 – Transferred Reserves 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................. ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................. ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................. ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................. ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................. ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................. ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................. ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................. ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 4 – Present Value of Incurred Claims 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................. ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................. ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................. ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................. ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................. ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................. ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................. ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................. ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 3 (continued) LTC EXPERIENCE DEVELOPMENT ($000 OMITTED)

1 2 3 4 5 6 7 8 Incurred Year 2013 2014 2015 2016 2017 2018 2019 2020

B. Group PART 1 – Total (Direct and Transferred) Amount Paid Policyholders

1. Prior ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 2. 2013 ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 3. 2014 ....... XXX ................................. ................................. ................................ ................................. ................................ ............................... ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................ ............................... ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................ ............................... ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................ ............................... ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................ ............................... ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ............................... ................................. 9. 20120 XXX XXX XXX XXX XXX XXX XXX

PART 2 – Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year 1. Prior ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 2. 2013 ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 3. 2014 ....... XXX ................................. ................................. ................................ ................................. ................................ ............................... ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................ ............................... ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................ ............................... ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................ ............................... ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................ ............................... ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ............................... ................................. 9. 20120 XXX XXX XXX XXX XXX XXX XXX

PART 3 – Transferred Reserves 1. Prior ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 2. 2013 ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 3. 2014 ....... XXX ................................. ................................. ................................ ................................. ................................ ............................... ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................ ............................... ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................ ............................... ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................ ............................... ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................ ............................... ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ............................... ................................. 9. 20120 XXX XXX XXX XXX XXX XXX XXX

PART 4 – Present Value of Incurred Claims 1. Prior ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 2. 2013 ....... ................................. ................................. ................................. ................................ ................................. ................................ ............................... ................................. 3. 2014 ....... XXX ................................. ................................. ................................ ................................. ................................ ............................... ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................ ............................... ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................ ............................... ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................ ............................... ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................ ............................... ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ............................... ................................. 9. 20120 XXX XXX XXX XXX XXX XXX XXX

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 3 (continued) LTC EXPERIENCE DEVELOPMENT ($000 OMITTED)

1 2 3 4 5 6 7 8 Incurred Year 2013 2014 2015 2016 2017 2018 2019 2020

C. Summary PART 1 – Total (Direct and Transferred) Amount Paid Policyholders

1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 2 – Sum of Total Amount Paid Policyholders and Claim Liability and Reserve Outstanding at End of Year 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 3 – Transferred Reserves 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

PART 4 – Present Value of Incurred Claims 1. Prior ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 2. 2013 ....... ................................. ................................ ................................. ................................ ................................. ................................. ................................ ................................. 3. 2014 ....... XXX ................................ ................................. ................................ ................................. ................................. ................................ ................................. 4. 2015 ....... XXX XXX ................................. ................................ ................................. ................................. ................................ ................................. 5. 2016 ....... XXX XXX XXX ................................ ................................. ................................. ................................ ................................. 6. 2017 ....... XXX XXX XXX XXX ................................. ................................. ................................ ................................. 7. 2018 ....... XXX XXX XXX XXX XXX ................................. ................................ ................................. 8. 2019 ....... XXX XXX XXX XXX XXX XXX ................................ ................................. 9. 2020 XXX XXX XXX XXX XXX XXX XXX

Indicate whether claim reserves and liabilities for prior years are based on historical or current reserving assumptions:: [ } Historical [ } Current

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 4 DIRECT GROUP EXPERIENCE - STAND-ALONE ONLY ($000 OMITTED) LIFE AND ANNUITY PRODUCTS WITH LTC ACCELERATED BENEFITS

REPORTING YEAR 20__ (To Be Filed By April 1)

NAIC Group Code NAIC Company Code

1 2 3 4 5 6 7 8

Calendar Year of Peak Issues

Third Party Funding (%)

Average Attained Age

Earned Premium

Incurred Claims

Number of Lives In force

Year End Number of

Terminations

Number of New Lives

Insured 1. Current (Comprehensive) .......................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 2. Total Inception-to-date (Comprehensive)................................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 3. Current (Institutional only) ....................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 4. Total Inception-to-date (Institutional only) .............................. ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 5. Current (Non-Institutional only) ............................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 6. Total Inception-to-date (Non-Institutional only) ...................... ....................... ....................... XXX ....................... ....................... XXX XXX ...................... 7. Current (Grand Total) ............................................................... ....................... ....................... ....................... ....................... ....................... ....................... ...................... ...................... 8. Total Inception-to-date (Grand Total) ....................... ....................... XXX ....................... ....................... XXX XXX ......................

1 2 3 4 5

Incurred Year Number of

Policies In Force Number of Certificates Death Claims

LTC Accelerated Claims Total Reserves

A. Individual

1. Current ........................... .................................... ............................... .............................. ............................. ..............................................

2. Prior ................................ .................................... ............................... .............................. ............................. ..............................................

3. 2nd Prior

B. Group

1. Current ........................... .................................... ............................... ............................... ............................. ..............................................

2. Prior ................................ .................................... ............................... ............................... ............................. ..............................................

3. 2nd Prior

C. Summary

1. Total Inception-to-Date

Total Reserves are reserves for these particular life products with LTC accelerated benefits.

Incurred claims are only the policies that claims have been triggered due to acceleration.

Attachment S


LONG-TERM CARE EXPERIENCE REPORTING FORM 5 EXPERIENCE IN THE STATE OF ___________________

STAND-ALONE AND HYBRID PRODUCTS - DIRECT STATE REPORTING ($000 OMITTED) REPORTING YEAR 20

(To Be Filed By April 1)

NAIC Group Code______________ NAIC Company Code

1 2 3 4 5 6 7 8 9 10

Number of New Lives

Insured

Number of Lives In-

force Year End

Earned Premiums

Incurred LTC

Claims

Incurred Extended Benefits Claims

Number of Claims

Remaining Open


Number of New

Extended Benefits Claims

Accelerated Benefits

Available

Extended Benefits

Available Stand-alone LTC 1. Current ............................................................... .................... ................... ................... ................... XXX ................... ................... XXX XXX XXX 2. Total Inception-to-date ...................................... .................... XXX ................... ................... XXX XXX ................... XXX XXX XXX Life/LTC Hybrid Policies and Riders 3. Current (Acceleration only) ............................... .................... ................... ................... ................... XXX ................... ................... XXX ................... XXX 4. Total Inception-to-Date (Acceleration only) ..... .................... XXX ................... ................... XXX XXX ................... XXX XXX XXX 5. Current (Extended Benefits Policies) ................ .................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 6 Total Inception-to-Date (Extended Benefits) XXX XXX XXX XXX

1 Earned

Premiums

2 Incurred Claims

3 In Force Count

End of Year

4 Lives In Force End of Year

1. Individual ................................................................................................. … . 2. Group ..........................................................................................................

....................... .......................

........................ ........................

........................ ........................

........................ ........................

3. Total ........................................................................................................ … ....................... ........................ ........................ ........................ 4. Actual total reported experience through prior year. .................................. ....................... ........................ XXX XXX 5. Actual total reported experience through statement year. XXX XXX


Attachment S




DATE: 02/21/2020

CONTACT PERSON: Aaron Brandenburg

TELEPHONE: 816 783 8271


ON BEHALF OF: Property & Casualty Insurance (C) Committee

NAME:

TITLE:

AFFILIATION:

ADDRESS:

FOR NAIC USE ONLY Agenda Item # 2020-15BWG MOD Year 2020Changes to Existing Reporting [ X ] New Reporting Requirement [ X ]



DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ X ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)



A new Private Flood Insurance Supplement collecting residential and commercial private flood insurance data and revisions to the Credit Insurance Experience Exhibit (CIEE) to collect lender-placed flood coverages.


The State Page currently collects private flood insurance data but does not split residential from commercial coverages. Regulators, as well as industry and consumers, have a desire to better monitor and assess the growth of the residential private flood insurance market as that market begins to grow. A new Supplement will separate residential from commercial as well as capturing stand-alone/endorsement and first dollar/excess policy information. The revisions to the CIEE will allow for the collection of lender-placed flood coverages in order to get a more complete picture of the private flood insurance market.

NAIC STAFF COMMENTS


Other Comments:


Attachment T



PRIVATE FLOOD INSURANCE SUPPLEMENT This supplement should be completed by those reporting entities including surplus line insurers and Risk Retention Groups that provide private flood insurance in a stand-alone policy or as part of a package policy. If the reporting entity’s answer to all of the question for Part 1 – Interrogatories would be “NO,” the reporting entity should not complete the supplement. If the reporting entity answers “YES” to any of those questions, the supplement should be completed. The supplement should be reported on a direct basis (before assumed and ceded reinsurance). If the reporting entity reports any premium, losses or loss adjustment expense for Annual Statement Line 2.5 on the Exhibit of Premiums and Losses (State Page), it should answer “YES” to at least one of the Part 1 – Interrogatories questions and complete this supplement. Standalone Policy: Private flood coverage sold as an individual policy or as a policy bundled with other policies. Endorsement: Private flood coverage sold as an endorsement to another policy. If a rider, endorsement or floater

acts like a separate policy with separate premium, deductible and limit, then it is to be recorded on the same annual statement line as if it were a stand-alone policy regardless of whether it is referred to as a rider, endorsement or floater. If there is no additional premium, separate deductible or limit, the rider, endorsement or floater should be reported on the same annual statement line as the base policy.

Creditor-placed (also known as lender-placed and force-placed insurance) is insurance that is placed by the lender subsequent

to the date of the credit transaction, providing coverage against loss, expense or damage to collateralized property as a result of fire, theft, collision or other risks of loss that would either impair a creditor’s interest or adversely affect the value of collateral covered by limited dual-interest insurance. It is purchased by the lender according to the terms of the credit agreement as a result of the borrower’s failure to provide required insurance, with the cost of the coverage being charged to the borrower. It may be either single-interest insurance or limited dual-interest insurance.

Part 1 - Interrogatories 1 Answer “YES” if the reporting entity writes stand-alone first-dollar private flood insurance on residential

property. Complete Part 2 if the question is answered “YES.” 2 Answer “YES” if the reporting entity writes stand-alone excess private flood insurance on residential property.

Complete Part 3 if the question is answered “YES.” 3 Answer “YES” if the reporting entity writes first-dollar private flood insurance as an endorsement on residential

property. Complete Part 4 if the question is answered “YES.” 4 Answer “YES” if the reporting entity writes excess private flood insurance as an endorsement on residential

property. Complete Part 5 if the question is answered “YES.” 5 Answer “YES” if the reporting entity writes stand-alone or excess private flood insurance as a stand-alone

policy or an endorsement on commercial property. Complete Part 6 if the question is answered “YES.”

Attachment T


GENERAL INSTRUCTIONS – PARTS 2 THROUGH 6 Column 1 – Direct Written Premium

For Lines 1 through 56, the sum of Parts 2 through 6 should equal Column 1, Line 2.5 of the corresponding Exhibit of Premiums and Losses (State Page) for the state.

For Line 57, the sum of Parts 2 through 6 should equal Column 1, Line 2.5 of the Exhibit of Premiums and Losses (State Page) – Grand Total.

Column 2 – Direct Premium Earned



Column 3 – Direct Losses Paid (Deducting Salvage)



Column 4 – Direct Losses Incurred



Column 5 – Direct Losses Unpaid



Column 6 – Defense and Cost Containment Paid



Attachment T


Column 7 – Defense and Cost Containment Case Incurred



Column 8 – Defense and Cost Containment Case Unpaid



Column 7 – Number of Policies In Force End of the Prior Year

Provide the number of policies in force as of the end of the prior reporting year, Dec. 31. Column 8 – Number of Policies In Force End of Current Year

Provide the number of policies in force as of the end of the current reporting year, Dec. 31. Column 9 – Number of Claims Open Beginning of the Current Year

Provide the number of claims open at the beginning of the reporting year, Jan. 1. Column 10 – Number of Claims Opened During the Reporting Year

Provide the number of claims opened during the reporting year. Column 11 – Number of Claims Open End of the Current Year

Provide the number of claims open at the end of the reporting year, Dec. 31. Column 12 – Number of Claims Closed with Payment

Provide the number of claims closed with payment for reporting year.

Attachment T


ANNUAL STATEMENT INSTRUCTIONS – PROPERTY AND LIFE/FRATERNAL

CREDIT INSURANCE EXPERIENCE EXHIBIT


10. Part 4 Coverage Definitions

Creditor-placed (also known as lender-placed and force-placed insurance) is insurance that is placed by the lender subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to collateralized property as a result of fire, theft, collision or other risks of loss that would either impair a creditor’s interest or adversely affect the value of collateral covered by limited dual-interest insurance. It is purchased by the lender according to the terms of the credit agreement as a result of the borrower’s failure to provide required insurance, with the cost of the coverage being charged to the borrower. It may be either single-interest insurance or limited dual-interest insurance. “Creditor Placed Insurance” means insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to property as a result of fire, theft, collision or other risks of loss that would either impair a creditor’s interest or adversely affect the value of collateral. “Creditor Placed Home Hazard” means “Creditor Placed Insurance” on homes, mobile homes and other real estate. “Creditor Placed Auto” means insurance on automobiles, boats or other vehicles.

“Single Interest” means insurance that protects only the creditor’s interest in the collateral securing a debtor’s credit transaction.

“Dual Interest” means insurance that protects the creditor’s and the debtor’s interest in the collateral securing the debtor’s credit transaction. “Dual Interest” includes insurance commonly referred to as “Limited Dual Interest.”

“Wind Only” means named-peril coverage for losses due to wind. “Flood Only” means named-peril coverage for losses due to flood.

“First Dollar” means coverage for first dollar losses, not contingent to alternate coverage (for example, an NFIP policy).

“Excess” means coverage for excess amounts over and above another policy (for example, an NFIP policy).

“Credit Personal Property Insurance” means insurance written in connection with a credit transaction where the collateral is not a motor vehicle, mobile home or real estate and that:

1. Covers perils to the goods purchased through a credit transaction or used as collateral for a credit transaction

and that concerns a creditor’s interest in the purchased goods or pledged collateral, either in whole or in part; or

2. Covers perils to goods purchased in connection with an open-end credit transaction. 11. Written Exposures (Line 6 – Part 4 only)

The total number of exposures, in car-years, of all policies issued during a given time period.

Attachment T


12. Earned Exposures (Line 7 – Part 4 only)

The portion of the total amount of exposure (risk) corresponding to the coverage provided during a given time period.


GAP insures the excess of the outstanding indebtedness over the primary property insurance benefits in the event of a total loss to a collateral asset. Primary property insurance refers to the underlying P&C insurance policy insuring the property, such as automobile physical damage insurance. For reporting experience in the CIEE, “Personal GAP” refers to contributory coverage for which the borrower pays the premium for the insurance and receives a certificate or policy of coverage.

“Credit Family Leave” provides a monthly or lump sum benefit during an unpaid leave of absence from employment resulting from specified causes, such as illness of a close relative, adoption or birth of a child. If the Credit Family Leave benefit is included with the involuntary unemployment benefit without a specific identifiable charge, Credit Family Leave experience may be included with the Involuntary Unemployment Experience in Part 3.


This exhibit is to be completed on a nationwide basis. The expense definitions follow those used in the Insurance Expense Exhibit.


Attachment T


ANNUAL STATEMENT BLANK – PROPERTY

PRIVATE FLOOD INSURANCE SUPPLEMENT For The Year Ended December 31, 2020

(To Be Filed by March 31April 1) NAIC Group Code ......................................... NAIC Company Code ................................... Company Name .........................................................................................................................................................................................................................

Part 1 - Interrogatories Private Flood Insurance Coverage: 1. Does the reporting entity write any stand-alone first-dollar residential private flood Yes [ ] No [ ]

If yes, complete Part 2

2. Does the reporting entity write any stand-alone excess residential private flood? Yes [ ] No [ ]


3. Does the reporting entity write any first-dollar residential private flood provided as an endorsement?

Yes [ ] No [ ]


4. Does the reporting entity write any excess residential private flood insurance provided as an

endorsement? Yes [ ] No [ ]


5. Does the reporting entity write any commercial private flood insurance provided as either a stand-alone or package policy? (include both first-dollar and excess)

Yes [ ] No [ ]


Attachment T


Part 2 – Standalone Residential Private Flood Policies Policy and Claims Data

First Dollar

1 2 3 4 5 6 7 8 9 10 11 12 13 14

States, Etc. Direct Written

Premium

Direct Premium Earned

Direct Losses Paid

(Deducting Salvage)

Direct Losses Incurred

Direct Losses Unpaid

Defense and Cost

Containment Expense Paid

Defense and Cost

Containment Expense Incurred

Defense and Cost

Containment Expense Unpaid

Number of Policies In

Force End of the Prior Year


Force End of the Current

Year

Number of Claims Open Beginning of the Current

Year


During the Reporting Year

Number of Claims Open

the End of Current Year

Number of Claims Closed with Payment

1. Alabama ........................................... AL 2. Alaska ............................................... AK 3. Arizona ............................................. AZ 4. Arkansas ........................................... AR 5. California .......................................... CA 6. Colorado ........................................... CO 7. Connecticut ....................................... CT 8. Delaware .......................................... DE 9. Dist. Columbia ................................. DC 10. Florida ............................................... FL 11. Georgia ............................................. GA 12. Hawaii ............................................... HI 13. Idaho .................................................. ID 14. Illinois ................................................ IL 15. Indiana ............................................... IN 16. Iowa ................................................... IA 17. Kansas ............................................... KS 18. Kentucky .......................................... KY 19. Louisiana .......................................... LA 20. Maine................................................ ME 21. Maryland ......................................... MD 22. Massachusetts .................................. MA 23. Michigan ........................................... MI 24. Minnesota ........................................ MN 25. Mississippi ........................................ MS 26. Missouri ........................................... MO 27. Montana ............................................ MT 28. Nebraska ........................................... NE 29. Nevada .............................................. NV 30. New Hampshire ................................ NH 31. New Jersey ........................................ NJ 32. New Mexico .................................... NM 33. New York ......................................... NY 34. No. Carolina ..................................... NC 35. No. Dakota ....................................... ND 36. Ohio .................................................. OH 37. Oklahoma ......................................... OK 38. Oregon .............................................. OR 39. Pennsylvania...................................... PA 40. Rhode Island ....................................... RI 41. So. Carolina ....................................... SC 42. So. Dakota ......................................... SD 43. Tennessee ......................................... TN 44. Texas ................................................ TX 45. Utah .................................................. UT 46. Vermont ............................................ VT 47. Virginia ............................................ VA 48. Washington ..................................... WA 49. West Virginia .................................. WV 50. Wisconsin .......................................... WI 51. Wyoming ......................................... WY 52. American Samoa ............................... AS 53. Guam ................................................ GU 54. Puerto Rico ........................................ PR 55. U.S. Virgin Islands ............................ VI 56. Northern Mariana Islands ................. MP 57. Totals

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

Attachment T


Part 3 - Standalone Residential Private Flood Policies Policy and Claims Data

Excess

1 2 3 4 5 6 7 8 9 10 11 12 13 14


Premium


Direct Losses Paid

(Deducting Salvage)



Defense and Cost


Defense and Cost


Defense and Cost






Year


Year




End of the Current Year



.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

Attachment T


Part 4 - Residential Private Flood Policy Endorsements Policy and Claims Data

1 2 3 4 5 6 7 8 9 10 11 12 13 14


Premium


Direct Losses Paid

(Deducting Salvage)



Defense and Cost


Defense and Cost


Defense and Cost






Year


Year







.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

Attachment T


Part 5 - Residential Private Flood Policy Endorsements Policy and Claims Data

Excess

1 2 3 4 5 6 7 8 9 10 11 12 13 14


Premium


Direct Losses Paid

(Deducting Salvage)



Defense and Cost


Defense and Cost


Defense and Cost






Year


Year







.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

Attachment T


Part 6 - Commercial Private Flood Policies Policy and Claims Data First Dollar and Excess

1 2 3 4 5 6 7 8 9 10 11 12 13 14


Premium


Direct Losses Paid

(Deducting Salvage)



Defense and Cost


Defense and Cost


Defense and Cost






Year


Year







.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

Attachment T


ANNUAL STATEMENT BLANK – PROPERTY AND LIFE/FRATERNAL

PART 4 – CREDIT PROPERTY INSURANCE

1 2 3 4 5 6 37 48 59 610 711

Creditor Placed Home Hazard-Single Interest

Creditor Placed Home Hazard -Dual Interest

Creditor Placed Wind Only Single

Interest

Creditor Placed Wind Only Dual

Interest

Creditor Placed Home Flood Only

First Dollar

Creditor Placed Home Flood Only

Excess

Creditor Placed Auto-Single

Interest

Creditor Placed Auto- Dual

Interest Personal Property-

Single Interest Personal Property-

Dual Interest Other (a) 1. Earned Premiums:

1.1 Gross written premiums ......................................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.2 Refunds on terminations......................................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.3 Net written premiums (Lines 1.1-1.2) .................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.4 Premium reserves, start of period ........................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.5 Premium reserves, end of period ............................................ .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.6 Actual earned premiums (Lines 1.3+1.4-1.5) ......................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................1.7 Earned premiums at prima facie rates .................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................

2. Incurred Claims:

2.1 Claims paid ............................................................................ .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................2.2 Total claim reserves, start of period ....................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................2.3 Total claim reserves, end of period ........................................ .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................2.4 Incurred claims (Lines 2.1-2.2+2.3) ....................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................

3. Incurred Compensation:

3.1 Commissions and service fees incurred ................................. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................3.2 Other incurred compensation ................................................. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................3.3 Total incurred compensation (Lines 3.1+3.2) ........................ .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................3.4 Commissions/service fee percentage (Lines 3.1/1.3) ............. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ............................... %3.5 Other incurred compensation percentage (Lines 3.2/1.6) ....... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ............................... %

4. Loss Percentage:

4.1 Actual loss percentage (Lines 2.4/1.6) ................................... .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ............................... %4.2 Loss percentage at prima facie rates (Lines 2.4/1.7) .............. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ............................... %

5. Incurred Loss Adjustment Expense: 5.1 Defense and cost containment expenses incurred .................. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................5.2 Adjusting and other expenses incurred .................................. .................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................

6. Written Exposures .............................................................................

.................................. .................................. .................................. .................................. .................................. .................................. ................................. .................................. .................................. .................................. ..................................

6. Earned Exposures

(a) Provide a description of "other" coverages (including their percent of Line 1.6, Column 7): ____________________________________________________________________________________________


Attachment T



Attachment T




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:

NAME: James W. Borrowman

TITLE: Financial Analyst

AFFILIATION: OR Dept. of Consumer & Business Services Div of Financial Reg Ins Institutions

ADDRESS:




DISPOSITION







Modify Questions 3.1 and 3.2 of General Interrogatories Part 2 and provide instructions for the questions.


The purpose of this proposal is to clarify capturing whether reporting entities have written participating policies in the current calendar year and reporting amount of premium written for both participating and non-participating policies.

NAIC STAFF COMMENTS


Other Comments:


Attachment U



PART 2 – PROPERTY AND CASUALTY INTERROGATORIES


3.1 Answer “YES” if the reporting entity has issued participating during the calendar year.

Participating Policies:

An insurance contract where the ultimate policy premium is affected by profitability which could result in a change of premium for the policy period written. The effect on premium could be in the form of a dividend, a refund in premium, experienced based premium or additional premium billable.

3.2 If “Yes”, provide the amount of premium written for participating and/or non-participating policies during the

calendar year.




PART 2 – PROPERTY & CASUALTY INTERROGATORIES


3.1 Does Did the reporting entity issue both participating and non-participating policies during the calendar year? Yes [ ] No [ ]

3.2 If yes, state provide the amount of premium written for participating and/or non-participating policies during the calendar year premiums written on:

3.21 Participating policies

3.22 Non-participating policies

$ _________________________ $ _________________________



Attachment U




DATE: 02/21/2020

CONTACT PERSON: Jane Barr

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF: Capital Adequacy Task Force

NAME: Tom Botsko

TITLE:

AFFILIATION:

ADDRESS:




DISPOSITION



[ X ] ANNUAL STATEMENT [ ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ X ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ ] Health (Life Supplement)



Adjust the AVR presentation to include separate lines for each of the expanded bond designation categories.


The Blanks Working Group and the Security Valuation Office have adopted the 20 bond designations for 2020 reporting. The reported designations will flow into the RBC but will not include factors. The current factor for designations 1-6 will remain in the RBC until an impact analysis can be done to confirm the new factors for the 20 designations. This proposal applies the same expanded presentation to the AVR as it is used to populate the life RBC formula.

NAIC STAFF COMMENTS


Other Comments:


Attachment V


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL AND SEPARATE ACCOUNTS

ASSET VALUATION RESERVE BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS

DEFAULT COMPONENT

Line Number

NAIC Desig- nation

Description

1 Book/

Adjusted Carrying

Value

2

Reclassify Related Party Encumbrances

3

Add Third Party

Encumbrances

4 Balance for

AVR Reserve Calculations

(Cols. 1+2+3)

Basic Contribution Reserve Objective Maximum Reserve 5

Factor

6

Amount (Cols. 4x5)

7

Factor

8

Amount (Cols. 4x7)

9

Factor

10

Amount (Cols. 4x9)

LONG-TERM BONDS 1 Exempt Obligations ........................................................................................... .................... XXX XXX ............................... 0.0000 ................... 0.0000 .................. 0.0000 ...................

2.1 1 NAIC Designation Category 1.AHighest Quality ............................................. .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.2 1 NAIC Designation Category 1.B ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.3 1 NAIC Designation Category 1.C ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.4 1 NAIC Designation Category 1.D ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.5 1 NAIC Designation Category 1.E ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.6 1 NAIC Designation Category 1.F ........................................................................ .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 2.7 1 NAIC Designation Category 1.G ....................................................................... XXX XXX 0.0005 0.0016 0.0033

2.8 Subtotal NAIC 1 (2.1+2.2+2.3+2.4+2.5+2.6+2.7) ............................................ XXX XXX XXX XXX XXX

3.1 2 NAIC Designation Category 2.AHigh Quality .................................................. .................... XXX XXX ............................... 0.0021 ................... 0.0064 .................. 0.0106 ................... 3.2 2 NAIC Designation Category 2.B ....................................................................... .................... XXX XXX ............................... 0.0021 ................... 0.0064 .................. 0.0106 ................... 3.3 2 NAIC Designation Category 2.C ....................................................................... XXX XXX 0.0021 0.0064 0.0106

3.4 Subtotal NAIC 2 (3.1+3.2+3.3) ......................................................................... XXX XXX XXX XXX XXX

4.1 3 NAIC Designation Category 3.AMedium Quality ............................................ .................... XXX XXX ............................... 0.0099 ................... 0.0263 .................. 0.0376 ................... 4.2 3 NAIC Designation Category 3.B ....................................................................... .................... XXX XXX ............................... 0.0099 ................... 0.0263 .................. 0.0376 ................... 4.3 3 NAIC Designation Category 3.C ....................................................................... XXX XXX 0.0099 0.0263 0.0376


5.1 4 NAIC Designation Category 4.ALow Quality ................................................... .................... XXX XXX ............................... 0.0245 ................... 0.0572 .................. 0.0817 ................... 5.2 4 NAIC Designation Category 4.B ....................................................................... .................... XXX XXX ............................... 0.0245 ................... 0.0572 .................. 0.0817 ................... 5.3 4 NAIC Designation Category 4.C ....................................................................... XXX XXX 0.0245 0.0572 0.0817 5.4 Subtotal NAIC 4 (5.1+5.2+5.3) XXX XXX XXX XXX XXX

6.1 5 NAIC Designation Category 5.ALower Quality................................................ .................... XXX XXX ............................... 0.0630 ................... 0.1128 .................. 0.1880 ................... 6.2 5 NAIC Designation Category 5.B ....................................................................... .................... XXX XXX ............................... 0.0630 ................... 0.1128 .................. 0.1880 ................... 6.3 5 NAIC Designation Category 5.C ....................................................................... XXX XXX 0.0630 0.1128 0.1880


7 6 In or Near DefaultNAIC 6 ................................................................................. .................... XXX XXX ............................... 0.0000 ................... 0.2370 .................. 0.2370 ...................

8 Total Unrated Multi-Class Securities Acquired by Conversion ........................ XXX XXX XXX XXX XXX

9 Total Long-Term Bonds (Sum of Lines 1 through 81+2.8+3.4+4.4+5.4+6.4+7+8)

XXX XXX XXX XXX XXX

PREFERRED STOCKS 10 1 Highest Quality .................................................................................................. .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 11 2 High Quality ....................................................................................................... .................... XXX XXX ............................... 0.0021 ................... 0.0064 .................. 0.0106 ................... 12 3 Medium Quality ................................................................................................. .................... XXX XXX ............................... 0.0099 ................... 0.0263 .................. 0.0376 ................... 13 4 Low Quality ....................................................................................................... .................... XXX XXX ............................... 0.0245 ................... 0.0572 .................. 0.0817 ................... 14 5 Lower Quality .................................................................................................... .................... XXX XXX ............................... 0.0630 ................... 0.1128 .................. 0.1880 ................... 15 6 In or Near Default .............................................................................................. .................... XXX XXX ............................... 0.0000 ................... 0.2370 .................. 0.2370 ................... 16 Affiliated Life with AVR ................................................................................... XXX XXX 0.0000 0.0000 0.0000

17 Total Preferred Stocks (Sum of Lines 10 through 16) XXX XXX XXX XXX XXX

Attachment V


ASSET VALUATION RESERVE (Continued) BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS

DEFAULT COMPONENT

Line Number

NAIC Desig- nation

Description

1 Book/

Adjusted Carrying

Value

2


3

Add Third Party

Encumbrances

4 Balance for


(Cols. 1+2+3)


Factor

6

Amount (Cols. 4x5)

7

Factor

8

Amount (Cols. 4x7)

9

Factor

10

Amount (Cols. 4x9)

SHORT-TERM BONDS 18 Exempt Obligations ........................................................................................... .................... XXX XXX ............................... 0.0000 ................... 0.0000 .................. 0.0000 ...................

19.1 1 NAIC Designation Category 1.AHighest Quality ............................................. .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.2 1 NAIC Designation Category 1.B ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.3 1 NAIC Designation Category 1.C ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.4 1 NAIC Designation Category 1.D ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.5 1 NAIC Designation Category 1.E ....................................................................... .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.6 1 NAIC Designation Category 1.F ........................................................................ .................... XXX XXX ............................... 0.0005 ................... 0.0016 .................. 0.0033 ................... 19.7 1 NAIC Designation Category 1.G ....................................................................... XXX XXX 0.0005 0.0016 0.0033

19.8 Subtotal NAIC 1 (19.1+19.2+19.3+19.4+19.5+19.6+19.7) .............................. XXX XXX XXX XXX XXX

20.1 2 NAIC Designation Category 2.AHigh Quality .................................................. .................... XXX XXX ............................... 0.0021 ................... 0.0064 .................. 0.0106 ................... 20.2 2 NAIC Designation Category 2.B ....................................................................... .................... XXX XXX ............................... 0.0021 ................... 0.0064 .................. 0.0106 ................... 20.3 2 NAIC Designation Category 2.C ....................................................................... XXX XXX 0.0021 0.0064 0.0106

20.4 Subtotal NAIC 2 (20.1+20.2+20.3) ................................................................... XXX XXX XXX XXX XXX

21.1 3 NAIC Designation Category 3.AMedium Quality ............................................ .................... XXX XXX ............................... 0.0099 ................... 0.0263 .................. 0.0376 ................... 21.2 3 NAIC Designation Category 3.B ....................................................................... .................... XXX XXX ............................... 0.0099 ................... 0.0263 .................. 0.0376 ................... 21.3 3 NAIC Designation Category 3.C ....................................................................... XXX XXX 0.0099 0.0263 0.0376


22.1 4 NAIC Designation Category 4.ALow Quality ................................................... .................... XXX XXX ............................... 0.0245 ................... 0.0572 .................. 0.0817 ................... 22.2 4 NAIC Designation Category 4.B ....................................................................... .................... XXX XXX ............................... 0.0245 ................... 0.0572 .................. 0.0817 ................... 22.3 4 NAIC Designation Category 4.C ....................................................................... XXX XXX 0.0245 0.0572 0.0817


23.1 5 NAIC Designation Category 5.ALower Quality................................................ .................... XXX XXX ............................... 0.0630 ................... 0.1128 .................. 0.1880 ................... 23.2 5 NAIC Designation Category 5.B ....................................................................... .................... XXX XXX ............................... 0.0630 ................... 0.1128 .................. 0.1880 ................... 23.3 5 NAIC Designation Category 5.C ....................................................................... XXX XXX 0.0630 0.1128 0.1880


24 6 In or Near DefaultNAIC 6 ................................................................................. XXX XXX 0.0000 0.2370 0.2370

25 Total Short-Term Bonds (Sum of Lines 18 through 2418+19.8+20.4+21.4+22.4+23.4+24)

XXX XXX XXX XXX XXX

DERIVATIVE INSTRUMENTS

26 Exchange Traded................................................................................................ ................... XXX XXX .............................. 0.0005 .................. 0.0016 .................. 0.0033 .................. 27 1 Highest Quality .................................................................................................. ................... XXX XXX .............................. 0.0005 .................. 0.0016 .................. 0.0033 .................. 28 2 High Quality ....................................................................................................... ................... XXX XXX .............................. 0.0021 .................. 0.0064 .................. 0.0106 .................. 29 3 Medium Quality ................................................................................................. ................... XXX XXX .............................. 0.0099 .................. 0.0263 .................. 0.0376 .................. 30 4 Low Quality ....................................................................................................... ................... XXX XXX .............................. 0.0245 .................. 0.0572 .................. 0.0817 .................. 31 5 Lower Quality .................................................................................................... ................... XXX XXX .............................. 0.0630 .................. 0.1128 .................. 0.1880 .................. 32 6 In or Near Default .............................................................................................. XXX XXX 0.0000 0.2370 0.2370

33 Total Derivative Instruments XXX XXX XXX XXX XXX

34 Total (Lines 9+ 17+ 25+ 33) XXX XXX XXX XXX XXX

Attachment V


ASSET VALUATION RESERVE (Continued) BASIC CONTRIBUTION, RESERVE OBJECTIVE AND MAXIMUM RESERVE CALCULATIONS

DEFAULT COMPONENT

Line Number

NAIC Designation

Description

1 Book/

Adjusted Carrying

Value

2


3

Add Third Party

Encumbrances

4 Balance for


(Cols. 1+2+3)


Factor

6

Amount (Cols. 4x5)

7

Factor

8

Amount (Cols. 4x7)

9

Factor

10

Amount (Cols. 4x9)

MORTGAGE LOANS In Good Standing:

35 Farm Mortgages – CM1 – Highest Quality ................................................... ................... .......................... XXX ................................ 0.0011 ................... 0.0057 ................... 0.0074 ........................ 36 Farm Mortgages – CM2 – High Quality ........................................................ ................... .......................... XXX ................................ 0.0040 ................... 0.0114 ................... 0.0149 ........................ 37 Farm Mortgages – CM3 – Medium Quality .................................................. ................... .......................... XXX ................................ 0.0069 ................... 0.0200 ................... 0.0257 ........................ 38 Farm Mortgages – CM4 – Low Medium Quality .......................................... ................... .......................... XXX ................................ 0.0120 ................... 0.0343 ................... 0.0428 ........................ 39 Farm Mortgages – CM5 – Low Quality ........................................................ ................... .......................... XXX ................................ 0.0183 ................... 0.0486 ................... 0.0628 ........................ 40 Residential Mortgages – Insured or Guaranteed ........................................... ................... .......................... XXX ................................ 0.0003 ................... 0.0007 ................... 0.0011 ........................ 41 Residential Mortgages – All Other ................................................................ ................... .......................... XXX ................................ 0.0015 ................... 0.0034 ................... 0.0046 ........................ 42 Commercial Mortgages – Insured or Guaranteed .......................................... ................... .......................... XXX ................................ 0.0003 ................... 0.0007 ................... 0.0011 ........................ 43 Commercial Mortgages – All Other – CM1 – Highest Quality ..................... ................... .......................... XXX ................................ 0.0011 ................... 0.0057 ................... 0.0074 ........................ 44 Commercial Mortgages – All Other – CM2 – High Quality ......................... ................... .......................... XXX ................................ 0.0040 ................... 0.0114 ................... 0.0149 ........................ 45 Commercial Mortgages – All Other – CM3 – Medium Quality ................... ................... .......................... XXX ................................ 0.0069 ................... 0.0200 ................... 0.0257 ........................ 46 Commercial Mortgages – All Other – CM4 – Low Medium Quality ........... ................... .......................... XXX ................................ 0.0120 ................... 0.0343 ................... 0.0428 ........................ 47 Commercial Mortgages – All Other – CM5 – Low Quality .......................... ................... .......................... XXX ................................ 0.0183 ................... 0.0486 ................... 0.0628 ........................

Overdue, Not in Process:

48 Farm Mortgages ............................................................................................. ................... .......................... XXX ................................ 0.0480 ................... 0.0868 ................... 0.1371 ........................ 49 Residential Mortgages – Insured or Guaranteed ........................................... ................... .......................... XXX ................................ 0.0006 ................... 0.0014 ................... 0.0023 ........................ 50 Residential Mortgages - All Other ................................................................. ................... .......................... XXX ................................ 0.0029 ................... 0.0066 ................... 0.0103 ........................ 51 Commercial Mortgages - Insured or Guaranteed .......................................... ................... .......................... XXX ................................ 0.0006 ................... 0.0014 ................... 0.0023 ........................ 52 Commercial Mortgages - All Other ............................................................... ................... .......................... XXX ................................ 0.0480 ................... 0.0868 ................... 0.1371 ........................

In Process of Foreclosure:

53 Farm Mortgages ............................................................................................. ................... .......................... XXX ................................ 0.0000 ................... 0.1942 ................... 0.1942 ........................ 54 Residential Mortgages - Insured or Guaranteed ............................................ ................... .......................... XXX ................................ 0.0000 ................... 0.0046 ................... 0.0046 ........................ 55 Residential Mortgages - All Other ................................................................. ................... .......................... XXX ................................ 0.0000 ................... 0.0149 ................... 0.0149 ........................ 56 Commercial Mortgages - Insured or Guaranteed .......................................... ................... .......................... XXX ................................ 0.0000 ................... 0.0046 ................... 0.0046 ........................ 57 Commercial Mortgages - All Other ............................................................... XXX 0.0000 0.1942 0.1942

58 Total Schedule B Mortgages (Sum of Lines 35 through 57) XXX XXX XXX XXX

59 Schedule DA Mortgages XXX 0.0034 0.0114 0.0149

60 Total Mortgage Loans on Real Estate (Lines 58 + 59) XXX XXX XXX XXX


Attachment V

© 2020 National Association of Insurance Commissioners 2020-18BWG_Modidied.doc 1



DATE: 02/21/2020

CONTACT PERSON: Charles Therriault

TELEPHONE: 212 386-1920


ON BEHALF OF:

NAME: Kevin Fry

TITLE: Chair, VOS Task Force

AFFILIATION:

ADDRESS:




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ ] BLANK




See next page for details.


The purpose of this proposal is to clarify where to find the list of funds that must have NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol provided on Schedule D, Part 2, Section 2 (annual filing) and Schedules D, Parts 3 and 4 (quarterly filing). Modify the reference to the Purposes and Procedures Manual of the NAIC Investment Analysis Office found in other investment instructions due to changes in the manual.

NAIC STAFF COMMENTS


Other Comments:


Attachment W


IDENTIFICATION OF ITEM(S) TO CHANGE Clarify the instructions for what funds reported on Schedule D, Part 2, Section 2 (annual filing) and Schedules D, Part 3 and 4 (quarterly filing) must have NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol. Modify the reference to the Purposes and Procedures Manual of the NAIC Investment Analysis Office found in the following investment instructions.

Annual Statement:

Investment Schedules General Instructions Summary Investment Schedule Schedule D, Part 1, Section 1 Schedule D, Part 2, Section 2 Schedule E, Part 2 Supplemental Investment Interrogatories

Quarterly Statement:

Investment Schedules General Instructions Schedule E, Part 2

Attachment W




COMMON STOCKS OWNED DECEMBER 31 OF CURRENT YEAR


Column 18 – NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol

For securities reported on Line 9499999 (Mutual Funds), Line 9599999 (Unit Investment Trusts) and Line 9699999 (Closed-End Funds), provide the appropriate NAIC Designation (1 through 6), NAIC Designation Modifier (A through G) and SVO Administrative Symbol combination as assigned by the Securities Valuation Office and published in AVS+ per the instructions in the Purposes and Procedures Manual of the NAIC Investment Analysis Office on the Compilation and Publication of the SVO List of Investment Securities. A list of these funds can be found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm).

NAIC Designation and NAIC Designation Modifier should not be provided for securities reported on these lines that have not been assigned one by the Securities Valuation Office. For all other common stock line categories, the NAIC Designation and NAIC Designation Modifier field should not be left blankprovided.


NAIC Designation Modifier:

The NAIC Designation Modifier should only be used for securities reported on Line 9499999 (Mutual Funds), Line 9599999 (Unit Investment Trusts) and Line 9699999 (Closed-End Funds) if eligible to receive one, as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual), otherwise, the field should not be left blankprovided.

The Designation Modifier should not be left blankprovided for securities reported on lines below.

Industrial and Miscellaneous (Unaffiliated) Publicly Traded Line 9099999

Industrial and Miscellaneous (Unaffiliated) Other Line 9199999

Parent, Subsidiaries and Affiliates Publicly Traded Line 9299999

Parent, Subsidiaries and Affiliates Other Line 9399999

Unit Investment Trusts Line 9599999

Closed-End Funds Line 9699999

As defined in the P&P Manual, there is not an NAIC Designation Modifier for investments reporting an NAIC Designation 6, therefore, the NAIC Designation Modifier field should not be left blankprovided.

Refer to the P&P Manual for the application of these modifiers.


Attachment W


SCHEDULE D – PART 1

LONG-TERM BONDS OWNED DECEMBER 31 OF CURRENT YEAR


Column 34 – Capital Structure Code

Please identify the capital structure of the security using the following codes consistent with the SVO Notching Guidelines in Part One, Section 3 of the Purposes and Procedures Manual of the NAIC Investment Analysis Office:

Capital structure is sometimes referred to as rank or payment priority and can be found in feeds from the sources listed in the Issue and Issuer column.

As a general rule, a security is senior unsecured debt unless legal terms of the security indicate another position in the capital structure. Securities are senior or subordinated and are secured or unsecured. Municipal bonds, Federal National Mortgage Association securities (FNMA or Fannie Mae) and Federal Home Loan Mortgage Corporation securities (FHLMC or Freddie Mac) generally are senior debt, though there are examples of subordinated debt issued by Fannie and Freddie. 1st Lien is a type of security interest and not capital structure but could be used to determine which capital structure designation the security should be reported under. The capital structure of “Other” should rarely be used.

Capital structure includes securities subject to SSAP No. 26R—Bonds and SSAP No. 43R—Loan-Backed and Structured Securities.

1. Senior Secured Debt

Senior secured is paid first in the event of a default and also has a priority above other senior debt with respect to pledged assets.

2. Senior Unsecured Debt

Senior unsecured securities have priority ahead of subordinated debt for payment in the event of default.

3. Subordinated Debt

Subordinated is secondary in its rights to receive its principal and interest payments from the borrower to the rights of the holders of senior debt (e.g., for loan-backed and structured securities, this would include mezzanine tranches).

(Subordinated means noting or designating a debt obligation whose holder is placed in precedence below secured and general unsecured creditors e.g., another debtholder could block payments to that holder or prevent that holder of that subordinated debt from taking any action.)

4. Not Applicable

Securities where the capital structure 1 through 3 above do not apply (e.g., Line 5899999 Exchange Traded Funds – as Identified by the SVO and Line 5999999 Bond Mutual Funds – as Identified by the SVO).

Attachment W


SUMMARY INVESTMENT SCHEDULE


Line 1.01 – U.S. Governments

Include: The value of all U.S. Government securities defined as U.S. Government Obligations as defined per the Purposes and Procedures Manual of the NAIC Investment Analysis Office Part Two, Section 4.

Column 1 should equal the Schedule D, Part 1, Line 0599999.


Line 1.05 – U.S. Special Revenue & Special Assessment Obligations, etc. Non-Guaranteed

Include: The value of those U.S. government issues not listed as “Securities That Are Considered “Exempt Obligations” For Purposes of Determining The Asset Valuation Reserve And The Risk-Based Capital Calculation” in Part Six, Section 2(e) of the Purposes and Procedures manual of the NAIC Investment Analysis Office, yet included as “Filing Exemptions for Other U.S. Government Obligations” in Part Two, Section 4(c)(ii). This category also includes bonds that are issued by states, territories, possessions and other political subdivisions that are issued for a specific financing project rather than as general obligation bonds.



Line 1.09 – SVO Identified Funds

Include: The value of all Bond Mutual Funds included on the “NAIC Bond Mutual Fund List as listed in Part Six, Section 2(h) of as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office and Exchange Traded Funds (ETF) included on the “SVO-Identified Bond ETF List” as published on the Securities Valuation Office Web page (https://www.naic.org/svo.htm) that the SVO has determined are in scope of SSAP No. 26R - Bonds and can be reported on Schedule D, Part 1 and the SVO assigned a NAIC Designation, NAIC Designation Category and SVO Administrative Symbol published in the NAIC’s AVS+ system per the instructions in the Purposes and Procedures Manual of the NAIC Investment Analysis Office on the Compilation and Publication of the SVO List of Investment Securities listed in Part Six, Section 2(i) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office.



Attachment W




Line 2 – Report the single 10 largest exposures to a single issuer/borrower/investment.

Determine the ten largest exposures by first, aggregating investments from all investment categories (except the excluded categories) by issuer. The first six digits of the CUSIP number can be used as a starting point; however, please note that the same issuer may have more than one unique series of the first six digits of the CUSIP. For example, the reporting entity owns bonds issued by the XYZ Company of $500,000 and common stock of the XYZ Company of $600,000. In addition the reporting entity has a mortgage loan to the XYZ Company of $300,000. The total exposure to Issuer XYZ Company is $1.4 million ($500,000+$600,000+$300,000).

For funds that are not diversified within the meaning of the Investment Company Act of 1940, insurance reporting entities are required to identify actual exposures and aggregate those exposures with directly held investments to determine the 10 largest exposures. For example, if a reporting entity directly holds a significant number of investments in Exxon Mobil and holds a non-diversified closed-end fund with a high concentration of Exxon Mobil, the reporting entity shall aggregate the direct investments with the investments in the closed-end funds to determine the aggregate investment risk to Exxon Mobil.

SEC registered investment funds are required by law to disclose holdings within 60 days following the fund’s fiscal quarter end. Insurers who own funds classified as “non-diversified” are to use the last publicly available fund holding disclosure to account for holdings that should be included in their Top 10 holdings.

Exclude: U.S. governmentGovernment and U. S. Government Agency securities listed as

“Securities That Are Considered “Exempt Obligations” For Purposes of Determining The Asset Valuation Reserve And The Risk-Based Capital Calculation” (Part Six, Section 2(e)), U. S. government agency securities (Part Six, Section 2(e)).

Those U.S. Government money market funds (Part Six, Section 2(f)) listed on “NAIC U.S. Direct Obligations/Full Faith and Credit Exemption List Money Market Fund List” found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm)in the Purposes and Procedures Manual of the NAIC Investment Analysis Office as exempt;

Property occupied by the company;

Policy loans

All SEC and foreign registered funds (open-end, closed-end, UIT and ETFs) and common trust funds that are diversified within the meaning of the Investment Company Act of 1940 [Section 5(b) (1)].

In Column 2, list the categories of securities that are included in the total for each issuer (e.g., bonds, mortgage loans, etc.)


Attachment W


Line 13.02 through 13.11 – Report the amounts and percentages of admitted assets held in the ten largest equity interests

(including investments in the shares of mutual funds, preferred stocks, publicly traded equity securities, and other equity securities (including Schedule BA equity interests), and excluding money market included on the “NAIC U.S. Direct Obligations/Full Faith and Credit Exemption Money Market Fund List”, exchange traded funds included on the “SVO-Identified Bond ETF List” and bond mutual funds included on the “NAIC Bond Mutual Fund List” as found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm) listed in Part Six, Sections 2(f) and (g) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office as exempt or NAIC 1).

Determine the ten largest equity interests by first aggregating investments included in this line by issuer. For example, the reporting entity owns preferred stock of the XYZ Company of $600,000 and common stock of the XYZ Company of $300,000. The total is $900,000 ($600,000+$300,000). The reporting entity also owns bonds issued by the XYZ Company of $500,000 that are excluded from this calculation because bonds are debt instruments. Other equity securities include partnerships and Limited Liability Companies (LLC) and any other investments reported in Schedule BA classified as equity.


Attachment W


QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE


LONG-TERM BONDS AND STOCKS ACQUIRED DURING THE CURRENT QUARTER



Provide the appropriate combination of NAIC Designation (1 through 6), NAIC Designation Modifier (A through G) and SVO Administrative Symbol (see below) at the end of the quarter for each security shown. The list of valid SVO Administrative Symbols is shown below.



The NAIC Designation Modifier should only be used for securities reported on the lines below if eligible to receive one, as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual), otherwise, the field should not be left blankprovided.

Bonds Lines 0199999 through 8299999

Preferred Stocks Line 8499999 and 8599999

Common Stocks Lines 9499999 through 9699999


For securities reported on Line 9499999 (Mutual Funds), Line 9599999 (Unit Investment Trusts) and Line 9699999 (Closed-End Funds) provide the appropriate NAIC Designation and NAIC Modifier as assigned by the Securities Valuation Office. NAIC Designation and NAIC Designation Modifier should not be provided for securities reported on these lines that have not been assigned one by the Securities Valuation Office and published in AVS+ per the instructions in the Purposes and Procedures Manual of the NAIC Investment Analysis Office on the Compilation and Publication of the SVO List of Investment Securities. For all other common stock line categories, the NAIC designation and NAIC Modifier a should not be provided.


SVO Administrative Symbol:


Attachment W


Common Stock:

For securities reported on Line 9499999 (Mutual Funds) provide the appropriate NAIC Designation (1 through 6) and NAIC Modifier as assigned by the Securities Valuation Office. For all other common stock the NAIC designation, NAIC Modifier and SVO Administrative Symbol field should be left blank.

Following are valid SVO Administrative Symbols for common stock. Refer to the P&P Manual for the application of these symbols.

YE Year-end carry over



LONG-TERM BONDS AND STOCKS SOLD, REDEEMED OR OTHERWISE DISPOSED OF DURING THE CURRENT QUARTER



Provide the appropriate combination of the NAIC Designation (1 through 6), NAIC Designation Modifier (A through G) and SVO Administrative Symbol (see below) at date of disposal for each security shown. The list of valid SVO Administrative Symbols is shown below.



The NAIC Designation Modifier should only be used for securities reported on the lines below if eligible to receive one, as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual), otherwise, the field should not be left blankprovided.


Preferred Stocks Line 8499999 and 8599999

Common Stocks Lines 9499999 through 9699999


Attachment W


For securities reported on Line 9499999 (Mutual Funds), Line 9599999 (Unit Investment Trusts) and Line 9699999 (Closed-End Funds) provide the appropriate NAIC Designation and NAIC Modifier as assigned by the Securities Valuation Office. NAIC Designation and NAIC Designation Modifier should not be provided for securities reported on these lines that have not been assigned one by the Securities Valuation Office and published in AVS+ per the instructions in the Purposes and Procedures Manual of the NAIC Investment Analysis Office on the Compilation and Publication of the SVO List of Investment Securities. For all other common stock line categories, the NAIC designation and NAIC Modifier a should not be provided.


SVO Administrative Symbol:


Common Stock:

For securities reported on Line 9499999 (Mutual Funds) provide the appropriate NAIC Designation (1 through 6) and NAIC Modifier as assigned by the Securities Valuation Office. For all other common stock the NAIC designation, NAIC Modifier and SVO Administrative Symbol field should be left blank.

Following are valid SVO Administrative Symbols for common stock. Refer to the P&P Manual for the application of these symbols.

YE Year-end carry over


Attachment W



SCHEDULE E – PART 2 – CASH EQUIVALENTS


A money market fund shall be reported in this schedule as an Exempt Money Market Mutual Fund if such money market fund is identified by the SVO as meeting the required conditions found in Part Six, Section 2(b)(i) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office. A “NAIC U.S. Direct Obligations/Full Faith and Credit Exemption Money Market Fund List” can be found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm). All money market mutual funds that are not identified by the SVO on the U.S. Direct Obligations/Full Faith and Credit Exempt List shall be reported in this schedule as an “all other money market mutual fund.” Column 1 – CUSIP Identification

All CUSIP numbers entered in this column must conform to those as published in the Purposes and Procedures Manual of the NAIC Investment Analysis Office, Part Six, Sections 2(f) and (g).

CUSIP identification is required and valid only for Exempt Money Market Mutual Funds – as Identified by SVO (Line 8599999) and All Other Money Market Mutual Funds (Line 8699999).


Attachment W


INVESTMENT SCHEDULES GENERAL INSTRUCTIONS (Applies to all investment schedules)


General Classifications Bonds Only: Refer to SSAP No. 26R—Bonds, SSAP No. 43R—Loan-Backed and Structured Securities and SSAP No. 97—Investments in Subsidiary, Controlled and Affiliated Entities for additional guidance.

U.S. Government:

U.S. Government shall be defined as U.S. Government Obligations as defined per the Purposes and Procedures Manual of the NAIC Investment Analysis Office. Part Two, Section 4:

(i) Filing Exemption for Direct Claims on, or Backed Full Faith and Credit of the United States

“U.S. Government Obligations” means all direct claims (including securities, loans, and leases) on, and the portions of claims that are directly and unconditionally guaranteed by the United States Government or its agencies.

“U.S. Government agency” means an instrumentality of the U.S. Government the debt obligations of which are fully guaranteed as to the timely payment of principal and interest by the full faith and credit of the U.S. Government. This category includes in addition to direct claims on, and the portions of claims that are directly and unconditionally guaranteed by, the United States Government agencies listed below, claims collateralized by securities issued or guaranteed by the U.S. government agencies listed below for which a positive margin of collateral is maintained on a daily basis, fully taking into account any change in the insurance company's exposure to the obligor or counterparty under a claim in relation to the market value of the collateral held in support of that claim.


U.S. Special Revenue and Special Assessment Obligations and All Non-Guaranteed Obligations of Agencies and Authorities of Governments and Their Political Subdivisions:

Those U.S. government issues not listed as “Securities That Are Considered “Exempt Obligations” For Purposes of Determining The Asset Valuation Reserve And The Risk-Based Capital Calculation” in Part Six, Section 2(e) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office, yet included as“Filing Exemptions for Other U.S. Government Obligations” in Part Two, Section 4(c)(ii). This category also includes bonds that are issued by states, territories, possessions and other political subdivisions that are issued for a specific financing project rather than as general obligation bonds. Also include mortgage reference securities that are within the scope of SSAP No. 43R—Loan-Backed and Structured Securities.

Industrial and Miscellaneous (Unaffiliated):

This category includes all non-governmental issues that do not qualify for some other category in Schedule D, Part 1, including privatized (non-government ownership) utility companies. Include Public Utilities.

Attachment W


SVO Identified Funds:

This category includes all Bond Mutual Funds included on the “List of Bond Mutual Funds Filed with the SVO (Bond Fund List)” as listed in Part Six, Section 2(h) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office and Exchange Traded Funds included on the “List of Exchange Traded Funds Eligible for Reporting as a Schedule D Bond (the ETF Bond List)” as found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm) listed in Part Six, Section 2(i) of the Purposes and Procedures Manual of the NAIC Investment Analysis Office.


General Classifications Preferred Stock Only: Refer to SSAP No. 32—Preferred Stock and SSAP No. 97—Investments in Subsidiary, Controlled and Affiliated Entities.

Industrial and Miscellaneous (Unaffiliated):

All unaffiliated preferred stocks. Include Public Utilities, Banks, Trusts and Insurance Companies. This category includes Exchange Traded Funds included on the “List of Exchange Traded Funds Eligible for Reporting as a Schedule D Preferred Stock” as found on the Securities Valuation Office Web page (https://www.naic.org/svo.htm) listed in Part Six, Section 2 of the Purposes and Procedures Manual of the NAIC Investment Analysis Office.


W:\QA\BlanksProposals\2020-18BWG_Modidied.doc

Attachment W



Attachment W




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ ] BLANK




Add a code of “%” to the code column for all investments which have been reported Schedule DA, Part 1 and Schedule E, Part 2 for more than one consecutive year. Add certification to the General Interrogatories, Part 1 inclusion of these investments on Schedule DA, Part 1 and Schedule E, Part 2.


To identify instances where cash equivalents and/or short-term investments (or substantially similar investments) remain on the applicable investment schedule for more than one reporting period (i.e. reported as a short-term investment for more than one consecutive year due to the investment being re-underwritten and renewed).

NAIC STAFF COMMENTS


Other Comments:


Attachment X



SCHEDULE DA – PART 1

SHORT-TERM INVESTMENTS OWNED DECEMBER 31 OF CURRENT YEAR


Column 2 – Code

Enter “*” in this column for all SVO Identified Funds designated for systematic value.

Enter “@” in this column for all Principal STRIP Bonds or other zero coupon bonds.

Enter “%” in this column for all investments which have been reported on this schedule for more than one consecutive year.

Enter “^” in this column for all assets that are bifurcated between the insulated separate account filing and the non-insulated separate account filing.

If short-term investments are not under the exclusive control of the company as shown in the General Interrogatories, they are to be identified by placing one of the codes (identified in the Investment Schedules General Instructions) in this column.

If the security is an SVO Identified Fund designated for systematic value or Principal STRIP bond or other zero coupon bond and is not under the exclusive control of the company, the “*”,“@” or “@” “%” should appear first, immediately followed by the appropriate code (identified in the Investment Schedules General Instructions).

If the “%” code is used in conjunction with the “*” or “@” codes, the “%” code should appear after the “*” or “@” codes immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).

Separate Account Filing Only:

If the asset is a bifurcated asset between the insulated separate account filing and the non-insulated separate account filing, the “^” should appear first and may be used simultaneously with the “*”,“@” or “@”“%”with the “^” preceding the “*”,“@” or “@”“%”depending on the asset being reported, immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).

If the “%” code is used in conjunction with the “*” or “@” codes, the “%” code should appear after the “*” or “@” codes immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).


Attachment X




Column 3 – Code

Enter “%” in this column for all investments except qualifying cash pooling structures per SSAP No. 2R and money market mutual funds which have been reported on this schedule for more than one consecutive quarter.

Enter “^” in this column for all assets that are bifurcated between the insulated separate account filing and the non-insulated separate account filing.

If a cash equivalent is not under the exclusive control of the company as shown in the General Interrogatories, it is to be identified by placing one of the codes identified in the Investment Schedules General Instructions in this column.

If the “%” code is used, the “%” code should appear first, immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).

Separate Account Filing Only:

If the asset is a bifurcated asset between the insulated separate account filing and the non-insulated separate account filing, the “^” should appear first and may be used simultaneously with the “%” code, immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).


Attachment X





OTHER 3637. The purpose of this General Interrogatory is to capture information about payments to any trade association,

service organization, and statistical or rating bureau. A “service organization” is defined as every person, partnership, association or corporation that formulates rules, establishes standards, or assists in the making of rates or standards for the information or benefit of insurers or rating organizations.

3738. The purpose of this General Interrogatory is to capture information about legal expenses paid during the year.

These expenses include all fees or retainers for legal services or expenses, including those in connection with matters before administrative or legislative bodies. It excludes salaries and expenses of company personnel, legal expenses in connection with investigation, litigation and settlement of policy claims, and legal fees associated with real estate transactions, including mortgage loans on real estate. Do not include amounts reported in General Interrogatories No. 36 37 and No. 3839.

3839. The purpose of this General Interrogatory is to capture information about expenditures in connection with

matters before legislative bodies, officers or departments of government paid during the year. These expenses are related to general legislative lobbying and direct lobbying of pending and proposed statutes or regulations before legislative bodies and/or officers or departments of government. Do not include amounts reported in General Interrogatories No. 36 37 and No. 3738.


Attachment X




INVESTMENTS OWNED END OF CURRENT QUARTER


Column 3 – Code

Enter “%” in this column for all investments except qualifying cash pooling structures per SSAP No. 2R and money market mutual funds which have been reported on this schedule for more than one consecutive quarter.

If a cash equivalent is not under the exclusive control of the reporting entity, it is to be identified by placing one of the codes identified in the Investment Schedules General Instructions in this column.

If the “%” code is used, the “%” code should appear first, immediately followed by the appropriate code for not being under the exclusive control of the company (identified in the Investment Schedules General Instructions).


Attachment X





GENERAL


INVESTMENT


35. By assigning FE to a Schedule BA non-registered private fund, the reporting entity is certifying the following elements of each

self-designated FE fund: a. The shares were purchased prior to January 1, 2019. b. The reporting entity is holding capital commensurate with the NAIC Designation reported for the security. c. The security had a public credit rating(s) with annual surveillance assigned by an NAIC CRP in its legal capacity as an

NRSRO prior to January 1, 2019. d. The fund only or predominantly holds bonds in its portfolio. e. The current reported NAIC Designation was derived from the public credit rating(s) with annual surveillance assigned by

an NAIC CRP in its legal capacity as an NRSRO. f. The public credit rating(s) with annual surveillance assigned by an NAIC CRP has not lapsed. Has the reporting entity assigned FE to Schedule BA non-registered private funds that complied with the above criteria? Yes [ ] No [ ]

36. By rolling/renewing short-term or cash equivalent investments with continued reporting on Schedule DA, Part 1 or Schedule E Part 2 (identified through a code (%) in those investment schedules), the reporting entity is certifying to the following:

a. The investment is a liquid asset that can be terminated by the reporting entity on the current maturity date. b. TheIf the investment is with a nonrelated party or nonaffiliate andthen it reflects an arms-length transaction with

renewal completed at the discretion of all involved parties. c. TheIf the investment is with a related party or affiliate andthen it the reporting entity has completed robust re-

underwriting of the transaction for which documentation is available for regulator review. d. Short-term and cash equivalent investments that have been renewed/rolled from the prior period that do not meet the

criteria in 36.a -36.c are reported as long-term investments. Has the reporting entity rolled/renewed short-term or cash equivalent investments in accordance with these criteria? Yes [ ] No [ ] N/A [ ]

OTHER

3637.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, if any? $ ____________________

3637.2 List the name of the organization and the amount paid if any such payment represented 25% or more of the total payments to trade associations, service organizations, and statistical or rating bureaus during the period covered by this statement.

1

Name 2

Amount Paid $ $ $ $

Attachment X


GENERAL INTERROGATORIES 3738.1 Amount of payments for legal expenses, if any? $ ____________________

3738.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payments for legal expenses during the period covered by this statement.

1 Name

2 Amount Paid

$ $ $ $

3839.1 Amount of payments for expenditures in connection with matters before legislative bodies, officers, or departments of government, if any?

$ ____________________

3839.2 List the name of the firm and the amount paid if any such payment represented 25% 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.

1

Name 2

Amount Paid $ $ $ $


Attachment X



Attachment X




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION







For Schedule D, Part 1, add code “10” to Column 26 – Collateral Type for ground lease financing. Renumber “Other” code to 11.


During the 2019 Fall National Meeting, the Valuation of Securities (E) Task Force adopted an amendment to add ground lease financing transactions as a newly defined asset class to the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual) effective January 1, 2020, and referred such action to the SAPWG for consideration. While an update was not required in the Accounting Procedures and Practices Manual (AP&P Manual), specific identification of such activities is warranted for analysis and reporting purposes.

NAIC STAFF COMMENTS


Other Comments:


Attachment Y




LONG-TERM BONDS OWNED DECEMBER 31 OF CURRENT YEAR


Column 26 – Collateral Type

Use only for securities included in the following subtotal lines.

Industrial and Miscellaneous (Unaffiliated)

Residential Mortgage-Backed/ Securities ............................................................................. 3399999 Commercial Mortgage-Backed Securities ............................................................................ 3499999 Other Loan-Backed and Structured Securities ...................................................................... 3599999

Enter one of the following codes to indicate collateral type. Pick exactly one collateral type for each reported security. For securities that fit in more than one type, pick the predominant one. Judgment may need to be used when making selections involving prime, Alt-A and subprime, as there are no uniform definitions for these collateral types. In the description field, use abbreviations like ABS, CDO or CLO to disclose the type of the loan-backed/structured security. Note: various investments below require SVO review and approval, please refer to the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual) for further description.

1 Residential Mortgage Loans/RMBS

Include all types of residential first lien mortgage loans as collateral (e.g., prime, subprime, Alt-A).

2 Commercial Mortgage Loans/CMBS

Include all types of commercial mortgage loans as collateral (e.g., conduits, single name, etc.).

3 Home Equity

Include all home equity loans and/or home equity lines of credit as collateral. These are not first liens and are deemed loans to individuals. Bonds that are collateralized by home equity loans/lines of credit are considered asset-backed securities (ABS) rather than RMBS.

4 Individual Obligations – Credit Card, Auto, Student Loans and Recreational Vehicles

Include bonds collateralized by individual obligations. Do not include individual obligations that have a real-estate aspect.

5 Corporate/Industrial Obligations – Tax Receivables, Utility Receivables, Trade Receivables,

Small Business Loans, Commercial Paper

Include bonds collateralized by corporate or industrial obligations (sometimes referred to as commercial obligations).

Attachment Y


6 Lease Transactions – Aircraft Leases, Equipment Leases and Equipment Trust Certificates

Include bonds collateralized by leases. Equipment leases are loans on heavy equipment. Equipment trust certificates are certificates that entitle the holder to the lease payments on the underlying assets.

7 CLO/CBO/CDO

Include bank loans, which securitize CLOs; investment grade and high-yield corporate bonds, which securitize CBOs; and corporate bonds and structured securities, which securitize CDOs.

8 Manufactured Housing and Mobile Home Loans

Include manufactured housing loans and mobile home loans as collateral. These are not typical residential mortgage loans, and when they securitize bonds, they are considered ABS.

9 Credit Tenant Loans

Real estate loans secured by the obligation of a single (usually investment grade) company to pay debt service by means of rental payments under a lease, where real estate is pledged as collateral also referred to as credit tenant lease, sale-leaseback or CTL.

10 Ground Lease Financing

Real estate loans secured by the obligation to pay debt service by means of rental payments of subleased property; where a long-term ground lease was issued in which the lessee intends significant land development and the subleasing of such property to other long-term tenants.

1011 Other

Include other collateral types that do not fit into categories 1 through 910.

For Columns 27 through 29, make whole call information is not required.



Attachment Y



Attachment Y




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION



[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK




Add new Line 4.05 for valuation allowance for mortgage loans to the Summary Investment Schedule and renumber existing Line 4.05 to 4.06. Modify the instructions to include a crosscheck for new Line 4.05 back to Schedule B – Verification Between years. Clarify the instructions for 4.01-4.04 to explicitly show crosschecking to Column 8 of Schedule B, Part 1.


The purpose of this schedule is to address the fact that the amount reported on Schedule B, Part 1, Column 8 excludes the valuation allowance but the total reported for mortgage loans in the Summary Investment Schedule must tie to the asset page which includes the valuation allowance.

NAIC STAFF COMMENTS


Other Comments:


Attachment Z





Line 4.01 – Mortgage Loans – Farm Mortgages

Include: The value of loans secured by farmland and improvements thereon, as evidenced by mortgages or other liens. Farmland includes all land known to be used or usable for agricultural purposes, such as crop and livestock production. Farmland includes grazing or pastureland, whether tillable or not and whether wooded or not. Include loans secured by farmland that are guaranteed by the Farmers Home Administration (FmHA) or by the Small Business Administration (SBA) and that are extended, serviced and collected by any party other than the FmHA or SBA.

Column 1 should equal the sum of Lines 0199999, 0999999, 1799999 and 2599999 on Schedule B, Part 1, Column 8.

Line 4.02 – Mortgage Loans – Residential Mortgages

Include: The value of loans secured by real estate as evidenced by mortgages (FHA, FmHA, VA or conventional) or other liens on nonfarm property containing one to four dwelling units (including vacation homes) or more than four dwelling units if each is separated from other units by dividing walls that extend from ground to roof (e.g., row houses, townhouses or the like); mobile homes where (a) state laws define the purchase or holding of a mobile home as the purchase or holding of real property and where (b) the loan to purchase the mobile home is secured by that mobile home as evidenced by a mortgage or other instrument on real property; individual condominium dwelling units and loans secured by an interest in individual cooperative housing units, even if in a building with five or more dwelling units; and housekeeping dwellings with commercial units combined where use is primarily residential and where only one to four family dwelling units are involved.

Column 1 should equal the sum of Lines 0299999, 0399999, 1099999, 1199999, 1899999, 1999999, 2699999 and 2799999 on Schedule B, Part 1, Column 8.

Line 4.03 – Mortgage Loans – Commercial Mortgages

Include: The value of loans secured by real estate as evidenced by mortgages or other liens on business and industrial properties, hotels, motels, churches, hospitals, educational and charitable institutions, dormitories, clubs, lodges, association buildings, "homes" for aged persons and orphans, golf courses, recreational facilities, and similar properties.

Column 1 should equal the sum of Lines 0499999, 0599999, 1299999, 1399999, 2099999, 2199999, 2899999 and 2999999 on Schedule B, Part 1, Column 8.

Attachment Z


Line 4.04 – Mortgage Loans – Mezzanine Real Estate Loans

Include: Mezzanine real estate loans as defined in SSAP No. 83—Mezzanine Real Estate Loans.

Column 1 should equal the sum of Lines 0699999, 1499999, 2299999 and 3099999 on Schedule B, Part 1, Column 8.

Line 4.05 – Total Valuation allowance

Column 1 should equal Schedule B – Verification Between Years Line 12. Line 4.0506 – Total Mortgage Loans

Sum of Lines 4.01 to 4.0405.

The amount reported in Column 1 should equal the amount reported in Line 3.1 plus Line 3.2, Column 1, Page 2, Assets.

The amount reported in Column 3 should equal the amount reported in Line 3.1 plus Line 3.2, Column 3, Page 2, Assets.


Attachment Z




Investment Categories

Gross Investment Holdings

Admitted Assets as Reported in the Annual Statement

1

Amount

2

Percentage of Column 1 Line 13

3

Amount

4 Securities Lending

Reinvested Collateral Amount

5

Total (Col. 3+4) Amount

6

Percentage of Column 5 Line 13


4. Mortgage loans (Schedule B):

4.01 Farm mortgages ............................................................................................... ..................... .................... ..................... .................... ..................... .................... 4.02 Residential mortgages ..................................................................................... ..................... .................... ..................... .................... ..................... .................... 4.03 Commercial mortgages .................................................................................... ..................... .................... ..................... .................... ..................... .................... 4.04 Mezzanine real estate loans ............................................................................. ..................... .................... ..................... .................... ..................... .................... 4.05 Total valuation allowance ............................................................................... ..................... .................... ..................... .................... ..................... .................... 4.0506 Total mortgage loans .................................................................................. ..................... .................... ..................... .................... ..................... ....................

5. Real estate (Schedule A): 5.01 Properties occupied by company ..................................................................... ..................... .................... ..................... .................... ..................... .................... 5.02 Properties held for production of income ........................................................ ..................... .................... ..................... .................... ..................... .................... 5.03 Properties held for sale ................................................................................... ..................... .................... ..................... .................... ..................... .................... 5.04 Total real estate ................................................................................................ ..................... .................... ..................... .................... ..................... ....................

6. Cash, cash equivalents and short-term investments: 6.01 Cash (Schedule E, Part 1) ................................................................................ ..................... .................... ..................... .................... ..................... .................... 6.02 Cash equivalents (Schedule E, Part 2)............................................................. ..................... .................... ..................... .................... ..................... .................... 6.03 Short-term investments (Schedule DA) .......................................................... ..................... .................... ..................... .................... ..................... .................... 6.04 Total cash, cash equivalents and short-term investments ............................... ..................... .................... ..................... .................... ..................... ....................

7. Contract loans ............................................................................................................ ..................... .................... ..................... .................... ..................... .................... 8. Derivatives (Schedule DB) ........................................................................................ ..................... .................... ..................... .................... ..................... .................... 9. Other invested assets (Schedule BA) ......................................................................... ..................... .................... ..................... .................... ..................... .................... 10. Receivables for securities ......................................................................................... ..................... .................... ..................... .................... ..................... .................... 11. Securities lending (Schedule DL, Part 1) .................................................................. ..................... .................... ..................... XXX XXX XXX 12. Other invested assets (Page 2, Line 11) ..................................................................... 13. Total invested assets


Attachment Z




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION




[ X ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ X ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)



Modify the instructions and illustration for Note 3A and a new Note 3E with instructions and illustrations to be data captured. Modify the blank and instructions for Schedule D, Part 6, Sections 1 and 2.


The purpose of this proposal is to make changes to the disclosures in the Notes to Financial Statement and Schedule D, Part 6 to reflect changes being adopted for SSAP No. 68—Business Combinations and Goodwill and SSAP No. 97—Investments in Subsidiary, Controlled and Affiliated Entities by Statutory Accounting Principles (E) Working Group (SAPWG).

NAIC STAFF COMMENTS


Other Comments:

Proposal is being exposed concurrently with SSAP changes being considered by SAPWG.


Attachment AA





3. Business Combinations and Goodwill

Instruction:

A. Statutory Purchase Method

For business combinations accounted for under the statutory purchase method, disclose the following for as long as unamortized goodwill is reported as a component of the investment:

The name and brief description of the acquired entity.

That the method of accounting is the statutory purchase method.

Acquisition date, cost of the acquired entity, the original amount of goodwill and the original amount

of admitted goodwill.

The SCA’s book value, the amount of amortization of goodwill recorded for the period, the SCA’s admitted goodwill as of the reporting date and

Total admitted goodwill as of the reporting date

admitted Admitted goodwill as a percentage of the SCA’s book adjusted carrying value (gross of

admitted goodwill). (Admitted goodwill as of the reporting date divided by book value of the SCA.


D. Impairment Loss

If an impairment loss was recognized, disclose the following in the period of the impairment write-down: (1) A description of the impaired assets and the facts and circumstances leading to the impairment,

and (2) The amount of the impairment charged to realized capital gains and losses and how fair value was

determined.

E. Subcomponents and Calculation of Adjusted Surplus and Total Admitted Goodwill

A reporting shall disclose the subcomponents and calculation of adjusted surplus and total admitted goodwill as a percentage of adjusted surplus.

Attachment AA


Illustration:

A. Statutory Purchase Method

The Company purchased 100% interest of XYZ Insurance Company on 6/30/_____. XYZ Insurance Company is licensed in 49 states and sells workers’ compensation products exclusively.

THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THESE ILLUSTRATIONS.

The transaction was accounted for as a statutory purchase and reflects the following:

1 2 3 4 5 6 7

Purchased entity Acquisition

date Cost of acquired

entity

Original amount of admitted

goodwill

Admitted goodwill as of the

reporting date

Amount of goodwill

amortized during the reporting

period

Admitted goodwill as a % of

SCA BACV, gross of admitted goodwill

............................................................................. ..................... $ ......................... $ ........................ $ ........................ $ ........................ ............. % ............................................................................. ..................... $ ......................... $ ........................ $ ........................ $ ........................ ............. % ............................................................................. ..................... $ ......................... $ ........................ $ ........................ $ ........................ ............. % ............................................................................. ..................... $ ......................... $ ........................ $ ........................ $ ........................ ............. % ............................................................................. ..................... $ ......................... $ ........................ $ ........................ $ ........................ ............. %

1 2 3 4 5

Purchased entity Acquisition date Cost of acquired

entity Original amount

of goodwill Original amount of admitted goodwill

............................................................................................. ......................... $ ................................ $ ................................ $ ................................ ............................................................................................. ......................... $ ................................ $ ................................ $ ................................ ............................................................................................. ......................... $ ................................ $ ................................ $ ................................ ............................................................................................. ......................... $ ................................ $ ................................ $ ................................ Totlal ................................................................................... XXX $ ................................ $ ................................ $ ................................

1 6 7 8 9

Purchased entity Admitted goodwill as of the reporting date

Amount of goodwill amortized during the

reporting period Book Value of SCA

Admitted goodwill as a % of SCA BACV,

gross of admitted goodwill

Col. 6/Col. 8 ............................................................................................. $ ................................ $ ................................ $ ................................ ...................... % ............................................................................................. $ ................................ $ ................................ $ ................................ ...................... % ............................................................................................. $ ................................ $ ................................ $ ................................ ...................... % ............................................................................................. $ ................................ $ ................................ $ ................................ ...................... % Total .................................................................................... $ ................................ $ ................................ $ ................................ XXX%


Attachment AA


D. Impairment Loss

The Company did not recognize an impairment loss on the transactions described above. THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THESE ILLUSTRATIONS.

E. Subcomponents and Calculation of Adjusted Surplus and Total Admitted Goodwill

Calculation of Limitation Using

Prior Quarter Numbers

Current Reporting Period

(1) Capital & Surplus .............................. XXX Less:

(2) Admitted Positive Goodwill .............................. XXX (3) Admitted EDP Equipment & Operating System Software .............................. XXX (4) Admitted Net Deferred Taxes .............................. XXX

(5) Adjusted Capital and Surplus (Line 1-+2-+3-+4) .............................. XXX (6) Limitation on amount of goodwill (adjusted capital and surplus times 10%

goodwill limitation [Line 5*10%]) .............................. XXX (7) Current period reported Admitted Goodwill XXX .............................. (8) Current Period Admitted Goodwill as a % of prior period Adjusted

Capital and Surplus (Line 7/Line 5) XXX ............................. %


Attachment AA



VALUATION OF SHARES OF SUBSIDIARY, CONTROLLED OR AFFILIATED COMPANIES


Column 7 – Do Insurer’s Assets Include Intangible Assets Connected with Holding of Such Company’s Stock?

State whether the assets shown by the reporting entity in this statement include, through the carrying value of stock of the SCA company valued under the SSAP No. 97—Subsidiary, Controlled and Affiliated Entities, intangible assets arising out of the purchase of such stock by the reporting entity or the purchase by the SCA Company of the stock of a lower-tier company controlled by the SCA Company. For purposes of this question, intangible assets at purchase shall be defined as the excess of the purchase price over the tangible net worth (total assets less intangible assets and total liabilities) represented by such shares as recorded, immediately prior to the date of purchase, on the books of the company whose stock was purchased.

Column 8 – Total Amount of Such Intangible AssetsGoodwill

If the answer in Column 7 is “Yes,” give the total amount of intangible assets involved whether admitted or nonadmitted. The intangible assetsgoodwill shown for the SCA Company should include any intangible assets that are included in the SCA Company’s carrying value of the stock of one or more lower-tier companies controlled by the SCA Company. In all cases, the current intangible assetsgoodwill equals the intangible assetsgoodwill calculated at purchase, as defined in SSAP No. 68—Business Combinations and Goodwillabove, minus any write-off thereof between the date of purchase and the statement date. If any portion of the total amount of intangible assetsgoodwill is required to be nonadmitted for all SCA companies combined in accordance with SSAP No. 97—Investments in Subsidiary, Controlled and Affiliated Entities and SSAP No. 68—Business Combinations and Goodwill state the total amount nonadmitted in the footnote at the bottom of the this section of the schedule.

Column 109 – Nonadmitted Amount

Provide the amount nonadmitted, if any, included in Column 2 of the Asset page. Column 1110 – Stock of Such Company Owned by Insurer on Statement Date Number of Shares and Column 1211 – Stock of Such Company Owned by Insurer on Statement Date % of Outstanding

State the number of shares of stock of the SCA Company owned by the reporting entity on the statement date and the percent owned of the outstanding shares of the same class.

** Column 13 12 through 16 15 will be electronic only. ** Column 1312 – Legal Entity Identifier (LEI)

Provide the 20-character Legal Entity Identifier (LEI) for any issuer as assigned by a designated Local Operating Unit. If no LEI number has been assigned, leave blank.

}

Attachment AA


Column 1413 – Issuer

Issuer Definition:

The name of the legal entity that develops, registers and sells securities for the purpose of financing its operations and may be domestic or foreign governments, corporations or investment trusts. The issuer is legally responsible for the obligations of the issue and for reporting financial conditions, material developments and any other operational activities as required by the regulations of their jurisdictions

Do not report ticker symbols, either internal or otherwise.

The issuer information should be the same as provided for Schedule D, Part 2, Sections 1 and 2.

Column 1514 – Issue

Issue information provides detailed data as to the type of security being reported.

Do not report ticker symbols, either internal or otherwise.

The issue information should be the same as provided for Schedule D, Part 2, Sections 1 and 2. Column 1615 – ISIN Identification

The International Securities Identification Numbering (ISIN) system is an international standard set up by the International Organization for Standardization (ISO). It is used for numbering specific securities, such as stocks, bonds, options and futures. ISIN numbers are administered by a National Numbering Agency (NNA) in each of their respective countries, and they work just like serial numbers for those securities. Record the ISIN number only if no valid CUSIP, CINS or PPN exists to report in Column 1.



Column 4 – Total Amount of Intangible AssetsGoodwill Included in Amount Shown in Column 8, Section 1

As explained in the instructions for Section 1, this amount is based on the intangible assetsgoodwill at purchase of the stock of the lower-tier company, reduced by any subsequent impairment/write-off. The reporting entity also bases the amount shown on the proportionate ownership of the lower-tier company.


}

Attachment AA



SCHEDULE D – PART 6 – SECTION 1 Valuation of Shares of Subsidiary, Controlled or Affiliated Companies

1

CUSIP Identification

2

Description Name of Subsidiary, Controlled or

Affiliated Company

3

Foreign

4

NAIC Company Code

5

ID Number

6

NAIC Valuation Method

7

Book/Adjusted Carrying Value Do Insurer's Assets Include Intangible Assets

Connected with Holding of Such Company's Stock?

8

Total Amount of Goodwill Included in

Book/Adjusted Carrying Value Such

Intangible Assets

9

Book / Adjusted

Carrying Value

109

Nonadmitted Amount

Stock of Such Company Owned by

Insurer on Statement Date 1110

Number of

Shares

1211

% of Outstanding

..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... ..................... .....................

.................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. ..................................................

............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ............... ...............

......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... ......................................... .........................................

...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ......................

................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. ................................. .................................

........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................

.................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. .................................. ..................................

............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ......................

.................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... ....................

1999999 Totals XXX XXX

1. Amount of insurer’s capital and surplus from the prior period’s statutory statement reduced by any admitted EDP, goodwill and net deferred tax assets included therein: $..................................... 12. Total amount of intangible assetsgoodwill nonadmitted $ .........................


1

CUSIP Identification

2

Name of Lower-Tier Company

3

Name of Company Listed in Section 1 Which Controls Lower-Tier Company

4 Total Amount of Intangible AssetsGoodwill

Included in Amount Shown in Column 8, Section 1

Stock in Lower-Tier Company Owned Indirectly by Insurer on Statement Date

5 Number of Shares

6 % of Outstanding

......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... .........................

............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ...............................................

........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................

................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................

.................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... ....................................................................................

................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... ...................................................................................

0399999 Total XXX XXX


Attachment AA



Attachment AA




DATE: 02/21/2020

CONTACT PERSON:

TELEPHONE:

EMAIL ADDRESS:

ON BEHALF OF:


TITLE: Chair SAPWG



Columbus, OH 43215




DISPOSITION




[ X ] Life, Accident & Health/Fraternal [ X ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ ] Health [ X ] Health (Life Supplement)



Add footnote to Exhibit 5 (life/fraternal & health – life supplement) and Exhibit 3 separate accounts.


While this update did not result in a statutory accounting change, this footnote will disclose cases when a mortality risk is no longer present or a significant factor – i.e. due to a policyholder electing a payout benefit.

NAIC STAFF COMMENTS


Other Comments:



Attachment BB


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL AND HEALTH (LIFE SUPPLEMENT)

EXHIBIT 5 – AGGREGATE RESERVE FOR LIFE CONTRACTS

1

Valuation Standard

2

Total (a)

3

Industrial

4

Ordinary

5 Credit

(Group and Individual)

6

Group LIFE INSURANCE ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................

............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ...........................................

............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ........................................... ...........................................

0199997 Totals (Gross) .................................................................... 0199998 Reinsurance ceded .............................................................

.......................................... ............................................ ........................................... .......................................... ...........................................

0199999 Totals (Net)........................................................................ ANNUITIES (excluding supplementary contracts with life contingencies): ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................ ............................................

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

...........................................

0299999 Totals (Net)........................................................................ XXX XXX SUPPLEMENTARY CONTRACTS WITH LIFE CONTINGENCIES: ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................

............................................ ............................................ ............................................

........................................... ........................................... ...........................................

............................................ ............................................ ............................................

........................................... ........................................... ...........................................


............................................ ............................................ ........................................... .......................................... ...........................................

0399999 Totals (Net)........................................................................ ACCIDENTAL DEATH BENEFITS: ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................

............................................ ............................................ ............................................

........................................... ........................................... ...........................................

............................................ ............................................ ............................................

........................................... ........................................... ...........................................


............................................ ............................................ ........................................... ............................................ ..........................................

0499999 Totals (Net)........................................................................ DISABILITY—ACTIVE LIVES: ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................ ............................................ ............................................

............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ...........................................

............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ...........................................


............................................ ............................................ ........................................... ........................................... ..........................................

0599999 Totals (Net)........................................................................ DISABILITY—DISABLED LIVES: ..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

............................................ ............................................ ............................................ ............................................ ............................................

............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ...........................................

............................................ ............................................ ............................................ ............................................ ............................................

........................................... ........................................... ........................................... ........................................... ...........................................


............................................ ............................................ ........................................... ............................................ ...........................................

0699999 Totals (Net)........................................................................ MISCELLANEOUS RESERVES ............................................................................................................................... ............................................ ............................................ ........................................... ............................................ ........................................... ............................................................................................................................... ............................................ ............................................ ........................................... ............................................ ........................................... ...............................................................................................................................

0799997 Totals (Gross) .................................................................... ............................................ ............................................ ........................................... ............................................ ........................................... 0799998 Reinsurance ceded ............................................................. 0799999 Totals (Net)........................................................................ 9999999 Totals (Net)-Page 3, Line 1

(a) Included in the above table are amounts of deposit-type contracts that originally contained a mortality risk. Amounts of deposit-type contracts in Column 2 that no longer contain a mortality risk are Life Insurance $__________, Annuities

$__________, Supplementary Contracts with Life Contingencies $__________, Accident and Health Contracts $__________, Miscellaneous Reserves $__________. $__________ (Life Insurance), $__________ (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives), $__________ (Miscellaneous Reserves).

Attachment BB


ANNUAL STATEMENT BLANK – SEPARATE ACCOUNTS

EXHIBIT 3 – AGGREGATE RESERVE FOR LIFE, ANNUITY AND ACCIDENT AND HEALTH CONTRACTS

1 Description of Valuation Basis

2 Total (a)

3 Ordinary

4 Group

Life insurance: ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................

.......................... .......................... .......................... .......................... .......................... ..........................

........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... ..........................

0199999 Totals ........................................................................................................................................ Annuities (excluding supplementary contracts): ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................

.......................... .......................... .......................... .......................... .......................... .......................... ..........................

........................... ........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... .......................... ..........................

0299999 Totals ........................................................................................................................................ Supplementary contracts with life contingencies: ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................

.......................... ..........................

........................... ...........................

.......................... ..........................

0399999 Totals ........................................................................................................................................ Accident and health contracts: ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................

........................... ...........................

........................... ...........................

.......................... ..........................

0499999 Totals ........................................................................................................................................ Miscellaneous reserves: ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................

.......................... ..........................

........................... ........................... ...........................

.......................... ..........................

0599999 Totals ........................................................................................................................................ 9999999 Totals (to Page 3, Line 1)

(a) Included in the above table are amounts of deposit-type contracts that originally contained a mortality risk. Amounts of deposit-type contracts that no longer contain a

mortality risk are $__________ (Life Insurance), $__________ in Column 2 Life Insurance $__________, Annuities $__________, Supplementary Contracts with Life Contingencies $__________, Accident and Health Contracts $__________, Miscellaneous Reserves $__________. (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives), $__________ (Miscellaneous Reserves).

EXHIBIT 3 – INTERROGATORIES

1.1 Has the reporting entity ever issued both participating and non-participating variable life insurance contracts? Yes [ ] No [ ] 2.1 Does the reporting entity at present issue both participating and non-participating variable life insurance contracts? Yes [ ] No [ ] 2.2 If not, state which kind is issued.......................................................................................................... 3.1 Is any surrender value promised in excess of the reserve as legally computed? Yes [ ] No [ ] N/A [ ] 3.2 If so, the amount of such excess must be included in surrender values in excess of reserves otherwise required and carried in this schedule. Has this been done? Yes [ ] No [ ] N/A [ ] Attach a statement of methods employed in the valuation of variable life insurance contracts issued at, or subsequently subject to, an extra premium or in the valuation of contracts otherwise issued on lives classified as substandard for the plan of contract issued or on special class lives (including paid-up variable life insurance).

EXHIBIT 3A – CHANGES IN BASES OF VALUATION DURING THE YEAR (Including supplementary contracts set up on a basis other than that used to determine benefits)

1

Description of Valuation Class

Valuation Basis 4 2

Changed From

3

Changed To

Increase in Actuarial

Reserve Due to Change

......................................................................................................................................................................................... ......................................................................................................................................................................................... ......................................................................................................................................................................................... .........................................................................................................................................................................................

........................ ........................ ........................

........................ ........................ ........................

........................ ........................ ........................

9999999 Totals (Page 6, Line 5, Analysis of Increase in Reserves)

Attachment BB


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL AND HEALTH (LIFE SUPPLEMENT)

EXHIBIT 5 – AGGREGATE RESERVES FOR LIFE CONTRACTS


Footnote (a):

Deposit-type contracts such as GICs and supplemental contracts are generally reported in Exhibit 7 – Deposit Type Contracts. However, certain contracts (which have similar characteristics to deposit-type contracts) incorporate mortality risk components which qualify those contracts to be reported in Exhibit 5 – Aggregate Reserve for Life Contracts. A common example is a supplemental contract which provides for a life-contingent payout with a specified certain period. Because the contract was life-contingent at issue, it is reported in Exhibit 5 and remains in Exhibit 5 after the death of the annuitant as remaining guaranteed payments continue to the beneficiary. Additionally, state insurance departments have the discretion to approve or require a contract to be classified as a life insurance contract. This footnote captures the amounts reported on Exhibit 5 for deposit-type contracts that originally contained a mortality risk, but no longer contain that risk.

EXHIBIT 3 – AGGREGATE RESERVE FOR LIFE, ANNUITY AND ACCIDENT AND HEALTH CONTRACTS


Footnote (a):

Deposit-type contracts such as GICs and supplemental contracts are generally reported in Exhibit 4 – Deposit Type Contracts. However, certain contracts (which have similar characteristics to deposit-type contracts) incorporate mortality risk components which qualify those contracts to be reported in Exhibit 3 – Aggregate Reserve for Life, Annuity and Accident and Health Contracts. A common example is a supplemental contract which provides for a life-contingent payout with a specified certain period. Because the contract was life-contingent at issue, it is reported in Exhibit 3 and remains in Exhibit 3 after the death of the annuitant as remaining guaranteed payments continue to the beneficiary. Additionally, state insurance departments have the discretion to approve or require a contract to be classified as a life insurance contract. This footnote captures the amounts reported on Exhibit 3 for deposit-type contracts that originally contained a mortality risk, but no longer contain that risk.


Attachment BB

Attachment CC




DATE: 03/30/2020

CONTACT PERSON: Pat Allison TELEPHONE: 816-783-8528 EMAIL ADDRESS: [email protected] ON BEHALF OF: LATF NAME: Mike Boerner, Chair TITLE: AFFILIATION: ADDRESS:




DISPOSITION [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify)


[ X ] ANNUAL STATEMENT [ ] INSTRUCTIONS [ ] CROSSCHECKS [ ] QUARTERLY STATEMENT [ X ] BLANK



IDENTIFICATION OF ITEM(S) TO CHANGE Remove questions 29,30, 31 and 32 from the Supplemental Exhibits and Schedules Interrogatories. Renumber the remaining questions.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** Certifications for business subject to Actuarial Guideline XLIII will be provided in the PBR Actuarial Report as required by VM-31.


Attachment CC



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 Responses

MARCH FILING

1. Will the Supplemental Compensation Exhibit be filed with the state of domicile by March 1? ...................................................... 2. Will the confidential Risk-based Capital Report be filed with the NAIC by March 1? ...................................................... 3. Will the confidential Risk-based Capital Report be filed with the state of domicile, if required, by March 1? ...................................................... 4. Will an actuarial opinion be filed by March 1? ......................................................


SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES

26. Will the C-3 RBC Certifications required under C-3 Phase II be filed with the state of domicile and electronically with the NAIC by March 1? ...................................................... 27. 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 1? ...................................................... 28. 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 1? ......................................................

29. Will the Actuarial Certification regarding the use of 2001 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 1? ...................................................... 30. Will the Workers’ Compensation Carve-Out Supplement be filed by March 1? (Not applicable to fraternal benefit societies) ...................................................... 31. Will Supplemental Schedule O be filed with the state of domicile and the NAIC by March 1? ...................................................... 32. Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March 1? ...................................................... 33. 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 1? ...................................................... 34. 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 1? ...................................................... 35. 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 1? ...................................................... 36. Will the VM-20 Reserves Supplement be filed with the state of domicile and the NAIC by March 1? ......................................................

Attachment CC


APRIL FILING

37. Will the confidential Regulatory Asset Adequacy Issues Summary (RAAIS) required by the Valuation Manual be filed with the state of domicile by April 1? ...................................................... 38. Will the Long-Term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April 1? ...................................................... 39. Will the Credit Insurance Experience Exhibit be filed with the state of domicile and the NAIC by April 1? (Not applicable to fraternal benefit societies) ...................................................... 40. Will the Accident and Health Policy Experience Exhibit be filed by April 1? ...................................................... 41. Will the Supplemental Health Care Exhibit (Parts 1, 2 and 3) be filed with the state of domicile and the NAIC by April 1? ...................................................... 42. Will the regulator only (non-public) Supplemental Health Care Exhibit’s Allocation Report be filed with the state of domicile and the NAIC by April 1? ...................................................... 43. Will the confidential Actuarial Memorandum required by Actuarial Guideline XXXVIII 8D be filed with the state of domicile by April 30? ...................................................... 44. Will the Supplemental Term and Universal Life Insurance Reinsurance Exhibit be filed with the state of domicile and the NAIC by April 1? ...................................................... 45. Will the Variable Annuities Supplement be filed with the state of domicile and the NAIC by April 1? ...................................................... 46. Will the confidential Executive Summary of the PBR Actuarial Report be filed with the state of domicile by April 1? ...................................................... 47. Will the confidential Life Summary of the PBR Actuarial Report be filed with the state of domicile by April 1? ...................................................... 48. Will the confidential Variable Annuities Summary of the PBR Actuarial Report be filed with the state of domicile by April 1? ......................................................

AUGUST FILING 49. Will Management’s Report of Internal Control Over Financial Reporting be filed with the state of domicile by August 1? ...................................................... Explanation: Bar code:


Attachment CC



Attachment DD




DATE: 04/09/2020

CONTACT PERSON: TELEPHONE: EMAIL ADDRESS: ON BEHALF OF: NAME: Jacob W. Garn TITLE: Chair, Blanks Working Group AFFILIATION: ADDRESS:






[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ X ] BLANK

[ ] Life, Accident & Health/Fraternal [ ] Separate Accounts [ ] Title [ ] Property/Casualty [ ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)

Anticipated Effective Date: 1st Quarter 2021

IDENTIFICATION OF ITEM(S) TO CHANGE Add new Column 5 to the blank for Schedule T with instructions to specifically capture the CHIP premium. Existing columns after the new Column 5 will be renumbered.

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** To assist regulators in identifying CHIPs/SCHIPs plan premiums associated with the Federal/State partnership created by Title XXI of the Social Security Act as it relates to guaranty fund assessments.


Attachment DD


QUARTERLY INSTRUCTIONS - HEALTH

SCHEDULE T – PREMIUMS AND OTHER CONSIDERATIONS

CURRENT YEAR TO DATE – ALLOCATED BY STATES AND TERRITORIES


Columns 2 thru 10 – Direct Business Only Year to Date

Display year-to-date direct premiums written by state.

Include: Gross premiums, including policy and membership fees, less return premiums and premiums on policies not taken.

Column 1 – Active Status

Use the following codes to identify the reporting entity’s status for each state or territory reported in the schedule as of the end of the reporting period. Enter the code that applies to the reporting entity’s status in the state or territory. Each line must have an entry in order to subtotal Footnote (a).

L – Licensed or Chartered (Licensed Insurance Carrier and Domiciled Risk Retention Groups

referred to in some states as admitted.) R – Registered (Non-domiciled Risk Retention Groups) E – Eligible (Reporting Entities eligible or approved to write Surplus Lines in

the state. In some states referred to as nonadmitted.) Q – Qualified (Qualified or Accredited Reinsurer)

N – None of the above (Not allowed to write business in the state or none of the above codes apply)

Column 2 – Accident and Health Premiums

Include: Policies providing stand-alone Medicare Part D Prescription Drug Coverage.

Exclude: Premiums reported in Columns 3 through 8 and Column 10.

Policies providing Medicare Part D Prescription Drug Coverage through a Medicare Advantage product.

Column 3 – Medicare Title XVIII

Include: Policies providing Medicare Part D Prescription Drug Coverage through a Medicare Advantage product.

Exclude: Policies providing stand-alone Medicare Part D Prescription Drug Coverage.

Column 5 – CHIP Title XXI

Policies issued in association with the Federal/State partnership created by Title XXI of the Social Security Act.

Attachment DD


Column 6 – Federal Employees Health Benefits Program Premiums

Include: Premiums allocable to the Federal Employees Health Benefits Program that are exempted from state taxes or other fees by Section 8909(f)(1) of Title 5 of the United States Code.

Column 7 – Life and Annuity Premiums and Other Considerations

Report premiums for life insurance and all supplemental benefits attached to life contracts, allocated annuity considerations for contracts that incorporate any mortality or morbidity risk, unallocated annuity considerations and other unallocated deposits which incorporate any mortality or morbidity risk.

Column 8 – Property/Casualty Premiums

Include: Premiums for property/casualty insurance business. Column 10 – Deposit Type Contracts

Report deposits and other amounts for contracts without any mortality or morbidity risk. Include deposits for guaranteed investment contracts and immediate annuities without life contingencies.

** Column 11 will be electronic only ** Column 11 – Branch Operations Indicator

Include the indicator “B” if any direct premium in the alien jurisdiction is written via branch operations. If the premium in the jurisdiction represents both branch operations and other direct business (e.g., the policyholder or group member residence changed to that jurisdiction), then indicate “B.” If there are no branch operations in the jurisdiction, then leave blank. The definition of “branch operations” is the definition used by the reporting entity’s state of domicile.


Attachment DD


ANNUAL INSTRUCTIONS - HEALTH

SCHEDULE T – PREMIUMS AND OTHER CONSIDERATIONS

ALLOCATED BY STATES AND TERRITORIES


Column 1 – Active Status

Use the following codes to identify the reporting entity’s status for each state or territory reported in the schedule as of the end of the reporting period. Enter the code that applies to the reporting entity’s status in the state or territory. Each line must have an entry in order to subtotal Footnote (a).

L – Licensed or Chartered (Licensed Insurance Carrier and Domiciled Risk Retention Groups

referred to in some states as admitted.)

R – Registered (Non-domiciled Risk Retention Groups)

E – Eligible (Reporting Entities eligible or approved to write Surplus Lines in the state. In some states referred to as nonadmitted.)

Q – Qualified (Qualified or Accredited Reinsurer)

N – None of the above (Not allowed to write business in the state or none of the above codes apply)

Column 2 – Accident and Health Premiums

Include: Policies providing stand alone Medicare Part D Prescription Drug Coverage.

Exclude: Premiums reported in Column 3 through 8 and Column 10.

Policies providing Medicare Part D Prescription Drug Coverage through a Medicare Advantage product.

Column 3 – Medicare Title XVIII

Include: Policies providing Medicare Part D Prescription Drug Coverage through a Medicare Advantage product.

Exclude: Policies providing stand alone Medicare Part D Prescription Drug Coverage.

Column 5 – CHIP Title XXI

Policies issued in association with the Federal/State partnership created by Title XXI of the Social Security Act.

Column 6 – Federal Employees Health Benefits Plan Premiums

Include: Premiums allocable to the Federal Employees Health Benefits Plan that are exempted from state taxes or other fees by Section 8909(f)(1) of Title 5 of the United States Code.

Attachment DD


Column 7 – Life and Annuity Premiums and Other Considerations

Report premiums for life insurance and all supplemental benefits attached to life contracts, allocated annuity considerations for contracts that incorporate any mortality or morbidity risk, unallocated annuity considerations and other unallocated deposits which incorporate any mortality or morbidity risk.

Column 8 – Property/Casualty Premiums

Include: Premiums for property/casualty insurance business. Column 10 – Deposit-Type Contracts

Report deposits and other amounts for contracts without any mortality or morbidity risk. Include deposits for guaranteed investment contracts and immediate annuities without life contingencies.

** Column 11 will be electronic only ** Column 11 – Branch Operations Indicator

Include the indicator “B” if any direct premium in the alien jurisdiction is written via branch operations. If the premium in the jurisdiction represents both branch operations and other direct business (e.g., the policyholder or group member residence changed to that jurisdiction), then indicate “B.” If there are no branch operations in the jurisdiction, then leave blank. The definition of “branch operations” is the definition used by the reporting entity’s state of domicile.


Line 60 – Reporting Entity Contributions for Employee Benefit Plans

Report the reporting entity’s share of costs for employee benefit plans. Exclude any premiums paid by employees; these should be allocated to the states as above.

Line 61 – Total (Direct Business)

The sum of Column 2, 3, 4, 5, 6, 7 and 8, Line 61 should equal the Underwriting and Investment Exhibit, Part 1, Column 1, Line 12.


Attachment DD


QUARTERLY BLANK - HEALTH

SCHEDULE T – PREMIUMS AND OTHER CONSIDERATIONS Current Year to Date – Allocated by States and Territories

1 Direct Business Only 2 3 4 5 6 7 8 9 10

State, Etc.

Active Status

(a)

Accident & Health

Premiums Medicare

Title XVIII Medicaid Title XIX

CHIP Title XXI

Federal Employees

Health Benefits Program

Premiums

Life & Annuity Premiums &

Other Considerations

Property/ Casualty

Premiums Total Columns 2

Through 8 Deposit-Type

Contracts 1. Alabama ...................... AL 2. Alaska..........................AK 3. Arizona ........................ AZ 4. Arkansas ...................... AR 5. California .................... CA 6. Colorado ...................... CO 7. Connecticut ................. CT 8. Delaware ..................... DE 9. Dist. Columbia ............ DC 10. Florida .......................... FL 11. Georgia ........................GA 12. Hawaii .......................... HI 13. Idaho............................. ID 14. Illinois ...........................IL 15. Indiana .......................... IN 16. Iowa .............................. IA 17. Kansas ......................... KS 18. Kentucky .....................KY 19. Louisiana ..................... LA 20. Maine ......................... ME 21. Maryland .................... MD 22. Massachusetts............. MA 23. Michigan ..................... MI 24. Minnesota ................... MN 25. Mississippi ................. MS 26. Missouri ..................... MO 27. Montana ..................... MT 28. Nebraska...................... NE 29. Nevada ........................NV 30. New Hampshire...........NH 31. New Jersey ................... NJ 32. New Mexico ............... NM 33. New York ....................NY 34. North Carolina............. NC 35. North Dakota ...............ND 36. Ohio .............................OH 37. Oklahoma ....................OK 38. Oregon ......................... OR 39. Pennsylvania ............... PA 40. Rhode Island ................ RI 41. South Carolina............. SC 42. South Dakota ............... SD 43. Tennessee .................... TN 44. Texas ........................... TX 45. Utah ............................. UT 46. Vermont ...................... VT 47. Virginia .......................VA 48. Washington ................ WA 49. West Virginia ............. WV 50. Wisconsin .................... WI 51. Wyoming .................... WY 52. American Samoa ......... AS 53. 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. Subtotal ............................ 60. Reporting entity

contributions for Employee Benefit Plans ...

61. Total (Direct Business)

........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... XXX XXX

XXX XXX

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

DETAILS OF WRITE-INS 58001. ...................................... 58002. ...................................... 58003. ...................................... 58998. Summary of remaining

write-ins for Line 58 from overflow page. .....

58999. Totals (Lines 58001 through 58003 plus 58998) (Line 58 above)

XXX XXX XXX

XXX

XXX

.......................... .......................... .......................... ..........................

............................ ............................ ............................ ............................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

.......................... .......................... .......................... ..........................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

.......................... .......................... .......................... ..........................

(a) Active Status Counts:

L – Licensed or Chartered - Licensed insurance carrier or domiciled RRG ................................................................................................... ______ R – Registered - Non-domiciled RRGs ........................................................... _____ E – Eligible - Reporting entities eligible or approved to write surplus lines in the state ................................................................................. ______ Q – Qualified - Qualified or accredited reinsurer ............................................ _____ N – None of the above - Not allowed to write business in the state ............................................................................................... ______

Attachment DD


ANNUAL BLANK - HEALTH

SCHEDULE T – PREMIUMS AND OTHER CONSIDERATIONS Allocated by States and Territories

1 Direct Business Only 2 3 4 5 6 7 8 9 10

State, Etc.

Active Status

(a)

Accident & Health

Premiums Medicare

Title XVIII Medicaid Title XIX

CHIP Title XXI

Federal Employees

Health Benefits Program

Premiums

Life & Annuity Premiums &

Other Considerations

Property/ Casualty

Premiums Total Columns 2

Through 8 Deposit-Type

Contracts 1. Alabama ...................... AL 2. Alaska..........................AK 3. Arizona ........................ AZ 4. Arkansas ...................... AR 5. California .................... CA 6. Colorado ...................... CO 7. Connecticut ................. CT 8. Delaware ..................... DE 9. Dist. Columbia ............ DC 10. Florida .......................... FL 11. Georgia ........................GA 12. Hawaii .......................... HI 13. Idaho............................. ID 14. Illinois ...........................IL 15. Indiana .......................... IN 16. Iowa .............................. IA 17. Kansas ......................... KS 18. Kentucky .....................KY 19. Louisiana ..................... LA 20. Maine ......................... ME 21. Maryland .................... MD 22. Massachusetts............. MA 23. Michigan ..................... MI 24. Minnesota ................... MN 25. Mississippi ................. MS 26. Missouri ..................... MO 27. Montana ..................... MT 28. Nebraska...................... NE 29. Nevada ........................NV 30. New Hampshire...........NH 31. New Jersey ................... NJ 32. New Mexico ............... NM 33. New York ....................NY 34. North Carolina............. NC 35. North Dakota ...............ND 36. Ohio .............................OH 37. Oklahoma ....................OK 38. Oregon ......................... OR 39. Pennsylvania ............... PA 40. Rhode Island ................ RI 41. South Carolina............. SC 42. South Dakota ............... SD 43. Tennessee .................... TN 44. Texas ........................... TX 45. Utah ............................. UT 46. Vermont ...................... VT 47. Virginia .......................VA 48. Washington ................ WA 49. West Virginia ............. WV 50. Wisconsin .................... WI 51. Wyoming .................... WY 52. American Samoa ......... AS 53. 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. Subtotal ............................ 60. Reporting entity

contributions for Employee Benefit Plans ...

61. Total (Direct Business)

........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... XXX XXX

XXX XXX

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ........................... ...........................

.......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... .......................... ..........................

DETAILS OF WRITE-INS 58001. ...................................... 58002. ...................................... 58003. ...................................... 58998. Summary of remaining

write-ins for Line 58 from overflow page. .....

58999. Totals (Lines 58001 through 58003 plus 58998) (Line 58 above)

XXX XXX XXX

XXX

XXX

.......................... .......................... .......................... ..........................

............................ ............................ ............................ ............................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

.......................... .......................... .......................... ..........................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

........................... ........................... ........................... ...........................

.......................... .......................... .......................... ..........................

(a) Active Status Counts:

L – Licensed or Chartered - Licensed insurance carrier or domiciled RRG ................................................................................................... ______ R – Registered - Non-domiciled RRGs ........................................................... ______ E – Eligible - Reporting entities eligible or approved to write surplus lines in the state ................................................................................. ______ Q – Qualified - Qualified or accredited reinsurer ............................................ ______ N – None of the above - Not allowed to write business in the state ................................................................................................................ ______

(b) Explanation of basis of allocation by states, premiums by state, etc.


Attachment DD



Attachment EE




DATE: 05/11/2020

CONTACT PERSON: TELEPHONE: EMAIL ADDRESS: ON BEHALF OF: NAME: Dale Bruggeman TITLE: Chair SAPWG AFFILIATION: Ohio Department of Insurance ADDRESS: 50W. Town St., 3rd Fl., Ste. 300 Columbus, OH 43215






[ X ] ANNUAL STATEMENT [ X ] INSTRUCTIONS [ X ] CROSSCHECKS [ X ] QUARTERLY STATEMENT [ X ] BLANK

[ X ] Life, Accident & Health/Fraternal [ X ] Separate Accounts [ X ] Title [ X ] Property/Casualty [ X ] Protected Cell [ ] Other _______________________ [ X ] Health [ ] Health (Life Supplement)

Anticipated Effective Date: 1st Quarter 2021

IDENTIFICATION OF ITEM(S) TO CHANGE Add a new Column 5 to Schedule DB, Part D, Section 1 and renumber the remining columns. Add instruction for the new Column 5, add the column reference to Column 7 and adjust other column references in crosschecks. Also correct column references for this schedule on the Liability Page, Asset Page and Schedule DB Verification. Modify instruction language for the disclosure Note 8A(8).

REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is to reflect on Schedule DB, Part D, Section 1 and the Notes to Financial Statement disclosure changes to SSAP No. 97—Derivatives adopted by Statutory Accounting Principles (E) Working Group (SAPWG)


Attachment EE



SCHEDULE DB – PART D – SECTION 1

COUNTERPARTY EXPOSURE FOR DERIVATIVE INSTRUMENTS OPEN DECEMBER 31 OF CURRENT YEAR


Column 4 – Fair Value of Acceptable Collateral

Leave blank for the aggregate reporting of Exchange-Traded Derivatives (Line 0199999999).

For OTC counterparties, show the Fair Value of acceptable collateral pledged by the counterparty.

For central clearinghouses, this amount would be the net positive variation margin received by the reporting entity.

“Acceptable collateral” means cash, cash equivalents, securities issued or guaranteed by the United States or Canadian governments or their government-sponsored enterprises, letters of credit, publicly traded obligations designated 1 by the SVO, government money market mutual funds, and such other items as may be defined as acceptable collateral in the Purposes and Procedures Manual of the NAIC Investment Analysis Office. For purposes of this definition, the term “letter of credit” means a clean, irrevocable and unconditional letter of credit issued or confirmed by, and payable and presentable at, a financial institution on the list of financial institutions meeting the standards for issuing such letter of credit published pursuant to the Purposes and Procedures Manual of the NAIC Investment Analysis Office. The letter of credit must have an expiration date beyond the term of the subject transaction.

Column 5 – Present Value of Financing Premium

Report the present value of the amount owed by the reporting entity (as a positive) and the amount due to the reporting entity (as a negative) representing derivative financing premiums. See SSAP No. 86—Derivatives.

For Columns 6 and 7, Book/Adjusted Carrying Values that are debit balances on the balance sheet are positive numbers; those that are credit balances are negative numbers. Column 6 – Contracts with Book/Adjusted Carrying Value > 0 (i.e., debit balance on balance sheet)

On the first line, show the aggregate sum for exchange traded derivatives that have a positive Book/Adjusted Carrying Value.

For futures, this equals the sum of the positive cumulative variation margin for highly effective futures (Part B, Section 1, Column 15), plus the sum of the ending balance of all cash deposits with brokers (Part B, Section 1, Broker Name/Net Cash Deposits Footnote – Ending Cash Balance).

On subsequent lines, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty or central clearinghouse that have a positive statement value.

Attachment EE


Column 7 – Contracts with Book/Adjusted Carrying Value < 0 (i.e., credit balance on balance sheet)

On the first line, show the sum of the statement values in parentheses ( ) of all exchange traded derivatives that have a negative Book/Adjusted Carrying Value.

For futures, this equals the sum of the negative cumulative variation margin for highly effective futures (Part B, Section 1, Column 15).

On subsequent lines, show the sum of the Book/Adjusted Carrying Values in parentheses ( ) of all derivative instruments with the counterparty or central clearinghouse that have a negative Book/Adjusted Carrying Value.

Column 8 – Exposure Net of Collateral (Book/Adjusted Carrying Value)

For the aggregate reporting of Exchange-Traded Derivatives (Line 0199999999), show the amount in Column 5.

For OTC counterparties, if no master agreement is in place, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty that has a positive Book/Adjusted Carrying Value, less any Acceptable Collateral and Present Value of Financing Premiums (Column 6 – Column 4 – Column 5).

For OTC counterparties with a master agreement in place and central clearinghouses, show the net sum of the Book/Adjusted Carrying Values of all derivative instruments, less any acceptable collateral and present value of financing premiums (Column 6 + Column 7 – Column 4 – Column 5).

This amount should not be less than zero.

For Columns 9 and 10, market values that would be debit balances on the balance sheet are positive numbers; those that would be credit balances are negative numbers.

Column 9 – Contracts with Fair Value > 0 (i.e., debit balance on the balance sheet)

Show the sum of the market values of all derivative instruments that have a positive market value. Column 10 – Contracts with Fair Value < 0 (i.e., credit balance on the balance sheet)

Show the sum of the market values in parentheses ( ) of all derivative instruments that have a negative market value.

Column 11 – Exposure Net of Collateral (Fair Value)

For the aggregate reporting of Exchange-Traded Derivatives (Line 0199999999), show the amounts in Column 9.

For OTC counterparties, if no master agreement is in place, show the sum of the market values of all derivative instruments with the counterparty that has a positive market value, less any acceptable collateral (Column 9 – Column 4).

For OTC counterparties with a master agreement in place, exchange-traded derivatives and central clearinghouses show the net sum of the market values of all derivative instruments, less any acceptable collateral (Column 9 + Column 10 – Column 4).


Attachment EE


Column 12 – Potential Exposure

Show the potential exposure for Parts A and B for Exchange-Traded Derivatives in aggregate (Line 0199999999) and for each OTC counterparty and central clearinghouse.

Column 13 – Off–Balance Sheet Exposure

For Exchange-Traded Derivatives (Line 0199999999), show Column 12.

For central clearinghouses:

Show [Column 6 + Column 7 – Column 4 + Column 12] – Column 8 but not less than zero.

For OTC counterparties:

If Column 2 = yes; show [Column 6 + Column 7 – Column 4 + Column 12] – Column 8 but not less than zero.

If Column 2 = no; show Column 12.

Optional: If there is no master netting agreement, companies may still encounter double-counting

in cases where a premium is received for an off-balance sheet derivative transaction, such as an interest rate swap. In such cases, report “no” in Column 2 and calculate off-balance sheet exposure on a contract-by-contract basis using the first formula.

** Column 14 will be electronic only. ** Column 14 – Legal Entity Identifier (LEI)

Provide the 20-character Legal Entity Identifier (LEI) for any counterparty as assigned by a designated Local Operating Unit. If no LEI number has been assigned, leave blank.

Attachment EE


SCHEDULE DB – VERIFICATION

BOOK/ADJUSTED CARRYING VALUE, FAIR VALUE AND POTENTIAL EXPOSURE OF DERIVATIVES The purpose of this schedule is to verify the amounts reported in each individual derivative schedule (Schedule DB, Part A, Section 1 and Schedule DB, Part B, Section 1) against those reported in the Counterparty Exposure schedule (Schedule DB, Part D).

BOOK/ADJUSTED CARRYING VALUE CHECK Line 1 – Total Book/Adjusted Carrying Value of all derivatives found on Schedule DB, Part A, Section 1, Column 14. Line 2 – Cumulative Variation Margin of highly effective derivatives found on Schedule DB, Part B, Section 1,

Column 15 plus Total Ending Cash Balance found on Schedule DB, Part B, Section 1, Broker Name/Net Cash Deposits Footnote.

Line 3 – Grand Total of Book/Adjusted Carrying Value from individual schedules (Lines 1 + 2). Line 4 – Total of all positive Book/Adjusted Carrying Value found on Schedule DB, Part D, Section 1, Column 6. Line 5 – Total of all negative Book/Adjusted Carrying Value found on Schedule DB, Part D, Section 1, Column 7. Line 6 – Grand Total Check for Book/Adjusted Carrying Value (Lines 3 – 4 – 5).

FAIR VALUE CHECK Line 7 – Total Fair Value of all derivatives found on Schedule DB, Part A, Section 1, Column 16. Line 8 – Total Fair Value of futures contracts found on Schedule DB, Part B, Section 1 Column 13. Line 9 – Grand Total of Fair Value from individual schedules (Lines 7 + 8). Line 10 – Total of all positive Fair Value found on Schedule DB, Part D, Section 1, Column 9. Line 11 – Total of all negative Fair Value found on Schedule DB, Part D, Section 1, Column 10. Line 12 – Grand Total Check for Fair Value (Lines 9 – 10 – 11).

POTENTIAL EXPOSURE CHECK Line 13 – Total Potential Exposure of all derivatives found on Schedule DB, Part A, Section 1, Column 21. Line 14 – Total Potential Exposure of all futures found on Schedule DB, Part B, Section 1, Column 20. Line 15 – Total Potential Exposure of all derivatives found on Schedule DB, Part D, Section 1, Column 12. Line 16 – Grand Total Check for Potential Exposure (Lines 13 + 14 – 15).

Attachment EE




8. Derivative Instruments

Instruction:

Disclose the following information by category of derivative financial instrument:

A. Derivatives under SSAP No. 86—Derivatives

Disclose the following information by category of derivative financial instrument:

(1) A discussion of the market risk, credit risk and cash requirements of the derivative.


(8) Disclose the aggregate, non-discounted total premium cost for these contracts and the premium cost due in each of the following four years, and thereafter. Also disclose the aggregate fair value of derivative instruments with financing premiums, excluding the impact of the deferred or financing premiums.


Attachment EE



SCHEDULE DB – PART D – SECTION 1

COUNTERPARTY EXPOSURE FOR DERIVATIVE INSTRUMENTS OPEN AS OF CURRENT STATEMENT DATE


Column 4 – Fair Value of Acceptable Collateral

Leave blank for the aggregate reporting of Exchange-Traded Derivatives (Line 0199999999).

For OTC counterparties, show the Fair Value of acceptable collateral pledged by the counterparty.

For central clearinghouses, this amount would be the net positive variation margin received by the company.

“Acceptable collateral” means cash, cash equivalents, securities issued or guaranteed by the United States or Canadian governments or their government-sponsored enterprises, letters of credit, publicly traded obligations designated 1 by the SVO, government money market mutual funds, and such other items as may be defined as acceptable collateral in the Purposes and Procedures Manual of the NAIC Investment Analysis Office. For purposes of this definition, the term “letter of credit” means a clean, irrevocable and unconditional letter of credit issued or confirmed by, and payable and presentable at, a financial institution on the list of financial institutions meeting the standards for issuing such letter of credit published pursuant to the Purposes and Procedures Manual of the NAIC Investment Analysis Office. The letter of credit must have an expiration date beyond the term of the subject transaction.

For Columns 6 and 7, Book/Adjusted Carrying Values that are debit balances on the balance sheet are positive numbers; those that are credit balances are negative numbers. Column 5 – Contracts with Book/Adjusted Carrying Value > 0 (i.e., debit balance on balance sheet)



On subsequent lines, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty or central clearinghouse that have a positive statement value.

Column 7 – Contracts with Book/Adjusted Carrying Value < 0 (i.e., credit balance on balance sheet)

On the first line, show the sum of the statement values in parentheses ( ) of all exchange traded derivatives that have a negative Book/Adjusted Carrying Value.

For Futures, this equals the sum of the negative cumulative variation margin for highly effective futures (Part B, Section 1, Column 15).


Attachment EE


Column 8 – Exposure Net of Collateral (Book/Adjusted Carrying Value)


For OTC counterparties, if no master agreement is in place, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty that have a positive Book/Adjusted Carrying Value, less any Acceptable Collateral and Present Value of Financing Premiums (Column 6 – Column 4 – Column 5).

For OTC counterparties with a master agreement in place and central clearinghouses, show the net sum of the Book/Adjusted Carrying Values of all derivative instruments, less any acceptable collateral and present value of financing premiums (Column 6 + Column 7 – Column 4 – Column 5).


For Columns 9 and 10, market values that would be debit balances on the balance sheet are positive numbers; those that would be credit balances are negative numbers. Column 9 – Contracts with Fair Value > 0 (i.e., debit balance on the balance sheet)

Show the sum of the market values of all derivative instruments that have a positive market value. Column 10 – Contracts with Fair Value < 0 (i.e., credit balance on the balance sheet)

Show the sum of the market values in parentheses ( ) of all derivative instruments that have a negative market value.

Column 11 – Exposure Net of Collateral (Fair Value)


For OTC counterparties, if no master agreement is in place, show the sum of the market values of all derivative instruments with the counterparty that has a positive market value, less any acceptable collateral (Column 9 – Column 4).

For OTC counterparties with a master agreement in place, exchange-traded derivatives and central clearinghouses show the net sum of the market values of all derivative instruments, less any acceptable collateral (Column 9 + Column 10 – Column 4).


Column 12 – Potential Exposure

Show the potential exposure for Parts A and B for Exchange-Traded Derivatives in aggregate (Line 0199999999) and for each OTC counterparty and central clearinghouse.

Attachment EE


Column 13 – Off-Balance Sheet Exposure

For Exchange-Traded Derivatives (Line 0199999999), show the amount in Column 12.

For central clearinghouses:

Show [Column 6 + Column 7 – Column 4 + Column 12] – Column 8 but not less than zero.

For OTC counterparties:

If Column 2 = yes; show [Column 6 + Column 7 – Column 4 + Column 12] – Column 8 but not less than zero.

If Column 2 = no; show the amount in Column 12.

Optional: If there is no master netting agreement, companies may still encounter double-counting in

cases where a premium is received for an off-balance sheet derivative transaction, such as an interest rate swap. In such cases, report “no” in Column 2 and calculate off-balance sheet exposure on a contract-by-contract basis using the first formula.

** Column 14 will be electronic only. ** Column 14 – Legal Entity Identifier (LEI)

Provide the 20-character Legal Entity Identifier (LEI) for counterparty as assigned by a designated Local Operating Unit. If no LEI number has been assigned, leave blank.

Attachment EE


SCHEDULE DB – VERIFICATION

BOOK /ADJUSTED CARRYING VALUE, FAIR VALUE AND POTENTIAL EXPOSURE OF DERIVATIVES The purpose of this schedule is to verify the amounts reported in each individual derivative schedule (Schedule DB, Part A, Section 1 and Schedule DB, Part B, Section 1) against those reported in the Counterparty Exposure schedule (Schedule DB, Part D).

BOOK/ADJUSTED CARRYING VALUE CHECK Line 1 – Total Book/Adjusted Carrying Value of all derivatives found on Schedule DB, Part A, Section 1, Column 14. Line 2 – Cumulative Variation Margin of highly effective derivatives found on Schedule DB, Part B, Section 1,

Column 15 plus Total Ending Cash Balance found on Schedule DB, Part B, Section 1, Broker Name/Net Cash Deposits Footnote.

Line 3 – Grand Total of Book/Adjusted Carrying Value from individual schedules (Lines 1 + 2). Line 4 – Total of all positive Book/Adjusted Carrying Value found on Schedule DB, Part D, Section 1, Column 6. Line 5 – Total of all negative Book/Adjusted Carrying Value found on Schedule DB, Part D, Section 1, Column 7. Line 6 – Grand Total Check for Book/Adjusted Carrying Value (Lines 3 – 4 – 5).

FAIR VALUE CHECK Line 7 – Total Fair Value of all derivatives found on Schedule DB, Part A, Section 1, Column 16. Line 8 – Total Fair Value of futures contracts found on Schedule DB, Part B, Section 1 Column 13. Line 9 – Grand Total of Fair Value from individual schedules (Lines 7 + 8). Line 10 – Total of all positive Fair Value found on Schedule DB, Part D, Section 1, Column 9. Line 11 – Total of all negative Fair Value found on Schedule DB, Part D, Section 1, Column 10. Line 12 – Grand Total Check for Fair Value (Lines 9 – 10 – 11).

POTENTIAL EXPOSURE CHECK Line 13 – Total Potential Exposure of all derivatives found on Schedule DB, Part A, Section 1, Column 21. Line 14 – Total Potential Exposure of all futures found on Schedule DB, Part B, Section 1, Column 20. Line 15 – Total Potential Exposure of all derivatives found on Schedule DB, Part D, Section 1, Column 12. Line 16 – Grand Total Check for Potential Exposure (Lines 13 + 14 – 15).

Attachment EE




8. Derivative Instruments

Instruction:

A. Derivatives under SSAP No. 86—Derivatives

(8) Disclose the aggregate, non-discounted total premium cost for these contracts and the premium cost due in each of the following four years, and thereafter. Also disclose the aggregate fair value of derivative instruments with financing premiums excluding the impact of the deferred or financing premiums.



ASSETS


Line 7 – Derivatives

Derivative asset amounts shown as debit balances. Should equal Schedule DB, Part D, Section 1, Column 6, Footnote Question 2. The gross amounts from Schedule DB shall be adjusted to reflect netting from the valid right to offset in accordance with SSAP No. 64—Offsetting and Netting of Assets and Liabilities.


Attachment EE


ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS – LIFE/FRATERNAL

LIABILITIES, SURPLUS AND OTHER FUNDS


Line 24.08 – Derivatives

Derivative liability amounts shown as credit balances. Should equal Schedule DB, Part D, Section 1, Column 7, Footnote Question 2 times -1. The gross amounts from Schedule DB shall be adjusted to reflect netting from the valid right to offset in accordance with SSAP No. 64—Offsetting and Netting of Assets and Liabilities.


ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS –HEALTH

LIABILITIES, CAPITAL AND SURPLUS





Attachment EE


ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS –PROPERTY






ANNUAL & QUARTERLY STATEMENT INSTRUCTIONS –TITLE






Attachment EE


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY, TITLE, SEPARATE ACCOUNTS AND PROTECTED CELL

SCHEDULE DB – VERIFICATION Verification of Book/Adjusted Carrying Value, Fair Value and Potential Exposure of all Open Derivative Contracts

Book/Adjusted Carrying Value Check

1. Part A, Section 1, Column 14 ........................................................................................................................ ___________________

2. Part B, Section 1, Column 15 plus Part B, Section 1 Footnote – Total Ending Cash Balance .................... ____________________

3. Total (Line 1 plus Line 2) ............................................................................................................................................................................. ___________________

4. Part D, Section 1, Column 6 ........................................................................................................................... ___________________


6. Total (Line 3 minus Line 4 minus Line 5) .................................................................................................................................................... ___________________

Fair Value Check


8. Part B, Section 1, Column 13 .......................................................................................................................... ___________________

9. Total (Line 7 plus Line 8) ............................................................................................................................................................................. ___________________


11. Part D, Section 1, Column 10 ......................................................................................................................... ___________________

12. Total (Line 9 minus Line 10 minus Line 11) ................................................................................................................................................ ___________________

Potential Exposure Check


14. Part B, Section 1, Column 20 .......................................................................................................................... ___________________

15. Part D, Section 1, Column 12 ......................................................................................................................... ___________________

16. Total (Lines 13 plus Line 14 minus Line 15) ................................................................................................................................................ ___________________

Attachment EE


QUARTERLY STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

SCHEDULE DB – VERIFICATION Verification of Book/Adjusted Carrying Value, Fair Value and Potential Exposure of all Open Derivative Contracts

Book/Adjusted Carrying Value Check

1. Part A, Section 1, Column 14 ............................................................................................................................................... _______________________

2. Part B, Section 1, Column 15 plus Part B, Section 1 Footnote – Total Ending Cash Balance ............................................ _______________________

3. Total (Line 1 plus Line 2) ..................................................................................................................................................................................................................... _______________________

4. Part D, Section 1, Column 6 ................................................................................................................................................. _______________________

5. Part D, Section 1, Column 7 .................................................................................................................................................. _______________________

6. Total (Line 3 minus Line 4 minus Line 5) ........................................................................................................................................................................................... _______________________

Fair Value Check


8. Part B, Section 1, Column 13 ................................................................................................................................................ _______________________

9. Total (Line 7 plus Line 8)...................................................................................................................................................................................................................... _______________________

10. Part D, Section 1, Column 9 ................................................................................................................................................. _______________________

11. Part D, Section 1, Column 10 ............................................................................................................................................... _______________________

12. Total (Line 9 minus Line 10 minus Line 11) ....................................................................................................................................................................................... _______________________

Potential Exposure Check


14. Part B, Section 1, Column 20 ............................................................................................................................................... _______________________

15. Part D, Section 1, Column 12 ............................................................................................................................................... _______________________

16. Total (Line 13 plus Line 14 minus Line 15) ........................................................................................................................................................................................ _______________________

Attachment EE


ANNUAL STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY, TITLE, SEPARATE ACCOUNTS AND PROTECTED CELL

SCHEDULE DB – PART D – SECTION 1 Counterparty Exposure for Derivative Instruments Open December 31 of Current Year

1 2 3 Counterparty Offset Book/Adjusted Carrying Value Fair Value 12 13

Description of Exchange, Counterparty or Central

Clearinghouse

Master Agreement (Y or N)

Credit Support

Annex (Y or N)

4

Fair Value of Acceptable Collateral

5

Present Value of Financing

Premium

6 Contracts With Book/Adjusted Carrying Value

>0


<0

8

Exposure Net of Collateral

9

Contracts With Fair Value >0

10

Contracts With Fair Value <0

11 Exposure Net of

Collateral Potential Exposure

Off-Balance Sheet Exposure

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

0999999999 Gross Totals

1. Offset per SSAP No. 64

2. Net after right of offset per SSAP No. 64

QUARTERLY STATEMENT BLANK – LIFE/FRATERNAL, HEALTH, PROPERTY AND TITLE

SCHEDULE DB – PART D – SECTION 1 Counterparty Exposure for Derivative Instruments Open as of Current Statement Date

1 2 3 Counterparty Offset Book/Adjusted Carrying Value Fair Value 12 13

Description of Exchange, Counterparty or Central

Clearinghouse

Master Agreement (Y or N)

Credit Support

Annex (Y or N)

4

Fair Value of Acceptable Collateral

5

Present Value of Financing

Premium


>0


<0

8

Exposure Net of Collateral

9

Contracts With Fair Value >0

10

Contracts With Fair Value <0

11 Exposure Net of

Collateral Potential Exposure

Off-Balance Sheet Exposure

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

........................................................... ...................... ...................... ........................... ............................ ........................... ........................... ............................ ........................... ........................... ........................... ........................... ............................

0999999999 Gross Totals

1. Offset per SSAP No. 64

2. Net after right of offset per SSAP No. 64


Attachment FF


Blanks (E) Working Group Editorial Revisions to the Blanks and Instructions (presented at the May 28, 2020, Meeting) Statement Type: H = Health; L/F = Life/Fraternal Combined; P/C = Property/Casualty; SA = Separate Accounts; T = Title

Effective Table Name Description Statement Type

Filing Type

2020 Investment Schedules General Instructions

CHANGE TO INSTRUCTION Remove reference to Web address as it is no longer valid and new location can’t be found. No alternate is being provided.

STOCK EXCHANGE LIST This is not a comprehensive list of stock exchanges. If a stock exchange is not listed, refer to www.fixprotocol.org/specifications/exchanges.shtml. If a stock exchange is not found in the list below one of the sources above, use a description or abbreviation that accurately identifies the exchange.

H, L/F, P/C, T

Annual

2020 Schedule D, Part 1 CHANGE TO INSTRUCTION Modify the instruction for Column 1 – CUSIP Identification as shown below to better clarify zero filling CUSIP. If no valid CUSIP, CINS or PPN number exists, then report the CUSIP field should be zero-filled and a valid ISIN security number should be reported in (Column 33) security number. The CUSIP field should be zero-filled.

H, L/F, P/C, T

Annual

2020 Schedule D, Part 2, Section 1

CHANGE TO INSTRUCTION Modify the instruction for Column 1 – CUSIP Identification as shown below to better clarify zero filling CUSIP. If no valid CUSIP, CINS or PPN number exists, then report the CUSIP field should be zero-filled and a valid ISIN security number should be reported in (Column 27) security number. The CUSIP field should be zero-filled.

H, L/F, P/C, T

Annual

Attachment FF



Filing Type



H, L/F, P/C, T

Annual


H, L/F, P/C, T

Annual


H, L/F, P/C, T

Annual


H, L/F, P/C, T

Annual

Attachment FF



Filing Type



H, L/F, P/C, T

Annual

2020 Schedule DL, Part 1 CHANGE TO INSTRUCTION Modify the instruction for Column 1 – CUSIP Identification as shown below to better clarify zero filling CUSIP. If no valid CUSIP, CINS or PPN number exists, then report the CUSIP field should be zero-filled and a valid ISIN security number should be reported in (Column 11) security number. The CUSIP field should be zero-filled.

H, L/F, P/C, T

Annual


H, L/F, P/C, T

Annual


H, L/F, P/C, T

Quarterly

Attachment FF



Filing Type


H, L/F, P/C, T

Quarterly


H, L/F, P/C, T

Quarterly


H, L/F, P/C, T

Quarterly

Attachment FF



Filing Type

2020 Schedule S, Part 1, Section 1

CHANGE TO INSTRUCTION Make the edit below for Column 7. All types of business shown above are as reported in the Analysis of Operations by Lines of Business and the Analysis of Annuity Operations by Lines of Business except as noted below:

L/F Annual


CHANGE TO INSTRUCTION Make the edit below for Column 7. All types of business shown above are as reported in the Analysis of Operations by Lines of Business and the Analysis of Annuity Operations by Lines of Business except as noted below:

L/F Annual


CHANGE TO INSTRUCTION Make the edit below for Column 7 to remove “Supplementary Contracts” from the table below because it is no longer reported separately on the Analysis of Operations by Lines of Business. Abbreviations:

IL Industrial Life FA Fixed Annuities XXXL XXX Life IA Indexed Annuities XXXLO XXX Life Other VA Variable Annuities AXXX AXXX Life OA Other Annuities CL Credit Life ADB Accidental Death Benefits SC Supplementary Contracts DIS Disability Benefits OL Other Life NOTE: The Type of Business Assumed code should be entered in all capital

letters.

L/F Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION Make the edit below for Column 7 to remove “Supplementary Contracts” from the table below because it is no longer reported separately on the Analysis of Operations by Lines of Business. Abbreviations:


letters.

L/F Annual

2020 Schedule S, Part 1, Section 1 (Life Supplement)

CHANGE TO INSTRUCTION Make the edit below for Column 7. All types of business shown above are as reported in the Life State Page – Life Insurance Section of the Life Supplement) Analysis of Operations by Lines of Business and the Analysis of Annuity Operations by Lines of Business except as noted below:

H Annual


CHANGE TO INSTRUCTION Make the edit below for Column 7. All types of business shown above are as reported in the Life State Page – Life Insurance Section of the Life Supplement) Analysis of Operations by Lines of Business and the Analysis of Annuity Operations by Lines of Business except as noted below:

H Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION Make the edit below for Column 7 to remove “Supplementary Contracts” from the table below for consistency with the table in the Life/Fraternal instructions because it is no longer reported separately on the Life/Fraternal Analysis of Operations by Lines of Business. Abbreviations:


letters.

H Annual


CHANGE TO INSTRUCTION Make the edit below for Column 7 to remove “Supplementary Contracts” from the table below for consistency with the table in the Life/Fraternal instructions because it is no longer reported separately on the Life/Fraternal Analysis of Operations by Lines of Business. Abbreviations:


letters.

H Annual

Attachment FF



Filing Type

2020 Schedule DB, Part D, Section 1

CHANGE TO INSTRUCTION Replace “statement value” reference with “Book/Adjusted Carrying Value” reference. Column 5 – Contracts with Book/Adjusted Carrying Value > 0 (i.e., debit balance on balance

sheet)



On subsequent lines, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty or central clearinghouse that have a positive Book/Adjusted Carrying Value statement value.

Column 6 – Contracts with Book/Adjusted Carrying Value < 0 (i.e., credit balance on balance

sheet)

On the first line, show the sum of the Book/Adjusted Carrying Value statement values in parentheses ( ) of all exchange traded derivatives that have a negative Book/Adjusted Carrying Value.



H, L/F, P/C, T

Annual

Attachment FF



Filing Type

2021 Schedule DB, Part D Section 1

CHANGE TO INSTRUCTION Replace “statement value” reference with “Book/Adjusted Carrying Value” reference. Column 5 – Contracts with Book/Adjusted Carrying Value > 0 (i.e., debit balance on balance

sheet)



On subsequent lines, show the sum of the Book/Adjusted Carrying Values of all derivative instruments with the counterparty or central clearinghouse that have a positive Book/Adjusted Carrying Value statement value.

Column 6 – Contracts with Book/Adjusted Carrying Value < 0 (i.e., credit balance on balance

sheet)

On the first line, show the sum of the Book/Adjusted Carrying Value statement values in parentheses ( ) of all exchange traded derivatives that have a negative Book/Adjusted Carrying Value.



H, L/F, P/C, T

Quarterly

Attachment FF



Filing Type

2020 Equity and Other Invested Asset Component – Basic Contribution, Reserve Objective and Maximum Reserve Calculations

CHANGE TO INSTRUCTION Update reserve factors as shown below. Line 1 – Unaffiliated Common Stocks – Public

Report the book/adjusted carrying value of all publicly issued common stock, including mutual funds (except money market mutual funds appropriately reported on Schedule E, Part 2) in unaffiliated companies in Columns 1 and 4. Multiply Column 4 by the reserve factor calculated for Columns 5, 7 and 9, and report the products in Columns 6, 8 and 10, respectively.

The Line 1, Column 7 and 9 reserve factors must be at least 1012.15% but not more than 2024.31%.

The reserve factor is equal to 1315.80% times the company’s weighted average portfolio beta. The weighted average portfolio beta is the market value weighted average of four (4) portfolio betas, one from the end of the prior year and the remaining from the first three (3) quarters of the current year. Calculation of this weighted average portfolio beta is illustrated in the following worksheet:

L/F Annual

Attachment FF



Filing Type

2020 Equity and Other Invested Asset Component – Basic Contribution, Reserve Objective and Maximum Reserve Calculations

CHANGE TO INSTRUCTION Update reserve factors as shown below. Lines 65 through 69 – Other Invested Assets with Underlying Characteristics of Common Stocks

Report the book/adjusted carrying value of all Schedule BA assets owned where the characteristics of the underlying investments are similar to common stock (Lines 1999999 and 2099999) in Columns 1 and 4. Line 68 should show all Schedule BA assets owned where the characteristics of the underlying investments are similar to subsidiary, controlled or affiliated company common stocks owned and these assets should be valued according to the Purposes and Procedures Manual of the NAIC Investment Analysis Office. Categorize these assets consistent with the directions for Pages 32 and 33, Lines 1 through 4, 15 and 16. For Line 65, the reserve factor must be calculated on an individual company basis. It is equal to 1315.80% times the beta factor as discussed in the Pages 32 and 33, Line 1 instructions, and must be at least 1012.15% but not more than 2024.31%. Multiply the amount in Column 4 by the calculated reserve factors in Columns 5, 7 and 9 and report the products in Columns 6, 8 and 10, respectively. For Lines 66 through 69, multiply the amounts in Column 4 by the reserve factors provided in Columns 5, 7 and 9 and report the products in Columns 6, 8 and 10, respectively.

L/F Annual

Attachment FF



Filing Type

2020 Notes to Financial Statements

CHANGE TO INSTRUCTION The change below was not reflected in proposal 2019-07BWG but was part of the changes adopted by the SAPWG for SSAP No. 100R—Fair Value. 20. Fair Value Measurements

Instruction:

A. The objective of the disclosure requirements is to provide information about assets and liabilities measured at fair value in the financial statements as well as fair value amounts disclosed in the Notes to Financial Statements or reporting schedules. A reporting entity shall disclose information that helps users of the financial statements to assess both of the following:

For assets and liabilities that are measured and reported at fair value or net asset value (NAV) in the statement of financial position after initial recognition, the valuation techniques and the inputs used to develop those measurements.

For fair value measurements in the statement of financial position determined using significant unobservable inputs (Level 3), the effect of the measurements on earnings (or changes in net assets) for the period.

H, L/F, P/C, T

Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION The change below was not reflected in proposal 2019-07BWG but was part of the changes adopted by the SAPWG for SSAP No. 100R—Fair Value. 20. Fair Value Measurements

Instruction:

A. The objective of the disclosure requirements is to provide information about assets and liabilities measured at fair value in the financial statements as well as fair value amounts disclosed in the Notes to Financial Statements or reporting schedules. A reporting entity shall disclose information that helps users of the financial statements to assess both of the following:

For assets and liabilities that are measured and reported at fair value or net asset value (NAV) in the statement of financial position after initial recognition, the valuation techniques and the inputs used to develop those measurements.

For fair value measurements in the statement of financial position determined using significant unobservable inputs (Level 3), the effect of the measurements on earnings (or changes in net assets) for the period.

H, L/F, P/C, T

Quarterly

2020 Schedule BA, Part 1 Schedule D, Part 1 Schedule D, Part 2 Sections 1 & 2

CHANGE TO INSTRUCTION Add the following to the Administrative Symbol List. Z* Regulatory review initiated by either the SVO Director, Financial Condition (E) Committee,

Executive (EX) Committee or VOSTF.

H, L/F, P/C, T

Annual

2021 Schedule BA, Part 2 Schedule D, Parts 2 & 3

CHANGE TO INSTRUCTION Add the following to the Administrative Symbol List. Z* Regulatory review initiated by either the SVO Director, Financial Condition (E) Committee,

Executive (EX) Committee or VOSTF.

H, L/F, P/C, T

Quarterly

Attachment FF



Filing Type

2020 Schedule DB, Part A, Section 1

CHANGE TO INSTRUCTION Modify the instruction for Column 32 as shown below to match the annual instructions. Column 32 – CDHS Identifier

Provide a unique identifier for each Clearly Defined Hedging Strategy (CDHS) reported on this schedule (e.g., 001, 002, etc.). This identifier will also be used for reporting of the CDHS in Column 1 of Schedule DB, Part E.

This column should only be used for the following line numbers:

Purchased Options Lines 0089999999 through 0139999999

Written Options Lines 0579999999 through 0629999999

Swaps Lines 1059999999 through 1099999999

Forwards Lines 14219999999 through 1469999999

H, L/F, P/C, T

Quarterly

2020 Supplemental Exhibits and Schedules Interrogatories

CHANGE TO BLANK Add the word “confidential” to Line 50, new lines 51 and 52 and renumbering subsequent lines. Also assign document identifiers for the documents in Lines 51 and 52. 50. Will the confidential Executive Summary of the PBR Actuarial Report be filed with the state

of domicile by April 1? 51. Will the confidential Life Summary of the PBR Actuarial Report be filed with the state of

domicile by April 1? 52. Will the confidential Variable Annuities Summary of the PBR Actuarial Report be filed with

the state of domicile by April 1?

L/F Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION Make the following changes to the instructions for Column 18. Column 18 – NAIC Designation, NAIC Designation Modifier and SVO Administrative

Symbol

For securities reported on Line 9499999 (Mutual Funds), provide the appropriate NAIC Designation (1 through 6), NAIC Designation Modifier (A through G) and SVO Administrative Symbol combination as assigned by the Securities Valuation Office. For all other common stock, the NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol NAIC Designation Modifier field should be left blank.

H, L/F, P/C, T

Annual


CHANGE TO INSTRUCTION Make the following changes to the instructions for Column 18. Column 18 – NAIC Designation, NAIC Designation Modifier and SVO Administrative

Symbol

The NAIC Designation, Designation Modifier and SVO Administrative Symbol Designation Modifier will be shown as one column on the printed schedule but will be twothree sub-columns in the data table.

• NAIC Designation Column 18A

• NAIC Designation Modifier Column 18B

• SVO Administrative Symbol Column 18C

H, L/F, P/C, T

Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION Make the changes below to remove the crosscheck. NAIC Designation Category Footnote:

Provide the total book/adjusted carrying value amount by NAIC Designation Category that represents the amount reported in Column 6.

The sum of the amounts reported for each NAIC Designation Category in the footnote should equal Line 9499999.

H, L/F, P/C, T

Annual

2020 Schedule DA, Part 1 CHANGE TO INSTRUCTION Modify the instruction for Column 22 as shown below and move to new location within the column instructions to reflect it doesn’t pertain just to the modifier. Column 22 – NAIC Designation Category

The NAIC Designation and NAIC Designation Modifier Equivalent should be left blank for the following lines:

• Parent, Subsidiaries and Affiliates –

Mortgage Loans Line 8499999

• Parent, Subsidiaries and Affiliates – Other Short-Term Invested Assets Line 8599999

• Mortgage Loans Line 8799999

• Other Short-Term Invested Assets Line 9099999

H, L/F, P/C, T

Annual

Attachment FF



Filing Type

2020 Schedule E, Part 2 CHANGE TO INSTRUCTION Modify the instruction for Column 11 as shown below and move to new location within the column instructions to reflect it doesn’t pertain just to the modifier. Column 11 – NAIC Designation Category

The NAIC Designation and NAIC Designation Modifier Equivalent should be left blank for the following lines:

• Sweep Accounts Line 8499999

• Exempt Money Market

Mutual Funds – as Identified by the SVO Line 8599999

• All Other Money Market Mutual Funds Line 8699999

• Other Cash Equivalents Line 8799999

H, L/F, P/C, T

Annual

2020 Exhibit of Premium and Losses

CHANGE TO BLANK Change the description for Column 7 from “Direct Premiums Earned” to “Net Premiums Earned”. The change will make the column consistent with the column on Schedule T and the crosscheck between the schedules.

Title Annual

2020 Exhibit of Premium and Losses

CHANGE TO INSTRUCTION Change the description for Column 7 from “Direct Premiums Earned” to “Net Premiums Earned”. The change will make the column consistent with the column on Schedule T and the crosscheck between the schedules. Column 7 – Net Direct Premiums Earned

Total to agree with Schedule T, Column 7, for the appropriate state.

Title Annual

Attachment FF



Filing Type

2020 Combined Statement CHANGE TO INSTRUCTION Modify instructions to indicate the footnote for Schedule D, Parts 1 and 2 should not be completed. 6. With the exception of Schedule Z, the format to be used is that of the NAIC Annual

Statement blank for property/casualty insurers. The specific pages, exhibits, and schedules to be included are as follows:

Title Page (in part) Assets Liabilities, Surplus and Other Funds Statement of Income Cash Flow Underwriting and Investment Exhibit, Parts 1 through 3 Exhibit of Net Investment Income Exhibit of Capital Gains (Losses) Schedule D, Summary by Country Schedule D, Part 1A, Sections 1 and 2 Schedule D, Parts 1 and 2, Totals (Line 8399999, 8999999 or 9899999) only

Note: Do not complete the footnote for Schedule D, Parts 1 and 2 Schedule F, Parts 1, 2 and 3, Subtotals and Totals only Schedule H, Parts 1 through 4 only Schedule P except interrogatories Schedule T Schedule Z Insurance Expense Exhibit (Supplemental Filing)

P/C Annual

Attachment FF



Filing Type

2020 Schedule BA, Part 1 CHANGE TO INSTRUCTION Make the changes below to correct line references for Column 7. Column 7 – NAIC Designation, NAIC Designation Modifier and SVO Administrative

Symbol

This column must be completed for those investments included on Lines 0799999, 0899999, 1599999 and 151699999.

For Schedule BA investments with the underlying characteristics of a bond or a preferred stock instrument, insert the appropriate combination of the NAIC Designation (1 through 6), NAIC Designation Modifier (A through G) and SVO Administrative Symbol. The list of valid SVO Administrative Symbols is shown below.

*** Detail Eliminated to Conserve Space ***


The NAIC Designation Modifier should only be used for securities reported on the lines below if eligible to receive one, as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual), otherwise, the field should be left blank.

• Underlying Characteristics of


• Underlying Characteristics of Preferred Stocks Line 131599999 through 141699999

As defined in the P&P Manual, there is not an NAIC Designation Modifier for investments reporting an NAIC Designation 6, therefore, the NAIC Designation Modifier field should be left blank.

H, L/F, P/C, T

Annual

Attachment FF



Filing Type

2021 Schedule BA, Part 1 CHANGE TO INSTRUCTION Make the changes below to correct line references for Column 6. Column 6 – NAIC Designation, NAIC Designation Modifier and SVO Administrative

Symbol


The NAIC Designation Modifier should only be used for securities reported on the lines below if eligible to receive one, as defined in the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual), otherwise, the field should be left blank.

• Underlying Characteristics of


• Underlying Characteristics of Preferred Stocks Line 131599999 through 141699999

As defined in the P&P Manual, there is not an NAIC Designation Modifier for investments reporting an NAIC Designation 6, therefore, the NAIC Designation Modifier field should be left blank.

H, L/F, P/C, T

Quarterly

2020 Supplemental Exhibits and Schedules Interrogatories

CHANGE TO BLANK For 2020 show Lines 29, 30, 31 and 32 as struck through and remove from specs data table. Proposal to formally remove the lines will be made for 2021. 29. 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 1? ................................................ 30. 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 1? ................................................ 31. 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 1? ................................................ 32. 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 1? ................................................

L/F Annual

Attachment FF



Filing Type


CHANGE TO INSTRUCTION Make the following changes to Note 32. Instructions: • Amount with current surrender charge of 5% or more included in A(1)b, B(1)b and C(1)b (from the tables illustrated

below) in the current year that will have less than a 5% surrender charge (and thus be reported in A(1)e, B(1)e and C(1)e (from the tables illustrated below) for the first time within the year subsequent to the balance sheet year (% column is not required).

Illustration: A. INDIVIDUAL ANNUITIES:

(1). Subject to discretionary withdrawal: a. With market value adjustment b. At book value less current surrender charge of 5% or more c. At fair value d. Total with market value adjustment or at fair value (total of a through c) e. At book value without adjustment (minimal or no charge or adjustment)

(2) Not subject to discretionary withdrawal (3) Total (gross: direct + assumed) (4) Reinsurance ceded (5) Total (net) (3) – (4) (6) Amount included in A(1)b above that will move to A(1)e for the first time within the year after the statement

date: B. GROUP ANNUITIES:

(1) Subject to discretionary withdrawal: a. With market value adjustment b. At book value less current surrender charge of 5% or more c. At fair value d. Total with market value adjustment or at fair value (total of a through c) e. At book value without adjustment (minimal or no charge or adjustment)

(2) Not subject to discretionary withdrawal (3) Total (gross: direct + assumed) (4) Reinsurance ceded (5) Total (net) (3) – (4) (6) Amount included in B(1)b above that will move to B(1)e for the first time within the year after the statement

date:

L/F Annual

Attachment FF



Filing Type

C. DEPOSIT-TYPE CONTRACTS (no life contingencies):

(1) Subject to discretionary withdrawal:

a. With market value adjustment b. At book value less current surrender charge of 5% or more c. At fair value d. Total with market value adjustment or at fair value (total of a through c) e. At book value without adjustment (minimal or no charge or adjustment)

(2) Not subject to discretionary withdrawal (3) Total (gross: direct + assumed) (4) Reinsurance ceded (5) Total (net) (3) – (4) (6) Amount included in C(1)b above that will move to C(1)e for the first time within the year after the statement

date:


Blanks (E) Working Group Summary of Comments for Mary 28, 2020

Conference Call

ITEMS RECEIVED FOR COMMENT

Reference Number Description

2019-25BWG Modified

Modify the instructions for Column 10, Schedule F, Part 3 – Property and Schedule F, Part 2 – Life/Fraternal Workers’ Compensation Carve-out supplement, removing instruction to exclude adjusting and other reserves from the column. Add instructions to include those with the defense and cost containment reserves. Add a new instruction for Column 12 for the same schedules. Add crosschecks to Schedule P, Part 1.

Comment #1 – Industry Interested Parties 02/21/2020 Letter Attachment HH Page 1 of 42

IPs have no comments.

2019-28BWG Modify the instruction for Supplemental Investment Risk Interrogatories Lines 13.02 through 13.11 clarifying when to identify the actual equity interests within a fund and aggregate those equity interests for determination of the ten largest equity interests.



2019-29BWG Modify the instruction and blank for Supplemental Investment Risk Interrogatories Question 14.01.



2019-30BWG Modified

Add a category and instructions for Reciprocal Jurisdiction Companies in Schedule S for the life/fraternal and health blanks and to Schedule F for the property and title blanks. Add a list of identification numbers is instruction to Schedule Y, Part 1A, Schedule Y, Part 2 and Schedule D, Part 6, Section 1 for Reciprocal Jurisdiction Companies. Add a reference to Reciprocal Jurisdiction Companies in the Trusteed Surplus Statement instructions for life/fraternal, health and property statements.

Comment #1 – Industry Interested Parties 02/21/2020 Letter Attachment EE Pages 1 & 2 of 42

At a high level, we have identified significant issues associated with implementing these new categories in both Schedules F and S. We expect that additional implementation issues and questions will arise as states and insurers work to operationalize the new reciprocal jurisdiction requirements. In addition, the proposed changes will require considerable effort by insurers to write new system specifications, develop coding and test the new reporting. Therefore, we do not believe the proposed 2020 year end effective date is reasonable and request that these changes be effective for year end 2021 reporting.

We do have some detailed comments as stated below:

****See full comment letter for details of specific edits to the proposal.****

Attachment GG



Comment # 2– Industry Interested Parties 05/11/2020 Letter Attachment HH Page 15 of 42

IPs recommend the following changes to the instructions: On page 19 of the PDF, ‘Certified Reinsurer Identification Number (CRIN)’ should not be struck out in the Schedule S – Part 5 (Reinsurance Ceded to Certified Reinsurers) instructions for Column 2. On page 40 of the PDF, ‘Certified Reinsurer Identification Number (CRIN)’ should not be struck out in the Schedule F – Part 4 (Provision For Reinsurance Ceded to Certified Reinsurers) instructions for Column 1.

2020-01BWG Add crosschecks to Lines 13 and 14 of the State Page to Lines 10 and 11 of the Underwriting and Investment Exhibit, Part 1. Also add crosschecks to Lines 9, 10 and 11 of the Underwriting and Investment Exhibit, Part 1 and Schedule T, Line 61.



2020-02BWG Modify the instruction and illustration for Note 10L. The illustration will not be data captured.


The information on disclosure of entities held by the noninsurance holding company regarding the assignment of goodwill (and how the assignment was determined), whether audited financial statements were obtained, and the ultimate admitted value needs to be added to the proposed annual statement instructions.


This re-exposure is a concurrent exposure with SAPWG 2019-14 (2019-14). 2019-14 states that if a reporting entity acquires a downstream holding company that qualifies for the “look through” approach, and the acquired holding company owns underlying SCAs any goodwill from the acquisition of the holding company must be attributed to underlying SCAs. In the original IP response to the SAPWG exposure, IPs stated that any attribution would be onerous and misleading to users of financial statements. To layer in a statutory attribution of goodwill is overly complex and not useful. Since comments on the SAPWG re-exposure are not due until May 29, 2020, we recommend that any action on this item be deferred until resolved/adopted at SAPWG.

Attachment GG



2020-03BWG Modified

Modify the instruction and illustration for 13(11) to the Notes to Financial Statement. Change the numbering from 1 through 11 to A through M.

Comment #1 – Industry Interested Parties 02/21/2020 Letter Attachment HH Pages 3, 6, 7 &8 of 42

IPs recommend revisions to the proposed disclosures which would provide regulators who are not involved in the approval and ongoing review of a surplus note transaction with information to assess the nature of the transaction and to determine whether more detailed review is needed. Specifically, our revisions would require disclosure of whether cash flows are offset but would differentiate between administrative offsetting and the contractual “linkage” that is of concern to regulators. These revisions would also remove information that we believe is confidential in nature and would not be appropriate for public disclosure. Finally, we have proposed several additions to the required disclosures, which we believe would provide useful information about transactions involving surplus notes. Our suggested revisions to the disclosures are included in Exhibit A and summarized below. For ease of review, revisions proposed by NAIC staff have been accepted, and interested parties’ comments are presented as tracked changes. ****See full comment letter for “Summary of Proposed Revisions” and details provided in their “Exhibit A”.****


IPs suggest changing the description of the exposure to “Change the numbering from 1 through 11 13 to A through M” to reflect the correct changes to the renumbering. The exposed changes to the instructions and illustration are correct. IPs recommend the following to ensure that the disclosures are identical to the SAPWG exposure:

Add “Information about any guarantees, support agreements or related party transactions associated with the surplus note issuance and whether payments have been made under such agreements” to the disclosures, which corresponds to #18.o of the SAPWG exposure.

Align the order of the disclosures between the SAPWG and Blanks exposures. Make the following change to the 10th bullet point: Percentage of offset interest payments offset through administrative offsetting (not inclusive of

amounts paid to a 3rd party liquidity provider).

2020-04BWG Modify the instruction and illustration for Note 23A – Unsecured Reinsurance Recoverables.


IPs have no comment.

2020-05BWG Modified

Modify the instruction and illustration for Note 2 – Accounting Changes and Correction of Errors.

Comment #1 – Industry Interested Parties 02/21/2020 Letter Attachment HH Pages 4, 9, 10 & 11 of 42

IPs propose the attached language in Exhibit B as being clearer in defining the amounts to be disclosed, to use language consistent with VM-21, and to recognize the role of VM-21 to define the reserve requirement.

Attachment GG





2020-06BWG Modified

Modify the instruction and illustration for Note 19 on MGAs and TPAs.


IPs note that the proposal does not define a TPA. It just states that TPAs “that write direct policies or provide claims adjusting or other services”. That is overly broad and could include a variety of entities that provide services. The NAIC model (NAIC Third Party Administrator Act, or NAIC model) guidelines define TPAs as it relates to life/health and workers compensation. Also, the NAIC model definition has a long list of activities that are excluded from the definition, such as self-insured employers administering its own workers’ compensation, insurers administering coverage, producers engaged in selling insurance, attorneys handling claims, MGAs, etc. We recommend that the proposed disclosure reference the NAIC model so that there is consistency in the definition used in applying the guidance. Additionally, it is unclear how the reporting threshold should be applied. The reporting applies to TPAs if “the claims adjusting services are greater than 5% of annual average claims volume”. Is that threshold based on the amount of claim dollars paid or the number of claims handled? Is that measured across all lines of business for the company? Would claims paid within insureds’ deductibles/SIRs be included? Depending on how this is defined, it could be quite burdensome for insurers to monitor. We recommend that the threshold be based on written premium, consistent with how other thresholds have been applied. On Page 3 of the proposal should the description of Table B, Column 1 be changed to “Licensed Name” to conform to Tables A and C? IPs also believe that the Table C Column 4 description should be changed from “Direct Written Premium/Produced” to “Direct Premiums - Written/Produced”.


IPs suggest deferring this Blanks item pending finalization of the corresponding work being done by SAPWG. SAPWG has re-exposed their corresponding item based on IP comments received from the original exposure. The SAPWG revisions, however, resulted in further concern on the part of IPs regarding the incorporated definition of Third-Part Administrators. A consistent and widely accepted definition of a TPA is not available because there are two versions of the Registration and Regulation of Third-Party Administrators (NAIC Guidelines) and states may adopt either version, if any. This could result in inconsistent reporting within the industry because of conflicting state law. Additionally, the reporting threshold and basis remains unclear. Is total count of claims processed by the TPA/MGA measured at a line of business or company level? Would claims paid within insureds’ deductibles be included? We believe it will be quite burdensome for insurers to monitor this metric as there is no reasonable basis for measurement that can be utilized from the Annual Statement. IPs has recommended to SAPWG that a state regulator/industry study group be formed to develop a uniform definition taking into consideration commonalities in existing state law. In addition to developing a uniform definition, the study group could also recommend the best way, and the proper mechanism, to develop the information requested. BWG would therefore need to defer this proposal at this time.

Attachment GG



2020-07BWG Add new disclosure Note 23 – Reinsurance for reinsurance credit (23H – Life/Fraternal, 23E Health and 23K Property).


For the first reporting year, IPs recommend that the disclosure be captured on a prospective basis (i.e. reinsurance contracts executed in 2020).

2020-08BWG Modified

Add a disclosure instruction for 10C to the Notes to Financial Statement for related party transactions not captured on Schedule Y. Combine existing 10C into 1B instructions and illustration narrative.


On Page 2 of the proposal the following changes should be made:

The word “for” is missing in the first sentence of Section C – “A reference number should be provided for each transaction”.

The second sentence of Section C should be clarified to better explain that multiple transactions with the same related party are not aggregated into a single row – “In each disclosure table each transaction for the same related party should be reported contiguously and not separated by other transactions with other related parties”.

Page 3 of the proposal lists options for type of transaction under the bullet for "Nature of Relationship" but should the listing instead be under the

bullet for "Type of Transaction"?

If this disclosure is to be data captured the normal instruction about using the exact format(s) needs to be added.

2020-09BWG Modify the Annual Statement Instructions for Schedule F, Part 3 to reflect the factors for all uncollateralized reinsurance recoverable from unrated reinsurers being the same for authorized, unauthorized, certified and reciprocal reinsurance.

Comment #1 – Industry Interested Parties 05/11/2020 Letter Attachment HH Page 16-17 of 42


2020-10BWG

Revise the column 10 header in the Variables Annuities Supplement blank to be Contract Level Reserves Less Cash Surrender Value. Revise the line descriptions in lines 1 through 3 in the footer and add a line for the Reserve Credit from Other Reinsurance and for Post-Reinsurance Ceded Aggregate Reserve. Adjust the instructions to correspond with changes made to the blanks as well as changes in the 2020 Valuation Manual for the new Variable Annuities Framework.



Attachment GG



2020-11BWG

For the VM-20, (Requirements for Principle-Based Reserves for Life Products, Reserves) Supplement blank, split Part 1 into Part 1A and Part 1B. For Part 1A: change the description header for column 3 to be “Due and Deferred Premium Asset” to match the instructions. Add “XXX” in the two places needed to indicate that a due and deferred premium asset does not need to be reported in the lines shown for Total Reserves. Change the reporting units for all columns to be in dollars rather than in thousands. Expand all columns to allow room for a number as large as 999,999,999,999. Change the product labels for clarity. For Part 1B: change the reporting units for the reserve columns to be in dollars rather than in thousands. Expand the reserve columns to allow room for a number as large as 999,999,999,999. Expand the face amount columns to allow room for a number as large as 9,999,999,999. Change the product labels for clarity. Remove Part 2 and re-number the remaining parts. Adjust the instructions according to the changes made to the blanks. Clarify instructions and add examples for Parts 1A and 1B


IPs recommend continuing to report Part 1A in thousands [e.g. ($000 Omitted)] and Part 1B in thousands except for number of policies [e.g. ($000 Omitted Except for Number of Policies)].

2020-12BWG The proposal will require appointed actuaries to attest to meeting Continuing Education (CE) requirements and participate in the Casualty Actuarial Society (CAS)/Society of Actuaries (SOA) CE review procedures, if requested. These proposed changes were adopted by the Accounting Practices and Procedures (E) Task Force Jan. 28, 2020.



Comment # 2 – American Academy of Actuaries Attachment HH Page 24-33 of 42

Our views fall into two different categories. First, the Blanks proposal presents a fundamental question of efficacy. We do not believe that the proposal will achieve National Association of Insurance Commissioners’ (“NAIC’s”) aims as we understand them. Second, notwithstanding its inability to meet NAIC’s goals, should NAIC nonetheless adopt the Blanks proposal, the Academy is far more suited to serve as the organization collecting CE certifications than either CAS or SOA. We address each separately….

Comment # 3 – COPLR of American Academy of Actuaries Attachment HH Page 34-42 of 42

First, the requirement for annual attestation, to be made available to the public, is redundant and unnecessary…. Second, we believe that statements pertaining to agreement “with the actuarial organizations” are factually incorrect….. Third, by requiring the Appointed Actuary “to attest,” the 2020 Instructions imply that the NAIC is responsible for regulating actuaries…… Fourth, neither the CAS nor SOA has authority over nonmembers…. Finally, with respect to the CE log, we reiterate our concerns regarding the proposed form and categorization, as documented in our March 10, 2020, comment letter (attached)….. See full comment letter for details.

Attachment GG



2020-13BWG Remove Line 24.04 from the General Interrogatories, Part 1 and renumber remaining lines for Interrogatory Question 24. Modify Lines 24.05 and 24.06 to require reporting amounts for conforming and non-conforming collateral programs.


IPs suggest changes to the following lines on page 3 of the PDF: Line 24.03 – change ‘…security securities lending program…’ for consistency of referencing within this interrogatory. Line 24.045 – add ‘For the reporting entity’s securities lending program, …’ at the beginning of the line for consistency with the other lines within this

interrogatory. Line 24.056 – add ‘For the reporting entity’s securities lending program, …’ at the beginning of the line for consistency with the other lines within this

interrogatory. Line 24.08 – add ‘7’ to the Line number to clarify the renumbering of this line. Line 24.109 – change ‘…security securities lending program…’ for consistency of referencing within this interrogatory.

2020-14BWG Modify the columns and rows on the blank pages for the Long-Term Care Experience Reporting Forms 1 through 5 and make appropriate changes to the instructions for those forms.


IPs suggest the following changes to items under the Definitions section for Form 5 on pages 19-20 of the PDF: Life/LTC Hybrid Accelerated Benefits Riders LTC Hybrid Extension ofExtended Benefits Riders Column 9 – Accelerated Benefits Available

o Maximum amount of death benefits available to be paid on an accelerated basis due to LTC Acceleration of Benefits riders on inforce business.

Column 10 – Extended Benefits Available o Maximum amount of extended benefits available to policyholders with extension of benefit riders on inforce business.

IPs suggest changing the description for the hybrid products section (lines 3-6) on page 30 of the PDF to ‘LTC Hybrid Policies and Riders’.

Attachment GG



202015BWG A new Private Flood Insurance Supplement collecting residential and commercial private flood insurance data and revisions to the Credit Insurance Experience Exhibit (CIEE) to collect lender-placed flood coverages.


IPs note that this proposal to further split the Private Flood line into five pieces (i.e., residential first dollar/excess/1st dollar endorsement/excess endorsement, and commercial) would require preparers to make a similar split of the Private Flood IBNR reserve. This is the result of requiring incurred and outstanding losses and DCC expense to be reported in the 5 respective line categories. The state page request for incurred and outstanding losses (and DCC) by line and by state is already a stretch for accuracy, with many of the values shown being allocations rather than the result of analyses. All allocations are tenuous, subject to breakdown and production of spurious results at times. IBNR reserves only make sense at an aggregate level where the volumes are large enough for reasonably reliable estimation. That is why they are generally only evaluated and set at an aggregate level, possibly only on a countrywide line level and not a subline or state level. The current requirement to break down a subline IBNR estimate (e.g., private Flood) to a state level is likely already the result of an allocation, not a detailed analysis, and as such it is not very reliable. This Blanks proposal is requesting an allocation of an allocation (i.e., allocating the private flood IBNR by state across 5 sub-sublines). To prevent the noted inaccuracies from occurring, IPs recommend that the proposal be modified to require the reporting of case incurred and case outstanding rather than total incurred and total outstanding (i.e. do not require an allocation of IBNR). While this would result in the supplement not balancing to the state page, it should reconcile to the state page with the reconciling item being the IBNR allocation in the state page. This recommendation for the reporting of case but not total values (that include IBNR) would be consistent with the Cybersecurity Insurance and Identity Theft Coverage Supplement. It is noted that the approach used for the cybersecurity supplement provides useful information and following this approach for the private flood supplement would also be expected to produce useful information.

2020-16BWG Modify Questions 3.1 and 3.2 of General Interrogatories Part 2 and provide instructions for the questions.



2020-17BWG Adjust the asset valuation reserve (AVR) presentation to include separate lines for each of the expanded bond designation categories.



Attachment GG



2020-18BWG Clarify the instructions to indicate which funds reported on Schedule D, Part 2, Section 2 (annual filing) and Schedules D, Part 3 and 4 (quarterly filing) must have NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol. Modify the reference to the Purposes and Procedures Manual of the NAIC Investment Analysis Office (P&P Manual) found in the following investment instructions.


IPs recommend changing the following item under Annual Statement on page 2 of the PDF: Schedule D, Part 1, Section 1 as there isn’t a Section 1 for this Part.

2020-19BWG Add a code of “%” to the code column for all investments which have been reported Schedule DA, Part 1 and Schedule E, Part 2 for more than one consecutive year. Add certification to the General Interrogatories, Part 1 inclusion of these investments on Schedule DA, Part 1 and Schedule E, Part 2.


IPs suggest modifying this exposure to be consistent with the corresponding SAPWG exposure by adding clarifying language to the instructions: For Schedule DA – Part 1, Column 2 on page 2 of the PDF revise the % definition as follows:

o Enter “%” in this column for all investments, except cash pooling structures and money market mutual funds, which have been reported on this schedule for more than one consecutive year.

For Schedule E – Part 2, Column 3 on pages 3 and 5 of the PDF revise the % definition as follows: o Enter “%” in this column for all investments, except cash pooling structures and money market mutual funds, which have been reported on

this schedule for more than one consecutive quarter. IPs recommend the following changes to parts b. and c. of the new General Interrogatory 36 because these 2 items are mutually exclusive: 36. By rolling/renewing short-term or cash equivalent investments with continued reporting on Schedule DA, Part 1 or Schedule E Part 2 (identified through a code (%) in those investment schedules), the reporting entity is certifying to the following: a. The investment is a liquid asset that can be terminated by the reporting entity on the current maturity date. b. TheIf the investment is with a nonrelated party or nonaffiliate andthen it reflects an arms-length transaction with renewal completed at the discretion

of all involved parties. c. TheIf the investment is with a related party or affiliate andthen the reporting entity has completed robust re-underwriting of the transaction for which

documentation is available for regulator review. d. Short-term and cash equivalent investments that have been renewed/rolled from the prior period that do not meet the criteria in 36.a -36.c are reported

as long-term investments. Has the reporting entity rolled/renewed short-term or cash equivalent investments in accordance with these criteria? Yes [ ] No [ ] N/A [ ]

Attachment GG



2020-20BWG For Schedule D, Part 1, add code “9” to Column 23 – Collateral Type for ground lease financing. Renumber “Other” code to 10.


IPs suggest changing the description of the exposure to “For Schedule D, Part 1, add code “910” to Column 2326 – Collateral Type for ground lease financing. Renumber “Other” code to 1011.” to reflect the correct changes to the renumbering. The exposed changes to the instructions and illustration are correct.

2020-21BWG Add new Line 4.05 for valuation allowance for mortgage loans to the Summary Investment Schedule and renumber existing Line 4.05 to 4.06. Modify the instructions to include a crosscheck for new Line 4.05 back to Schedule B – Verification Between years. Clarify the instructions for 4.01 through 4.04 to explicitly show crosschecking to Column 8 of Schedule B, Part 1.


IPs recommend changing the instructions on page 3 for ‘Line 4.0506’ to add the appropriate lines: “Sum of Lines 4.01 to 4.0405”.

2020-22BWG Modify the instructions and illustration for Note 3A and a new Note 3E with instructions and illustrations to be data captured. Modify the blank and instructions for Schedule D, Part 6, Sections 1 and 2.


IPs suggest the following items be changed: On Pages 2/3, the 5th bullet states “Total admitted goodwill as of the reporting date” but the illustration does not capture a total line. If a total line is to be

added, then does this amount represent what is reported in Column 6? On Pages 2/3, the 6th bullet point should be revised to be consistent with the description of admitted goodwill and include clarifying language on how

Column 9 is calculated: SCA admitted goodwill as a percentage of the SCA’s book adjusted carrying value (gross of admitted goodwill), which is calculated by dividing Column 6 by column 8.

On Page 3, the header for Column 6 in the illustration needs to add “SCA” at the beginning of the description to be consistent with the instructions. On Page 4, the formula on Line (5) should be ‘(Line 1-2-3-4)’ to be consistent with the presentation of lines 1-4. On Page 7, change the description in Column 4 of Schedule D – Part 6 – Section 2 to include ‘Amount of’, which is struck through, to be consistent with

the instructions.

Attachment GG



2020-23BWG Add footnote to Exhibit 5 (life/fraternal and health – life supplement) and Exhibit 3 separate accounts to disclose cases when a mortality risk is no longer present or a significant factor; i.e., due to a policyholder electing a payout benefit.


IPs recommend the following changes to the Exhibit 5 footnote: Revise the footnote for clarity as follows: (a) Included in the above table are amounts on deposit-type contracts that originally contained a mortality risk. Amounts on deposit-type contracts in Column 2 that no longer contain a mortality risk are $__________ (Life Insurance), $__________ (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives), $__________ (Miscellaneous Reserves). Add the following to the instructions for the Exhibit 5 footnote: Deposit-type contracts such as GICs and supplemental contracts are generally reported in Exhibit 7 – Deposit Type Contracts. However, certain contracts (which have similar characteristics to deposit-type contracts) incorporate mortality risk components which qualify those contracts to be reported in Exhibit 5 – Aggregate Reserve for Life Contracts. A common example is a supplemental contract which provides for a life-contingent payout with a specified certain period. Because the contract was life-contingent at issue, it is reported in Exhibit 5 and remains in Exhibit 5 after the death of the annuitant as remaining guaranteed payments continue to the beneficiary. Additionally, state insurance departments have the discretion to approve or require a contract to be classified as a life insurance contract. This footnote captures the amounts reported on Exhibit 5 for deposit-type contracts that originally contained a mortality risk, but no longer contain that risk. IPs recommend the following changes to the Exhibit 3 footnote: Revise the footnote for clarity and to reflect the categories in the Separate Account blank as follows: (a) Included in the above table are amounts on deposit-type contracts that originally contained a mortality risk. Amounts on deposit-type contracts in Column 2 that no longer contain a mortality risk are $__________ (Life Insurance), $__________ in Column 2 (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives Accident and Health Contracts), $__________ (Miscellaneous Reserves). Add the following to the instructions for the Exhibit 3 footnote:


Attachment GG



Attachment GG

John Bauer, FLMI Vice President, Regulatory Reporting Prudential Financial Office: 973-802-5803 Email: [email protected]

Connie Jasper Woodroof, FLMI NAIC Liaison Sapiens, Inc. 800-373-3366 x 85761Email: [email protected]

February 21, 2020

Mr. Jake Garn, Chair Blanks Working Group National Association of Insurance Commissioners 1100 Walnut St. Kansas City, MO 64106

SUBJECT: Blanks Working Group (“BWG”) Proposals Exposed on, and Subsequent to, the BWG Conference Call on December 17, 2019

Dear Mr. Garn:

Interested parties (“IPs”) appreciate the opportunity to review and comment on the proposals that were exposed by the BWG on, and subsequent to, the December 17, 2019 BWG conference call with a comment deadline of February 21, 2020.

Please note that the proposals exposed on January 17, 2020 concurrent with Statutory Accounting Principle Working Group (“SAPWG”) exposures may require revisions and re-exposure at the 2020 NAIC Spring National Meeting.

2019-25 IPs have no comments.



2019-30 At a high level, we have identified significant issues associated with implementing these new categories in both Schedules F and S. We expect that additional implementation issues and questions will arise as states and insurers work to operationalize the new reciprocal jurisdiction requirements. In addition, the proposed changes will require considerable effort by insurers to write new system specifications, develop coding and test the new reporting. Therefore, we do not believe the proposed 2020 year end effective date is reasonable and request that these changes be effective for year end 2021 reporting.

We do have some detailed comments as stated below:

• Why do the instructions for Schedule S – Part 4, Column 2 include the RJIN? Part 4applies only to unauthorized companies; therefore, reciprocal jurisdiction reinsurers willnot be included. In fact, the CRIN should not be included in the Column 2 instructions

1

Attachment HH

mailto:[email protected]

mailto:[email protected]

either for the same reason. If the idea is to keep the ID Number Column instructions consistent between all parts of Schedule S, that might be admirable, but is also confusing and contradictory to the purpose of some of the parts. The same comments apply to Schedule S – Part 5 reporting specific to certified reinsurers, Column 2 and in the Title Statement instructions for Schedule F – Parts 3 and 4.

• On Page 20 of the proposal why does the limited scope language reference only lossesincurred and reserves? The reporting of premiums and other balances is necessaryeven if there are no losses yet under the reinsurance contract.

• On Page 29 of the proposal, reciprocal jurisdiction was added to the line description, butthere is no reference to that line number. Also, the total line numbers are incorrect. Thecorrect references would be (changes in yellow):

Total Authorized, Reciprocal Jurisdiction, Unauthorized and Certified Excluding Protected Cells (Sum of 1499999, 2899999, and 4299999 and 5699999 ) .......................................................................................... 4399999 5749999 Total Protected Cells (Sum of 1399999, 2799999, and 4199999 and 5599999) ............................................ 4499999 5899999 Totals (Sum of 4399999 5799999 and 4499999 5899999) ............................................................................. 9999999

• Throughout the proposal, “reciprocal jurisdiction” reinsurance is often capitalized, whenreferences to other types of reinsurance are not. For example:

The same reinsurer may be listed on the same Schedule S by the ceding insurer with an AIIN for unauthorized reinsurance, a CRIN for certified reinsurance, and a RJIN for Reciprocal Jurisdiction reinsurance.

There is no apparent reason for capitalizing “reciprocal jurisdiction.”

• The instructions for Schedule S – Part 3 Sections 1 & 2 Line 9999999 formula referenceis incorrect. The formula reference should sum Lines 4599999 and 9099999.

• The Trusteed Surplus Statement Instruction revisions in the proposal are the quarterlystatement instructions - the references to the “quarterly statement” should be replacedwith “annual statement” for the annual statement instructions.

2020-01 IPs have no comment.

2020-02 The information on disclosure of entities held by the noninsurance holding company regarding the assignment of goodwill (and how the assignment was determined), whether audited financial statements were obtained, and the ultimate admitted value needs to be added to the proposed annual statement instructions.

2

Attachment HH

2020-03 IPs recommend revisions to the proposed disclosures which would provide regulators who are not involved in the approval and ongoing review of a surplus note transaction with information to assess the nature of the transaction and to determine whether more detailed review is needed. Specifically, our revisions would require disclosure of whether cash flows are offset but would differentiate between administrative offsetting and the contractual “linkage” that is of concern to regulators. These revisions would also remove information that we believe is confidential in nature and would not be appropriate for public disclosure. Finally, we have proposed several additions to the required disclosures, which we believe would provide useful information about transactions involving surplus notes.

Our suggested revisions to the disclosures are included in Exhibit A and summarized below. For ease of review, revisions proposed by NAIC staff have been accepted, and interested parties’ comments are presented as tracked changes.

Summary of Proposed Revisions

• Expand the disclosure requirement to the financial statements of the ceding company aswell as the surplus note issuer.

• Retain the current disclosure of total interest paid (gross of any administrative or othernetting)

• Replace quantitative disclosure of “interest remitted” and “cost of liquidity” with three Y/Ndisclosure columns which correspond to the criteria used in the data call scoping:

1. Do surplus note / associated asset terms negate or reduce cash flow exchanges,and/or are amounts payable under surplus notes and amounts receivable underother agreements contractually linked? (For example, the asset provides interestpayments only when the surplus note provides interest payments.)

2. Are any amounts due under surplus notes and associated assets netted or offset(partially or in full) thus eliminating or reducing the exchange of cash or assetsthat would normally occur throughout the duration, or at maturity, of theagreement? (This may be referred to as administrative offsetting.)

3. Were the proceeds from the issuance of a surplus note used to purchase anasset directly or indirectly from the holder of the surplus note?

• Replace confidential information about 3rd party liquidity (e.g. maximum liquidity amountand cost of liquidity source) with a description of terms under which liquidity would beprovided should a triggering event occur.

• Add requirement for narrative disclosure of any related guarantees or supportagreements.

2020-04 IPs have no comment.

3

Attachment HH

2020-05 IPs propose the attached language in Exhibit B as being clearer in defining the amounts to be disclosed, to use language consistent with VM-21, and to recognize the role of VM-21 to define the reserve requirement.

2020-06 IPs note that the proposal does not define a TPA. It just states that TPAs “that write direct policies or provide claims adjusting or other services”. That is overly broad and could include a variety of entities that provide services. The NAIC model (NAIC Third Party Administrator Act, or NAIC model) guidelines define TPAs as it relates to life/health and workers compensation. Also, the NAIC model definition has a long list of activities that are excluded from the definition, such as self-insured employers administering its own workers’ compensation, insurers administering coverage, producers engaged in selling insurance, attorneys handling claims, MGAs, etc. We recommend that the proposed disclosure reference the NAIC model so that there is consistency in the definition used in applying the guidance.

Additionally, it is unclear how the reporting threshold should be applied. The reporting applies to TPAs if “the claims adjusting services are greater than 5% of annual average claims volume”. Is that threshold based on the amount of claim dollars paid or the number of claims handled? Is that measured across all lines of business for the company? Would claims paid within insureds’ deductibles/SIRs be included? Depending on how this is defined, it could be quite burdensome for insurers to monitor. We recommend that the threshold be based on written premium, consistent with how other thresholds have been applied.

On Page 3 of the proposal should the description of Table B, Column 1 be changed to “Licensed Name” to conform to Tables A and C? IPs also believe that the Table C Column 4 description should be changed from “Direct Written Premium/Produced” to “Direct Premiums - Written/Produced”.

2020-07 For the first reporting year, IPs recommend that the disclosure be captured on a prospective basis (i.e. reinsurance contracts executed in 2020).

2020-08 On Page 2 of the proposal the following changes should be made:

• The word “for” is missing in the first sentence of Section C – “A reference number shouldbe provided for each transaction”.

• The second sentence of Section C should be clarified to better explain that multipletransactions with the same related party are not aggregated into a single row – “In eachdisclosure table each transaction for the same related party should be reportedcontiguously and not separated by other transactions with other related parties”.

• Page 3 of the proposal lists options for type of transaction under the bullet for "Nature ofRelationship" but should the listing instead be under the bullet for "Type of Transaction"?

• If this disclosure is to be data captured the normal instruction about using the exactformat(s) needs to be added.

4

Attachment HH

John Bauer, FLMI Connie Jasper Woodroof, FLMI Vice President, Regulatory Reporting NAIC Liaison Prudential Financial Sapiens, Inc.

CC: Rose Albrizio, AXA Financial Keith Bell, Travelers Mary Caswell, NAIC Calvin Ferguson, NAIC Kim Hudson, Vice-Chair, California

5

Attachment HH

Disclosures 18. The notes to the financial statements of a reporting entity that issues surplus notes shall disclose

the following as long as the surplus notes are outstanding:

a. Date issued;

b. Description and fair value of the assets received;

c. Holder of the note or if public, the names of the underwriter and trustee, withidentification on whether the holder of the surplus note is a related party per SSAPNo. 25;

d. Original issue amount of note;

e. Carrying value of note;

f. The rate at which interest accrues;

g. Maturity dates or repayment schedules, if stated;

h. Unapproved interest and/or principal;

i. Life-to-date and current year approved interest and/or principal recognized1;

j. Disclosure of whether the surplus note was issued as “paid”part of a transactionwith identificationany of the amount of approvedfollowing attributes:

i. Do surplus note / associated asset terms negate or reduce cash flowexchanges, and/or are amounts payable under surplus notes and amounts receivable under other agreements contractually linked (For example, the asset provides interest and/or principal remittedpayments only when the surplus note provides interest payments)?

ii. Are any amounts due under surplus notes and associated assets netted oroffset (partially or in full) thus eliminating or reducing the exchange of cash or assets that would normally occur throughout the duration, or at maturity, of the agreement. (This may be referred to as administrative offsetting)?

i.iii. Were the proceeds from the issuance of a surplus note used to purchase anasset directly or indirectly from the holder of the surplus note (actual transfer of cash / assets) and the amount of approved interest and/or principal not remitted to the holder of the surplus note (no transfer of cash / assets). ? If so, was the asset issuer a related party per SSAP 25?

j. Information regarding a 3rd party liquidity source including name, identification if arelated party, cost of the liquidity guarantee, and maximum amount availableshould a triggering event occur.

k. Principal amount and fair value of assets received upon Surplus Note issuance, ifapplicable;

k.l. Subordination terms;

l.m. Liquidation preference to the reporting entity’s common and preferred shareholders;

m.n. The repayment conditions and restrictions.;

1 Interest and principal reported pursuant to 18.i include amounts offset by amounts receivable under other agreements, unless the reporting entity has a legal right of offset. Such offsetting arrangements shall be disclosed pursuant to paragraph 18.j.i through 18.j.iii

6

Attachment HH

o. Information about any guarantees, support agreements, or related partytransactions associated with the surplus note issuance, and whether payments have been made under such agreements

19. If a reporting entity has ceded business to a surplus note issuer that is not remitting actualcash or assets toa related party as part of a reinsurance transaction in which the surplus note meetsany of the criteria in 18. j above, the ceding entity shall provide a description of the transaction,including whether the criteria in 18. j. above were met with respect to the surplus note issuance, aslong as the reinsurance agreement remains in force. The ceding entity should provide a descriptionof the risks reinsured, the related party reinsurer, any guarantees or support agreements and theamount of notes outstanding.

19.20. If the proceeds from the issuance of a surplus note used to purchase an asset directly or indirectly from the holder of the surplus note for approved interest or principal (as reported under paragraph 18.h), because the reporting entity is offsetting the amount owed under the surplus note with an amount receivable from a reported asset, the following information shall be disclosed regarding the offsetting assetassets received:

a. Identification of asset, including the investment schedule where the asset isreported and reported NAIC designation.;

b. Book/ adjusted carrying value of asset and interest income recognized in as of thecurrent year.

b. Amount of principle return and interest income from the asset not received by thereporting entity as the amounts were offset with approved amounts owed by thereporting entity’s issued surplus note. date.

c. A description of terms under which liquidity would be provided should a triggeringevent occur.

c.

20.21. In addition to the above, a reporting entity shall identify all affiliates that hold any portion of a surplus debenture or similar obligation (including an offering registered under the Securities Act of 1933 or distributed pursuant to rule 144A under the Securities Act of 1933), and any holder of 10% or more of the outstanding amount of any surplus note registered under the Securities Act of 1933 or distributed pursuant to Rule 144A under the Securities Act of 1933.

Proposed Blanks Disclosures:

Date Issued

Interest Rate

Original Issue

Amount of Note

Is Surplus

Note Holder a Related Party (Y/N) Fair

Value of Assets

Received Upon

Issuance

Type of Assets

Received Upon

Issuance

Carrying Value of

Note Prior Year

Carrying Value of

Note Current

Year

Unapproved Interest

And / Or Principal

Approved Interested

RecognizedInterest Paid Current Year

Life-To-DateTotal Interest

Remitted (Actual


Paid

Principal Paid

Current Year

Life-To-Date Total Principal (Actual


Remitted Paid

Date of Maturity

1311999 Total

XXX

7

Attachment HH

Current Year Approved Interested

Remitted (Actual Transfer of

Cash/Assets) Are Surplus Note

payments contractually linked? (Y/N)

Current Year Approved Principal Remitted (Actual

Transfer of Cash/Assets)Are

Surplus Note payments subject to

administrative offsetting provisions?

(Y/N)

Current Year Approved Interest

Not Remitted Since Issuance (No Transfer of

Cash/Assets) *Were Surplus

Note proceeds used to purchase an

asset directly from the holder of the

surplus note? (Y/N)

Current Year Approved Principal Not Remitted Since

Issuance (No Transfer of

Cash/Assets) *Is Asset Issuer a Related Party

(Y/N)

Type of Assets Received Upon IssuanceIs Non-Remitted Interest

or Principal Offset with Amounts

Owed from Surplus Note

Holder? (Y/N)

Does Remitted Interest or Principal Payments

Result with Acquisition of a Source of Liquidity

Through the Surplus Note Holder?

(Y/N)Principal Amount of Assets Received

Upon Issuance

Book/Adjusted Carry Value of

AssetsIs Surplus Note Holder a

Related Party (Y/N)

* Include amounts offset with amounts owed from the holder of the surplus note.

Name of 3rd Party Liquidity Source

Acquired

Is Liquidity Source a Related Party to the Surplus Note Issuer?

Current Year Total Cost of

Liquidity Source

Current Year Cost of Liquidity

Source Reported as Surplus Note

Interest

Total Cost of Liquidity Source Since Acquisition

Total Cost of Liquidity Source Reported as

Surplus Note Interest Since Acquisition

Maximum Amount Surplus Note Issuer Can Receive from Liquidity

Source

8

Attachment HH

Attachment HH Exhibit B: 2019-47 Marked changes

SSAP No. 51R:

Change In Valuation Basis

36. A change in valuation basis for reserves determined under paragraphs 18-21,except for reserves defined under Actuarial Guideline XLIII—CARVM: For VariableAnnuities (AG 43), as detailed in Appendix C of this Manual, shall be defined as a changein the interest rate, mortality assumption, or reserving method (e.g., net level, preliminaryterm, etc.) or other factors affecting the reserve computation of policies in force and meetsthe definition of an accounting change as defined in SSAP No. 3—Accounting Changes andCorrections of Errors (SSAP No. 3).

37. Changes in reserves developed under paragraph 22 or AG 43 shall be reviewedto determine whether the change represents a change in valuation basis and if it meets thedefinition of a change in accounting as defined in SSAP No. 3.

a. Changes in principle-based reserving assumptions are often the result ofupdating assumptions and other factors required by the existing reservingmethodology. Reserve changes resulting from the application of principle-based reserving methodology including, but not limited to, updatingassumptions based on reporting entity, industry or other experience, andhaving the reported reserve transition between net premium reserve,deterministic reserve or stochastic reserve, as required under existingguidance, shall not be considered a change in valuation basis. These typesof changes also include, but are not limited to, periodic updates in ValuationManual tables, such as industry valuation basic tables, asset spread tablesand default cost tables.

b. A change in valuation basis for principle-based reserves shall include caseswhere the required reserve methodology has changed, or the insurer makesa voluntary decision to choose one allowable reserving method overanother. These types of changes include, but are not limited to, newstandardized mortality tables such as Commissioners Standard Ordinarytables and regulatory changes in methodology.

38. Consistent with SSAP No. 3, any increase (strengthening) or decrease(destrengthening) in actuarial reserves resulting from such a change in valuation basis shallbe recorded directly to surplus (under changes to surplus in the change in valuation basisannual statement line) rather than as a part of the reserve change recognized in the summaryof operations.

39. The impact of a change in valuation basis on surplus is based on the differencebetween the reported reserve under the old and new methods as of the beginning of theyear. This difference shall not be graded in over time unless this statement or the ValuationManual in section VM-21 Requirements for Principle-Based Reserves for Variable

9


Annuities (VM-21) prescribes a new method and a specific transition that allows for grading. If the grading permitted by this statement or Valuation Manual section VM-21 represents an increase in the reserve liabilities, the unrecognized change in valuation basis reserve increase shall initially be reflected as an allocation from unassigned funds to special surplus until fully recognized in reserving and unassigned funds. The reclassification from unassigned funds to special surplus does not reduce total surplus, but highlights the ungraded in amount for transparency as it represents an unrecognized adjustment (decrease) to total surplus. The allocation to special surplus is reversed to unassigned funds as the grading of the increase in reserving is recognized as a decrease to total surplus. Some changes will meet the definition of a change in accounting as defined in SSAP No. 3 and a change in valuation basis as described in paragraphs 36-38 of this statement, but the adjustment to surplus will be zero. This can happen when the change in valuation basis is prospective and only applies to new policies and reserves meaning that policies inforce for the prior year-end are not affected, or situations in which the change in reserving methodology did not change the reserves reported in the financial statements. Some changes will meet the definition of a change in accounting as defined in SSAP No. 3 and a change in valuation basis as described in paragraphs 36-38 of this statement, but the adjustment to surplus will be zero. This can happen when the change in valuation basis is prospective and only applies to new policies and reserves meaning that policies inforce for the prior year-end are not affected, or situations in which the change in reserving methodology did not change the reserves reported in the financial statements as of 1/1.[JB1] The changes remain subject to the disclosures prescribed in SSAP No. 3. Effective January 1, 2020, if the phase-in provision of the Valuation Manual section VM-21 (on variable annuities) is elected or this statement prescribes or permits a grading in period or provides the option of multiple grading periods, reporting entities shall also include in the change in accounting disclosures required by SSAP No. 3, disclosure of the following:

a. the grade phase-in period being applied, and the remaining time period ofthe grade phase-in

b. any adjustments to the grade phase-in period.

c. The phase-in amount as defined in VM-21of change in valuation basis gradein, which has been recognized in unassigned funds and

d. the remaining amount to be graded phase-in amount (reflected in specialsurplus if the ungraded in amount represents an increase in reserving).

40. Some changes will meet the definition of a change in accounting as defined inSSAP No. 3 and a change in valuation basis as described in paragraphs 36-38 of thisstatement, but the adjustment to surplus will be zero. This can happen when the change invaluation basis is prospective and only applies to new policies and reserves meaning thatpolicies inforce for the prior year-end are not affected, or situations in which the change inreserving methodology did not change the reserves reported in the financial statements.While Tthe Valuation Manual is effective prospectively for policies written on or after theoperative date, subsequent changes may be applied retroactively to all business issued since

10


that operative date however, as the CARVM methodology was already principles based, some changes to the CARVM methodology in section VM-21 (on variable annuities) and to the related AG 43, which may result in retroactive application to the reserving for existing contracts. Therefore, upon the initial prospective adoption of principle-based reserving, the change in valuation basis reflected as an adjustment to surplus will be zero. After initial adoption of the Valuation Manual, changes in valuation basis will need to be evaluated to determine the amount of any surplus adjustments.

SSAP No. 3—Accounting Changes and Corrections of Errors

Disclosures

Disclosure of material changes in accounting and correction of errors shall include:

a. A brief description of the change, encompassing a general disclosure of thereason and justification for change or correction;

b. The impact of the change or correction on net income, surplus, total assets,and total liabilities for the two years presented in the financial statements(i.e., the balance sheet and statement of income and operations); and

c. The effect on net income of the current period for a change in estimate thataffects several future periods, such as a change in the service lives ofdepreciable assets or actuarial assumptions affecting pension costs.Disclosure of the effect on those income statement amounts is not necessaryfor estimates made each period in the ordinary course of accounting foritems such as uncollectible accounts; however, disclosure is recommendedif the effect of a change in the estimate is material;

d. Changes in accounting that are changes in reserve valuation basis asdescribed in SSAP No. 51R—Life Contracts which have elected gradephase-in or other optional application features defined in the ValuationManual, shall also include in the change in accounting disclosuresinformation regarding the application of any grade phase-in as provided forin SSAP No. 51R. and

e. When subsequent financial statements are issued containing comparativerestated results as a result of the filing of an amended financial statement,the reporting entity shall disclose that the prior period has been restated andthe nature and amount of such restatement.

11

Attachment HH

The interested parties, as noted below, for the Blanks Working Group agree with the comments contained in this letter:

Organization Name Phone Number

E-Mail Address

AEGON Arthur C. Schneider

319-355-7974 [email protected]

Aetna Joseph A. Alfano 860-273-7199 [email protected]

Allstate Insurance Group Thomas Helsdingen


Anthem Anne Honisch 262-523-3687 [email protected] American Council of Life Insurers (356 members)

Mike Monahan 202-624-2324 [email protected]

American Health Insurance Plans

Tom Finnell [email protected]

American Property Casualty Insurance Association

Matt Vece [email protected]

AXA Equitable Rose Albrizio 212-314-5630 [email protected]

Bankers Life and Casualty Company

James M. Crafton 317-817-3394 [email protected]

Blue Cross Blue Shield Association

Joseph Zolecki 312-297-5766 [email protected]

Brighthouse Financial Greg Hendler 980-949-3519 [email protected]

CIGNA Nancy Ruffino 860-226-4632 [email protected]

CNA Jeff Alton 312-822-7901 [email protected]

CUNA Mutual Insurance Society

Cami Douglas 608-231-7105 [email protected]

General Electric Company – North American Life & Health

Ann S. McAuliffe 203-357-3429 [email protected]

12

Attachment HH

Genworth Patricia Merrill 804-662-2414 [email protected]

Hartford Financial Services Group, Inc.

Patrick Coyne 860-297-6340 [email protected]

ING Joe Elmy 770-850-7578 [email protected]

Lafayette Life Insurance Company

Lynn Laswell 513-629-1553 [email protected]

Liberty Mutual Insurance Company

Russell Carlson 617-574-6633 [email protected]

MetLife Nicole Sackedis Kolitsopoulos


Minnesota Life Insurance Company

David J. LePlavy 651-665-4122 [email protected]

Mortgage Insurance Companies of America

Robert Hayes [email protected]

Mutual of Omaha Insurance Company

Kurt S. Christiansen

402-351-2160 Kurt.Christiansen@MutualofOmaha. com

NAMIC Michelle Rogers [email protected]

Nationwide Insurance Pamela Biesecker 614-677-1823 [email protected]

Northwestern Mutual Mike Reis 414-665-3561 [email protected]

Pacific Life Insurance Company

Thomas Mays 949-219-3639 [email protected]

Penn Mutual Life Insurance Company

James G. Murray 215-956-8302 [email protected]

Principal Life Insurance Company

Richard H. Wireman, II


Protective Life Corporation

Charles D. Evers, Jr.


Prudential Financial John J. Bauer 973-802-5803 [email protected]

13

Attachment HH

Reinsurance Association of America (36 members)

Joseph B. Sieverling


Security Mutual Life Insurance Company of New York

Kevin J. McKeown


SOVOS Randy Hefel 319-739-3528 [email protected] StoneRiver Connie Jasper

Woodroof 913-788-8201 [email protected]

Thrivent Tip Tipton 612-844-7298 [email protected] TIAA-CREF Resh Reese 704-988-1351 [email protected]

Torchmark Corporation Frank Svoboda 972-569-3659 [email protected]

Travelers D. Keith Bell 860-277-0537 [email protected]

UnitedHealthcare Sherry Gillespie 920-661-4318 [email protected]

Zurich North America Richard Hauser [email protected]

14

Attachment HH

Tip Tipton, CPA Randy Hefel Accounting Policy Manager Senior Regulatory Specialist Thrivent SOVOS Office: 612.844.7298 Office: 319.739.3528 Email: [email protected] Email: [email protected]

May 11, 2020

Mr. Jake Garn, Chair Blanks Working Group National Association of Insurance Commissioners 1100 Walnut St. Kansas City, MO 64106

SUBJECT: Blanks Working Group (“BWG”) Proposals Exposed on March 24, 2020 via email

Dear Mr. Garn:

Interested parties (“IPs”) appreciate the opportunity to review and comment on the proposals that were exposed by the BWG on March 24, 2020 in lieu of the 2020 NAIC Spring National Meeting with a comment deadline of May 11, 2020.

2019-30 [Re-exposed changes to the instructions and blanks for various schedules, notes and instructions to allow credit for reinsurance for domestic ceding insurers for reinsurance that has been ceded to reinsurers from Reciprocal Jurisdictions]

IPs recommend the following changes to the instructions:

On page 19 of the PDF, ‘Certified Reinsurer Identification Number (CRIN)’ should not be struck out in the Schedule S – Part 5 (Reinsurance Ceded to Certified Reinsurers) instructions for Column 2.

On page 40 of the PDF, ‘Certified Reinsurer Identification Number (CRIN)’ should not be struck out in the Schedule F – Part 4 (Provision For Reinsurance Ceded to Certified Reinsurers) instructions for Column 1.

2020-02 [Re-exposed changes to the instructions and illustration of Note 10L (Investment in Downstream Holding Company) based on the re-exposed item from SAPWG 2019-14 regarding Attribution of Goodwill]

This re-exposure is a concurrent exposure with SAPWG 2019-14 (2019-14). 2019-14 states that if a reporting entity acquires a downstream holding company that qualifies for the “look through” approach, and the acquired holding company owns underlying SCAs any goodwill from the acquisition of the holding company must be attributed to underlying SCAs.

In the original IP response to the SAPWG exposure, IPs stated that any attribution would be onerous and misleading to users of financial statements. To layer in a statutory attribution of goodwill is overly complex and not useful.

Since comments on the SAPWG re-exposure are not due until May 29, 2020, we recommend that any action on this item be deferred until resolved/adopted at SAPWG.

15

Attachment HH

2020-03 [Re-exposed changes to the instructions and illustration for Note 13K (formerly Note 13(11)) (Surplus Notes) based on the re-exposed item from SAPWG 2019-37 regarding enhanced disclosures for Surplus Notes]

IPs suggest changing the description of the exposure to “Change the numbering from 1 through 11 13 to A through M” to reflect the correct changes to the renumbering. The exposed changes to the instructions and illustration are correct.

IPs recommend the following to ensure that the disclosures are identical to the SAPWG exposure:

Add “Information about any guarantees, support agreements or related partytransactions associated with the surplus note issuance and whether payments havebeen made under such agreements” to the disclosures, which corresponds to #18.o ofthe SAPWG exposure.

Align the order of the disclosures between the SAPWG and Blanks exposures. Make the following change to the 10th bullet point: Percentage of offset interest

payments offset through administrative offsetting (not inclusive of amounts paid to a 3rdparty liquidity provider).

2020-05 [Re-exposed changes to the instructions and illustration for Note 2 (Accounting Changes and Corrections of Errors) based on the re-exposed item from SAPWG 2019-47 regarding options for phasing in the change in reserving valuation basis necessitated by VM-21]


2020-06 [Re-exposed changes to the instructions and illustration for Note 19 (Direct Premium Written/Produced by Managing General Agents/Third Party Administrators) based on the re-exposed item from SAPWG 2019-36 regarding expanded disclosures for MGAs and TPAs]

IPs suggest deferring this Blanks item pending finalization of the corresponding work being done by SAPWG. SAPWG has re-exposed their corresponding item based on IP comments received from the original exposure. The SAPWG revisions, however, resulted in further concern on the part of IPs regarding the incorporated definition of Third-Part Administrators. A consistent and widely accepted definition of a TPA is not available because there are two versions of the Registration and Regulation of Third-Party Administrators (NAIC Guidelines) and states may adopt either version, if any. This could result in inconsistent reporting within the industry because of conflicting state law.

Additionally, the reporting threshold and basis remains unclear. Is total count of claims processed by the TPA/MGA measured at a line of business or company level? Would claims paid within insureds’ deductibles be included? We believe it will be quite burdensome for insurers to monitor this metric as there is no reasonable basis for measurement that can be utilized from the Annual Statement.

IPs has recommended to SAPWG that a state regulator/industry study group be formed to develop a uniform definition taking into consideration commonalities in existing state law. In addition to developing a uniform definition, the study group could also recommend the best way, and the proper mechanism, to develop the information requested. BWG would therefore need to defer this proposal at this time.

2020-09 [Exposed changes to the instructions for Schedule F, Part 3 (Ceded Reinsurance) based on the adoption from the P/C RBC Working Group which reflects the factors for all uncollateralized

16

Attachment HH

reinsurance recoverable from unrated reinsurers be the same for authorized, unauthorized, certified, and reciprocal reinsurance]


2020-10 [Exposed changes to the blank and instructions for the Variable Annuities Supplement based on a submission from the Life Actuarial Task Force regarding changes made to the blanks as well as changes in the 2020 Valuation Manual for the new VA Framework]


2020-11 [Exposed changes to the blank and instructions for the VM-20 Reserve Supplement based on a submission from the Life Actuarial Task Force which will attain consistency with other annual statement blanks and in company reporting]

IPs recommend continuing to report Part 1A in thousands [e.g. ($000 Omitted)] and Part 1B in thousands except for number of policies [e.g. ($000 Omitted Except for Number of Policies)].

2020-12 [Exposed changes to the Actuarial Opinion based on an adopted item by the Casualty Actuarial and Statistical Task Force which will require appointed actuaries to attest to meeting Continuing Education (CE) requirements and participate in the Casualty Actuarial Society/Society of Actuaries CE review procedures]


2020-13 [Exposed changes to the General Interrogatories-Part 1 (Common Interrogatories) based on a submission by the Capital Adequacy Task Force regarding conforming and non-conforming collateral programs for securities lending programs]

IPs suggest changes to the following lines on page 3 of the PDF: Line 24.03 – change ‘…security securities lending program…’ for consistency of referencing

within this interrogatory. Line 24.045 – add ‘For the reporting entity’s securities lending program, …’ at the beginning

of the line for consistency with the other lines within this interrogatory. Line 24.056 – add ‘For the reporting entity’s securities lending program, …’ at the beginning

of the line for consistency with the other lines within this interrogatory. Line 24.08 – add ‘7’ to the Line number to clarify the renumbering of this line. Line 24.109 – change ‘…security securities lending program…’ for consistency of

referencing within this interrogatory.

2020-14 [Exposed changes to the blank and instructions for the Long-Term Care Insurance Experience Reporting Forms 1-5 as adopted by the Health Actuarial Task Force regarding changes that are proposed to provide more accurate and useful information to regulators and their customers, and to facilitate greater consistency among and ease of reporting by insurers]

IPs suggest the following changes to items under the Definitions section for Form 5 on pages 19-20 of the PDF:

Life/LTC Hybrid Accelerated Benefits Riders LTC Hybrid Extension ofExtended Benefits Riders Column 9 – Accelerated Benefits Available

o Maximum amount of death benefits available to be paid on an accelerated basisdue to LTC Acceleration of Benefits riders on inforce business.

Column 10 – Extended Benefits Available

17

Attachment HH

o Maximum amount of extended benefits available to policyholders with extensionof benefit riders on inforce business.

IPs suggest changing the description for the hybrid products section (lines 3-6) on page 30 of the PDF to ‘LTC Hybrid Policies and Riders’.

2020-15 [Exposed changes to create a new Private Flood Insurance Supplement, based on a submission by the Property & Casualty Insurance (C) Committee, which will collect residential and commercial private flood insurance data and revise the Credit Insurance Exhibit to collect lender-placed flood coverages]

IPs note that this proposal to further split the Private Flood line into five pieces (i.e., residential first dollar/excess/1st dollar endorsement/excess endorsement, and commercial) would require preparers to make a similar split of the Private Flood IBNR reserve. This is the result of requiring incurred and outstanding losses and DCC expense to be reported in the 5 respective line categories.

The state page request for incurred and outstanding losses (and DCC) by line and by state is already a stretch for accuracy, with many of the values shown being allocations rather than the result of analyses. All allocations are tenuous, subject to breakdown and production of spurious results at times. IBNR reserves only make sense at an aggregate level where the volumes are large enough for reasonably reliable estimation. That is why they are generally only evaluated and set at an aggregate level, possibly only on a countrywide line level and not a subline or state level. The current requirement to break down a subline IBNR estimate (e.g., private Flood) to a state level is likely already the result of an allocation, not a detailed analysis, and as such it is not very reliable. This Blanks proposal is requesting an allocation of an allocation (i.e., allocating the private flood IBNR by state across 5 sub-sublines).

To prevent the noted inaccuracies from occurring, IPs recommend that the proposal be modified to require the reporting of case incurred and case outstanding rather than total incurred and total outstanding (i.e. do not require an allocation of IBNR). While this would result in the supplement not balancing to the state page, it should reconcile to the state page with the reconciling item being the IBNR allocation in the state page.

This recommendation for the reporting of case but not total values (that include IBNR) would be consistent with the Cybersecurity Insurance and Identity Theft Coverage Supplement. It is noted that the approach used for the cybersecurity supplement provides useful information and following this approach for the private flood supplement would also be expected to produce useful information.

2020-16 [Exposed changes to modify certain questions and instructions for General Interrogatories Part 2 (Property & Casualty Interrogatories) to clarify capturing whether reporting entities have written participating policies in the current calendar year and reporting amount of premium written for both participating and non-participating policies]


2020-17 [Exposed changes to adjust the AVR presentation to include separate lines for each of the expanded bond designation categories to accommodate the 20 bond designations as adopted by Blanks and the SVO]


18

Attachment HH

2020-18 [Exposed changes to clarify the instructions for what funds reported on Schedule D, Part 2, Section 2 (annual filing) and Schedules D, Part 3 and 4 (quarterly filing) must have NAIC Designation, NAIC Designation Modifier and SVO Administrative Symbol as submitted by VOSTF]

IPs recommend changing the following item under Annual Statement on page 2 of the PDF: Schedule D, Part 1, Section 1 as there isn’t a Section 1 for this Part.

2020-19 [Exposed changes to add a code of “%” to the code column for all investments which have been reported on Schedule DA, Part 1 (Short-Term Investments) and Schedule E, Part 2 (Cash Equivalents) for more than one consecutive year; add certification to the General Interrogatories, Part 1 (Common Interrogatories) inclusion of these investments on Schedule DA, Part 1 and Schedule E, Part 2 based on the re-exposed item from SAPWG 2019-20 regarding Rolling Short-Term Investments]

IPs suggest modifying this exposure to be consistent with the corresponding SAPWG exposure by adding clarifying language to the instructions:

For Schedule DA – Part 1, Column 2 on page 2 of the PDF revise the % definition asfollows:

o Enter “%” in this column for all investments, except cash pooling structures andmoney market mutual funds, which have been reported on this schedule for morethan one consecutive year.

For Schedule E – Part 2, Column 3 on pages 3 and 5 of the PDF revise the % definitionas follows:

o Enter “%” in this column for all investments, except cash pooling structures andmoney market mutual funds, which have been reported on this schedule for morethan one consecutive quarter.

IPs recommend the following changes to parts b. and c. of the new General Interrogatory 36 because these 2 items are mutually exclusive:

36. By rolling/renewing short-term or cash equivalent investments with continued reporting onSchedule DA, Part 1 or Schedule E Part 2 (identified through a code (%) in those investmentschedules), the reporting entity is certifying to the following:

a. The investment is a liquid asset that can be terminated by the reporting entity on thecurrent maturity date.b. TheIf the investment is with a nonrelated party or nonaffiliate andthen it reflects an arms-length transaction with renewal completed at the discretion of all involved parties.c. TheIf the investment is with a related party or affiliate andthen the reporting entity hascompleted robust re-underwriting of the transaction for which documentation is available forregulator review.d. Short-term and cash equivalent investments that have been renewed/rolled from theprior period that do not meet the criteria in 36.a -36.c are reported as long-term investments.

Has the reporting entity rolled/renewed short-term or cash equivalent investments in accordance with these criteria? Yes [ ] No [ ] N/A [ ]

2020-20 [Exposed changes to add code “10” to Column 26 (Collateral Type) of Schedule D, Part 1 (Bonds) for ground lease financing transactions and renumber “Other” code to 11 based on an adoption by VOSTF 2019-014-01 as this was added as a newly defined asset class to the P&P Manual]

IPs suggest changing the description of the exposure to “For Schedule D, Part 1, add code “910” to Column 2326 – Collateral Type for ground lease financing. Renumber “Other” code to 1011.” to reflect the correct changes to the renumbering. The exposed changes to the instructions and illustration are correct.

19

Attachment HH

2020-21 [Exposed changes to add a line for mortgage loans valuation allowance in the Summary Investment Schedule to correct a crosscheck to the Assets page based on the exposed item from SAPWG 2020-07]

IPs recommend changing the instructions on page 3 for ‘Line 4.0506’ to add the appropriate lines: “Sum of Lines 4.01 to 4.0405”.

2020-22 [Exposed changes to the instructions and illustration for Note 3A (Statutory Purchase Method); add a new Note 3E (Subcomponents and Calculation of Adjusted Surplus and Total Admitted Goodwill); modify the blank and instructions for Schedule D-Part 6 (Valuation of Shares of Subsidiary, Controlled or Affiliated Companies) based on the exposed item from SAPWG 2020-03 regarding enhanced goodwill disclosures]

IPs suggest the following items be changed: On Pages 2/3, the 5th bullet states “Total admitted goodwill as of the reporting date” but the

illustration does not capture a total line. If a total line is to be added, then does this amountrepresent what is reported in Column 6?

On Pages 2/3, the 6th bullet point should be revised to be consistent with the description ofadmitted goodwill and include clarifying language on how Column 9 is calculated: SCAadmitted goodwill as a percentage of the SCA’s book adjusted carrying value (gross ofadmitted goodwill), which is calculated by dividing Column 6 by column 8.

On Page 3, the header for Column 6 in the illustration needs to add “SCA” at the beginningof the description to be consistent with the instructions.

On Page 4, the formula on Line (5) should be ‘(Line 1-2-3-4)’ to be consistent with thepresentation of lines 1-4.

On Page 7, change the description in Column 4 of Schedule D – Part 6 – Section 2 toinclude ‘Amount of’, which is struck through, to be consistent with the instructions.

2020-23 [Exposed changes to add a footnote to Exhibit 5-Life/Fraternal and Health (Life Supplement) (Aggregate Reserve for Life Contracts) and Exhibit 3-Separate Account (Aggregate Reserve for Life, Annuity and Accident and Health Contracts) based on the item adopted from SAPWG 2019-08 for updating reporting on deposit-type contracts]

IPs recommend the following changes to the Exhibit 5 footnote:

Revise the footnote for clarity as follows: (a) Included in the above table are amounts on deposit-type contracts that originally contained a mortality risk. Amounts on deposit-type contracts in Column 2 that no longer contain a mortality risk are $__________ (Life Insurance), $__________ (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives), $__________ (Miscellaneous Reserves).

Add the following to the instructions for the Exhibit 5 footnote: Deposit-type contracts such as GICs and supplemental contracts are generally reported in Exhibit 7 – Deposit Type Contracts. However, certain contracts (which have similar characteristics to deposit-type contracts) incorporate mortality risk components which qualify those contracts to be reported in Exhibit 5 – Aggregate Reserve for Life Contracts. A common example is a supplemental contract which provides for a life-contingent payout with a specified certain period. Because the contract was life-contingent at issue, it is reported in Exhibit 5 and remains in Exhibit 5 after the death of the annuitant as remaining guaranteed payments continue to the beneficiary. Additionally, state insurance departments have the discretion to approve or require a contract to be classified as a life insurance contract. This footnote captures

20

Attachment HH

the amounts reported on Exhibit 5 for deposit-type contracts that originally contained a mortality risk, but no longer contain that risk.

IPs recommend the following changes to the Exhibit 3 footnote:

Revise the footnote for clarity and to reflect the categories in the Separate Account blank as follows: (a) Included in the above table are amounts on deposit-type contracts that originally contained a mortality risk. Amounts on deposit-type contracts in Column 2 that no longer contain a mortality risk are $__________ (Life Insurance), $__________ in Column 2 (Annuities), $__________ (Supplementary Contracts with Life Contingencies), $__________(Accidental Death Benefits), $__________(Disability – Active Lives), $__________(Disability – Disabled Lives Accident and Health Contracts), $__________ (Miscellaneous Reserves).

Add the following to the instructions for the Exhibit 3 footnote:


Tip Tipton, CPA Randy Hefel Accounting Policy Manager NAIC Liaison Thrivent SOVOS

CC: Kim Hudson, Vice-Chair, California Mary Caswell, NAIC Calvin Ferguson, NAIC Rose Albrizio, Equitable Financial Keith Bell, Travelers Connie Jasper Woodroof, Sapiens John Bauer, Prudential Financial

21

The interested parties, as noted below, for the Blanks Working Group agree with the comments contained in this letter:

Organization Name Phone Number

E-Mail Address

AEGON Arthur C.

Schneider 319-355-7974 [email protected]

Aetna Joseph A. Alfano 860-273-7199 [email protected] Allstate Insurance Group Thomas

Helsdingen 847-402-6944 [email protected]

Anthem Anne Honisch 262-523-3687 [email protected] American Council of Life Insurers (356 members)

Mike Monahan 202-624-2324 [email protected]

American Health Insurance Plans

Tom Finnell [email protected]

American Property Casualty Insurance Association

Matt Vece [email protected]

Equitable Rose Albrizio 212-314-5630 [email protected] Bankers Life and Casualty Company

James M. Crafton 317-817-3394 [email protected]

Blue Cross Blue Shield Association

Joseph Zolecki 312-297-5766 [email protected]

Brighthouse Financial Greg Hendler 980-949-3519 [email protected]

CIGNA Nancy Ruffino 860-226-4632 [email protected] CNA Jeff Alton 312-822-7901 [email protected] CUNA Mutual Insurance Society

Cami Douglas 608-231-7105 [email protected]

General Electric Company – North American Life & Health

Ann S. McAuliffe 203-357-3429 [email protected]

Genworth Patricia Merrill 804-662-2414 [email protected] Hartford Financial Services Group, Inc.

Patrick Coyne 860-297-6340 [email protected]

ING Joe Elmy 770-850-7578 [email protected] Lafayette Life Insurance Company

Lynn Laswell 513-629-1553 [email protected]

Liberty Mutual Insurance Company

Russell Carlson 617-574-6633 [email protected]

MetLife Nicole Sackedis Kolitsopoulos


Minnesota Life Insurance Company

David J. LePlavy 651-665-4122 [email protected]

22

Mortgage Insurance Companies of America

Robert Hayes [email protected]

Mutual of Omaha Insurance Company

Kurt S. Christiansen

402-351-2160 Kurt.Christiansen@MutualofOmaha. com

NAMIC Michelle Rogers [email protected] Nationwide Insurance Pamela Biesecker 614-677-1823 [email protected] Northwestern Mutual Mike Reis 414-665-3561 [email protected] Pacific Life Insurance Company

Thomas Mays 949-219-3639 [email protected]

Penn Mutual Life Insurance Company

James G. Murray 215-956-8302 [email protected]

Principal Life Insurance Company

Richard H. Wireman, II


Protective Life Corporation

Charles D. Evers, Jr.


Prudential Financial John J. Bauer 973-802-5803 [email protected] Reinsurance Association of America (36 members)

Joseph B. Sieverling


Security Mutual Life Insurance Company of New York

Kevin J. McKeown


SOVOS Randy Hefel 319-739-3528 [email protected] Sapiens Connie Jasper

Woodroof 913-788-8201 [email protected]

Thrivent Tip Tipton 612-844-7298 [email protected] TIAA-CREF Resh Reese 704-988-1351 [email protected] Torchmark Corporation Frank Svoboda 972-569-3659 [email protected] Travelers D. Keith Bell 860-277-0537 [email protected] UnitedHealthcare Sherry Gillespie 920-661-4318 [email protected] Zurich North America Richard Hauser [email protected]

23

mailto:Kurt.Christiansen@MutualofOmaha

May 5, 2020

Mr. Jacob Garn Chair Blanks (E) Working Group National Association of Insurance Commissioners

c/o

Ms. Mary Caswell Senior Manager – Data Quality National Association of Insurance Commissioners 1100 Walnut Street Suite 1500 Kansas City, Missouri 64106-2197

Mr. Calvin Ferguson Senior Insurance Reporting Analyst National Association of Insurance Commissioners 1100 Walnut Street Suite 1500 Kansas City, Missouri 64106-2197

Re: 2020-12BWG – Certification of Continuing Education by “Appointed Actuaries”

Dear Mr. Garn:

We hope you are well.

On behalf of the American Academy of Actuaries (the “Academy”), we write concerning the January 28 Blanks (E) Working Group proposal regarding certification of continuing education (“CE”) compliance by “Appointed Actuaries” who sign statements of actuarial opinion for property and casualty insurers. As we read the proposal, such “Appointed Actuaries” would certify compliance with CE requirements through either the Casualty Actuary Society (“CAS”) or the Society of Actuaries (“SOA”). We believe that this proposal needlessly compounds the complexity the 2019 revisions of the statutory statement instructions created. The Academy,

Attachment HH

24

which promulgates the specific CE requirements included in the U.S. Qualification Standards (“USQS”) for actuaries practicing in the United States and is the sole organization dedicated only to the U.S. profession, has an essential perspective for the Working Group to consider.

Our views fall into two different categories. First, the Blanks proposal presents a fundamental question of efficacy. We do not believe that the proposal will achieve National Association of Insurance Commissioners’ (“NAIC’s”) aims as we understand them. Second, notwithstanding its inability to meet NAIC’s goals, should NAIC nonetheless adopt the Blanks proposal, the Academy is far more suited to serve as the organization collecting CE certifications than either CAS or SOA. We address each separately.

The Ability of the Blanks Proposal to Meet NAIC’s Aims

At the outset, the Blanks proposal is unnecessary. “Appointed Actuaries” for property and casualty insurers already effectively certify their compliance with CE requirements under NAIC’s existing instructions for statements of opinion. Under those instructions, an actuary may be an “Appointed Actuary” only if he or she is a “Qualified Actuary.” An actuary is a “Qualified Actuary” only if he or she satisfies the USQS, which necessarily means fulfilling the CE requirement. Indeed, the existing instructions for annual statements for property and casualty insurers require the “Appointed Actuary” to specify how he or she qualifies under the USQS. The 2019 Regulatory Guidance could hardly be clearer. It directs that “Appointed Actuar[ies] should provide” the following statement:

I meet the basic education, experience and continuing education requirements of the Specific Qualification Standards for Statements of Actuarial Opinion, NAIC Property and Casualty Annual Statement, as set forth in the Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States (U.S. Qualification Standards), promulgated by the American Academy of Actuaries (Academy). (emphasis added).

That statement is to be followed by a description of how the “Appointed Actuary,” among other things, actually meets his or her CE obligations. Thus, the Blanks proposal is redundant.

That flaw aside, as we understand NAIC’s aims, CE certification is intended to be a proxy either for continuing competence or a substitute for “recertification” of basic education. CE, certified or not, is neither and is not intended to be.

The USQS set forth general and specific qualification standards for actuaries signing statements of opinion. While both the general and specific qualification standards contain basic education and continuing education requirements, the latter is not a repeat of the basic education. “Basic education” is just what it says – the foundational educational attainments that the profession has long treated as necessary for actuarial practice. Under the USQS, basic education serves essentially the same function as a degree in other learned professions, such as law and medicine. No profession asks of its practitioners that they periodically “recertify” their basic educational attainment. Some have attempted to implement “recertification” programs with advanced professional credentials. For example, certain medical boards that certify doctors in various

Attachment HH

25

specialties have instituted “recertification” procedures. These efforts have had mixed results at best and have spawned a great deal of antitrust litigation. We doubt that is the model that best serves NAIC’s intent.

To the extent that the Blanks Working Group or NAIC more generally views CE as a proxy for continuing competence, that view misapprehends its purpose. While continuing education is valuable and important in determining who is qualified to carry out an actuarial assignment, its aim is to assist the actuary in maintaining “current knowledge of applicable standards and principles in the area of actuarial practice of the Statement of Actuarial Opinion.” USQS § 3.3. CE can help give an actuary tools to carry out assignments, but treating it as a proxy for competence on any particular assignment puts a burden upon it that it simply cannot bear. In other words, a CE certification requirement cannot do what the Blanks Working Group apparently thinks it can do.

The best reassurances for regulators are services that the Academy already provides. First is the Code of Professional Conduct (the “Code”), which requires actuaries subject to it to meet the requirements of the USQS. The Academy believes that virtually all actuaries adhere to the Code and practice with great skill and integrity. That belief is borne out by the relatively few complaints about actuarial work and conduct that the Actuarial Board for Counseling and Discipline (“ABCD”) receives each year. As of 2018, the Bureau of Labor Statistics estimated that there were roughly 25,000 actuarial positions in the United States. Fewer than 1/10 of one percent of those actuaries will be subject to a complaint warranting the ABCD’s investigation in any particular year.

Second is the Academy’s disciplinary process, which investigates claims of violations of the Code. Actuaries are self-regulating. The Academy has taken the lead not only to promulgate the Code but to establish a mechanism for its enforcement. That process has been remarkably successful in addressing Code violations and taking appropriate action against actuaries who fail to carry out their professional responsibilities. Serious violations are made public by the Academy, and the reputational effects of being found to have violated the Code serve as a significant deterrent to bad practices.

Finally, for truly egregious conduct and personal injury redress, the law of each state itself provides remedies to those harmed by actuarial misfeasance or malfeasance, which adds yet another substantial layer of deterrence to incompetent actuarial practice.

In sum, the CE certification requirement in the Blanks proposal is likely an empty gesture. It cannot achieve its aims and is far less efficacious than existing tools that the Academy already has in place to protect the public. We believe that NAIC would be better served by working with the Academy to address its concerns and to look to the Academy to implement procedures that are far more suited to its goals. We would be happy to discuss those with you.

The Organization Receiving Certification of Continuing Education Compliance

Notwithstanding what we believe are serious conceptual flaws, should NAIC proceed with the Blanks proposal, the Academy is far more suited to collect certifications from “Appointed

Attachment HH

26

Actuaries.” As the Academy’s Committee on Property and Liability Financial Reporting (“COPLFR”) noted in its March 10 letter to the Casualty Actuarial and Statistical Task Force commenting on the continuing education template (a copy of that letter is attached), we already provide a robust on-line tool for actuaries in all practice areas, whether Academy members or not, to report their continuing education. In 2018, the tool had 1,586 users who added 23,151 records; in 2019, there were 1,437 users who added 25,386 records. Thus, at best, the Blanks proposal reinvents the wheel. We will not repeat COPLFR’s March 10 comments on the CE reporting template, which expose significant difficulties with that document. Rather, we limit these comments solely to the Blanks proposal directing “Appointed Actuaries” to certify continuing education compliance to either CAS or the SOA.

At the threshold, this certification requirement makes sense only as a means of tracking whether “Appointed Actuaries” meet one of three vital aspects of the USQS. In fact, the CE requirement exists only because of the USQS. The Academy, through its Committee on Qualifications, develops the USQS, which take effect only upon approval by the Academy’s Board of Directors. The USQS, in turn, apply to actuaries practicing in the United States through the Code, which the Academy also develops and promulgates. While other actuarial organizations may adopt the Code, they rely on the Academy, which is the only national organization of the U.S. actuarial profession and the only organization focused on the needs of the American public, to maintain the Code and make any changes if necessary. In other words, the Academy has long been the leader in this area.

In addition, when an actuary violates the Code– actuaries who do not meet the USQS run afoul of Precept 21 – disciplinary proceedings begin with the ABCD, which is housed within the Academy. The ABCD investigates any alleged Code violations and, if the facts warrant, recommends discipline to each of the organizations of which the subject actuary is a member. The ABCD’s investigative and fact-finding roles in the actuarial disciplinary process are yet another reason that the Academy is the appropriate entity to receive CE certifications from “Appointed Actuaries.” In disciplinary proceedings in which an actuary’s qualifications are at issue, it is far easier for the ABCD to perform its function if the CE compliance information is already in the Academy’s possession, custody, and control. The Academy is prepared, should the NAIC adopt the certification requirement, to ensure that any compliance information that “Appointed Actuaries” send to it is available to the ABCD in any matter in which CE compliance is genuinely in issue.

The Academy also plays a central role in assessing whether certain actuaries meet the definition of “Qualified Actuary” in the NAIC’s Statement of Actuarial Opinion instructions. For those who do not obtain their basic education credentials through either CAS or SOA, the instructions create an exception for actuaries “evaluated by the Academy’s Casualty Practice Council and determined to be a Qualified Actuary for particular lines of business and business activities.”

Finally, the Blanks proposal apparently contemplates that certain “Appointed Actuaries” who are not members of the CAS or SOA will certify with one or the other organization. But, again, this

1 Precept 2 reads: “An Actuary shall perform Actuarial Services only when the Actuary is qualified to do so on the basis of basic and continuing education and experience, and only when the Actuary satisfies applicable qualification standards.”

Attachment HH

27

is a function that the Academy should perform. “Appointed Actuaries” who are neither CAS nor SOA members are far more likely to have a relationship with the Academy than any other U.S.-based organization, either (1) as an Academy member – a number of Enrolled Actuaries, for example, are Academy members even if they are not members of any other U.S.-based organization; or (2) as a foreign actuary practicing in the U.S. subject to the Code and the Academy’s disciplinary processes through a Cross-Border Discipline Agreement.

Actuarial qualification has long been a principal concern for the Academy. The NAIC has not only recognized the Academy’s role in that area but also assigned specific qualification evaluation and approval responsibilities to an Academy practice council. Accordingly, to the extent that the NAIC adopts any CE certification requirement for “Appointed Actuaries,” the Academy, not the CAS or SOA, should be the organization receiving the certification. We would perform this service subject to appropriate terms and conditions for “Appointed Actuaries” – for example, we would obtain consent to provide certifications to the NAIC. While we could make no representation or warranty about the competence of, or quality of work performed by, any “Appointed Actuary,” we would work with you to design the CE certification process to meet NAIC’s goals.

We appreciate your consideration and attention to this matter.

Yours truly,

D. Joeff Williams,MAAA, FSA

President American Academy of Actuaries

Thomas Campbell, MAAA, FSA, CERA President-Elect American Academy of Actuaries

Shawna Ackerman, MAAA, FCAS Immediate Past President American Academy of Actuaries

Attachment: COPFLR March 10, 2020 Letter

cc: Andrew Beal

Attachment HH

28

March 10, 2020 COPFLR Letter

Attachment HH

29

1850 M Street NW Suite 300 Washington, DC 20036 Telephone 202 223 8196 Facsimile 202 872 1948 www.actuary.org

March10,2020

CasualtyActuarialandStatistical(C)TaskForcec/oKrisDeFrain

CAS/SOACETaskForcec/oAnnWeber

Re:AppointedActuary2020CElog

[email protected]@soa.org

DearMs.DeFrainandMs.Weber,

OnbehalfoftheCommitteeonPropertyandLiabilityFinancialReporting(COPLFR)oftheAmericanAcademyofActuaries1,IappreciatethisopportunitytoprovidequestionsandcommentsonthedraftAppointedActuary2020CELog(hereinafterreferredtoas“template”or“form”),issuedbytheNationalAssociationofInsuranceCommissioners(NAIC)forpubliccommentonFebruary7,2020.

COPLFRappreciatestheNAICCasualtyActuarialStatisticalTaskForce(CASTF)effortsinprovidingguidanceonwhatcontinuingeducation(CE)isneededtobeaQualifiedActuarysigningNAICPropertyandCasualty(P&C)StatementsofActuarialOpinions(SAOs).However,wedonotbelieveaprescriptiveformisnecessarynorisitthebestormosteffectivewaytodeterminewhetherornotanAppointedActuarymeetstheCErequirements.Inparticular,Section6.1oftheU.S.QualificationStandards(USQS)setsforthrecommendedrecordkeepingofCE.Currently,themethodofrecordkeepingisultimatelyuptotheindividualactuary.WenotethatmembersoftheAcademyhaveaccesstoanon‐linerecordkeepingtool(TRACE™)whichcanbeeasilycustomizedbyeachactuaryandisalsopre‐populatedwithmanyoftheCEandEAcreditactivitiessponsoredbytheAcademy,andotherorganizationsthatprovidetheirinformationtoTRACE,includingASPPA,CAS,CCAandSOA,facilitatingrecordingofmanyusualactuarialorganization‐sponsoredcreditentries.

Wealsodonotbelievethattheinformationprovidedinthetemplatewillbevaluableasitwilllikelybecompiledinconsistentlyand,evenifconsistentlycompiled,theresultsmaynotbeactionable.WedonotbelievetheformwillindicatewhetherachangeinCErequirementsisneeded,asCE

1TheAmericanAcademyofActuariesisa19,500memberprofessionalassociationwhosemissionistoservethepublicandtheU.S.actuarialprofession.TheAcademyassistspublicpolicymakersonalllevelsbyprovidingleadership,objectiveexpertise,andactuarialadviceonriskandfinancialsecurityissues.TheAcademyalsosetsqualification,practice,andprofessionalismstandardsforactuariesintheUnitedStates

Attachment HH

30


requirementsofeachAppointedActuaryarelikelytobedifferent,basedontheuniquecharacteristicsofthecompanyorcompaniessubjecttotheSAO.

WecontinuetoexpresstheconcernthatonlyP&Cactuaries,andeventhen,onlyP&CAppointedActuariesarerequiredtocompletethisform.ThereisnosimilarrequirementforlifeandhealthactuariesorP&CactuariesthatdonotsignSAOs.WedonotthinkthatthisCELogwilldemonstratethataP&Cactuaryis,orisnot,qualifiedtosignSAOsorcanprovethatanactuaryhasmettheCErequirementsoftheUSQS.AllexistingCEattestationsareself‐reported,justasbeingqualifiedundertheUSQSisalwaysalookinthemirrortestatthepointintimethatanactuarysignsanactuarialopinionandisamatterofprofessionaljudgmentandethicalresponsibilityundertheCodeofProfessionalConduct.

Ourmembershavealsoexpressedconcernwiththetimingofexposureoftheformforcommentsincetheactuariesimpactedareattheirbusiesttimeoftheyear,withtheNAICSAOandActuarialOpinionSummarydeadlinesonMarch1andMarch15,respectively.Inordertoensurethatcomprehensivefeedbackisreceived,theNAICmaywanttoconsiderextendingtheamountoftimethistemplateisavailableforpubliccomment.Thefollowingprovidesspecificcommentswithrespecttotheinformationcontainedinthetemplate:

1. Thenameoftheindividual’semployerandemployer’saddressdonotseemnecessarysincetheactuaryisrequiredtosatisfytheCErequirements,nothisorheremployer.WealsonotethatemploymentcanchangeoverthecourseofaCEyear.Wouldtheactuaryrecordmultipleemployersinthetemplate?Further,includingtheemployer’snameisduplicativewithcolumnH(“Isthesponsoryouremployer?”).

2. Theterm“CPD”isnotusedintheUSQS.Werecommendusingconsistentterminologyregarding“continuingeducation”or“CE”throughoutthetemplate.

3. ColumnDofthetemplatetrackstimeinminutes.Theinstructionsforthiscolumnsay,“thespreadsheetwillconvertto50‐minutehours”,howeveritdoesnotappearthatthisconversionisbeingperformedinthecurrentformatofthetemplate.

4. WerecommendthatcolumnsE(“EventType”),F(“DescriptionofEventType(if“Other”)),andI(“Organized/Other”)beconsolidatedinaccordancewiththeSection2.2.7oftheUSQSwhichstates“Continuingeducationcanbeobtainedthrougheither“organizedactivities”thatinvolveinteractionwithactuariesorotherprofessionalsworkingfordifferentorganizationsor“otheractivities”.Specifically,therequiredinformationcouldbecontainedinoneortwocolumnsthatidentifiedtheactivityas“organizedactivities”or“otheractivities”.

5. IncolumnEofthelog,thedifferencebetween“meeting”and“seminar”isnotclear.Similarly,therearemanyonlinemeetingsthatcouldbeconsideredwebinars.Giventhe“organized”componentisalreadycapturedseparately,thevalueoftheinformationcapturedinthiscolumnisnotevident.WealsoreiteratethatthewordingusedinthistemplateshouldbeinalignmentwiththatintheUSQS.Inparticular,section2.2.7states:

Attachment HH

31


““Organizedactivities”includebutarenotlimitedto,conferences,seminars,webcasts,in‐personoronlinecourses,orcommitteeworkthatisdirectlyrelevanttotheareaofpracticeofthesubjectoftheStatementofActuarialOpinion.”

Useofconsistentterminologywillavoidambiguitybetweentermslike“meeting”and“seminar”.

6. Theredoesnotappeartobeclearidentificationof“general”(inaccordancewithSection2.3oftheUSQS)or“specific”(inaccordancewithSection3.3oftheUSQS)CE.

7. Theterm“PRIMARYcoveragearea”isnewanditisnotclearhowitalignswiththeUSQSsincetheitemsinthedropdownboxincolumnK“Section3.1.1.2CPDCategorization(Primary)”donotalignwiththe5topicsidentifiedinsection3.1.1.2.Peritem2above,werecommendusingwordingthatisconsistentwiththerequirementsintheUSQS.Specifically,USQSidentifiesthefollowingtopics:(a)policyformsandcoverages,underwriting,andmarketing;(b)principlesofratemaking;(c)statutoryinsuranceaccountingandexpenseanalysis;(d)premium,loss,andexpensereserves;and(e)reinsurance.

UseofterminologythatisinconsistentwiththeUSQShastheresultofconfusingand/orpossiblyalteringandpotentiallyexpandingtheCErequirementsbeyondwhatiscurrentlyprovidedbytheUSQS.Forexample,the“Primarycoveragearea”includesbusinessskillswhichisasignificantexpansiononwhatisallowedinUSQS3.1.1.2.ItisuncleariftheintentisfortheNAICtorequireadifferentqualificationstandardfromtheUSQS.Weexpectthattheuseofadifferentstandardwouldbeofconcerntotheprofessionandshouldalsobetoanycompanyboardthatischargedwithapprovingappointedactuariesbasedoninconsistentorconfusingrequirements.

8. WefurthernotethatthewordinginthetemplateignorestherequirementfortheCEtobe“directlyrelevantto”thelistedtopics,ratherthan“in”thoselistedtopics.TheU.S.QualificationStandardsrequirementforCEinsection3.3statesasfollows:

“Ataminimum,anactuarymustcomplete15credithourspercalendaryearofcontinuingeducationthatisdirectlyrelevanttothetopicsidentifiedinSection3.1.1.Aminimumof6ofthe15hoursmustbeobtainedthroughexperiencesthatinvolveinteractionswithoutsideactuariesorotherprofessionals,suchasseminars,in‐personoronlinecourses,orcommitteeworkthatisdirectlyrelevanttothetopicsidentifiedinSection3.1.1.”

Notethatsection3.3doesnotrequiretheCEtobe“in”thosetopics.ItrequiresthatCEtobe“directlyrelevantto”thosetopics.Anexampleisinternationalaccountingrequirementsforinsurance(IFRS17).Understandinghowtheaccountingstandardwillworkisdirectlyrelevanttotheunderstandingofthefinancialstrengthofacompany’sreinsurer’sfinancialstrengthifthatreinsurerisanIFRS17filer.Inthiscase,theCEisnot“in”thetopicofiteme. reinsurance,butrather“directlyrelevantto”thetopicofiteme.reinsurance.Theproposedtemplateseemstobeignoringthis“directlyrelevant”wording.ToalignwiththeUSQS,thetemplatewouldhavetocapturethoseitemsthatare“directlyrelevantto”thetopicsidentifiedinsection3.1.1.2.

Attachment HH

32

9. Theterm“SECONDARYcoveragearea”isnew.Werecommendthatthisbedefined,anditspurposebeexplained.ItisunclearhowhavingadropdownwithlimiteddescriptionsincludedintheworksheetimprovestheCEdocumentation.Ifthe“Secondarycoveragearea”isretained,wehaveconcernsabouthowitisusedintheworksheet,namely:

a. The“secondary”columnheadingsinMthroughParenotinalignmentwithtopics(a) through(e)insection3.1.1.2.

b. Thedropdownboxesrequirechoosingthemostapplicablechoiceinthelistofcategories.InmanycasestherewillbemultipleitemsapplicabletoagivenCEsession.Thiswillleadtoanyanalysisoftheresultstobeunreliable.Thisisanissuebothwithregardtotheprimarycategoryandthesecondarycategoryascurrentlystated.

c. Eachofthesecondarycategorizationsrequirebetterdefinitiontobevaluable.Itisunclearwhatthedifferenceisbetween"reservinganalysis"and"reservingcalculations".AsessiononestimatingreservesforandpopulatingScheduleFcould"statutoryaccounting","reservingcalculations",or"reinsurancereserving".

d. ItisunclearwhattheAppointedActuaryistodoifasessioncoversmultipletopics.Forexample,ifa50‐minutesessiontouchesonASOPsfor15minutes,NAICAnnualStatementInstructionsfor10minutes,andreinsurancereservingfor25minutes,itwouldseemoverlyburdensomeifthesessionneededtobeenteredas3separatelineitems.

e. "Company‐specific"sitsunder"requirements&practicenotes".Itisunclearwhatthisismeanttocover.

Therearemanymorequestionslikethis,butingeneralthefeedbackisthattheseneedtobemuchmoreclearlydefinedorweshouldrelyonlyontheprimaryclassification.

10. WefindithelpfulwhenCElogsincludesummationstoshow(1)totalCE,(2)organizedCE,(3) specificCE,(4)professionalismCE,and(5)businessskillsCEvs.therequirements/limitsforeachofthosecategories.

11. Onthesecondtabofthefile,cellB4isnotedasbeingsection2.3oftheUSQS,butitappearstoquotesection2.2.2.

Weappreciateyourconsiderationofthesequestionsandcomments.

Sincerely,

KathleenC.Odomirok,MAAA,FCASChairperson, COPLFRAmerican Academy of Actuaries


Attachment HH

33

May 11, 2020

Mr. Jacob Garn Chair Blanks (E) Working Group National Association of Insurance Commissioners

c/o Ms. Mary Caswell Senior Manager—Data Quality National Association of Insurance Commissioners 1100 Walnut St. Suite 1500 Kansas City, MO 64106-2197

Mr. Calvin Ferguson Senior Insurance Reporting Analyst National Association of Insurance Commissioners 1100 Walnut St. Suite 1500 Kansas City, MO 64106-2197 Re: 2020 Property and Casualty Actuarial Opinion Instructions (2020-12BWG)

Dear Mr. Garn,

On behalf of the Committee on Property and Liability Financial Reporting (COPLFR) of the American Academy of Actuaries,1 I appreciate this opportunity to provide questions and comments on the draft 2020 Property and Casualty Actuarial Opinion Instructions (hereinafter referred to as “2020 Opinion” or “Instructions”), issued by the National Association of Insurance Commissioners (NAIC) for public comment on Feb. 21, 2020.

1 The American Academy of Actuaries is a 19,500-member professional association whose mission is to serve the public and the U.S. actuarial profession. For more than 50 years, the Academy has assisted public policymakers on all levels by providing leadership, objective expertise, and actuarial advice on risk and financial security issues. The Academy also sets qualification, practice, and professionalism standards for actuaries in the United States.

Attachment HH

34

COPLFR appreciates the NAIC Blanks Working Group efforts to provide guidance on the attestation requirements and type of continuing education (CE) needed to be qualified to sign NAIC Property and Casualty (P&C) Statements of Actuarial Opinions (SAOs).

Given the changes to the 2020 Opinion are confined to two paragraphs, I have included them here as reference:

If subject to the U.S. Qualification Standards, the Appointed Actuary shall annually attest to having met the continuing education requirements under Section 3 of the U.S. Qualification Standards for issuing Actuarial Opinions. As agreed with the actuarial organizations, the Casualty Actuarial Society (CAS) and Society of Actuaries (SOA) will determine the process for receiving the attestations for their respective members and make available the attestations to the public. An Appointed Actuary subject to the U.S. Qualification Standards and not a member of the CAS or SOA shall select one of the above organizations to submit their attestation.

In accordance with the CAS and SOA’s continuing education review procedures, an Appointed Actuary who is subject to the U.S. Qualification Standards and selected for review shall submit a log of their continuing education in a form determined by the CAS and SOA. The log shall include categorization of continuing education approved for use by the Casualty Actuarial and Statistical Task Force. As agreed with the actuarial organizations, the CAS and SOA will provide an annual consolidated report to the NAIC identifying the types and subject matter of continuing education being obtained by Appointed Actuaries. An Appointed Actuary subject to the U.S. Qualification Standards and not a member of the CAS or SOA shall follow the review procedures for the organization in which they submitted their attestation.

Further, for reference, I have included a snapshot of relevant definitions from the 2019 (“current”) Instructions below, which appear to remain unchanged in 2020.

Attachment HH

35

As we understand it, the proposed changes to the 2020 Instructions require Appointed Actuaries who are subject to the U.S. Qualification Standards (USQS) to:

(1) Annually attest to having met the CE requirements of the USQS based on a process setforth by the CAS and SOA, with such attestations made available by the CAS and SOAto the public; and

(2) Submit a log of their CE to the CAS or SOA in a form that includes categorizationapproved by the Casualty Actuarial and Statistical Task Force if selected for CE reviewby either the CAS or SOA, respectively.

As provided below, we have several concerns with respect to the need, accuracy, and potential misinterpretation of the proposed changes as currently set forth in the 2020 Instructions.

First, the requirement for annual attestation, to be made available to the public, is redundant and unnecessary because attestation is already required within the current Instructions in the form of:

A statement within the IDENTIFICATION paragraph of the SAO indicating the“qualifications for acting as Appointed Actuary.” This attestation is already available tothe public given that the SAO is a public document.

Qualification documentation provided to the Board of Directors describing “how thedefinition of ‘Qualified Actuary’ is met or expected to be met (in the case of continuingeducation) for that year.”

We further note that the definition of Qualified Actuary, as provided in the current Instructions, already requires adherence to the USQS, which in turn require compliance with CE.

Second, we believe that statements pertaining to agreement “with the actuarial organizations” are factually incorrect. The 2020 Instructions imply an agreement between the NAIC and “the actuarial organizations” that the CAS and SOA oversee the process for attestation and consolidated reporting of CE. However, it is important to remember that there are five U.S.-based organizations within which an Appointed Actuary could be a member in order to comply with item iii. of the definition of a Qualified Actuary according to the current Instructions.2 The 2020 Instructions imply that the three other U.S.-based organizations have agreed to the CAS/SOA process. This is factually incorrect, in particular, as the Academy was not included in this agreement.

Third, by requiring the Appointed Actuary “to attest,” the 2020 Instructions imply that the NAIC is responsible for regulating actuaries. The five U.S.-based actuarial organizations are responsible for regulating their members. These organizations require adherence to the Code of Professional Conduct, promulgated by the Academy, and the USQS, and also participate in the Actuarial Board for Counseling and Discipline (ABCD). As noted earlier, the definition of Qualified Actuary in the current Instructions requires adherence to the same.

2 Item iii. of the definition of Qualified Actuary within the current Instructions requires membership “in an actuarial organization that requires adherence to the same Code of Professional Conduct promulgated by the Academy, requires adherence to the U.S. Qualification Standards, and participates in the Actuarial Board for Counseling and Discipline when its members are practicing in the U.S.” There are five U.S.-based actuarial organizations that comply with this requirement, namely: (1) American Academy of Actuaries; (2) CAS; (3) SOA; (4) American Society of Enrolled Actuaries; and (5) Conference of Consulting Actuaries (CCA).

Attachment HH

36

Fourth, neither the CAS nor SOA has authority over nonmembers. Therefore, nonmembers are not required to comply with either the CAS or SOA CE policies or attestation requirements as set forth in the 2020 Instructions. As a result, the P&C Appointed Actuary who is a member of the CAS or SOA is required to comply with a process that a member of another U.S.-based organization or the individual otherwise approved by the domiciliary commissioner is not. We further note that the P&C Appointed Actuary is being held to a different standard than Life & Health Appointed Actuaries and/or non-Appointed Actuaries. As reference, there are fewer than 500 P&C Appointed Actuaries compared to nearly 20,000 members of the Academy and over 8,000 and 30,000 members of the CAS and SOA, respectively.

Finally, with respect to the CE log, we reiterate our concerns regarding the proposed form and categorization, as documented in our March 10, 2020, comment letter (attached). We further find the phrase “selected for review” in the 2020 Instructions confusing, as it suggests that only those Appointed Actuaries “selected for review” will be required to submit the log. Regardless, we do not see the value of consolidating the CE information for reporting, whether it contains information from 1% or 100% of the fewer than 500 P&C Appointed Actuaries.

We appreciate your consideration of these questions and comments.

Sincerely,

Kathleen C. Odomirok, MAAA, FCAS Chairperson, COPLFR American Academy of Actuaries

attachment

cc: Kris DeFrain


Attachment HH

37


March10,2020

CasualtyActuarialandStatistical(C)TaskForcec/oKrisDeFrain

CAS/SOACETaskForcec/oAnnWeber

Re:AppointedActuary2020CElog

[email protected]@soa.org

DearMs.DeFrainandMs.Weber,

OnbehalfoftheCommitteeonPropertyandLiabilityFinancialReporting(COPLFR)oftheAmericanAcademyofActuaries1,IappreciatethisopportunitytoprovidequestionsandcommentsonthedraftAppointedActuary2020CELog(hereinafterreferredtoas“template”or“form”),issuedbytheNationalAssociationofInsuranceCommissioners(NAIC)forpubliccommentonFebruary7,2020.

COPLFRappreciatestheNAICCasualtyActuarialStatisticalTaskForce(CASTF)effortsinprovidingguidanceonwhatcontinuingeducation(CE)isneededtobeaQualifiedActuarysigningNAICPropertyandCasualty(P&C)StatementsofActuarialOpinions(SAOs).However,wedonotbelieveaprescriptiveformisnecessarynorisitthebestormosteffectivewaytodeterminewhetherornotanAppointedActuarymeetstheCErequirements.Inparticular,Section6.1oftheU.S.QualificationStandards(USQS)setsforthrecommendedrecordkeepingofCE.Currently,themethodofrecordkeepingisultimatelyuptotheindividualactuary.WenotethatmembersoftheAcademyhaveaccesstoanon‐linerecordkeepingtool(TRACE™)whichcanbeeasilycustomizedbyeachactuaryandisalsopre‐populatedwithmanyoftheCEandEAcreditactivitiessponsoredbytheAcademy,andotherorganizationsthatprovidetheirinformationtoTRACE,includingASPPA,CAS,CCAandSOA,facilitatingrecordingofmanyusualactuarialorganization‐sponsoredcreditentries.

Wealsodonotbelievethattheinformationprovidedinthetemplatewillbevaluableasitwilllikelybecompiledinconsistentlyand,evenifconsistentlycompiled,theresultsmaynotbeactionable.WedonotbelievetheformwillindicatewhetherachangeinCErequirementsisneeded,asCE

1TheAmericanAcademyofActuariesisa19,500memberprofessionalassociationwhosemissionistoservethepublicandtheU.S.actuarialprofession.TheAcademyassistspublicpolicymakersonalllevelsbyprovidingleadership,objectiveexpertise,andactuarialadviceonriskandfinancialsecurityissues.TheAcademyalsosetsqualification,practice,andprofessionalismstandardsforactuariesintheUnitedStates

Attachment HH

38


requirementsofeachAppointedActuaryarelikelytobedifferent,basedontheuniquecharacteristicsofthecompanyorcompaniessubjecttotheSAO.

WecontinuetoexpresstheconcernthatonlyP&Cactuaries,andeventhen,onlyP&CAppointedActuariesarerequiredtocompletethisform.ThereisnosimilarrequirementforlifeandhealthactuariesorP&CactuariesthatdonotsignSAOs.WedonotthinkthatthisCELogwilldemonstratethataP&Cactuaryis,orisnot,qualifiedtosignSAOsorcanprovethatanactuaryhasmettheCErequirementsoftheUSQS.AllexistingCEattestationsareself‐reported,justasbeingqualifiedundertheUSQSisalwaysalookinthemirrortestatthepointintimethatanactuarysignsanactuarialopinionandisamatterofprofessionaljudgmentandethicalresponsibilityundertheCodeofProfessionalConduct.

Ourmembershavealsoexpressedconcernwiththetimingofexposureoftheformforcommentsincetheactuariesimpactedareattheirbusiesttimeoftheyear,withtheNAICSAOandActuarialOpinionSummarydeadlinesonMarch1andMarch15,respectively.Inordertoensurethatcomprehensivefeedbackisreceived,theNAICmaywanttoconsiderextendingtheamountoftimethistemplateisavailableforpubliccomment.Thefollowingprovidesspecificcommentswithrespecttotheinformationcontainedinthetemplate:

1. Thenameoftheindividual’semployerandemployer’saddressdonotseemnecessarysincetheactuaryisrequiredtosatisfytheCErequirements,nothisorheremployer.WealsonotethatemploymentcanchangeoverthecourseofaCEyear.Wouldtheactuaryrecordmultipleemployersinthetemplate?Further,includingtheemployer’snameisduplicativewithcolumnH(“Isthesponsoryouremployer?”).

2. Theterm“CPD”isnotusedintheUSQS.Werecommendusingconsistentterminologyregarding“continuingeducation”or“CE”throughoutthetemplate.

3. ColumnDofthetemplatetrackstimeinminutes.Theinstructionsforthiscolumnsay,“thespreadsheetwillconvertto50‐minutehours”,howeveritdoesnotappearthatthisconversionisbeingperformedinthecurrentformatofthetemplate.

4. WerecommendthatcolumnsE(“EventType”),F(“DescriptionofEventType(if“Other”)),andI(“Organized/Other”)beconsolidatedinaccordancewiththeSection2.2.7oftheUSQSwhichstates“Continuingeducationcanbeobtainedthrougheither“organizedactivities”thatinvolveinteractionwithactuariesorotherprofessionalsworkingfordifferentorganizationsor“otheractivities”.Specifically,therequiredinformationcouldbecontainedinoneortwocolumnsthatidentifiedtheactivityas“organizedactivities”or“otheractivities”.

5. IncolumnEofthelog,thedifferencebetween“meeting”and“seminar”isnotclear.Similarly,therearemanyonlinemeetingsthatcouldbeconsideredwebinars.Giventhe“organized”componentisalreadycapturedseparately,thevalueoftheinformationcapturedinthiscolumnisnotevident.WealsoreiteratethatthewordingusedinthistemplateshouldbeinalignmentwiththatintheUSQS.Inparticular,section2.2.7states:

Attachment HH

39


““Organizedactivities”includebutarenotlimitedto,conferences,seminars,webcasts,in‐personoronlinecourses,orcommitteeworkthatisdirectlyrelevanttotheareaofpracticeofthesubjectoftheStatementofActuarialOpinion.”

Useofconsistentterminologywillavoidambiguitybetweentermslike“meeting”and“seminar”.

6. Theredoesnotappeartobeclearidentificationof“general”(inaccordancewithSection2.3oftheUSQS)or“specific”(inaccordancewithSection3.3oftheUSQS)CE.

7. Theterm“PRIMARYcoveragearea”isnewanditisnotclearhowitalignswiththeUSQSsincetheitemsinthedropdownboxincolumnK“Section3.1.1.2CPDCategorization(Primary)”donotalignwiththe5topicsidentifiedinsection3.1.1.2.Peritem2above,werecommendusingwordingthatisconsistentwiththerequirementsintheUSQS.Specifically,USQSidentifiesthefollowingtopics:(a)policyformsandcoverages,underwriting,andmarketing;(b)principlesofratemaking;(c)statutoryinsuranceaccountingandexpenseanalysis;(d)premium,loss,andexpensereserves;and(e)reinsurance.

UseofterminologythatisinconsistentwiththeUSQShastheresultofconfusingand/orpossiblyalteringandpotentiallyexpandingtheCErequirementsbeyondwhatiscurrentlyprovidedbytheUSQS.Forexample,the“Primarycoveragearea”includesbusinessskillswhichisasignificantexpansiononwhatisallowedinUSQS3.1.1.2.ItisuncleariftheintentisfortheNAICtorequireadifferentqualificationstandardfromtheUSQS.Weexpectthattheuseofadifferentstandardwouldbeofconcerntotheprofessionandshouldalsobetoanycompanyboardthatischargedwithapprovingappointedactuariesbasedoninconsistentorconfusingrequirements.

8. WefurthernotethatthewordinginthetemplateignorestherequirementfortheCEtobe“directlyrelevantto”thelistedtopics,ratherthan“in”thoselistedtopics.TheU.S.QualificationStandardsrequirementforCEinsection3.3statesasfollows:

“Ataminimum,anactuarymustcomplete15credithourspercalendaryearofcontinuingeducationthatisdirectlyrelevanttothetopicsidentifiedinSection3.1.1.Aminimumof6ofthe15hoursmustbeobtainedthroughexperiencesthatinvolveinteractionswithoutsideactuariesorotherprofessionals,suchasseminars,in‐personoronlinecourses,orcommitteeworkthatisdirectlyrelevanttothetopicsidentifiedinSection3.1.1.”

Notethatsection3.3doesnotrequiretheCEtobe“in”thosetopics.ItrequiresthatCEtobe“directlyrelevantto”thosetopics.Anexampleisinternationalaccountingrequirementsforinsurance(IFRS17).Understandinghowtheaccountingstandardwillworkisdirectlyrelevanttotheunderstandingofthefinancialstrengthofacompany’sreinsurer’sfinancialstrengthifthatreinsurerisanIFRS17filer.Inthiscase,theCEisnot“in”thetopicofiteme. reinsurance,butrather“directlyrelevantto”thetopicofiteme.reinsurance.Theproposedtemplateseemstobeignoringthis“directlyrelevant”wording.ToalignwiththeUSQS,thetemplatewouldhavetocapturethoseitemsthatare“directlyrelevantto”thetopicsidentifiedinsection3.1.1.2.

Attachment HH

40

9. Theterm“SECONDARYcoveragearea”isnew.Werecommendthatthisbedefined,anditspurposebeexplained.ItisunclearhowhavingadropdownwithlimiteddescriptionsincludedintheworksheetimprovestheCEdocumentation.Ifthe“Secondarycoveragearea”isretained,wehaveconcernsabouthowitisusedintheworksheet,namely:

a. The“secondary”columnheadingsinMthroughParenotinalignmentwithtopics(a) through(e)insection3.1.1.2.

b. Thedropdownboxesrequirechoosingthemostapplicablechoiceinthelistofcategories.InmanycasestherewillbemultipleitemsapplicabletoagivenCEsession.Thiswillleadtoanyanalysisoftheresultstobeunreliable.Thisisanissuebothwithregardtotheprimarycategoryandthesecondarycategoryascurrentlystated.

c. Eachofthesecondarycategorizationsrequirebetterdefinitiontobevaluable.Itisunclearwhatthedifferenceisbetween"reservinganalysis"and"reservingcalculations".AsessiononestimatingreservesforandpopulatingScheduleFcould"statutoryaccounting","reservingcalculations",or"reinsurancereserving".

d. ItisunclearwhattheAppointedActuaryistodoifasessioncoversmultipletopics.Forexample,ifa50‐minutesessiontouchesonASOPsfor15minutes,NAICAnnualStatementInstructionsfor10minutes,andreinsurancereservingfor25minutes,itwouldseemoverlyburdensomeifthesessionneededtobeenteredas3separatelineitems.

e. "Company‐specific"sitsunder"requirements&practicenotes".Itisunclearwhatthisismeanttocover.

Therearemanymorequestionslikethis,butingeneralthefeedbackisthattheseneedtobemuchmoreclearlydefinedorweshouldrelyonlyontheprimaryclassification.

10. WefindithelpfulwhenCElogsincludesummationstoshow(1)totalCE,(2)organizedCE,(3) specificCE,(4)professionalismCE,and(5)businessskillsCEvs.therequirements/limitsforeachofthosecategories.

11. Onthesecondtabofthefile,cellB4isnotedasbeingsection2.3oftheUSQS,butitappearstoquotesection2.2.2.

Weappreciateyourconsiderationofthesequestionsandcomments.

Sincerely,

KathleenC.Odomirok,MAAA,FCASChairperson, COPLFRAmerican Academy of Actuaries


Attachment HH

41

blanks (e) working groupcontent.naic.org/sites/default/files/call_materials/bwg 5.28.2020...

Documents