attachment 5 capital adequacy (e) task force · on behalf of: life risk-based capital (e) working...
TRANSCRIPT
¤2019 National Association of Insurance Commissioners
Capital Adequacy (E) Task Force RBC Proposal Form
[ ] Capital Adequacy (E) Task Force [ ] Health RBC (E) Working Group [ X ] Life RBC (E) Working Group [ ] Catastrophe Risk (E) Subgroup [ ] Investment RBC (E) Working Group [ ] Operational Risk (E) Subgroup [ ] C3 Phase II/ AG43 (E/A) Subgroup [ ] P/C RBC (E) Working Group [ ] Longevity Risk (A/E) Subgroup
DATE: 12/11/18
CONTACT PERSON: Dave Fleming
TELEPHONE: 816-783-8121
EMAIL ADDRESS: [email protected]
ON BEHALF OF: Life Risk-Based Capital (E) Working Group
NAME: Philip Barlow, Chair
TITLE: Associate Commissioner for Insurance
AFFILIATION: District of Columbia
ADDRESS: 1050 First Street, NE Suite 801
Washington, DC 20002
FOR NAIC USE ONLY
Agenda Item # 2018-18-L
Year 2019
DISPOSITION
[ ] ADOPTED
[ ] REJECTED
[ ] DEFERRED TO
[ ] REFERRED TO OTHER NAIC GROUP
[ ] EXPOSED
[ ] OTHER (SPECIFY)
IDENTIFICATION OF SOURCE AND FORM(S)/INSTRUCTIONS TO BE CHANGED
[ ] Health RBC Blanks [ ] Property/Casualty RBC Blanks [ X ] Life RBC Instructions
[ X ] Fraternal RBC Blanks [ ] Health RBC Instructions [ ] Property/Casualty RBC Instructions [ X ] Life RBC Blanks [ X ] Fraternal RBC Instructions [ ] OTHER ______________
DESCRIPTION OF CHANGE(S) Combine the RBC reporting for life and fraternal companies into one formula. The combined formula will be based on changes to the existing life blank and instructions.
REASON OR JUSTIFICATION FOR CHANGE ** The fraternal annual statement blank is being eliminated beginning with yearend 2019. The life and fraternal RBC formulas are nearly identical except for a few items which are not applicable to fraternals and references to the fraternal annual statement blank. A combined formula will eliminate the need to maintain two sets of instructions and blank pages along with reducing time spent on maintenance of tables, specs and validation rules.
Additional Staff Comments: • 02-22-19: Proposal was exposed with comments due 03-25-19 (DBF)• 04-26-19: Proposal was re-exposed with comments due 05-09-19 (DBF)
___________________________________________________________________________________________________ ** This section must be completed on all forms. Revised 6-2018
Attachment 5
¤2019 National Association of Insurance Commissioners
Life / Fraternal Combination Items that are not applicable to fraternals LR017 – Off Balance Sheet and Other Items – Lines 32 and 33 LR019 – Health Premiums – Lines 10-13, 17-20, 23-27, 31, 34 and 35 LR021 – Underwriting Risk – Other – Lines 4 thru 6.2 LR024 – Health Claim Reserves – Lines 11 and 12 LR025 – Life Insurance – Lines 3, 4 and 9 thru 21 LR026 – Premium Stabilization Reserves – Lines 1 thru 6 LR032 – Capital Notes Before Limitation LR033 – Calculation of Total Adjusted Capital – Lines 10.1 thru 10.4, 13, 14 and 18 LR038 – Additional Information Required – Lines 10.11 thru 10.13 Annual Statement references that will be different from what is in the current fraternal RBC formula LR004 – Mortgages – First footnote’s reference to page 3 LR006 – Separate Accounts – Lines 10 thru 12 references to page 3 LR009 – BA Mortgages – First footnote’s reference to page 3 LR016 – Reinsurance – Lines 13 thru 16 references to page 3 LR024 – Health Claim Reserves – Lines 1 thru 6 references to Exhibit 6 LR025 – Life Insurance – Line 1 reference to Exhibit of Life Insurance LR029 – Business Risk – Lines 37 and 38 references to page 3 and line 45 reference to Exhibit 3 LR033 – Calculation of Total Adjusted Capital – Lines 1 and 2 references to page 3 LR034 – Risk-Based Capital Level of Action – Lines 1 and 4 references to 5-Year Historical LR035 – Trend Test – Lines 4 thru 7 references to 5-Year Historical LR038 – Additional Information Required – Line 7.1 and 7.2 references to 5-Year Historical and line 9.1 page 3 reference LR039 – Title of schedule will be different – Authorized Control Level instead of 50% of the Calculated RBC Amount Changes needed to the existing life RBC blank Jurat – Title to be Life and Fraternal Risk-Based Capital, remove “life” from Risk-Based Capital for contact person LR019 – Line 34 reference to Exhibit 6 changed to column 10 LR024 – Lines 1 and 11 changed to company records, lines 2-6 and 12 to be blank or zero-filled LR026 – Lines 3 and 4 changed to company records LR030 – Title to be Calculation of Tax Effect for Life and Fraternal Risk-Based Capital LR031 – Calculation of Authorized Control Level Risk-Based Capital – Lines 10, 19, 41, 48, 51, 54, 57, 62 and 65 references to LR030 to include title change reflecting and Fraternal LR038 – Add and Fraternal to lines 1.2 and 2.2 LR043 – Column 2 heading to be Total from Life and Fraternal Risk-Based Capital Report
Attachment 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
Aff
ix B
ar C
ode
Her
e
T
Tife
an
at
ena
l is
kas
e
apita
l o
the
ea
nin
g e
ebe
(A)
Com
pany
Nam
e
(B)
NA
IC G
roup
Cod
e(C
) N
AIC
Com
pany
Cod
e(D
) Em
ploy
er's
ID N
umbe
r
(E)
Org
aniz
ed u
nder
the
Law
s of t
he S
tate
of
Con
tact
Per
son
for L
ife R
isk-
Bas
ed C
apita
l:
(F)
Firs
t Nam
e(G
)M
iddl
e(H
) L
ast N
ame
(I)
Mai
l Add
ress
of C
onta
ct P
erso
n(S
treet
and
Num
ber o
r P.O
. Box
)
(J)
City
(K)
Stat
e(L
)Zi
p
(M)
Phon
e N
umbe
r of R
BC
Con
tact
Per
son
Exte
nsio
n
(N)
E-m
ail A
ddre
ss o
f RB
C C
onta
ct P
erso
n
(O)
Dat
e Pr
epar
ed
(P)
Prep
arer
(if d
iffer
ent t
han
Con
tact
)Fi
rst N
ame
Mid
dle
Las
t Nam
e(
)Is
this
filin
g an
Orig
inal
, Am
ende
d or
R
efili
ng?
(1)
If
Am
ende
d, A
men
dmen
t Num
ber:
(R)
Wer
e an
y ite
ms t
hat c
ome
dire
ctly
from
the
annu
al st
atem
ent e
nter
ed m
anua
llyfo
r thi
s fili
ng?
(Yes
or N
o)
Off
icer
s Nam
e:
Off
icer
s Titl
e:
Each
says
that
they
are
the
abov
e de
scrib
ed o
ffic
ers o
f the
said
insu
rer,
and
that
this
risk
-bas
ed c
apita
l rep
ort i
s a tr
ue a
nd fa
ir re
pres
enta
tion
of th
e co
mpa
ny’s
aff
airs
and
has
bee
n co
mpl
eted
in a
ccor
danc
e w
ith th
e N
AIC
inst
ruct
ions
ac
cord
ing
to th
e be
st o
f the
ir in
form
atio
n, k
now
ledg
e an
d be
lief,
resp
ectiv
ely.
(Sig
natu
re)
(Sig
natu
re)
(Sig
natu
re)
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR00
1
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
(1)
(2)
(3)
(4)
(5)
(6)
Invo
lunt
ary
Boo
k / A
djus
ted
Res
erve
Cum
ulat
ive
Ave
rage
RB
CA
nnua
l Sta
tem
ent S
ourc
eC
arry
ing
Val
ueA
djus
tmen
t
RB
C S
ubto
tal
Writ
edow
nsFa
ctor
Req
uire
men
tIn
Goo
d St
andi
ng(1
)R
esid
entia
l Mor
tgag
es-In
sure
d or
Gua
rant
eed
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
0X
XX
X0.
0014
=(2
)R
esid
entia
l Mor
tgag
es-A
ll O
ther
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
1X
XX
X0.
0068
=(3
)C
omm
erci
al M
ortg
ages
-Insu
red
or G
uara
ntee
dA
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
42
XX
XX
0.00
14=
(4)
Com
mer
cial
Mor
tgag
es -
All
Oth
er -
Cat
egor
y C
M1
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
3X
XX
X0.
0090
=(5
)C
omm
erci
al M
ortg
ages
- A
ll O
ther
- C
ateg
ory
CM
2A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
44
XX
XX
0.01
75=
(6)
Com
mer
cial
Mor
tgag
es -
All
Oth
er -
Cat
egor
y C
M3
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
5X
XX
X0.
0300
=(7
)C
omm
erci
al M
ortg
ages
- A
ll O
ther
- C
ateg
ory
CM
4A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
46
XX
XX
0.05
00=
(8)
Com
mer
cial
Mor
tgag
es -
All
Oth
er -
Cat
egor
y C
M5
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
7X
XX
X0.
0750
=
(9)
Tota
l Com
mer
cial
Mor
tgag
es-A
ll O
ther
Line
s (4)
+ (5
) + (6
) + (7
) + (8
)
(10)
Farm
Mor
tgag
es -
Cat
egor
y C
M1
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 3
5X
XX
X0.
0090
=(1
1)Fa
rm M
ortg
ages
- C
ateg
ory
CM
2A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
36
XX
XX
0.01
75=
(12)
Farm
Mor
tgag
es -
Cat
egor
y C
M3
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 3
7X
XX
X0.
0300
=(1
3)Fa
rm M
ortg
ages
- C
ateg
ory
CM
4A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
38
XX
XX
0.05
00=
(14)
Farm
Mor
tgag
es -
Cat
egor
y C
M5
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 3
9X
XX
X0.
0750
=
(15)
Tota
l Far
m M
ortg
ages
Line
s (10
) + (1
1) +
(12)
+ (1
3) +
(14)
90 D
ays O
verd
ue, N
ot in
Pro
cess
of F
orec
losu
re(1
6)Fa
rm M
ortg
ages
- C
ateg
ory
CM
6A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
48
X
=(1
7)R
esid
entia
l Mor
tgag
es-In
sure
d or
Gua
rant
eed
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 4
9X
=
(18)
Res
iden
tial M
ortg
ages
-All
Oth
erA
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
50
X
=(1
9)C
omm
erci
al M
ortg
ages
-Insu
red
or G
uara
ntee
dA
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
51
X
=(2
0)C
omm
erci
al M
ortg
ages
-All
Oth
er -
Cat
egor
y C
M6
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 5
2X
=
In P
roce
ss o
f For
eclo
sure
(21)
Farm
Mor
tgag
es -
Cat
egor
y C
M7
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 5
3X
=
(22)
Res
iden
tial M
ortg
ages
-Insu
red
or G
uara
ntee
dA
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
54
X
=(2
3)R
esid
entia
l Mor
tgag
es-A
ll O
ther
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 5
5X
=
(24)
Com
mer
cial
Mor
tgag
es-In
sure
d or
Gua
rant
eed
AV
R D
efau
lt C
ompo
nent
Col
umn
1 Li
ne 5
6X
=
(25)
Com
mer
cial
Mor
tgag
es-A
ll O
ther
- C
ateg
ory
CM
7A
VR
Def
ault
Com
pone
nt C
olum
n 1
Line
57
X
=D
ue a
nd U
npai
d Ta
xes
(26)
Due
and
Unp
aid
Taxe
s on
Mor
tgag
esSc
hedu
le B
Par
t 1 F
ootn
ote
#3X
1.00
0=
Ove
rdue
, Not
in P
roce
ss o
f For
eclo
sure
1st a
mou
nt(2
7)D
ue a
nd U
npai
d Ta
xes o
n Fo
recl
osed
Sche
dule
B P
art 1
Foo
tnot
e #4
X1.
000
=M
ortg
ages
1st a
mou
nt
(28)
Tota
l Mor
tgag
es (i
nclu
ding
due
and
unp
aid
taxe
s)Li
nes (
1) +
(2) +
(3) +
(9) +
(15)
plu
s the
(C
olum
n (1
) sho
uld
equa
l Pag
e 2
Col
umn
3 Li
nes 3
.1
Sum
of L
ines
(16)
thro
ugh
(27)
+ 3
.2 +
Sch
edul
e B
Par
t 1 F
ootn
ote
#3 1
st a
mou
nt
+ S
ched
ule
B P
art 1
Foo
tnot
e #4
1st
am
ount
).(2
9)R
educ
tion
in R
BC
for M
OD
CO
/Fun
ds W
ithhe
ld
Rei
nsur
ance
Ced
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(3
0)In
crea
se in
RB
C fo
r MO
DC
O/F
unds
With
held
R
eins
uran
ce A
ssum
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(3
1)To
tal M
ortg
ages
(in
clud
ing
MO
DC
O/F
unds
With
held
.)Li
nes (
28) -
(29)
+ (3
0)
Invo
lunt
ary
rese
rves
are
rese
rves
that
are
hel
d as
an
offs
et to
a p
artic
ular
ass
et th
at is
cle
arly
a tr
oubl
ed a
sset
and
are
incl
uded
on
Page
3 L
ine
25 o
f the
Ann
ual S
tate
men
t.C
umul
ativ
e w
rited
owns
incl
ude
the
tota
l am
ount
of w
rited
owns
, non
-adm
issi
ons,
and
invo
lunt
ary
rese
rves
that
hav
e be
en ta
ken
or e
stab
lishe
d w
ith re
spec
t to
a pa
rticu
lar m
ortg
age.
For L
ines
(16)
thro
ugh
(20)
and
Lin
es (2
1) th
roug
h (2
5), C
olum
n (5
) is c
alcu
late
d as
Col
umn
(6) d
ivid
ed b
y C
olum
n (3
).
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR00
4
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
(1)
(2)
(3)
Boo
k / A
djus
ted
Fact
orR
BC
Ann
ual S
tate
men
t Sou
rce
Car
ryin
g V
alue
or C
alc
Req
uire
men
tSe
para
te A
ccou
nts w
ith G
uara
ntee
s(1
)G
uara
ntee
d In
dexe
dPa
ge 2
Col
umn
3 Li
ne 2
7 in
par
t*
(2)
Non
-Ind
exed
, Res
erve
d at
Boo
k V
alue
Com
pany
reco
rds
RB
C x
1.0
00(3
)N
on-I
ndex
ed, R
eser
ved
at F
air V
alue
Com
pany
reco
rds
RB
C x
1.0
00(le
ss "h
airc
ut")
(4)
Tota
l Ass
ets i
n Se
para
te A
ccou
nts w
ith G
uara
ntee
sLi
nes (
1) +
(2) +
(3)
(pre
-MO
DC
O/F
unds
With
held
)(5
)R
educ
tion
in R
BC
for M
OD
CO
/Fun
ds W
ithhe
ld
Rei
nsur
ance
Ced
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(6
)In
crea
se in
RB
C fo
r MO
DC
O/F
unds
With
held
R
eins
uran
ce A
ssum
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(7
)To
tal A
sset
s in
Sepa
rate
Acc
ount
s with
Gua
rant
ees
(incl
udin
g M
OD
CO
/Fun
ds W
ithhe
ld.)
Line
s (4)
- (5
) + (6
)
Synt
hetic
GIC
's(8
)Sy
nthe
tic G
IC's
C-1
Req
uire
men
tC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)R
BC
x 1
.000
(less
"hai
rcut
")Su
rplu
s in
Non
-Gua
rant
eed
Sepa
rate
Acc
ount
s(9
)A
sset
s in
Sepa
rate
Acc
ount
sPa
ge 2
Col
umn
3 Li
ne 2
7 in
par
tX
0.11
0=
(10)
Less
Lia
bilit
ies i
n Se
para
te A
ccou
nts
Page
3 C
olum
n 1
Line
27
in p
art
X0.
110
=(1
1)Ex
pens
e A
llow
ance
Tra
nsfe
rs -
All
Oth
erPa
ge 3
Col
umn
1 Li
ne 1
3 in
par
tX
0.11
0=
(12)
Expe
nse
Allo
wan
ce T
rans
fers
- Su
rren
der C
harg
e B
ased
Page
3 C
olum
n 1
Line
13
in p
art
X0.
024
=on
Fun
d C
ontri
butio
n an
d th
e Fu
nd B
alan
ce E
xcee
dsth
e Su
m o
f the
Pre
miu
ms L
ess W
ithdr
awal
s(1
3)To
tal S
urpl
us in
Non
-Gua
rant
eed
Sepa
rate
Acc
ount
sLi
nes (
9) -
(10)
+ (1
1) +
(12)
(14)
Tota
l Sep
arat
e A
ccou
nts A
sset
sLi
nes (
4) +
(9)
(Col
umn
(1) s
houl
d eq
ual P
age
2 C
olum
n 3
Line
27)
The
amou
nt re
porte
d in
Col
umn
(3) s
houl
d no
t be
less
than
zer
o.Th
e ex
pens
e al
low
ance
tran
sfer
s for
Lin
es (1
1) a
nd (1
2) sh
ould
be
ente
red
as a
pos
itive
val
ue in
Col
umn
(1).
If C
olum
n (1
) is n
ot e
qual
to z
ero,
Col
umn
(2) i
s cal
cula
ted
as C
olum
n (3
) div
ided
by
Col
umn
(1).
*C
olum
n (3
) is c
alcu
late
d ac
cord
ing
to th
e ris
k-ba
sed
capi
tal i
nstru
ctio
ns.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR00
6
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
(1)
(2)
(3)
(4)
(5)
(6)
Invo
lunt
ary
Boo
k / A
djus
ted
Res
erve
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ulat
ive
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rage
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nnua
l Sta
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alue
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ubto
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orR
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rem
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VR
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ity C
ompo
nent
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1 Li
ne 4
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45
XX
XX
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14=
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Una
ffilia
ted
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tgag
es w
ith C
oven
ants
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R E
quity
Com
pone
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olum
n 1
Line
57
XX
XX
*=
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Una
ffilia
ted
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ease
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ith G
over
nmen
t Sec
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ity C
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umn
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ne 5
8X
XX
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0090
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naffi
liate
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enio
rA
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ity C
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nent
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umn
1 Li
ne 5
9X
XX
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0175
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naffi
liate
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ortg
ages
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ll O
ther
AV
R E
quity
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pone
nt C
olum
n 1
Line
60
XX
XX
0.03
00=
(6)
Affi
liate
d M
ortg
ages
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ateg
ory
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Equ
ity C
ompo
nent
Col
umn
1 Li
ne 3
8X
XX
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0090
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ffilia
ted
Mor
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es -
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egor
y C
M2
AV
R E
quity
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pone
nt C
olum
n 1
Line
39
XX
XX
0.01
75=
(8)
Affi
liate
d M
ortg
ages
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ateg
ory
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VR
Equ
ity C
ompo
nent
Col
umn
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ne 4
0X
XX
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ffilia
ted
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egor
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M4
AV
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quity
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pone
nt C
olum
n 1
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41
XX
XX
0.05
00=
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Affi
liate
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ortg
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ateg
ory
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5A
VR
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ity C
ompo
nent
Col
umn
1 Li
ne 4
2X
XX
X0.
0750
=
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l In
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andi
ngSu
m o
f Lin
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ough
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ays O
verd
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cess
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uara
ntee
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rdue
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pone
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olum
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47
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ne 4
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ther
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ll O
ther
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ffilia
ted
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quity
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pone
nt C
olum
n 1
Line
48
+ Li
ne 5
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=
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Tota
l 90
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s Ove
rdue
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in P
roce
ss o
f For
eclo
sure
Line
s (12
) + (1
3) +
(14)
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roce
ss o
f For
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Insu
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uara
ntee
d in
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cess
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losu
reA
VR
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ity C
ompo
nent
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umn
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ne 5
2 +
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54
X=
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er in
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cess
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orec
losu
re -
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ffilia
ted
AV
R E
quity
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pone
nt C
olum
n 1
Line
62
X=
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er in
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cess
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orec
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re -
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liate
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VR
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ity C
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nent
Col
umn
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ne 5
3 +
Line
55
X=
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l In
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ess o
f For
eclo
sure
Line
s (16
) + (1
7) +
(18)
(20)
Tota
l Sch
edul
e B
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ortg
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ance
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nter
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tal S
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Mor
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es(in
clud
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unds
With
held
.)Li
nes (
20) -
(21)
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lunt
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that
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hel
d as
an
offs
et to
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artic
ular
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et th
at is
cle
arly
a tr
oubl
ed a
sset
and
are
incl
uded
on
Page
3 L
ine
25 o
f the
Ann
ual S
tate
men
t.C
umul
ativ
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rited
owns
incl
ude
the
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l am
ount
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rited
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volu
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serv
es th
at h
ave
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take
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est
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ect t
o a
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This
will
be
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ssoc
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ith th
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tego
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eter
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ed in
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orks
heet
.Fo
r Lin
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2) th
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4) a
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ines
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thro
ugh
(18)
, Col
umn
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s cal
cula
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ided
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umn
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otes
item
s tha
t mus
t be
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ually
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ered
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e.
LR00
9
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ent 5
Com
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ffili
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119
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0078
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t 2 C
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229
9999
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0078
=(3
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npai
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t 2 C
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119
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0078
=(4
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ecov
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npai
d Lo
sses
(A&
H)
Sche
dule
S P
art 2
Col
umn
7 Li
ne 2
2999
99X
0.00
78=
(5)
Une
arne
d Pr
emiu
ms (
A&
H)
Sche
dule
S P
art 3
Sec
tion
2 C
olum
n 9
Line
349
9999
X0.
0078
=(6
)O
ther
Res
erve
Cre
dits
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H)
Sche
dule
S P
art 3
Sec
tion
2 C
olum
n 10
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e 34
9999
9X
0.00
78=
(7)
Res
erve
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dit (
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hedu
le S
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t 3 S
ectio
n 1
Col
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ne 3
4999
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78=
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wne
dR
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Stat
emen
t Val
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ffili
ates
RB
C S
ubto
tal
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orR
equi
rem
ent
Rei
nsur
ance
Ass
umed
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dit
(8)
Aff
iliat
e R
eser
ve C
redi
t (Li
fe)
Sche
dule
S P
art 1
Sec
tion
1 C
olum
n 9
Line
079
9999
X-0
.007
8=
(9)
Aff
iliat
e R
eins
uran
ce P
ayab
le (L
ife)
Sche
dule
S P
art 1
Sec
tion
1 C
olum
n 11
Lin
e 07
9999
9X
-0.0
078
=(1
0)R
eins
uran
ce A
ssum
ed o
n U
near
ned
Sche
dule
S P
art 1
Sec
tion
2 C
olum
n 9
Line
X-0
.007
8=
Prem
ium
s (A
&H
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9999
9(1
1)R
eins
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ce A
ssum
ed O
ther
Res
erve
dSc
hedu
le S
Par
t 1 S
ectio
n 2
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umn
10 L
ine
X-0
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8=
Cre
dits
(A&
H)
0799
999
(12)
Rei
nsur
ance
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umed
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sses
Sche
dule
S P
art 1
Sec
tion
2 C
olum
n 11
Lin
eX
-0.0
078
=(A
&H
)07
9999
9
Rei
nsur
ance
Pay
able
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dit
(13)
Rei
nsur
ance
in U
naut
horiz
edPa
ge 3
Col
umn
1 Li
ne 2
4.02
X-0
.007
8=
and
Cer
tifie
d Co
mpa
nies
(14)
Fund
s Hel
d in
Una
utho
rized
Page
3 C
olum
n 1
Line
24.
03X
-0.0
078
=an
d C
ertif
ied
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nsur
ers
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Fund
s Hel
d in
Aut
horiz
ed R
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sPa
ge 3
Col
umn
1 Li
ne 2
5 in
par
t and
Com
pany
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8=
and
Trus
teed
Col
late
ral S
uppo
rting
R
ecor
dsA
utho
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nsur
ance
(16)
Oth
er R
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ce R
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ves "
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stab
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n Pa
ge 3
Page
3 C
olum
n 1
Line
25
in p
art
X-0
.007
8=
(17)
Tota
l Rei
nsur
ance
Sum
of L
ines
(1) t
hrou
gh (1
6)
St
atem
ent v
alue
s sho
uld
be n
et o
f pol
icy
loan
s if p
olic
y lo
ans a
re p
art o
f the
rein
sura
nce
trans
actio
n.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR01
6
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
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T T
(1
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ss N
onco
ntro
lled
Ass
ets F
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ngG
uara
ntee
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para
te A
ccou
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o
Ann
ual S
tate
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t Sou
rce
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GIC
's an
d C
erta
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abili
ties
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otal
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orR
equi
rem
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pons
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onco
ntro
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ets
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ed to
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form
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ritie
s G
ener
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terr
ogat
orie
s Par
t 1 L
ine
24.0
5X
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20=
Lend
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Prog
ram
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Loan
ed to
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Sec
uriti
es L
endi
ng
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 24
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X0.
0126
=Pr
ogra
ms -
Oth
er(3
)Su
bjec
t to
Rep
urch
ase
Agr
eem
ents
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 25
.21
X0.
0126
=(4
)Su
bjec
t to
Rev
erse
Rep
urch
ase
Agr
eem
ents
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 25
.22
X0.
0126
=(5
)Su
bjec
t to
Dol
lar R
epur
chas
e A
gree
men
tsG
ener
al In
terr
ogat
orie
s Par
t 1 L
ine
25.2
3X
0.01
26=
(6)
Subj
ect t
o R
ever
se D
olla
r Rep
urch
ase
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 25
.24
X0.
0126
=A
gree
men
ts(7
)Pl
aced
Und
er O
ptio
n A
gree
men
tsG
ener
al In
terr
ogat
orie
s Par
t 1 L
ine
25.2
5X
0.01
26=
(8)
Lette
r Sto
ck o
r Oth
er S
ecur
ities
Res
trict
ed a
s to
sale
- ex
clud
ing
FHLB
Cap
ital S
tock
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 25
.26
X0.
0126
=(9
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LB C
apita
l Sto
ckG
ener
al In
terr
ogat
orie
s Par
t 1 L
ine
25.2
7X
0.01
26=
(10)
On
Dep
osit
with
Sta
tes
Gen
eral
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rrog
ator
ies P
art 1
Lin
e 25
.28
X0.
0126
=(1
1)O
n D
epos
it w
ith O
ther
Reg
ulat
ory
Bod
ies
Gen
eral
Inte
rrog
ator
ies P
art 1
Lin
e 25
.29
X0.
0126
=(1
2.1)
Pled
ged
as C
olla
tera
l - e
xclu
ding
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late
ral P
ledg
ed to
an
FHLB
G
ener
al In
terr
ogat
orie
s Par
t 1 L
ine
25.3
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2.2)
Less
Der
ivat
ive
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late
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ledg
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hedu
le D
B P
art D
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tion
2 C
olum
n 7,
Lin
e 01
9999
9X
0.00
39=
(12.
3)Pl
edge
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late
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exc
ludi
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to a
n FH
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ess D
eriv
ativ
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olla
tera
l Ple
dged
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1) -
(12.
2)X
0.01
26=
(13)
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as C
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clud
ing
Ass
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acki
ng F
undi
ng A
gree
men
tsG
ener
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terr
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s Par
t 1 L
ine
25.3
1X
#=
(14)
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erG
ener
al In
terr
ogat
orie
s Par
t 1 L
ine
25.3
2X
0.01
26=
(15)
Tota
l Non
cont
rolle
d A
sset
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m o
f Lin
es (1
) thr
ough
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s Lin
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2.2)
thro
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(14)
Der
ivat
ive
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rum
ents
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Exch
ange
Tra
ded
and
Cen
trally
Cle
ared
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
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in p
art
X0.
0039
=(1
7)O
ff-B
alan
ce S
heet
Exp
osur
e NA
IC 1
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
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in p
art
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0039
=(1
8)O
ff-B
alan
ce S
heet
Exp
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e NA
IC 2
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
999,
in p
art
X0.
0126
=(1
9)O
ff-B
alan
ce S
heet
Exp
osur
e NA
IC 3
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
999,
in p
art
X0.
0446
=(2
0)O
ff-B
alan
ce S
heet
Exp
osur
e NA
IC 4
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
999,
in p
art
X0.
0970
=(2
1)O
ff-B
alan
ce S
heet
Exp
osur
e NA
IC 5
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
0999
999,
in p
art
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2231
=(2
2)O
ff-B
alan
ce S
heet
Exp
osur
e NA
IC 6
Sche
dule
DB
Par
t D S
ectio
n 1
Col
umn
12, L
ine
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in p
art
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3000
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tal D
eriv
ativ
e In
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men
ts O
ff-B
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eet E
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ure
Sum
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ines
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thro
ugh
(22)
(24)
Gua
rant
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or A
ffili
ates
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es to
Fin
anci
al S
tate
men
ts N
umbe
r 14A
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ontin
gent
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bilit
ies
Not
es to
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anci
al S
tate
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ts N
umbe
r 14A
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26=
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Long
Ter
m L
ease
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otes
to F
inan
cial
Sta
tem
ents
Num
ber 1
5A2a
1X
0.00
00=
(27)
Tota
l Off
-Bal
ance
She
et It
ems
Line
s (15
) + (2
3) +
(24)
+ (2
5) +
(26)
(pre
-MO
DC
O/F
unds
With
held
)(2
8)R
educ
tion
in R
BC
for M
OD
CO
/Fun
ds W
ithhe
ld
Rei
nsur
ance
Ced
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(2
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crea
se in
RB
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r MO
DC
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unds
With
held
R
eins
uran
ce A
ssum
ed A
gree
men
tsC
ompa
ny R
ecor
ds (e
nter
a p
re-ta
x am
ount
)(3
0)To
tal O
ff-B
alan
ce S
heet
Item
s(in
clud
ing
MO
DC
O/F
unds
With
held
.)Li
nes (
27) -
(28)
+ (2
9)
Oth
er It
ems
(31)
Is th
e en
tity
resp
onsi
ble
for f
iling
the
U.S
. "Y
es",
"No"
or "
N/A
" in
Col
umn
(6)
Fede
ral i
ncom
e ta
x re
turn
for t
he re
porti
ng
insu
rer a
regu
late
d in
sura
nce
com
pany
?(3
2)SS
AP
No.
101
Par
agra
ph 1
1a D
efer
red
Tax
Ass
ets
Not
es to
Fin
anci
al S
tate
men
ts It
em 9
A2(
a)X
=(3
3)SS
AP
No.
101
Par
agra
ph 1
1b D
efer
red
Tax
Ass
ets
Not
es to
Fin
anci
al S
tate
men
ts It
em 9
A2(
b)X
0.01
00=
(34)
Tota
l Off
-Bal
ance
She
et a
nd O
ther
Item
sLi
ne (3
0) +
Lin
e (3
2) +
Lin
e (3
3)
If L
ine
(31)
Col
umn
(6) i
s "Y
es",
then
the
fact
or is
0.0
05. I
f Lin
e (3
1) C
olum
n (6
) is "
No"
, the
n th
e fa
ctor
is 0
.010
. If L
ine
(31)
Col
umn
(6) i
s "N
/A",
then
the
fact
or is
0.0
00.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
For C
olum
n (2
) Lin
e (1
3), i
nclu
de a
sset
s ple
dged
as c
olla
tera
l oth
er th
an a
sset
s rel
ated
to th
e Fe
dera
l Res
erve
’s T
erm
Ass
et L
oan
Faci
lity
(TA
LF).
For C
olum
n (2
) inc
lude
exc
ess a
sset
s hel
d by
a F
HLB
but
not
ass
ocia
ted
with
a F
HLB
adv
ance
(i.e
. ass
ets a
bove
the
requ
ired
colla
tera
l am
ount
and
ther
efor
e av
aila
ble
to b
e re
calle
d by
the
insu
rer)
. F
or C
olum
n (2
) als
o in
clud
e an
am
ount
equ
al to
the
less
or o
f Sta
tem
ent V
alue
of F
HLB
liab
ilitie
s sub
ject
to C
3P1
Cas
h Fl
ow T
estin
g or
5%
of t
otal
net
adm
itted
ass
ets.
In m
ost i
nsta
nces
, app
ly a
fact
or b
ased
on
the
NA
IC ra
tings
cat
egor
y eq
uiva
lent
to a
n un
secu
red
debt
obl
igat
ion
of th
e FH
LB.
A h
ighe
r fac
tor a
pplie
s if F
HLB
fund
ed a
dvan
ce li
abili
ties a
ssoc
iate
d w
ith sp
read
-lend
ing
activ
ities
exc
eed
5% o
f tot
al n
et a
dmitt
ed a
sset
s. T
his h
ighe
r fac
tor s
hall
equa
l the
fact
or
for a
Baa
cor
pora
te b
ond
asse
t fac
tor (
Line
14
Col
umn
4).
If th
e hi
gher
fact
or is
app
licab
le, t
he b
lend
ed fa
ctor
for c
olum
n 4
shal
l be
pror
ated
bas
ed o
n th
e co
llate
ral i
n co
lum
n 3
subj
ect t
o th
e ty
pica
l fac
tor (
i.e. l
iqui
dity
and
spre
ad-le
ndin
g be
low
the
limit)
and
the
high
er fa
ctor
(onl
y sp
read
-lend
ing
abov
e th
e lim
it).
LR01
7
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
(1
)(2
)St
atem
ent
RB
CA
nnua
l Sta
tem
ent S
ourc
eV
alue
Fact
orR
equi
rem
ent
Med
ical
Insu
ranc
e Pr
emiu
ms -
Indi
vidu
al M
orbi
dity
(1)
Usu
al a
nd C
usto
mar
y M
ajor
Med
ical
and
Hos
pita
lEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
XX
X(2
)M
edic
are
Supp
lem
ent
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
XX
(3)
Den
tal a
nd V
isio
nEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
XX
X(4
)St
and-
Alo
ne M
edic
are
Part
D C
over
age
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
XX
(5)
Supp
lem
enta
l ben
efits
with
in S
tand
-Alo
ne P
art D
Cov
erag
e (C
laim
s Inc
urre
d)C
ompa
ny R
ecor
dsX
0.50
0=
(6)
Med
icai
d Pa
ss-T
hrou
gh P
aym
ents
Rep
orte
d as
Pre
miu
mC
ompa
ny R
ecor
dsX
0.02
0(7
)H
ospi
tal I
ndem
nity
and
Spe
cifie
d D
isea
seEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X*
=(8
)A
D&
D (M
axim
um R
etai
ned
Ris
k Pe
r Life
)Ea
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X=
(9)
Oth
er A
ccid
ent
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.05
0=
Med
ical
Insu
ranc
e Pr
emiu
ms -
Gro
up a
nd C
redi
t Mor
bidi
ty(1
0)U
sual
and
Cus
tom
ary
Maj
or M
edic
al, H
ospi
tal
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
XX
(11)
Den
tal a
nd V
isio
nEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
XX
X(1
2)St
op L
oss a
nd M
inim
um P
rem
ium
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
=(1
3)M
edic
are
Supp
lem
ent
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
XX
(14)
Stan
d-A
lone
Med
icar
e Pa
rt D
Cov
erag
e (s
ee in
stru
ctio
ns fo
r lim
its)
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
XX
(15)
Supp
lem
enta
l ben
efits
with
in S
tand
-Alo
ne P
art D
Cov
erag
e (C
laim
s Inc
urre
d)C
ompa
ny R
ecor
dsX
0.50
0=
(16)
Med
icai
d Pa
ss-T
hrou
gh P
aym
ents
Rep
orte
d as
Pre
miu
mC
ompa
ny R
ecor
dsX
0.02
0(1
7)H
ospi
tal I
ndem
nity
and
Spe
cifie
d D
isea
seEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X*
=(1
8)A
D&
D (M
axim
um R
etai
ned
Ris
k Pe
r Life
))
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
=(1
9)O
ther
Acc
iden
tEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X0.
050
=(2
0)Fe
dera
l Em
ploy
ee H
ealth
Ben
efit
Plan
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.00
0=
Dis
abili
ty In
com
e Pr
emiu
m(2
1)N
onca
ncel
labl
e D
isab
ility
Inco
me
- Ind
ivid
ual M
orbi
dity
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
=(2
2)O
ther
Dis
abili
ty In
com
e - I
ndiv
idua
l Mor
bidi
tyEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X=
(23)
Dis
abili
ty In
com
e - C
redi
t Mon
thly
Bal
ance
Pla
nsEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X=
(24)
Dis
abili
ty In
com
e - G
roup
Lon
g-Te
rmEa
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X=
(25)
Dis
abili
ty In
com
e-C
redi
t Sin
gle
Prem
ium
with
Add
ition
al R
eser
ves
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
=(2
6)D
isab
ility
Inco
me-
Cre
dit S
ingl
e Pr
emiu
m w
ithou
t Add
ition
al R
eser
ves
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
=(2
7)D
isab
ility
Inco
me
- Gro
up S
hort-
Term
Ea
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X=
Long
-Ter
m C
are
(28)
Non
canc
ella
ble
Long
-Ter
m C
are
Prem
ium
- R
ate
Ris
k**
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.12
7**
=(2
9)O
ther
Lon
g-Te
rm C
are
Prem
ium
Ea
rned
Pre
miu
m (S
ched
ule
H P
art 1
Lin
e 2
in p
art)
X0.
000
=H
ealth
Pre
miu
m W
ith L
imite
d U
nder
writ
ing
Ris
k(3
0)A
SC B
usin
ess R
epor
ted
as R
even
ue P
rem
ium
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.00
0=
Oth
er H
ealth
(31)
Wor
kers
Com
pens
atio
n C
arve
-Out
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.00
0=
(32)
Oth
er H
ealth
Earn
ed P
rem
ium
(Sch
edul
e H
Par
t 1 L
ine
2 in
par
t)X
0.12
0=
(33)
Tota
l Ear
ned
Prem
ium
sSu
m o
f Lin
es (1
) thr
ough
(32)
(Col
umn
(1) s
houl
d eq
ual S
ched
ule
H P
art 1
Col
umn
1 Li
ne 2
)(3
4)A
dditi
onal
Res
erve
s for
Cre
dit D
isab
ility
Pla
nsEx
hibi
t 6, C
olum
n
, Lin
e 2
(3
5)A
dditi
onal
Res
erve
s for
Cre
dit D
isab
ility
Pla
ns, p
rior y
ear
Exhi
bit 6
, Col
umn
3, L
ine
2, p
rior y
ear
The
prem
ium
am
ount
s in
thes
e lin
es a
re tr
ansf
erre
d to
LR
020
Und
erw
ritin
g R
isk
– Ex
perie
nce
Fluc
tuat
ion
Ris
k Li
nes (
1.1)
and
(1.2
) for
the
calc
ulat
ion
of ri
sk-b
ased
cap
ital.
The
pre
miu
m a
mou
nts
are
incl
uded
her
e to
ass
ist i
n th
e ba
lanc
ing
of to
tal h
ealth
pre
miu
m.
If m
anag
ed c
are
arra
ngem
ents
hav
e be
en e
nter
ed in
to, t
he c
ompa
ny m
ay a
lso
com
plet
e LR
022
Und
erw
ritin
g R
isk
– M
anag
ed
Car
e C
redi
t. In
whi
ch c
ase,
the
com
pany
will
als
o ne
ed to
com
plet
e LR
028
Hea
lth C
redi
t Ris
k in
the
(C-3
) por
tion
of th
e fo
rmul
a. I
f the
re a
re a
mou
nts i
n an
y of
line
s (1)
, (2)
, (3)
, (10
), (1
1) o
r (13
)on
pag
e LR
019
Hea
lth P
rem
ium
s, th
e co
mpa
ny w
ill a
lso
be d
irect
ed to
com
plet
e th
e H
ealth
Adm
inis
trativ
e Ex
pens
e po
rtion
of L
R02
9 B
usin
ess R
isk
in th
e (C
-4) p
ortio
n of
the
form
ula.
Th
e tw
o tie
red
calc
ulat
ion
is il
lust
rate
d in
the
risk-
base
d ca
pita
l ins
truct
ions
for L
R01
9 H
ealth
Pre
miu
ms.
The
bala
nce
of th
e R
BC
requ
irem
ent f
or L
ong
Term
Car
e - M
orbi
dity
Ris
k is
cal
cula
ted
on p
age
LR02
3. T
he p
rem
ium
is sh
own
to a
llow
tota
ls to
che
ck to
Sch
edul
e H
. *
If th
ere
is p
rem
ium
incl
uded
on
eith
er o
r bot
h of
thes
e lin
es, t
he R
BC
requ
irem
ent i
n C
olum
n (2
) will
incl
ude
3.5
perc
ent o
f suc
h pr
emiu
m a
nd $
50,0
00 (i
nclu
ded
in th
e lin
e w
ith th
e la
rger
pre
miu
m).
**Th
e fa
ctor
app
lies t
o al
l Non
canc
ella
ble
prem
ium
.
Thes
e am
ount
s are
use
d to
adj
ust t
he p
rem
ium
bas
e fo
r sin
gle
prem
ium
cre
dit d
isab
ility
pla
ns th
at c
arry
add
ition
al ta
bula
r res
erve
s.A
fact
or o
f .35
0 w
ill b
e ap
plie
d to
the
first
$25
,000
,000
in C
olum
n (1
), Li
ne (1
2) a
nd a
fact
or o
f .25
0 w
ill b
e ap
plie
d to
the
rem
aini
ng p
rem
ium
in e
xces
s of $
25,0
00,0
00
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR01
9
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
(1)
(2)
Ann
ual S
tate
men
t Sou
rce
Am
ount
Fact
orR
BC
Req
uire
men
t
(1)
Bus
ines
s with
Rat
e G
uara
ntee
s Bet
wee
n 15
-36
Mon
ths
Com
pany
Rec
ords
X0.
024
=(2
)B
usin
ess w
ith R
ate
Gua
rant
ees O
ver 3
6 M
onth
sC
ompa
ny R
ecor
dsX
0.06
4=
(3)
Fede
ral E
mpl
oyee
s Hea
lth B
enef
it Pr
ogra
m (F
EHB
P)C
laim
s Inc
urre
dC
ompa
ny R
ecor
dsX
0.02
0=
Wor
kers
Com
pens
atio
n C
arve
-Out
Ris
k(4
)N
et P
rem
ium
s Writ
ten
Wor
kers
Com
pens
atio
n C
arve
Out
Sup
plem
ent
X0.
364
=U
nder
writ
ing
and
Inve
stm
ent E
xhib
it Pa
rt 2
Col
umn
5 Li
ne 1
(5)
Cla
im L
iabi
lity
and
Res
erve
Wor
kers
Com
pens
atio
n C
arve
Out
Sup
plem
ent
X0.
347
=Sc
hedu
le P
Par
t 1 C
olum
n 24
Lin
e 12
x 1
000
(6.1
)R
eins
uran
ce R
ecov
erab
le B
alan
ces
Wor
kers
Com
pens
atio
n C
arve
Out
Sup
plem
ent
Sche
dule
F P
art 2
Col
umn
15 L
ines
079
9999
,09
9999
9, 1
1999
99, 1
2999
99, 2
1999
99, 2
3999
99,
2599
999,
269
9999
, 359
9999
, 379
9999
, 399
9999
an
d 40
9999
9 x
1000
(6.2
)R
eins
uran
ce R
ecov
erab
le fo
r ua
lifyi
ng V
olun
tary
Poo
lsC
ompa
ny R
ecor
ds(6
.3)
All
Oth
er R
eins
uran
ce R
ecov
erab
le B
alan
ces
Line
(6.1
) - L
ine
(6.2
)X
0.06
0=
(7)
Tota
l, O
ther
Und
erw
ritin
g R
isk
Line
s (1)
+ (2
) + (3
) + (4
) + (5
) + (6
.3)
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
1
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
A
ltern
ativ
e 2
(1
)(2
)(3
)(4
)Le
ss W
orke
rsC
ompe
nsat
ion
RB
CA
nnua
l Sta
tem
ent S
ourc
eSt
atem
ent V
alue
Car
ve O
utR
BC
Sub
tota
lFa
ctor
Req
uire
men
tIn
divi
dual
Cla
im R
eser
ves
(1)
Exhi
bit 6
Col
lect
ivel
y R
enew
able
Tota
l Ind
ivid
ual C
laim
Res
erve
s Ex
hibi
t 6 C
olum
n 4
Line
16 C
ompa
ny R
ecor
ds
(2)
Exhi
bit 6
Non
-Can
cella
ble
Cla
im R
eser
ves L
ine
is to
be
left
blan
k or
zer
o-fil
led
for 2
019
Exhi
bit 6
Col
umn
5 Li
ne 1
6(3
)Ex
hibi
t 6 G
uara
ntee
d R
enew
able
Cla
im R
eser
ves L
ine
is to
be
left
blan
k or
zer
o-fil
led
for 2
019
Exhi
bit 6
Col
umn
6 Li
ne 1
6(4
)Ex
hibi
t 6 N
on-R
enew
able
for S
tate
d R
easo
n O
nly L
ine
is to
be
left
blan
k or
zer
o-fil
led
for 2
019
Exhi
bit 6
Col
umn
7 Li
ne 1
6C
laim
Res
erve
s(5
)Ex
hibi
t 6 O
ther
Acc
iden
t Onl
y C
laim
Res
erve
s Lin
e is
to b
e le
ft bl
ank
or z
ero-
fille
d fo
r 201
9Ex
hibi
t 6 C
olum
n 8
Line
16
(6)
Exhi
bit 6
All
Oth
er C
laim
Res
erve
s Lin
e is
to b
e le
ft bl
ank
or z
ero-
fille
d fo
r 201
9Ex
hibi
t 6 C
olum
n 9
Line
16
(7)
Mod
ified
Coi
nsur
ance
Ass
umed
Res
erve
sSc
hedu
le S
Par
t 1 S
ectio
n 2
Colu
mn
12, i
n pa
rt (8
)Le
ss M
odifi
ed C
oins
uran
ce C
eded
Res
erve
sSc
hedu
le S
Par
t 3 S
ectio
n 2
Colu
mn
13, i
n pa
rt (9
)D
isab
ility
Inco
me
and
Long
-Ter
m C
are
Cla
im
Com
pany
Rec
ords
X0.
063
=R
eser
ves
(10)
Tota
l Ind
ivid
ual C
laim
Res
erve
sLi
nes (
1) +
(2) +
(3) +
(4) +
(5) +
(6)
+ (7
) - (8
) - (9
)X
0.05
0=
Gro
up a
nd C
redi
t Cla
im R
eser
ves
(11)
Exhi
bit 6
Tot
al G
roup
& C
redi
t Cla
im R
eser
ves
Exhi
bit 6
Col
umn
2 Li
ne 1
6 Com
pany
Rec
ords
(12)
Exhi
bit 6
Cre
dit C
laim
Res
erve
s Lin
e is
to b
e le
ft bl
ank
or z
ero-
fille
d fo
r 201
9Ex
hibi
t 6 C
olum
n 3
Line
16
(13)
Mod
ified
Coi
nsur
ance
Ass
umed
Res
erve
sSc
hedu
le S
Par
t 1 S
ectio
n 2
Colu
mn
12, i
n pa
rt (1
4)Le
ss M
odifi
ed C
oins
uran
ce C
eded
Res
erve
sSc
hedu
le S
Par
t 3 S
ectio
n 2
Colu
mn
13, i
n pa
rt (1
5)D
isab
ility
Inco
me
and
Long
-Ter
m C
are
Cla
im
Com
pany
Rec
ords
X0.
063
=R
eser
ves
(16)
Tota
l Exh
ibit
6 G
roup
and
Cre
dit C
laim
Res
erve
sLi
nes (
11) +
(12)
+ (1
3) -
(14)
- (1
5)X
0.05
0=
(17)
Tota
l Cla
im R
eser
ves
Line
s (9)
+ (1
0) +
(15)
+ (1
6)
(18)
Tota
l Hea
lth R
BC
LR01
9 H
ealth
Pre
miu
ms C
olum
n (2
) Lin
e (3
3) +
LR
020
Und
erw
ritin
g R
isk
Expe
rienc
e Fl
uctu
atio
n R
isk
Col
umn
(5) L
ine
(18)
+ L
R02
1 U
nder
writ
ing
Ris
k O
ther
Col
umn
(2) L
ine
(7) +
LR
023
Long
-Ter
m
Car
e M
orbi
dity
Ris
k C
olum
n (4
) Lin
e (7
) +
LR02
4 H
ealth
Cla
im R
eser
ves C
olum
n (4
) Lin
e (1
7)
Incl
ude
only
the
porti
on w
hich
rela
tes t
o cl
aim
rese
rves
that
, if w
ritte
n on
a d
irect
bas
is, w
ould
be
incl
uded
on
Exhi
bit 6
.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
4
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
(1)
(2)
RB
CA
nnua
l Sta
tem
ent S
ourc
eSt
atem
ent V
alue
Fact
orR
equi
rem
ent
Indi
vidu
al &
Indu
stria
l Net
Am
ount
at R
isk
(1)
Ord
inar
y Li
fe In
For
ceEx
hibi
t of L
ife In
sura
nce
Col
umn
4 Li
ne 2
3 x
1000
(2)
Less
Ord
inar
y Li
fe R
eser
ves
Exhi
bit 5
Col
umn
4 Li
ne 0
1999
99(3
)Pl
us In
dust
rial L
ife In
For
ceEx
hibi
t of L
ife In
sura
nce
Col
umn
2 Li
ne 2
3 x
1000
(4)
Less
Indu
stria
l Life
Res
erve
sEx
hibi
t 5 C
olum
n 3
Line
019
9999
(5)
Less
Sep
arat
e A
ccou
nts
Sepa
rate
Acc
ount
s Exh
ibit
3 C
olum
n 3
Line
019
9999
(6)
Less
Mod
ified
Coi
nsur
ance
Ass
umed
Res
erve
sSc
hedu
le S
Par
t 1 S
ectio
n 1
Col
umn
12, i
n pa
rt (7
)Pl
us M
odifi
ed C
oins
uran
ce C
eded
Res
erve
sSc
hedu
le S
Par
t 3 S
ectio
n 1
Col
umn
14, i
n pa
rt (8
)To
tal I
ndiv
idua
l and
Indu
stria
l Net
Am
ount
at
Line
s (1)
+ (3
) + (7
) - (2
) - (4
) - (5
) - (6
) X
=
Ris
k
Gro
up a
nd C
redi
t Net
Am
ount
at R
isk
(9)
Gro
up L
ife In
For
ceEx
hibi
t of L
ife In
sura
nce
Col
umn
9 Li
ne 2
3 x
1000
(10)
Less
Gro
up F
EGLI
Exhi
bit o
f Life
Insu
ranc
e C
olum
n 4
Line
43
x 10
00(1
1)Le
ss G
roup
SG
LIEx
hibi
t of L
ife In
sura
nce
Col
umn
4 Li
ne 4
4 x
1000
(12)
Less
Gro
up L
ife R
eser
ves
Exhi
bit 5
Col
umn
6 Li
ne 0
1999
99(1
3)Pl
us C
redi
t Life
In F
orce
Exhi
bit o
f Life
Insu
ranc
e C
olum
n 6
Line
23
x 10
00(1
4)Le
ss C
redi
t FEG
LIEx
hibi
t of L
ife In
sura
nce
Col
umn
2 Li
ne 4
3 x
1000
(15)
Less
Cre
dit S
GLI
Exhi
bit o
f Life
Insu
ranc
e C
olum
n 2
Line
44
x 10
00(1
6)Le
ss C
redi
t Life
Res
erve
sEx
hibi
t 5 C
olum
n 5
Line
019
9999
(17)
Less
Sep
arat
e A
ccou
nts
Sepa
rate
Acc
ount
s Exh
ibit
3 C
olum
n 4
Line
019
9999
(18)
Less
Mod
ified
Coi
nsur
ance
Ass
umed
Res
erve
sSc
hedu
le S
Par
t 1 S
ectio
n 1
Col
umn
12, i
n pa
rt (1
9)Pl
us M
odifi
ed C
oins
uran
ce C
eded
Res
erve
sSc
hedu
le S
Par
t 3 S
ectio
n 1
Col
umn
14, i
n pa
rt (2
0)To
tal G
roup
and
Cre
dit N
et A
mou
nt a
t Ris
kLi
nes (
9) +
(13)
+ (1
9) -
(10)
- (1
1) -
(12)
- (1
4) -
(15)
X
= -
(16)
- (1
7) -
(18)
(21)
FEG
LI/S
GLI
Life
In F
orce
Exhi
bit o
f Life
Insu
ranc
e C
olum
n 2
and
4 Li
ne 4
3 an
dX
0.00
08=
44 x
100
0
(22)
Tota
l Life
Line
s (8)
+ (2
0) +
(21)
Th
e tie
red
calc
ulat
ion
is il
lust
rate
d in
the
Life
Insu
ranc
e se
ctio
n of
the
risk-
base
d ca
pita
l ins
truct
ions
.In
clud
e on
ly th
e po
rtion
whi
ch re
late
s to
polic
y re
serv
es th
at, i
f writ
ten
on a
dire
ct b
asis
, wou
ld b
e in
clud
ed o
n Ex
hibi
t 5.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
5
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
(1
)(2
)R
BC
Ann
ual S
tate
men
t Sou
rce
Stat
emen
t Val
ueFa
ctor
Req
uire
men
tG
roup
and
Cre
dit L
ife a
nd H
ealth
Rep
orte
d Pr
emiu
m S
tabi
lizat
ion
Res
erve
s(1
)St
abili
zatio
n R
eser
ves a
nd E
xper
ienc
e R
atin
g R
efun
ds in
clud
ed
Page
3 C
olum
n 1
Line
3 in
par
tX
0.50
0=
in L
ine
3(2
)Pr
ovis
ion
for E
xper
ienc
e R
atin
g R
efun
dsPa
ge 3
Col
umn
1 Li
ne 9
.2 in
par
tX
0.50
0=
(3)
Res
erve
for G
roup
Rat
e C
redi
tsEx
hibi
t 6 C
olum
n 2
Line
5 C
ompa
ny R
ecor
dsX
0.50
0=
(4)
Res
erve
for C
redi
t Rat
e C
redi
tsEx
hibi
t 6 C
olum
n 3
Line
5 C
ompa
ny R
ecor
dsX
0.50
0=
(5)
Prem
ium
Sta
biliz
atio
n R
eser
ves
Page
3 C
olum
n 1
Line
25
in p
art
X0.
500
=
(6)
Tota
l of P
relim
inar
y Pr
emiu
m S
tabi
lizat
ion
Res
erve
Cre
dit
Sum
of L
ines
(1) t
hrou
gh (5
)
Gro
up &
Cre
dit L
ife a
nd H
ealth
Ris
k-B
ased
Cap
ital
(7)
Life
LR02
5 Li
fe In
sura
nce
Col
umn
(2) L
ine
(20)
(8)
Hea
lthLR
024
Hea
lth C
laim
Res
erve
s Col
umn
(4) L
ine
(16)
+
[LR
024
Col
umn
(4) L
ine
(15)
x 0
.65]
+ L
R01
9H
ealth
Pre
miu
ms C
olum
n (2
) Lin
es (1
2), (
17),
(18)
an
d (1
9) +
[[LR
019
Col
umn
(2) L
ines
(23)
, (24
),an
d (2
7)] x
0.6
5] +
[LR
020
Und
erw
ritin
g R
isk
-Ex
perie
nce
Fluc
tuat
ion
Ris
k C
olum
n (5
) Lin
e (1
8) -
Col
umn
(4) L
ine
(18)
x L
ine
(1.2
) / L
ine
(1.3
) ](9
)M
axim
um R
isk-
Bas
ed C
apita
lLi
nes (
7) +
(8)
(10)
Fina
l Pre
miu
m S
tabi
lizat
ion
Res
erve
Col
umn
(2) L
ine
(6),
but n
ot m
ore
than
X-1
.000
=C
olum
n (1
) Lin
e (9
)
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
6
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
(1)
(2)
RB
CA
nnua
l Sta
tem
ent S
ourc
eSt
atem
ent V
alue
Fact
orR
equi
rem
ent
Life
Insu
ranc
e Pr
emiu
ms
(1)
Tota
l Life
Pre
miu
ms
Sche
dule
T C
olum
n 2
Line
59
(2)
Less
Am
eric
an S
amoa
Life
Pre
miu
ms
Sche
dule
T C
olum
n 2
Line
52
(3)
Less
Gua
m L
ife P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
3(4
)Le
ss P
uerto
Ric
o Li
fe P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
4(5
)Le
ss U
.S. V
irgin
Isla
nds L
ife P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
5(6
)Le
ss N
orth
ern
Mar
iana
Isla
nds L
ife P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
6(7
)Le
ss C
anad
a Li
fe P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
7(8
)Le
ss O
ther
Alie
n Li
fe P
rem
ium
sSc
hedu
le T
Col
umn
2 Li
ne 5
8(9
)Su
btot
al N
et L
ife P
rem
ium
sLi
ne (1
) les
s the
Sum
of L
ines
(2) t
hrou
gh (8
)(1
0)Pl
us F
orei
gn V
aria
ble
and
Oth
er L
ife P
rem
ium
sSe
e In
stru
ctio
ns(1
1)Le
ss T
otal
Var
iabl
e an
d O
ther
Life
Pre
miu
ms
See
Inst
ruct
ions
(12)
Net
Life
Pre
miu
ms
Line
(9) p
lus L
ine
(10)
less
Lin
e (1
1)X
0.02
53=
Ann
uity
Con
side
ratio
ns(1
3)To
tal A
nnui
ty C
onsi
dera
tions
Sche
dule
T C
olum
n 3
Line
59
(14)
Less
Am
eric
an S
amoa
Ann
uity
Con
side
ratio
nsSc
hedu
le T
Col
umn
3 Li
ne 5
2(1
5)Le
ss G
uam
Ann
uity
Con
side
ratio
nsSc
hedu
le T
Col
umn
3 Li
ne 5
3(1
6)Le
ss P
uerto
Ric
o A
nnui
ty C
onsi
dera
tions
Sche
dule
T C
olum
n 3
Line
54
(17)
Less
U.S
. Virg
in Is
land
s Ann
uity
Con
side
ratio
nsSc
hedu
le T
Col
umn
3 Li
ne 5
5(1
8)Le
ss N
orth
ern
Mar
iana
Isla
nds A
nnui
ty C
onsi
dera
tions
Sche
dule
T C
olum
n 3
Line
56
(19)
Less
Can
ada
Ann
uity
Con
side
ratio
nsSc
hedu
le T
Col
umn
3 Li
ne 5
7(2
0)Le
ss O
ther
Alie
n A
nnui
ty C
onsi
dera
tions
Sche
dule
T C
olum
n 3
Line
58
(21)
Subt
otal
Net
Ann
uity
Con
side
ratio
nsLi
ne (1
3) le
ss th
e Su
m o
f Lin
es (1
4) th
roug
h (2
0)(2
2)Pl
us F
orei
gn V
aria
ble
and
Oth
er A
nnui
ty C
onsi
dera
tions
See
Inst
ruct
ions
(23)
Less
Tot
al V
aria
ble
and
Oth
er A
nnui
ty C
onsi
dera
tions
See
Inst
ruct
ions
(24)
Net
Ann
uity
Con
side
ratio
nsLi
ne (2
1) p
lus L
ine
(22)
less
Lin
e (2
3)X
0.02
53=
Acc
iden
t and
Hea
lth P
rem
ium
s(2
5)To
tal A
ccid
ent a
nd H
ealth
Pre
miu
ms
Sche
dule
T C
olum
n 4
Line
59
(26)
Less
Am
eric
an S
amoa
Acc
iden
t and
Hea
lth P
rem
ium
sSc
hedu
le T
Col
umn
4 Li
ne 5
2(2
7)Le
ss G
uam
Acc
iden
t and
Hea
lth P
rem
ium
sSc
hedu
le T
Col
umn
4 Li
ne 5
3(2
8)Le
ss P
uerto
Ric
o A
ccid
ent a
nd H
ealth
Pre
miu
ms
Sche
dule
T C
olum
n 4
Line
54
(29)
Less
U.S
. Virg
in Is
land
s Acc
iden
t and
Hea
lth P
rem
ium
sSc
hedu
le T
Col
umn
4 Li
ne 5
5(3
0)Le
ss N
orth
ern
Mar
iana
Isla
nds A
ccid
ent a
nd H
ealth
Pre
miu
ms
Sche
dule
T C
olum
n 4
Line
56
(31)
Less
Can
ada
Acc
iden
t and
Hea
lth P
rem
ium
sSc
hedu
le T
Col
umn
4 Li
ne 5
7(3
2)Le
ss O
ther
Alie
n A
ccid
ent a
nd H
ealth
Pre
miu
ms
Sche
dule
T C
olum
n 4
Line
58
(33)
Subt
otal
Net
Acc
iden
t and
Hea
lth P
rem
ium
sLi
ne (2
5) le
ss th
e Su
m o
f Lin
es (2
6) th
roug
h (3
2)(3
4)Pl
us F
orei
gn V
aria
ble
and
Oth
er A
&H
Pre
miu
ms
See
Inst
ruct
ions
(35)
Less
Tot
al V
aria
ble
and
Oth
er A
&H
Pre
miu
ms
See
Inst
ruct
ions
(36)
Net
Acc
iden
t and
Hea
lth P
rem
ium
sLi
ne (3
3) p
lus L
ine
(34)
less
Lin
e (3
5)X
0.00
63=
Ente
r am
ount
s onl
y if
incl
uded
in S
ched
ule
T C
olum
n 2
(life
), C
olum
n 3
(ann
uity
) or C
olum
n 4
(acc
iden
t and
hea
lth).
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
9
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
(1)
(2)
RB
CA
nnua
l Sta
tem
ent S
ourc
eSt
atem
ent V
alue
Fact
orR
equi
rem
ent
Sepa
rate
Acc
ount
Lia
bilit
ies
(37)
Tota
l Lia
bilit
ies f
rom
Sep
arat
e A
ccou
nts S
tate
men
tPa
ge 3
Col
umn
1 Li
ne 2
7(3
8)Tr
ansf
ers t
o Se
para
te A
ccou
nts D
ue o
r Acc
rued
Page
3 C
olum
n 1
Line
13
(39)
Tota
l Sep
arat
e A
ccou
nt L
iabi
litie
sLi
ne (3
7) p
lus L
ine
(38)
X0.
0006
=
(40)
Bus
ines
s Ris
k (C
-4a)
Line
s (12
) + (2
4) +
(36)
+ (3
9)
Adm
inis
trativ
e Ex
pens
es fo
r Cer
tain
A&
H C
over
ages
(41)
Tota
l Acc
iden
t and
Hea
lth P
rem
ium
sLR
019
Hea
lth P
rem
ium
s Col
umn
(1) L
ine
(33)
(42)
Acc
iden
t and
Hea
lth P
rem
ium
s fro
m U
nder
writ
ing
Ris
kLR
020
Und
erw
ritin
g R
isk
Col
umn
(5) L
ine
(1.3
) (4
3)A
ccid
ent a
nd H
ealth
Pre
miu
ms F
acto
rLi
ne (4
2) /
Line
(41)
(44)
Exhi
bit 2
Adm
inis
trativ
e Ex
pens
es fo
r Hea
lth In
sura
nce
Exhi
bit 2
Col
umn
2 +
Col
umn
3 Li
ne 1
0 (4
5)Ex
hibi
t 3 A
dmin
istra
tive
Expe
nses
for H
ealth
Insu
ranc
e Ex
hibi
t 3 C
olum
n 2
Line
7
(46)
Less
Adm
inis
trativ
e Ex
pens
es fo
r Adm
inis
trativ
e Se
rvic
e C
ontra
cts (
ASC
) In
clud
ed in
Exh
ibit
2 C
ol. 2
+ C
ol. 3
and
Exh
ibit
3 C
ol. 2
(47)
Less
Adm
inis
trativ
e Ex
pens
es fo
r Adm
inis
trativ
e Se
rvic
esO
nly
(ASO
) Bus
ines
sIn
clud
ed in
Exh
ibit
2 C
ol. 2
+ C
ol. 3
and
Exh
ibit
3 C
ol. 2
(48)
Less
Adm
inis
trativ
e Ex
pens
es fo
r Com
mis
sion
s and
Pr
emiu
m T
axes
Incl
uded
in E
xhib
it 2
Col
. 2 +
Col
. 3 a
nd E
xhib
it 3
Col
. 2(4
9)N
et A
dmin
istra
tive
Expe
nses
Line
s (44
) + (4
5) -
(46)
- (4
7) -
(48)
(50)
Com
posi
te H
ealth
Adm
inis
trativ
e Ex
pens
e R
isk
Fact
or
7% o
f Lin
e (4
2) u
p to
$25
mill
ion
+ 4%
of
exce
ss/L
ine
(42)
(51)
Adm
inis
trativ
e Ex
pens
e C
ompo
nent
for H
ealth
Line
(49)
x fa
ctor
Lin
e (4
3) x
fact
or L
ine
(50)
Hea
lth A
SO/A
SC(5
2)A
dmin
istra
tive
Expe
nses
for A
SC B
usin
ess
Com
pany
Rec
ords
X0.
0200
=(5
3)A
dmin
istra
tive
Expe
nses
for A
SO B
usin
ess
Com
pany
Rec
ords
X0.
0200
=(5
4)A
SC C
laim
s Rep
orte
d as
Incu
rred
Cla
ims
Com
pany
Rec
ords
X0.
0100
=(5
5)O
ther
Med
ical
Cos
ts P
aid
thro
ugh
ASC
Arr
ange
men
tsC
ompa
ny R
ecor
dsX
0.01
00=
(56)
Fee-
for-
Serv
ice
Rec
eive
d fr
om H
ealth
Ent
ities
Com
pany
Rec
ords
X0.
0100
=
(57)
Bus
ines
s Ris
k (C
-4b)
C
olum
n (2
) Lin
es (5
1) +
(52)
+ (5
3) +
(54)
+ (5
5) +
(56)
Line
(52)
shou
ld b
e gr
eate
r tha
n or
equ
al to
Lin
e (4
6). L
ine
(53)
shou
ld b
e gr
eate
r tha
n or
equ
al to
Lin
e (4
7).
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR02
9
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
(1)
(2)
Sour
ceR
BC
Am
ount
Tax
Fact
orR
BC
Tax
Eff
ect
ASS
ET R
ISK
SB
onds
(001
)Lo
ng-te
rm B
onds
– N
AIC
1LR
002
Bon
ds C
olum
n (2
) Lin
e (2
) + L
R01
8 O
ff-B
alan
ce S
heet
Col
late
ral
X0.
1575
=C
olum
n (3
) Lin
e (2
)(0
02)
Long
-term
Bon
ds –
NA
IC 2
LR00
2 B
onds
Col
umn
(2) L
ine
(3) +
LR
018
Off
-Bal
ance
She
et C
olla
tera
lX
0.15
75=
Col
umn
(3) L
ine
(3)
(003
)Lo
ng-te
rm B
onds
– N
AIC
3LR
002
Bon
ds C
olum
n (2
) Lin
e (4
) + L
R01
8 O
ff-B
alan
ce S
heet
Col
late
ral
X0.
1575
=C
olum
n (3
) Lin
e (4
)(0
04)
Long
-term
Bon
ds –
NA
IC 4
LR00
2 B
onds
Col
umn
(2) L
ine
(5) +
LR
018
Off
-Bal
ance
She
et C
olla
tera
lX
0.15
75=
Col
umn
(3) L
ine
(5)
(005
)Lo
ng-te
rm B
onds
– N
AIC
5LR
002
Bon
ds C
olum
n (2
) Lin
e (6
) + L
R01
8 O
ff-B
alan
ce S
heet
Col
late
ral
X0.
1575
=C
olum
n (3
) Lin
e (6
)(0
06)
Long
-term
Bon
ds –
NA
IC 6
LR00
2 B
onds
Col
umn
(2) L
ine
(7) +
LR
018
Off
-Bal
ance
She
et C
olla
tera
lX
0.21
00=
Col
umn
(3) L
ine
(7)
(007
)Sh
ort-t
erm
Bon
ds –
NA
IC 1
LR00
2 B
onds
Col
umn
(2) L
ine
(10)
X0.
1575
=(0
08)
Shor
t-ter
m B
onds
– N
AIC
2LR
002
Bon
ds C
olum
n (2
) Lin
e (1
1)X
0.15
75=
(009
)Sh
ort-t
erm
Bon
ds –
NA
IC 3
LR00
2 B
onds
Col
umn
(2) L
ine
(12)
X0.
1575
=(0
10)
Shor
t-ter
m B
onds
– N
AIC
4LR
002
Bon
ds C
olum
n (2
) Lin
e (1
3)X
0.15
75=
(011
)Sh
ort-t
erm
Bon
ds –
NA
IC 5
LR00
2 B
onds
Col
umn
(2) L
ine
(14)
X0.
1575
=(0
12)
Shor
t-ter
m B
onds
– N
AIC
6LR
002
Bon
ds C
olum
n (2
) Lin
e (1
5)X
0.21
00=
(013
)C
redi
t for
Hed
ging
- N
AIC
1 T
hrou
gh 5
Bon
dsLR
014
Hed
ged
Ass
et B
ond
Sche
dule
Col
umn
(13)
Lin
e (0
1999
99)
X0.
1575
=(0
14)
Cre
dit f
or H
edgi
ng -
NA
IC 6
Bon
dsLR
014
Hed
ged
Ass
et B
ond
Sche
dule
Col
umn
(13)
Lin
e (0
2999
99)
X0.
2100
=(0
15)
Bon
d R
educ
tion
- Rei
nsur
ance
LR00
2 B
onds
Col
umn
(2) L
ine
(19)
X0.
2100
=(0
16)
Bon
d In
crea
se -
Rei
nsur
ance
LR00
2 B
onds
Col
umn
(2) L
ine
(20)
X0.
2100
=(0
17)
Non
-Exe
mpt
NA
IC 1
U.S
. Gov
ernm
ent A
genc
yLR
002
Bon
ds C
olum
n (2
) Lin
e (2
2)X
0.15
75=
(018
)B
onds
Siz
e Fa
ctor
LR00
2 B
onds
Col
umn
(2) L
ine
(26)
- LR
002
Bon
ds C
olum
n (2
) Lin
e (2
1)X
0.15
75=
Mor
tgag
es
In G
ood
Stan
ding
(019
)R
esid
entia
l Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(1)
X0.
1575
=(0
20)
Res
iden
tial M
ortg
ages
- O
ther
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(2)
X0.
1575
=(0
21)
Com
mer
cial
Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(3)
X0.
1575
=(0
22)
Tota
l Com
mer
cial
Mor
tgag
es -
All
Oth
erLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (9
)X
0.15
75=
(023
)To
tal F
arm
Mor
tgag
esLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (1
5)X
0.15
75=
90 D
ays O
verd
ue(0
24)
Farm
Mor
tgag
esLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (1
6)X
0.15
75=
(025
)R
esid
entia
l Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(17)
X0.
1575
=(0
26)
Res
iden
tial M
ortg
ages
- O
ther
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(18)
X0.
1575
=(0
27)
Com
mer
cial
Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(19)
X0.
1575
=(0
28)
Com
mer
cial
Mor
tgag
es -
Oth
erLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (2
0)X
0.15
75=
In P
roce
ss o
f For
eclo
sure
(029
)Fa
rm M
ortg
ages
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(21)
X0.
1575
=
Den
otes
line
s tha
t are
ded
ucte
d fr
om th
e to
tal r
athe
r tha
n ad
ded.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
0
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
T
(1)
(2)
Sour
ceR
BC
Am
ount
Tax
Fact
orR
BC
Tax
Eff
ect
(030
)R
esid
entia
l Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(22)
X0.
1575
=(0
31)
Res
iden
tial M
ortg
ages
- O
ther
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(23)
X0.
1575
=(0
32)
Com
mer
cial
Mor
tgag
es -
Insu
red
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(24)
X0.
1575
=(0
33)
Com
mer
cial
Mor
tgag
es -
Oth
erLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (2
5)X
0.15
75=
(034
)D
ue &
Unp
aid
Taxe
s Mor
tgag
esLR
004
Mor
tgag
es C
olum
n (6
) Lin
e (2
6)X
0.15
75=
(035
)D
ue &
Unp
aid
Taxe
s - F
orec
losu
res
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(27)
X0.
1575
=(0
36)
Mor
tgag
e R
educ
tion
- Rei
nsur
ance
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(29)
X0.
2100
=(0
37)
Mor
tgag
e In
crea
se -
Rei
nsur
ance
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(30)
X0.
2100
=Pr
efer
red
Stoc
k an
d H
ybrid
Sec
uriti
es(0
38)
Una
ffili
ated
Pre
ferr
ed S
tock
and
Hyb
rids N
AIC
1LR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(1) +
Lin
e (8
)X
0.15
75=
+ LR
018
Off
-Bal
ance
She
et C
olla
tera
l Col
umn
(3) L
ine
(9)
(039
)U
naff
iliat
ed P
refe
rred
Sto
ck a
nd H
ybrid
s NA
IC 2
LR00
5 U
naff
iliat
ed P
refe
rred
and
Com
mon
Sto
ck C
olum
n (5
) Lin
e (2
) + L
ine
(9)
X0.
1575
=+
LR01
8 O
ff-B
alan
ce S
heet
Col
late
ral C
olum
n (3
) Lin
e (1
0)(0
40)
Una
ffili
ated
Pre
ferr
ed S
tock
and
Hyb
rids N
AIC
3LR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(3) +
Lin
e (1
0)X
0.15
75=
+ LR
018
Off
-Bal
ance
She
et C
olla
tera
l Col
umn
(3) L
ine
(11)
(041
)U
naff
iliat
ed P
refe
rred
Sto
ck a
nd H
ybrid
s NA
IC 4
LR00
5 U
naff
iliat
ed P
refe
rred
and
Com
mon
Sto
ck C
olum
n (5
) Lin
e (4
) + L
ine
(11)
X0.
1575
=+
LR01
8 O
ff-B
alan
ce S
heet
Col
late
ral C
olum
n (3
) Lin
e (1
2)(0
42)
Una
ffili
ated
Pre
ferr
ed S
tock
and
Hyb
rids N
AIC
5LR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(5) +
Lin
e (1
2)X
0.15
75=
+ LR
018
Off
-Bal
ance
She
et C
olla
tera
l Col
umn
(3) L
ine
(13)
(043
)U
naff
iliat
ed P
refe
rred
Sto
ck a
nd H
ybrid
s NA
IC 6
LR00
5 U
naff
iliat
ed P
refe
rred
and
Com
mon
Sto
ck C
olum
n (5
) Lin
e (6
) + L
ine
(13)
X0.
2100
=+
LR01
8 O
ff-B
alan
ce S
heet
Col
late
ral C
olum
n (3
) Lin
e (1
4)(0
44)
Pref
erre
d St
ock
Red
uctio
n-R
eins
uran
ceLR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(16)
X0.
2100
=(0
45)
Pref
erre
d St
ock
Incr
ease
-Rei
nsur
ance
LR00
5 U
naff
iliat
ed P
refe
rred
and
Com
mon
Sto
ck C
olum
n (5
) Lin
e (1
7)X
0.21
00=
Sepa
rate
Acc
ount
s(0
46)
Gua
rant
eed
Inde
xLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(1)
X0.
1575
=(0
47)
Non
inde
x-B
ook
Res
erve
LR00
6 Se
para
te A
ccou
nts C
olum
n (3
) Lin
e (2
)X
0.15
75=
(048
)Se
para
te A
ccou
nts N
onin
dex-
Mar
ket R
eser
veLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(3)
X0.
1575
=(0
49)
Sepa
rate
Acc
ount
s Red
uctio
n-R
eins
uran
ceLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(5)
X0.
2100
=(0
50)
Sepa
rate
Acc
ount
s Inc
reas
e-R
eins
uran
ceLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(6)
X0.
2100
=(0
51)
Synt
hetic
GIC
sLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(8)
X0.
1575
=(0
52)
Sepa
rate
Acc
ount
Sur
plus
LR00
6 Se
para
te A
ccou
nts C
olum
n (3
) Lin
e (1
3)X
0.15
75=
Rea
l Est
ate
(053
)C
ompa
ny O
ccup
ied
Rea
l Est
ate
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (3
)X
0.21
00=
(054
)Fo
recl
osed
Rea
l Est
ate
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (6
)X
0.21
00=
(055
)In
vest
men
t Rea
l Est
ate
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (9
)X
0.21
00=
(056
)R
eal E
stat
e R
educ
tion
- Rei
nsur
ance
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (1
1)X
0.21
00=
(057
)R
eal E
stat
e In
crea
se -
Rei
nsur
ance
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (1
2)X
0.21
00=
Sche
dule
BA
(058
)Sc
h B
A R
eal E
stat
e Ex
clud
ing
Low
Inco
me
LR00
7 R
eal E
stat
e C
olum
n (3
) Lin
e (1
6)X
0.21
00=
Hou
sing
Tax
Cre
dits
(059
)G
uara
ntee
d Lo
w In
com
e H
ousi
ng T
ax C
redi
tsLR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(17)
+ L
ine
(19)
X0.
0000
=(0
60)
Non
-Gua
rant
eed
and
All
Oth
er L
ow In
com
e H
ousi
ng T
ax C
redi
tsLR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(18)
+ L
ine
(20)
+ L
ine
(21)
X0.
0000
=(0
61)
Sch
BA
Rea
l Est
ate
Red
uctio
n - R
eins
uran
ceLR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(23)
X0.
2100
=(0
62)
Sch
BA
Rea
l Est
ate
Incr
ease
- R
eins
uran
ceLR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(24)
X0.
2100
=
Den
otes
line
s tha
t are
ded
ucte
d fr
om th
e to
tal r
athe
r tha
n ad
ded.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
0
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
T
(1)
(2)
Sour
ceR
BC
Am
ount
Tax
Fact
orR
BC
Tax
Eff
ect
(063
)Sc
h B
A B
ond
NA
IC 1
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(2)
X0.
1575
=(0
64)
Sch
BA
Bon
d N
AIC
2LR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (3
)X
0.15
75=
(065
)Sc
h B
A B
ond
NA
IC 3
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(4)
X0.
1575
=(0
66)
Sch
BA
Bon
d N
AIC
4LR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (5
)X
0.15
75=
(067
)Sc
h B
A B
ond
NA
IC 5
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(6)
X0.
1575
=(0
68)
Sch
BA
Bon
d N
AIC
6LR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (7
)X
0.21
00=
(069
)B
A B
ond
Red
uctio
n - R
eins
uran
ceLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (9
)X
0.21
00=
(070
)B
A B
ond
Incr
ease
- R
eins
uran
ceLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (1
0)X
0.21
00=
(071
)B
A P
refe
rred
Sto
ck N
AIC
1LR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (1
2.3)
X0.
1575
=(0
72)
BA
Pre
ferr
ed S
tock
NA
IC 2
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(13)
X0.
1575
=(0
73)
BA
Pre
ferr
ed S
tock
NA
IC 3
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(14)
X0.
1575
=(0
74)
BA
Pre
ferr
ed S
tock
NA
IC 4
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(15)
X0.
1575
=(0
75)
BA
Pre
ferr
ed S
tock
NA
IC 5
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(16)
X0.
1575
=(0
76)
BA
Pre
ferr
ed S
tock
NA
IC 6
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(17)
X0.
2100
=(0
77)
BA
Pre
ferr
ed S
tock
Red
uctio
n-R
eins
uran
ceLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (1
9)X
0.21
00=
(078
)B
A P
refe
rred
Sto
ck In
crea
se -
Rei
nsur
ance
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(20)
X0.
2100
=(0
79)
Rat
ed S
urpl
us N
otes
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(31)
X0.
1575
=(0
80)
Rat
ed C
apita
l Not
esLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (4
1)X
0.15
75=
(081
)B
A C
omm
on S
tock
Aff
iliat
edLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (4
8.3)
X0.
2100
=(0
82)
BA
Col
late
ral L
oans
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(50)
X0.
1575
=(0
83)
Oth
er B
A A
sset
sLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (5
2.3)
+ L
R01
8 O
ff-B
alan
ceX
0.21
00=
Shee
t Col
late
ral C
olum
n (3
) Lin
e (1
7) +
Lin
e (1
8)(0
84)
Oth
er B
A A
sset
s Red
uctio
n-R
eins
uran
ceLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (5
4)X
0.21
00=
(085
)O
ther
BA
Ass
ets I
ncre
ase
- Rei
nsur
ance
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(55)
X0.
2100
=(0
86)
BA
Mor
tgag
es -
In G
ood
Stan
ding
LR00
9 Sc
hedu
le B
A M
ortg
ages
Col
umn
(6) L
ine
(11)
X0.
1575
=(0
87)
BA
Mor
tgag
es -
90 D
ays O
verd
ueLR
009
Sche
dule
BA
Mor
tgag
es C
olum
n (6
) Lin
e (1
5)X
0.15
75=
(088
)B
A M
ortg
ages
- In
Pro
cess
of F
orec
losu
reLR
009
Sche
dule
BA
Mor
tgag
es C
olum
n (6
) Lin
e (1
9)
X0.
1575
=(0
89)
Red
uctio
n - R
eins
uran
ceLR
009
Sche
dule
BA
Mor
tgag
es C
olum
n (6
) Lin
e (2
1)X
0.21
00=
(090
)In
crea
se -
Rei
nsur
ance
LR00
9 Sc
hedu
le B
A M
ortg
ages
Col
umn
(6) L
ine
(22)
X0.
2100
=M
isce
llane
ous
(091
)A
sset
Con
cent
ratio
n Fa
ctor
LR01
0 A
sset
Con
cent
ratio
n Fa
ctor
Col
umn
(6) L
ine
(68)
Gra
nd T
otal
Pag
eX
0.15
75=
(092
)M
isce
llane
ous A
sset
sLR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (7
)X
0.15
75=
(093
)D
eriv
ativ
es -
Col
late
ral a
nd E
xcha
nge
Trad
edLR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
es (8
) + (9
) + (1
0)X
0.15
75=
(094
)D
eriv
ativ
es N
AIC
1LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
1)X
0.15
75=
(095
)D
eriv
ativ
es N
AIC
2LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
2)X
0.15
75=
(096
)D
eriv
ativ
es N
AIC
3LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
3)X
0.15
75=
(097
)D
eriv
ativ
es N
AIC
4LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
4)X
0.15
75=
(098
)D
eriv
ativ
es N
AIC
5LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
5)X
0.15
75=
(099
)D
eriv
ativ
es N
AIC
6LR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
6)X
0.21
00=
(100
)M
isce
llane
ous A
sset
s Red
uctio
n-R
eins
uran
ceLR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (1
9)X
0.21
00=
(101
)M
isce
llane
ous A
sset
s Inc
reas
e-R
eins
uran
ceLR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (2
0)X
0.21
00=
Den
otes
line
s tha
t are
ded
ucte
d fr
om th
e to
tal r
athe
r tha
n ad
ded.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
0
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
T
(1)
(2)
Sour
ceR
BC
Am
ount
Tax
Fact
orR
BC
Tax
Eff
ect
(102
)R
eplic
atio
nsLR
013
Rep
licat
ion
(Syn
thet
ic A
sset
) Tra
nsac
tions
and
Man
dato
ry
X0.
1575
=C
onve
rtibl
e Se
curit
ies C
olum
n (7
) Lin
e (9
9999
99)
(103
)R
eins
uran
ceLR
016
Rei
nsur
ance
Col
umn
(4) L
ine
(17)
X0.
2100
=(1
04)
Inve
stm
ent A
ffili
ates
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(6)
X0.
2100
=(1
05)
Inve
stm
ent i
n Pa
rent
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(10)
X0.
2100
=(1
06)
Oth
er A
ffili
ate:
Pro
perty
and
Cas
ualty
Insu
rers
LR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (1
1)X
0.21
00=
not S
ubje
ct to
Ris
k-B
ased
Cap
ital
(107
)O
ther
Aff
iliat
e: L
ife In
sure
rs n
ot S
ubje
ct to
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(12)
X0.
2100
=R
isk-
Bas
ed C
apita
l(1
08)
Publ
icly
Tra
ded
Insu
ranc
e A
ffili
ates
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(14)
X0.
2100
=(1
09)
Subt
otal
for C
-1o
Ass
ets
Sum
of L
ines
(001
) thr
ough
(108
), R
ecog
nizi
ng th
e D
educ
tion
of L
ines
(013
), (0
14),
(015
), (0
36),
(044
), (0
49),
(056
), (0
61),
(069
), (0
77),
(084
), (0
89) a
nd (1
00)
C-0
Aff
iliat
ed C
omm
on S
tock
(110
)O
ff-B
alan
ce S
heet
and
Oth
er It
ems
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n (5
) Lin
e (2
7)X
0.15
75=
(111
)O
ff-B
alan
ce S
heet
Item
s Red
uctio
n - R
eins
uran
ceLR
017
Off
-Bal
ance
She
et a
nd O
ther
Item
s Col
umn
(5) L
ine
(28)
X0.
2100
=(1
12)
Off
-Bal
ance
She
et It
ems I
ncre
ase
- Rei
nsur
ance
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n (5
) Lin
e (2
9)X
0.21
00=
(113
)A
ffili
ated
US
Prop
erty
- C
asua
lty In
sure
rs
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(1)
X0.
2100
=D
irect
ly O
wne
d(1
14)
Aff
iliat
ed U
S Li
fe In
sure
rs D
irect
ly O
wne
dLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (2
)X
0.21
00=
(115
)A
ffili
ated
US
Hea
lth In
sure
rs D
irect
ly a
ndLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (3
)X
0.21
00=
Indi
rect
ly O
wne
d(1
16)
Aff
iliat
ed U
S Pr
oper
ty -
Cas
ualty
Insu
rers
LR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (4
)X
0.21
00=
Indi
rect
ly O
wne
d(1
17)
Aff
iliat
ed U
S Li
fe In
sure
rs In
dire
ctly
Ow
ned
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(5)
X0.
2100
=(1
18)
Aff
iliat
ed A
lien
Life
Insu
rers
- C
anad
ian
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(8)
X0.
2100
=(1
19)
Aff
iliat
ed A
lien
Life
Insu
rers
- A
ll O
ther
sLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (9
)X
0.00
00=
(120
)Su
btot
al fo
r C-0
Aff
iliat
ed C
omm
on S
tock
Line
s (11
0)-(
111)
+(11
2)+(
113)
+(11
4)+(
115)
+(11
6)+(
117)
+(11
8)+(
119)
Com
mon
Sto
ck(1
21)
Una
ffili
ated
Com
mon
Sto
ckLR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(25)
+
X0.
2100
=LR
018
Off
-Bal
ance
She
et C
olla
tera
l Col
umn
(3) L
ine
(16)
(122
)C
redi
t for
Hed
ging
- C
omm
on S
tock
LR01
5 H
edge
d A
sset
Com
mon
Sto
ck S
ched
ule
Col
umn
(10)
Lin
e (0
2999
99)
X0.
2100
=(1
23)
Stoc
k R
educ
tion
- Rei
nsur
ance
LR00
5 U
naff
iliat
ed P
refe
rred
and
Com
mon
Sto
ck C
olum
n (5
) Lin
e (2
7)X
0.21
00=
(124
)St
ock
Incr
ease
- R
eins
uran
ceLR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(28)
X0.
2100
=(1
25)
BA
Com
mon
Sto
ck U
naff
iliat
edLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (4
7)X
0.21
00=
(126
)B
A C
omm
on S
tock
Aff
iliat
ed -
C-1
csLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) Lin
e (4
9.2)
X0.
2100
=(1
27)
Com
mon
Sto
ck C
once
ntra
tion
Fact
orLR
011
Com
mon
Sto
ck C
once
ntra
tion
Fact
or C
olum
n (6
) Lin
e (6
)X
0.21
00=
(128
)N
AIC
01
Wor
king
Cap
ital F
inan
ce N
otes
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(51.
1)X
0.15
75=
(129
)N
AIC
02
Wor
king
Cap
ital F
inan
ce N
otes
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(51.
2)X
0.15
75=
(130
)A
ffili
ated
Pre
ferr
ed S
tock
and
Com
mon
Sto
ck -
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(7)
X0.
2100
=H
oldi
ng C
ompa
ny in
Exc
ess o
f Ind
irect
Sub
s(1
31)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
-LR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (1
3)X
0.21
00=
All
Oth
er(1
32)
Tota
l for
C-1
cs A
sset
sLi
nes (
121)
-(12
2)-(
123)
+(12
4)+(
125)
+(12
6)+(
127)
+(12
8)+(
129)
+(13
0)+(
131)
Insu
ranc
e R
isk
(133
)D
isab
ility
Inco
me
Prem
ium
LR01
9 H
ealth
Pre
miu
ms C
olum
n (2
) Lin
es (2
1) th
roug
h (2
7)X
0.21
00=
Den
otes
line
s tha
t are
ded
ucte
d fr
om th
e to
tal r
athe
r tha
n ad
ded.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
0
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
T
(1)
(2)
Sour
ceR
BC
Am
ount
Tax
Fact
orR
BC
Tax
Eff
ect
(134
)Lo
ng-T
erm
Car
eLR
019
Hea
lth P
rem
ium
s Col
umn
(2) L
ine
(28)
+ L
R02
3 Lo
ng-T
erm
Car
eX
0.21
00=
Col
umn
(4) L
ine
(7)
(135
)Li
fe In
sura
nce
C-2
Ris
kLR
025
Life
Insu
ranc
e C
olum
n (2
) Lin
e (8
)X
0.21
00=
(136
)G
roup
Insu
ranc
e C
-2 R
isk
LR02
5 Li
fe In
sura
nce
Col
umn
(2) L
ines
(20)
and
(21)
X0.
2100
=(1
37)
Dis
abili
ty a
nd L
ong-
Term
Car
e H
ealth
LR
024
Hea
lth C
laim
Res
erve
s Col
umn
(4) L
ine
(9) +
Lin
e (1
5)X
0.21
00=
Cla
im R
eser
ves
(138
)Pr
emiu
m S
tabi
lizat
ion
Cre
dit
LR02
6 Pr
emiu
m S
tabi
lizat
ion
Res
erve
s Col
umn
(2) L
ine
(10)
X0.
0000
=(1
39)
Tota
l C-2
Ris
kLi
nes (
133)
+ (1
34) +
(135
) + (1
36) +
(137
) + (1
38)
(140
)In
tere
st R
ate
Ris
kLR
027
Inte
rest
Rat
e R
isk
Col
umn
(3) L
ine
(36)
X0.
2100
=(1
41)
Hea
lth C
redi
t Ris
kLR
028
Hea
lth C
redi
t Ris
k C
olum
n (2
) Lin
e (7
)X
0.00
00=
(142
)M
arke
t Ris
kLR
027
Inte
rest
Rat
e R
isk
Col
umn
(3) L
ine
(37)
X0.
2100
=(1
43)
Bus
ines
s Ris
kLR
029
Bus
ines
s Ris
k C
olum
n (2
) Lin
e (4
0)X
0.21
00=
(144
)H
ealth
Adm
inis
trativ
e Ex
pens
esLR
029
Bus
ines
s Ris
k C
olum
n (2
) Lin
e (5
7)X
0.00
00=
(145
)To
tal T
ax E
ffec
tLi
nes (
109)
+ (1
20) +
(132
) + (1
39) +
(140
) + (1
41) +
(142
) + (1
43) +
(144
)
Den
otes
line
s tha
t are
ded
ucte
d fr
om th
e to
tal r
athe
r tha
n ad
ded.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
0
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
(1
)R
BC
Sour
ceR
equi
rem
ent
Ass
et R
isk
- Aff
iliat
ed A
mou
nts (
C-0
)(1
)A
ffili
ated
US
Prop
erty
-Cas
ualty
Insu
rers
Dire
ctly
Ow
ned
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(1)
(2)
Aff
iliat
ed U
S Li
fe In
sure
rs D
irect
ly O
wne
dLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (2
)(3
)A
ffili
ated
US
Hea
lth In
sure
rs D
irect
ly a
nd In
dire
ctly
Ow
ned
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(3)
(4)
Aff
iliat
ed U
S Pr
oper
ty-C
asua
lty In
sure
rs In
dire
ctly
Ow
ned
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(4)
(5)
Aff
iliat
ed U
S Li
fe In
sure
rs In
dire
ctly
Ow
ned
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(5)
(6)
Aff
iliat
ed A
lien
Life
Insu
rers
- C
anad
ian
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(8)
(7)
Aff
iliat
ed A
lien
Life
Insu
rers
- A
ll O
ther
sLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (9
)(8
)O
ff-B
alan
ce S
heet
and
Oth
er It
ems
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n (5
) Lin
e (3
4)(9
)To
tal (
C-0
) - P
re-T
axSu
m o
f Lin
es (1
) thr
ough
(8)
(10)
(C-0
) Tax
Eff
ect
LR03
0 C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
n
ate
nal R
isk-
Bas
ed C
apita
l Col
umn
(2) L
ine
(120
)(1
1)N
et (C
-0) -
Pos
t-Tax
Line
(9) -
Lin
e (1
0)
Ass
et R
isk
– U
naff
iliat
ed C
omm
on S
tock
and
Aff
iliat
ed N
on-I
nsur
ance
Sto
ck (C
-1cs
)(1
2)Sc
hedu
le D
Una
ffili
ated
Com
mon
Sto
ckLR
005
Una
ffili
ated
Com
mon
Sto
ck C
olum
n (5
) Lin
e (2
9) +
LR
018
Off
-Bal
ance
She
etC
olla
tera
l Col
umn
(3) L
ine
(16)
(13)
Sche
dule
BA
Una
ffili
ated
Com
mon
Sto
ckLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) lin
e (4
7)(1
4)Sc
hedu
le B
A A
ffili
ated
Com
mon
Sto
ck -
C-1
csLR
008
Oth
er L
ong-
Term
Ass
ets C
olum
n (5
) lin
e (4
9.2)
(15)
Com
mon
Sto
ck C
once
ntra
tion
Fact
or
LR01
1 C
omm
on S
tock
Con
cent
ratio
n Fa
ctor
Col
umn
(6) L
ine
(6)
(16)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- H
oldi
ng C
ompa
ny in
Exc
ess o
fLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (7
)In
dire
ct S
ubsi
diar
ies
(17)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- A
ll O
ther
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(13)
(18)
Tota
l (C
-1cs
) - P
re-T
axSu
m o
f Lin
es (1
2) th
roug
h (1
7)(1
9)(C
-1cs
) Tax
Eff
ect
LR03
0 C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
n
ate
nal R
isk-
Bas
ed C
apita
l Col
umn
(2) L
ine
(132
)(2
0)N
et (C
-1cs
) - P
ost-T
axLi
ne (1
8) -
Line
(19)
Ass
et R
isk
- All
Oth
er (C
-1o)
(21)
Bon
ds a
fter S
ize
Fact
orLR
002
Bon
ds C
olum
n (2
) Lin
e (2
7) +
LR
018
Off
-Bal
ance
She
et C
olla
tera
l C
olum
n (3
) Lin
e (8
)(2
2)M
ortg
ages
(inc
ludi
ng p
ast d
ue a
nd u
npai
d ta
xes)
LR00
4 M
ortg
ages
Col
umn
(6) L
ine
(31)
(23)
Una
ffili
ated
Pre
ferr
ed S
tock
Incl
udin
g H
ybrid
sLR
005
Una
ffili
ated
Pre
ferr
ed a
nd C
omm
on S
tock
Col
umn
(5) L
ine
(18)
+
LR01
8 O
ff-B
alan
ce S
heet
Col
late
ral C
olum
n (3
) Lin
e (1
5)(2
4)A
ffili
ated
Pre
ferr
ed S
tock
and
Com
mon
Sto
ck -
Inve
stm
ent S
ubsi
diar
ies
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(6)
(25)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- Pa
rent
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(10)
(26)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- Pr
oper
ty a
nd C
asua
lty In
sure
rs n
otLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (1
1)Su
bjec
t to
Ris
k-B
ased
Cap
ital
(27)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- Li
fe In
sure
rs n
ot S
ubje
ct to
Ris
k-B
ased
LR04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(4) L
ine
(12)
Cap
ital
(28)
Aff
iliat
ed P
refe
rred
Sto
ck a
nd C
omm
on S
tock
- Pu
blic
ly T
rade
d In
sure
rs H
eld
atLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (4
) Lin
e (1
4)Fa
ir V
alue
(exc
ess o
f sta
tem
ent v
alue
ove
r boo
k va
lue)
(29)
Sepa
rate
Acc
ount
s with
Gua
rant
ees
LR00
6 Se
para
te A
ccou
nts C
olum
n (3
) Lin
e (7
)
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
1
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
(1
)R
BC
Sour
ceR
equi
rem
ent
(30)
Synt
hetic
GIC
's (C
-1o)
LR00
6 Se
para
te A
ccou
nts C
olum
n (3
) Lin
e (8
)(3
1)Su
rplu
s in
Non
-Gua
rant
eed
Sepa
rate
Acc
ount
sLR
006
Sepa
rate
Acc
ount
s Col
umn
(3) L
ine
(13)
(32)
Rea
l Est
ate
(gro
ss o
f enc
umbr
ance
s)LR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(13)
(33)
Sche
dule
BA
Rea
l Est
ate
(gro
ss o
f enc
umbr
ance
s)LR
007
Rea
l Est
ate
Col
umn
(3) L
ine
(25)
(34)
Oth
er L
ong-
Term
Ass
ets
LR00
8 O
ther
Lon
g-Te
rm A
sset
s Col
umn
(5) L
ine
(56)
+ L
R01
8 O
ff-B
alan
ce S
heet
C
olla
tera
l Col
umn
(3) L
ine
(17)
+ L
ine
(18)
(35)
Sche
dule
BA
Mor
tgag
esLR
009
Sche
dule
BA
Mor
tgag
es C
olum
n (6
) Lin
e (2
3)(3
6)C
once
ntra
tion
Fact
orLR
010
Ass
et C
once
ntra
tion
Fact
or C
olum
n (6
) Lin
e (6
8) G
rand
Tot
al P
age
(37)
Mis
cella
neou
sLR
012
Mis
cella
neou
s Ass
ets C
olum
n (2
) Lin
e (2
1)(3
8)R
eplic
atio
n Tr
ansa
ctio
ns a
nd M
anda
tory
Con
verti
ble
Secu
ritie
s LR
013
Rep
licat
ion
(Syn
thet
ic A
sset
) Tra
nsac
tions
and
Man
dato
ry
Con
verti
ble
Secu
ritie
s Col
umn
(7) L
ine
(999
9999
)(3
9)R
eins
uran
ceLR
016
Rei
nsur
ance
Col
umn
(4) L
ine
(17)
(40)
Tota
l (C
-1o)
- Pr
e-Ta
xSu
m o
f Lin
es (2
1) th
roug
h (3
9)(4
1)(C
-1o)
Tax
Eff
ect
LR03
0 C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
n
ate
nal R
isk-
Bas
ed C
apita
l Col
umn
(2) L
ine
(109
)(4
2)N
et (C
-1o)
- Po
st-T
axLi
ne (4
0) -
Line
(41)
Insu
ranc
e R
isk
(C-2
)(4
3)In
divi
dual
and
Indu
stria
l Life
Insu
ranc
eLR
025
Life
Insu
ranc
e C
olum
n (2
) Lin
e (8
)(4
4)G
roup
and
Cre
dit L
ife In
sura
nce
and
FEG
I/SG
LILR
025
Life
Insu
ranc
e C
olum
n (2
) Lin
es (2
0) a
nd (2
1)(4
5)To
tal H
ealth
Insu
ranc
eLR
024
Hea
lth C
laim
Res
erve
s Col
umn
(4) L
ine
(18)
(46)
Prem
ium
Sta
biliz
atio
n R
eser
ve C
redi
tLR
026
Prem
ium
Sta
biliz
atio
n R
eser
ves C
olum
n (2
) Lin
e (1
0)(4
7)To
tal (
C-2
) - P
re-T
axSu
m o
f Lin
es (4
3) th
roug
h (4
6)(4
8)(C
-2) T
ax E
ffec
tLR
030
Cal
cula
tion
of T
ax E
ffec
t for
Life
an
at
ena
l Ris
k-B
ased
Cap
ital C
olum
n (2
) Lin
e (1
39)
(49)
Net
(C-2
) - P
ost-T
axLi
ne (4
7) -
Line
(48)
Inte
rest
Rat
e R
isk
(C-3
a)(5
0)To
tal I
nter
est R
ate
Ris
k - P
re-T
axLR
027
Inte
rest
Rat
e R
isk
Col
umn
(3) L
ine
(36)
(51)
(C-3
a) T
ax E
ffec
tLR
030
Cal
cula
tion
of T
ax E
ffec
t for
Life
an
at
ena
l Ris
k-B
ased
Cap
ital C
olum
n (2
) Lin
e (1
40)
(52)
Net
(C-3
a) -
Post
-Tax
Line
(50)
- Li
ne (5
1)
Hea
lth C
redi
t Ris
k (C
-3b)
(53)
Tota
l Hea
lth C
redi
t Ris
k - P
re-T
axLR
028
Hea
lth C
redi
t Ris
k C
olum
n (2
) Lin
e (7
)(5
4)(C
-3b)
Tax
Eff
ect
LR03
0 C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
n
ate
nal R
isk-
Bas
ed C
apita
l Col
umn
(2) L
ine
(141
)(5
5)N
et (C
-3b)
- Po
st-T
axLi
ne (5
3) -
Line
(54)
Mar
ket R
isk
(C-3
c)(5
6)To
tal M
arke
t Ris
k - P
re-T
axLR
027
Inte
rest
Rat
e R
isk
Col
umn
(3) L
ine
(37)
(57)
(C-3
c) T
ax E
ffec
tLR
030
Cal
cula
tion
of T
ax E
ffec
t for
Life
an
at
ena
l Ris
k-B
ased
Cap
ital C
olum
n (2
) Lin
e (1
42)
(58)
Net
(C-3
c) -
Post
-Tax
Line
(56)
- Li
ne (5
7)
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
1
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
T
(1
)R
BC
Sour
ceR
equi
rem
ent
Bus
ines
s Ris
k (C
-4a)
(59)
Prem
ium
Com
pone
nt
LR02
9 B
usin
ess R
isk
Col
umn
(2) L
ines
(12)
+ (2
4) +
(36)
(60)
Liab
ility
Com
pone
ntLR
029
Bus
ines
s Ris
k C
olum
n (2
) Lin
e (3
9)(6
1)Su
btot
al B
usin
ess R
isk
(C-4
a) -
Pre-
Tax
Line
s (59
) + (6
0)
(62)
(C-4
a) T
ax E
ffec
tLR
030
Cal
cula
tion
of T
ax E
ffec
t for
Life
an
at
ena
l Ris
k-B
ased
Cap
ital C
olum
n (2
) Lin
e (1
43)
(63)
Net
(C-4
a) -
Post
-Tax
Line
(61)
- Li
ne (6
2)
Bus
ines
s Ris
k (C
-4b)
(64)
Hea
lth A
dmin
istra
tive
Expe
nse
Com
pone
nt o
f Bus
ines
s Ris
k (C
-4b)
- Pr
e-Ta
xLR
029
Bus
ines
s Ris
k C
olum
n (2
) Lin
e (5
7)(6
5)(C
-4b)
Tax
Eff
ect
LR03
0 C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
n
ate
nal R
isk-
Bas
ed C
apita
l Col
umn
(2) L
ine
(144
)(6
6)N
et (C
-4b)
- Po
st-T
axLi
ne (6
4) -
Line
(65)
Tota
l Ris
k-B
ased
Cap
ital A
fter C
ovar
ianc
e B
efor
e B
asic
Ope
ratio
nal R
isk
(67)
C-0
+ C
-4a
+ Sq
uare
Roo
t of [
(C-1
o +
C-3
a) +
(C-1
cs +
C-3
c) +
(C-2
) +
(C-3
b)
REP
OR
T A
MO
UN
T O
N P
AR
ENT
CO
MPA
NY
'S R
BC
IF A
PPLI
CA
BLE
+ (C
-4b)
]L(
11)+
L(63
) + S
quar
e R
oot o
f [(L
(42)
+ L
(52)
) +
(L(2
0) +
L(5
8))
+ L(
49)
+ L
(55)
+
L(66
)]
(68)
Gro
ss B
asic
Ope
ratio
nal R
isk
0.0
3 x
L(67
)(6
9)C
-4a
of U
.S. L
ife In
sura
nce
Subs
idia
ries
Com
pany
Rec
ords
(70)
Net
Bas
ic O
pera
tiona
l Ris
kLi
ne (6
8) -
(Lin
e (6
3) +
Lin
e (6
9))
(Not
less
than
zer
o)
(71)
Prim
ary
Secu
rity
Shor
tfall
Cal
cula
ted
in A
ccor
danc
e W
ith A
ctua
rial G
uide
line
XLV
III
LR03
6 X
XX
/AX
XX
Rei
nsur
ance
Prim
ary
Secu
rity
Shor
tfall
by C
essi
on C
olum
n (7
) Lin
e (9
9999
99)
Mul
tiplie
d by
2M
ultip
lied
by 2
(72)
Tota
l Ris
k-B
ased
Cap
ital A
fter C
ovar
ianc
e (I
nclu
ding
Bas
ic O
pera
tiona
l Ris
k an
d Pr
imar
y Se
curit
y Sh
ortfa
ll m
ultip
lied
by 2
)Li
ne (6
7) +
Lin
e (7
0) +
Lin
e (7
1)
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l (A
fter C
ovar
ianc
e A
djus
tmen
t and
Sho
rtfal
l)(7
3)To
tal R
isk-
Bas
ed C
apita
l Afte
r Cov
aria
nce
Tim
es F
ifty
Perc
ent
Line
(72)
x 0
.50
Tax
Sens
itivi
ty T
est
(74)
Tax
Sens
itivi
ty T
est:
Tota
l Ris
k-B
ased
Cap
ital A
fter C
ovar
ianc
eL(
9)+L
(61)
+ S
quar
e R
oot o
f [(L
(40)
+ L
(50)
) +
(L(1
8) +
L(5
6))
+ L(
47)
+ L
(53)
+
L(64
)](7
5)Ta
x Se
nsiti
vity
Tes
t: A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital
Line
(74)
x 0
.50
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
1
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
T
T
(1)
(2)
(3)
(4)
Orig
inal
Prin
cipa
lLi
mita
tion
Lim
itatio
n on
Cur
rent
Prin
cipa
lC
redi
t to
Tota
lY
ears
to M
atur
ity a
t the
Tim
e of
the
Stat
emen
tA
mou
ntFa
ctor
Prin
cipa
l Am
ount
Am
ount
Adj
uste
d C
apita
l
Cap
ital N
otes
Mat
urin
g 15
Yea
rs o
r les
s fro
m th
e Y
ear o
f Iss
ue(1
)G
reat
er th
an 0
and
less
than
or e
qual
to 1
X0.
0=
(2)
Gre
ater
than
1 a
nd le
ss th
an o
r equ
al to
2X
0.2
=(3
)G
reat
er th
an 2
and
less
than
or e
qual
to 3
X0.
4=
(4)
Gre
ater
than
3 a
nd le
ss th
an o
r equ
al to
4X
0.6
=(5
)G
reat
er th
an 4
and
less
than
or e
qual
to 5
X0.
8=
(6)
Gre
ater
than
5X
1.0
=
Cap
ital N
otes
Mat
urin
g m
ore
than
15
Yea
rs fr
om th
e Y
ear o
f Iss
ue(7
)G
reat
er th
an 0
and
less
than
or e
qual
to 1
X0.
0=
(8)
Gre
ater
than
1 a
nd le
ss th
an o
r equ
al to
2X
0.1
=(9
)G
reat
er th
an 2
and
less
than
or e
qual
to 3
X0.
2=
(10)
Gre
ater
than
3 a
nd le
ss th
an o
r equ
al to
4X
0.3
=(1
1)G
reat
er th
an 4
and
less
than
or e
qual
to 5
X0.
4=
(12)
Gre
ater
than
5 a
nd le
ss th
an o
r equ
al to
6X
0.5
=(1
3)G
reat
er th
an 6
and
less
than
or e
qual
to 7
X0.
6=
(14)
Gre
ater
than
7 a
nd le
ss th
an o
r equ
al to
8X
0.7
=(1
5)G
reat
er th
an 8
and
less
than
or e
qual
to 9
X0.
8=
(16)
Gre
ater
than
9 a
nd le
ss th
an o
r equ
al to
10
X0.
9=
(17)
Gre
ater
than
10
X1.
0=
(18)
Cre
dit f
or C
apita
l Not
es B
efor
e Li
mita
tion
(sum
of l
ines
(1) t
hrou
gh (1
7))
Col
umn
(4) i
s cal
cula
ted
as th
e le
sser
of C
olum
n (2
) or C
olum
n (3
).
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
2
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
TT
T
T
(I
nclu
ding
Tot
al A
djus
ted
Cap
ital T
ax S
ensi
tivity
Tes
t)(1
)(2
)
Ann
ual S
tate
men
t Sou
rce
Stat
emen
t Val
ueFa
ctor
Adj
uste
d C
apita
lC
ompa
ny A
mou
nts
(1)
Cap
ital a
nd S
urpl
usPa
ge 3
Col
umn
1 Li
ne 3
8X
1.00
0=
(2)
Ass
et V
alua
tion
Res
erve
Page
3 C
olum
n 1
Line
24.
01
X1.
000
=(3
)D
ivid
ends
App
ortio
ned
for P
aym
ent
Page
3 C
olum
n 1
Line
6.1
, in
part
X0.
500
=(4
)D
ivid
ends
Not
Yet
App
ortio
ned
Page
3 C
olum
n 1
Line
6.2
, in
part
X0.
500
=(5
)H
edgi
ng F
air V
alue
Adj
ustm
ent
Com
pany
Rec
ords
X-1
.000
=
Life
Sub
sidi
ary
Com
pany
Am
ount
s(6
)A
sset
Val
uatio
n R
eser
veSu
bsid
iarie
s' A
nnua
l Sta
tem
ent P
age
3 Co
lum
n 1
Line
24.
01
X1.
000
=(7
)D
ivid
end
Liab
ility
Subs
idia
ries'
Ann
ual S
tate
men
t Pag
e 3
Colu
mn
1 Li
ne 6
.1 +
Lin
e 6.
2X
0.50
0=
Prop
erty
and
Cas
ualty
and
Oth
er N
on-U
.S. A
ffili
ated
Am
ount
s(8
)N
on-T
abul
ar d
isco
unt a
nd/o
r Alie
n In
sura
nce
Subs
idia
ries:
Oth
erIn
clud
ed in
Sub
sidia
ries'
Ann
ual S
tate
men
t Pag
e 3
Colu
mn
1 Li
ne 1
+ 3
X1.
000
=an
d/or
Sch
edul
e D
Par
t 6, S
ectio
n 1
Col
umn
8 Li
ne 0
5999
99 a
nd
Line
149
9999
, in
part
(9)
Tota
l Adj
uste
d C
apita
l Bef
ore
Cap
ital N
otes
Sum
of L
ines
(1) t
hrou
gh (7
) les
s Lin
e (8)
Cre
dit f
or C
apita
l Not
es(1
0.1)
Surp
lus N
otes
Page
3 C
olum
n 1
Line
32
(10.
2)Li
mita
tion
on C
apita
l Not
es0.
5 x
[Lin
e (9)
- Li
ne (1
0.1)
] - L
ine (
10.1
), bu
t not
less
than
0(1
0.3)
Cap
ital N
otes
Bef
ore
Lim
itatio
nLR
032
Cap
ital N
otes
Bef
ore
Lim
itatio
n C
olum
n (4
) Lin
e (1
8)(1
0.4)
Cre
dit f
or C
apita
l Not
esLe
sser
of C
olum
n (1
) Lin
e (10
.2) o
r Lin
e (10
.3)
(11)
XX
X/A
XX
X R
eins
uran
ce R
BC
Sho
rtfal
lLR
037
XX
X/A
XX
X C
aptiv
e R
eins
uran
ce C
onso
lidat
ed E
xhib
it C
olum
n (1
0) L
ine
(10)
(12)
Tota
l Adj
uste
d C
apita
lLi
ne (9
) + L
ine
(10.
4) -
Line
(11)
Tax
Sens
itivi
ty T
est
Com
pany
Am
ount
s(1
3)D
efer
red
Tax
Ass
et (D
TA) V
alue
Page
2 C
olum
n 3
Line
18.
2 X
-1.0
00 =
(14)
Def
erre
d Ta
x Li
abili
ty (D
TL) V
alue
Page
3 C
olum
n 1
Line
15.
2 X
1.00
0 =
Subs
idia
ry A
mou
nts
(15)
Def
erre
d Ta
x A
sset
(DTA
) Val
ueC
ompa
ny R
ecor
dsX
-1.0
00 =
(16)
Def
erre
d Ta
x Li
abili
ty (D
TL) V
alue
Com
pany
Rec
ords
X1.
000
=
(17)
Tax
Sens
itivi
ty T
est:
Tota
l Adj
uste
d C
apita
lLi
ne (1
2)+(
13)+
(14)
+(15
)(1
6)
Ex D
TA A
CL
RB
C R
atio
Sen
sitiv
ity T
est
(18)
Def
erre
d Ta
x A
sset
-Com
pany
Am
ount
sPa
ge 2
Col
umn
3 Li
ne 1
8.2
X1.
000
=
(19)
Tota
l Adj
uste
d C
apita
l Les
s Def
erre
d Ta
x A
sset
Am
ount
sLi
ne (1
2) le
ss L
ine
(18)
(20)
Aut
horiz
ed C
ontro
l Lev
el R
BC
LR
034
Ris
k-B
ased
Cap
ital L
evel
of A
ctio
n Li
ne (4
) X
1.00
0 =
(21)
Ex D
TA A
CL
RB
C R
atio
Li
ne (1
9) /
Line
(20)
0.
000%
A
CA
Fee
RB
C R
atio
Sen
sitiv
ity T
est
(22)
AC
A F
ee (D
ata
Yea
r Am
ount
to b
e Pa
id in
the
Fee
Yea
r)N
ote
22B
X1.
000
=(2
3)To
tal A
djus
ted
Cap
ital L
ess A
CA
Fee
Line
(12)
less
Lin
e (2
2)
(24)
Aut
horiz
ed C
ontro
l Lev
el R
BC
LR
034
Ris
k-B
ased
Cap
ital L
evel
of A
ctio
n Li
ne (4
) (2
5)A
CA
Fee
RB
C R
atio
Line
(23)
/ Li
ne (2
4)
0.00
0%
Incl
udin
g su
bsid
iarie
s ow
ned
by h
oldi
ng c
ompa
nies
.M
ultip
ly st
atem
ent v
alue
by
perc
ent o
f ow
ners
hip.
The
porti
on o
f the
AV
R th
at c
an b
e co
unte
d as
cap
ital i
s Iim
ited
to th
e am
ount
not
util
ized
in a
sset
ade
quac
y te
stin
g in
supp
ort o
f the
Act
uaria
l Opi
nion
for r
eser
ves.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
3
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
n
lin
g T
a
ensi
tiity
Tes
t
(1)
Sour
ceR
BC
Am
ount
(1)
Tota
l Adj
uste
d C
apita
l - R
EPO
RT
AM
OU
NT
IN F
IVE-
YEA
R H
ISTO
RIC
AL
LR03
3 C
alcu
latio
n of
Tot
al A
djus
ted
Cap
ital C
olum
n (2
) Lin
e (1
2)D
ATA
PA
GE
22 C
OLU
MN
1 L
INE
30
Trig
ger P
oint
s for
Lev
el o
f Reg
ulat
ory
Act
ion:
(2)
Com
pany
Act
ion
Leve
l = 2
00%
of A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital
2.0
times
LR
031
Cal
cula
tion
of T
otal
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l Col
umn
(1) L
ine
(73)
(3)
Reg
ulat
ory
Act
ion
Leve
l = 1
50%
of A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital
1.5
times
LR
031
Cal
cula
tion
of T
otal
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l Col
umn
(1) L
ine
(73)
(4)
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l - R
EPO
RT
AM
OU
NT
IN F
IVE-
YEA
R1.
0 tim
es L
R03
1 C
alcu
latio
n of
Tot
al A
utho
rized
Con
trol L
evel
Ris
k-H
ISTO
RIC
AL
DA
TA P
AG
E 22
CO
LUM
N 1
LIN
E 31
Bas
ed C
apita
l Col
umn
(1) L
ine
(73)
(5)
Man
dato
ry C
ontro
l Lev
el =
70%
of A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital
0.7
times
LR
031
Cal
cula
tion
of T
otal
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l Col
umn
(1) L
ine
(73)
(6)
Leve
l of A
ctio
n:
(7)
Aut
horiz
ed C
ontro
l Lev
el R
BC
Rat
ioLi
ne (1
) / L
ine
(4)
0.00
0%
Tax
Sens
itivi
ty T
est
(8)
Tax
Sens
itivi
ty T
est:
Tota
l Adj
uste
d C
apita
lLR
033
Cal
cula
tion
of T
otal
Adj
uste
d C
apita
l Col
umn
(2) L
ine
(17)
(9)
Tax
Sens
itivi
ty T
est:
Com
pany
Act
ion
Leve
l = 2
00%
of A
utho
rized
Con
trol L
evel
2.
0 tim
es L
R03
1 C
alcu
latio
n of
Tot
al A
utho
rized
Con
trol L
evel
Ris
k-R
isk-
Bas
ed C
apita
lB
ased
Cap
ital C
olum
n (1
) Lin
e (7
5)(1
0)Ta
x Se
nsiti
vity
Tes
t: R
egul
ator
y A
ctio
n Le
vel =
150
% o
f Aut
horiz
ed C
ontro
l 1.
5 tim
es L
R03
1 C
alcu
latio
n of
Tot
al A
utho
rized
Con
trol L
evel
Ris
k-Le
vel R
isk-
Bas
ed C
apita
lB
ased
Cap
ital C
olum
n (1
) Lin
e (7
5)(1
1)Ta
x Se
nsiti
vity
Tes
t:Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l1.
0 tim
es L
R03
1 C
alcu
latio
n of
Tot
al A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital C
olum
n (1
) Lin
e (7
5)(1
2)Ta
x Se
nsiti
vity
Tes
t: M
anda
tory
Con
trol L
evel
= 7
0% o
f Aut
horiz
ed C
ontro
l 0.
7 tim
es L
R03
1 C
alcu
latio
n of
Tot
al A
utho
rized
Con
trol L
evel
Ris
k-Le
vel R
isk-
Bas
ed C
apita
lB
ased
Cap
ital C
olum
n (1
) Lin
e (7
5)
(13)
Tax
Sens
itivi
ty T
est:
Leve
l of A
ctio
n:
If T
otal
Adj
uste
d C
apita
l Lin
e (1
) exc
eeds
Com
pany
Act
ion
Leve
l Ris
k-B
ased
Cap
ital L
ine
(2),
Non
e w
ill b
e in
dica
ted
(unl
ess t
he T
rend
Tes
t trig
gers
Com
pany
Act
ion
Leve
l).
Oth
erw
ise,
the
appr
opria
te le
vel o
f act
ion
will
be
indi
cate
d.If
the
trend
test
is a
pplic
able
for t
he c
ompa
ny, t
he le
vel t
hat t
he tr
end
test
app
lies t
o fo
r the
stat
e of
dom
icile
as r
epor
ted
on L
R03
5 Tr
end
Test
Lin
e (1
8) is
indi
cate
d as
bei
ng:
(000
0001
)If
3.0
had
bee
n se
lect
ed fo
r LR
035
Tren
d Te
st L
ine
(18)
as t
he st
ate
of d
omic
ile le
vel,
the
Line
(6) l
evel
of a
ctio
n ab
ove
wou
ld h
ave
been
:(0
0000
02)
If 2
.5 h
ad b
een
sele
cted
for L
R03
5 Tr
end
Test
Lin
e (1
8) a
s the
stat
e of
dom
icile
leve
l, th
e Li
ne (6
) lev
el o
f act
ion
abov
e w
ould
hav
e be
en:
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
4
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T T
T
(1)
(2)
(3)
(4)
Sour
ce3.
0 A
mou
nt3.
0 R
esul
t2.
5 A
mou
nt2.
5 R
esul
tC
riter
ia fo
r App
lyin
g Tr
end
Test
(1)
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
lLR
031
Cal
cula
tion
of A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital C
olum
n (1
) Lin
e (7
3)(2
)Tr
end
Test
Saf
e H
arbo
rC
olum
n (1
)=3.
0 x
Line
(1),
Col
umn
(3)=
2.5
x Li
ne (1
)
(3)
Tota
l Adj
uste
d C
apita
lLR
033
Cal
cula
tion
of T
otal
Adj
uste
d C
apita
l Lin
e (1
2)
Tren
d Te
st D
ata
(4)
Firs
t Prio
r Yea
r Tot
al A
djus
ted
Cap
ital
Five
-Yea
r His
toric
al D
ata
Page
22
Col
umn
2 Li
ne 3
0(5
)Fi
rst P
rior Y
ear A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital
Five
-Yea
r His
toric
al D
ata
Page
22
Col
umn
2 Li
ne 3
1(6
)Th
ird P
rior Y
ear T
otal
Adj
uste
d C
apita
lFi
ve-Y
ear H
isto
rical
Dat
a Pa
ge 2
2 C
olum
n 4
Line
30
(7)
Third
Prio
r Yea
r Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
lFi
ve-Y
ear H
isto
rical
Dat
a Pa
ge 2
2 C
olum
n 4
Line
31
Tren
d Te
st C
alcu
latio
n (o
nly
if ap
plic
able
)(8
)C
urre
nt Y
ear M
argi
nLi
ne (3
) - L
ine
(1)
(9)
Firs
t Prio
r Yea
r Mar
gin
Line
(4) -
Lin
e (5
)(1
0)Th
ird P
rior Y
ear M
argi
nLi
ne (6
) - L
ine
(7)
(11)
Dec
reas
e in
Mar
gin
from
Firs
t Prio
r Yea
rLi
ne (9
) - L
ine
(8) (
use
zero
if n
egat
ive)
(12)
Dec
reas
e in
Mar
gin
from
Thi
rd P
rior Y
ear
Line
(10)
- Li
ne (8
) (us
e ze
ro if
neg
ativ
e)(1
3)A
vera
ge d
ecre
ase
in L
ast T
hree
Yea
rs1/
3 of
Lin
e (1
2)(1
4)M
argi
nal D
iffer
ence
Gre
ater
of L
ine
(11)
and
Lin
e (1
3)(1
5)To
tal A
djus
ted
Cap
ital L
ess M
argi
n D
iffer
ence
Line
(3) -
Lin
e (1
4)
(16)
Leve
l of R
isk-
Base
d Ca
pita
l1.
9 x
Line
(1)
(17)
Neg
ativ
e Tr
end?
(18)
For c
ompa
nies
whe
re o
ne o
f the
abo
ve tr
end
test
s app
lies,
Sele
ct "2
.5",
"3.0
" or "
N/A
"do
es th
e st
ate
of d
omic
ile re
quire
act
ion
at 2
.5 o
r 3.0
tim
esA
utho
rized
Con
trol L
evel
RB
C?
The
Tren
d Te
st a
pplie
s onl
y if
Tot
al A
djus
ted
Cap
ital L
ine
(3) i
s les
s tha
n th
e Tr
end
Test
Saf
e H
arbo
r Lin
e (2
) and
the
LR03
4 Ris
k-B
ased
Cap
ital L
evel
of A
ctio
n Lin
e (6
) is “
Non
e”.
If L
ine
(15)
is le
ss th
an L
ine
(16)
, the
com
pany
trig
gers
regu
lato
ry a
ttent
ion
at th
e C
ompa
ny A
ctio
n Le
vel b
ased
on
the
trend
test
. The
NA
IC is
in th
e pr
oces
s of c
hang
ing
the
uppe
r lev
el w
here
the
trend
te
st c
an b
e tri
gger
ed fr
om 2
.5 ti
mes
the
Aut
horiz
ed C
ontro
l Lev
el R
BC
to 3
.0 ti
mes
the
Aut
horiz
ed C
ontro
l Lev
el R
BC
. Unt
il al
l sta
tes h
ave
trans
ition
ed to
the
3.0
stan
dard
, the
re m
ay b
e
diff
eren
ces b
etw
een
stat
es a
s to
whe
ther
col
umns
(1) a
nd (2
) or c
olum
ns (3
) and
(4) o
f the
LR
035
Tren
d Te
st p
age
appl
y to
a p
artic
ular
com
pany
, so
info
rmat
ion
is p
rovi
ded
to a
lert
user
s to
po
tent
ial a
ltern
ativ
e tre
nd te
st re
sults
dur
ing
the
trans
ition
per
iod.
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
5
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
T
(1
)
Sour
ceSt
atem
ent V
alue
(1.2
)O
ther
Aff
iliat
es: S
ubsi
diar
ies
Subs
idia
ries'
Life
and
Frat
erna
l Ris
k-B
ased
Cap
ital L
R04
2 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
Col
umn
(1) L
ine
(13)
; Pro
perty
and
Cas
ualty
Ris
k-B
ased
Cap
ital P
R00
5 Su
mm
ary
For S
ubsi
diar
y, C
ontro
lled
and
Aff
iliat
ed In
vest
men
ts fo
r Cro
ss-C
heck
ing
Stat
emen
t Val
ues C
olum
n (1
) Lin
e (8
) and
Lin
e (1
7)(2
.2)
Non
cont
rolle
d A
sset
s: S
ubsi
diar
ies
Subs
idia
ries'
Life
and
Frat
erna
l Ris
k-B
ased
Cap
ital L
R01
7 O
ff-B
alan
ce S
heet
and
Oth
er Ite
ms C
olum
n (1
) Lin
e (1
5); P
rope
rty a
nd
Cas
ualty
PR
014
Mis
cella
neou
s Off
-Bal
ance
She
et It
ems C
olum
n (1
) Lin
e (1
5)(3
.2)
Gua
rant
ees f
or A
ffili
ates
: Sub
sidi
arie
sSu
bsid
iarie
s' Li
fe N
otes
to F
inan
cial
Sta
tem
ents
#14
A3c
1; Pr
oper
ty a
nd C
asua
lty N
otes
to F
inan
cial
Sta
tem
ents
#14A
3c1
(4.2
)C
ontin
gent
Lia
bilit
ies:
Sub
sidi
arie
sSu
bsid
iarie
s' Li
fe N
otes
to F
inan
cial
Sta
tem
ents
#14
A1;
Pro
perty
and
Cas
ualty
Not
es to
Fin
anci
al S
tate
men
ts #
14A
1(5
.2)
Long
Ter
m L
ease
s: S
ubsi
diar
ies
Subs
idia
ries'
Life
Not
es to
Fin
anci
al S
tate
men
ts #
15A
2a1;
Pro
perty
and
Cas
ualty
Not
es to
Fin
anci
al S
tate
men
ts #
15A
2a1
(7.1
1)To
tal A
ffili
ated
Inve
stm
ents
: Com
pany
Com
pany
's A
nnua
l Sta
tem
ent F
ive-
Yea
r His
toric
al D
ata
Col
umn
1 Li
ne 5
0(7
.12)
Less
Aff
iliat
ed C
omm
on S
tock
:C
ompa
ny's
Ann
ual S
tate
men
t Fiv
e-Y
ear H
isto
rical
Dat
a C
olum
n 1
Line
46
Com
pany
(7.1
3)Le
ss A
ffili
ated
Pre
ferr
ed S
tock
:C
ompa
ny's
Ann
ual S
tate
men
t Fiv
e-Y
ear H
isto
rical
Dat
a C
olum
n 1
Line
45
Com
pany
(7.1
4)N
et A
ffili
ated
Inve
stm
ents
: Com
pany
Line
s (7.
11) -
(7.1
2) -
(7.1
3)(7
.2)
Aff
iliat
ed In
vest
men
ts: S
ubsi
diar
ies
Subs
idia
ries'
Life
Ann
ual S
tate
men
t Fiv
e-Y
ear H
isto
rical
Dat
a C
olum
n 1
Line
50
Less
Lin
es 4
5 an
d 46
; Pro
perty
and
Cas
ualty
Ann
ual S
tate
men
t Fiv
e-Y
ear H
isto
rical
Dat
a C
olum
n 1
Line
48
Less
Lin
es 4
3 an
d 44
(9.1
)Su
rplu
s Not
es: C
ompa
nyC
ompa
ny's
Ann
ual S
tate
men
t Pag
e 3
Col
umn
1 Li
ne 3
2(9
.2)
Surp
lus N
otes
: Sub
sidi
arie
sSu
bsid
iarie
s' Li
fe A
nnua
l Sta
tem
ent P
age
3 C
olum
n 1
Line
32;
Pro
perty
and
Cas
ualty
Ann
ual S
tate
men
t Pag
e 3
Col
umn
1Li
ne 3
3(1
0.11
)C
apita
l Pai
d In
: Com
pany
Com
pany
's A
nnua
l Sta
tem
ent P
age
4 C
olum
n 1
Line
50.
1(1
0.12
)Su
rplu
s Pai
d In
: Com
pany
Com
pany
's A
nnua
l Sta
tem
ent P
age
4 C
olum
n 1
Line
51.
1(1
0.13
)To
tal C
urre
nt Y
ear's
Cap
ital
Con
tribu
tions
: Com
pany
Line
(10.
11) +
Lin
e (1
0.12
)(1
0.2)
Cur
rent
Yea
r's C
apita
l Con
tribu
tions
:Su
bsid
iarie
s' Li
fe A
nnua
l Sta
tem
ent P
age
4 C
olum
n 1
Line
s 50.
1 +
51.1
; Pro
perty
and
Cas
ualty
Ann
ual S
tate
men
t Pag
e 4
Subs
idia
ries
Col
umn
1 Li
nes 3
2.1
+ 33
.1
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
8
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
TT
TT
T
T
(1)
(2)
(3)
(4)
Sens
itivi
ty T
ests
Aff
ectin
gA
dditi
onal
Aut
horiz
edA
utho
rized
Aut
horiz
ed C
ontro
l Lev
elSe
nsiti
vity
Con
trol L
evel
Con
trol L
evel
Ris
k-B
ased
Cap
ital
Sour
ceSt
atem
ent V
alue
Fact
orA
dditi
onal
RB
CB
efor
e Te
stA
fter T
est
(1.1
)O
ther
Aff
iliat
es: C
ompa
nyLR
042
Sum
mar
y fo
r Aff
iliat
ed In
vest
men
ts C
olum
n0.
700
(1) L
ine
(13)
(1.2
)O
ther
Aff
iliat
es: S
ubsi
diar
ies
LR03
8 A
dditi
onal
Info
rmat
ion
Req
uire
d C
olum
n (1
)0.
700
Line
(1.2
)(1
.99)
Tota
l Oth
er A
ffili
ates
0.70
0
(2.1
)N
onco
ntro
lled
Ass
ets -
Com
pany
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n 0.
020
(1) L
ine
(15)
(2.2
)N
onco
ntro
lled
Ass
ets -
LR03
8 A
dditi
onal
Info
rmat
ion
Req
uire
d C
olum
n (1
)0.
020
Subs
idia
ries
Line
(2.2
)(2
.99)
Tota
l Non
cont
rolle
d A
sset
s0.
020
(3.1
)G
uara
ntee
s for
Aff
iliat
es: C
ompa
nyLR
017
Off
-Bal
ance
She
et a
nd O
ther
Item
s Col
umn
0.02
0(1
) Lin
e (2
4)(3
.2)
Gua
rant
ees f
or A
ffili
ates
:LR
038
Add
ition
al In
form
atio
n R
equi
red
Col
umn
(1)
0.02
0Su
bsid
iarie
sLi
ne (3
.2)
(3.9
9)To
tal G
uara
ntee
s for
Aff
iliat
es0.
020
(4.1
)C
ontin
gent
Lia
bilit
ies:
Com
pany
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n 0.
020
(1) L
ine
(25)
(4.2
)C
ontin
gent
Lia
bilit
ies:
Sub
sidi
arie
sLR
038
Add
ition
al In
form
atio
n R
equi
red
Col
umn
(1)
0.02
0Li
ne (4
.2)
(4.9
9)To
tal C
ontin
gent
Lia
bilit
ies
0.02
0
(5.1
)Lo
ng-T
erm
Lea
ses:
Com
pany
LR01
7 O
ff-B
alan
ce S
heet
and
Oth
er It
ems C
olum
n 0.
030
(1) L
ine
(26)
(5.2
)Lo
ng-T
erm
Lea
ses:
Sub
sidi
arie
sLR
038
Add
ition
al In
form
atio
n R
equi
red
Col
umn
(1)
0.03
0Li
ne (5
.2)
(5.9
9)To
tal L
ong-
Term
Lea
ses
0.03
0
(7.1
)A
ffilia
ted
Inve
stm
ents
: Com
pany
LR03
8 A
dditi
onal
Info
rmat
ion
Req
uire
d C
olum
n (1
)0.
100
Line
(7.1
4)(7
.2)
Affi
liate
d In
vest
men
ts:
LR03
8 A
dditi
onal
Info
rmat
ion
Req
uire
d C
olum
n (1
)0.
100
Subs
idia
ries
Line
(7.2
)(7
.99)
Tota
l Aff
iliat
ed In
vest
men
ts0.
100
Excl
udin
g af
filia
ted
pref
erre
d an
d co
mm
on st
ock
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR03
9
Atta
chm
ent 5
Com
pany
Nam
eC
onfid
entia
l whe
n C
ompl
eted
NA
IC C
ompa
ny C
ode
T
TT
Aff
iliat
ed P
refe
rred
Sto
ck(1
)(2
)(3
)To
tal f
rom
Ann
ual S
tate
men
tA
nnua
l Sta
tem
ent
Life
an
at
ena
l Ris
k-B
ase d
Sche
dule
D P
art 6
Sec
tion
1 Ty
peLi
ne N
umbe
rTo
tal P
refe
rred
Sto
ckC
apita
l Rep
ort
Diff
eren
ce(1
)Pa
rent
0199
999
(2)
U.S
. Pro
perty
and
Cas
ualty
Insu
rer
0299
999
(3)
U.S
. Life
Insu
rer
0399
999
(4)
U.S
. Hea
lth E
ntity
0499
999
(5)
Alie
n In
sure
r05
9999
9(6
)N
on-I
nsur
er W
hich
Con
trols
Insu
rer
0699
999
(7)
Inve
stm
ent S
ubsi
diar
y07
9999
9(8
)O
ther
Aff
iliat
es08
9999
9(9
)To
tal (
Sum
of L
ines
(1) t
hrou
gh (8
))
Aff
iliat
ed C
omm
on S
tock
(1)
(2)
(3)
Tota
l fro
mA
nnua
l Sta
tem
ent
Ann
ual S
tate
men
tLi
fe a
n
ate
nal R
isk-
Bas
e dSc
hedu
le D
Par
t 6 S
ectio
n 1
Type
Line
Num
ber
Tota
l Com
mon
Sto
ckCa
pita
l Rep
ort
Diff
eren
ce(1
0)Pa
rent
1099
999
(11)
U.S
. Pro
perty
and
Cas
ualty
Insu
rer
1199
999
(12)
U.S
. Life
Insu
rer
1299
999
(13)
U.S
. Hea
lth E
ntity
1399
999
(14)
Alie
n In
sure
r14
9999
9(1
5)N
on-I
nsur
er W
hich
Con
trols
Insu
rer
1599
999
(16)
Inve
stm
ent S
ubsi
diar
y16
9999
9(1
7)O
ther
Aff
iliat
es17
9999
9(1
8)To
tal (
Sum
of L
ines
(10)
thro
ugh
(17)
)
Col
umn
(1) L
ines
(1) t
hrou
gh (8
) and
(10)
thro
ugh
(17)
com
e fr
om S
ched
ule
D P
art 6
Sec
tion
1 C
olum
n 9
of th
e an
nual
stat
emen
t.C
olum
n (2
) Lin
es (1
) thr
ough
(8) c
ome
from
LR
044
Det
ails
for A
ffili
ated
Inve
stm
ents
Col
umn
(7).
Col
umn
(2) L
ines
(10)
thro
ugh
(17)
com
e fr
om L
R04
4 D
etai
ls fo
r Aff
iliat
ed In
vest
men
ts C
olum
n (5
).
Den
otes
item
s tha
t mus
t be
man
ually
ent
ered
on
the
filin
g so
ftwar
e.
LR04
3
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
ife a
n
ate
nal
isk
ase
ap
ital
epo
t
nl
ing
oe
astin
g an
nst
tions
fo
opa
nies
as o
f e
ebe
NAIC
atio
nal
sso
iatio
n o
f ns
ane
ois
sion
es
onfi
entia
l he
n o
plet
e
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
Tab
le o
f on
tent
s
Prem
ium
Sta
biliz
atio
n R
eser
ves .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
..... L
R02
6 In
tere
st R
ate
Ris
k an
d M
arke
t Ris
k ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... L
R02
7 H
ealth
Cre
dit R
isk
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... L
R02
8 B
usin
ess R
isk .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... L
R02
9 O
pera
tiona
l Ris
k (F
or In
form
atio
nal P
urpo
ses O
nly)
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
LR02
9-A
C
alcu
latio
n of
Tax
Eff
ect f
or L
ife a
nd F
rate
rnal
Ris
k-B
ased
Cap
ital .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. LR
030
Cal
cula
tion
of A
utho
rized
Con
trol L
evel
Ris
k-B
ased
Cap
ital .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. LR
031
Cap
ital N
otes
bef
ore
Lim
itatio
n ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... L
R03
2 C
alcu
latio
n of
Tot
al A
djus
ted
Cap
ital (
Incl
udin
g To
tal A
djus
ted
Cap
ital T
ax S
ensi
tivity
Tes
t) ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
LR
033
Ris
k-B
ased
Cap
ital L
evel
of A
ctio
n (I
nclu
ding
Tax
Sen
sitiv
ity T
est)
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. LR
034
Tren
d Te
st ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. LR
035
XX
X/A
XX
X R
eins
uran
ce P
rimar
y Se
curit
y Sh
ortfa
ll by
Ces
sion
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. LR
036
XX
X/A
XX
X C
aptiv
e R
eins
uran
ce C
onso
lidat
ed E
xhib
it ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
LR
037
Add
ition
al In
form
atio
n R
equi
red
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... L
R03
8 Se
nsiti
vity
Tes
ts –
Aut
horiz
ed C
ontro
l Lev
el ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. LR
039
Sens
itivi
ty T
ests
– T
otal
Adj
uste
d C
apita
l ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... L
R04
0 Fe
dera
l AC
A R
isk
Adj
ustm
ent a
nd R
isk
Cor
ridor
Sen
sitiv
ity T
est .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
..... L
R04
1 Su
mm
ary
for A
ffili
ated
Inve
stm
ents
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
LR
042
Cro
ssch
ecki
ng fo
r Aff
iliat
ed In
vest
men
ts ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. LR
043
Det
ails
for A
ffili
ated
Inve
stm
ents
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... L
R04
4 M
OD
CO
or F
unds
With
held
Rei
nsur
ance
Agr
eem
ents
– R
eins
uran
ce C
eded
Bon
ds C
-1o
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
..... L
R04
5 M
OD
CO
or F
unds
With
held
Rei
nsur
ance
Agr
eem
ents
– R
eins
uran
ce A
ssum
ed B
onds
C-1
o ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... L
R04
6 M
OD
CO
or F
unds
With
held
Rei
nsur
ance
Agr
eem
ents
– R
eins
uran
ce C
eded
All
Oth
er A
sset
s C-0
, C-1
o an
d C
-1cs
......
......
......
......
......
......
......
......
......
......
......
LR
047
MO
DC
O o
r Fun
ds W
ithhe
ld R
eins
uran
ce A
gree
men
ts –
Rei
nsur
ance
Ass
umed
All
Oth
er A
sset
s C-0
, C-1
o an
d C
-1cs
.....
......
......
......
......
......
......
......
......
......
.. LR
048
Exem
ptio
n Te
st: C
ash
Flow
Tes
ting
for C
-3 R
BC
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. LR
049
ife
an
at
ena
l is
kas
e
apita
l ep
ot
nto
tion
Ris
k-ba
sed
capi
tal (
RB
C) i
s a m
etho
d of
mea
surin
g th
e m
inim
um a
mou
nt o
f cap
ital a
ppro
pria
te fo
r an
insu
ranc
e co
mpa
ny to
supp
ort i
ts o
vera
ll bu
sine
ss o
pera
tions
in c
onsi
dera
tion
of
its s
ize
and
risk
prof
ile. I
t pro
vide
s an
ela
stic
mea
ns o
f se
tting
the
capi
tal r
equi
rem
ent i
n w
hich
the
degr
ee o
f ris
k ta
ken
by th
e in
sure
r is
the
prim
ary
dete
rmin
ant.
The
five
maj
or
cate
gorie
s of r
isks
invo
lved
are
:
Ass
et R
isk
- Aff
iliat
es
C–0
Th
is is
the
risk
of a
sset
s’ d
efau
lt fo
r cer
tain
aff
iliat
ed in
vest
men
ts.
Ass
et R
isk
- Oth
er
C–1
Th
is is
the
risk
of a
sset
s’ d
efau
lt of
prin
cipa
l and
inte
rest
or f
luct
uatio
n in
fair
valu
e.
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
3
Insu
ranc
e R
isk
C–2
Th
is is
the
risk
of u
nder
estim
atin
g lia
bilit
ies f
rom
bus
ines
s alre
ady
writ
ten
or in
adeq
uate
ly p
ricin
g bu
sines
s to
be w
ritte
n in
th
e co
min
g ye
ar.
Inte
rest
Rat
e R
isk,
C
–3
This
is th
e ris
k of
loss
es d
ue to
cha
nges
in in
tere
st ra
te le
vels
and
the
risk
that
hea
lth b
enef
its p
repa
id to
pro
vide
rs b
ecom
e H
ealth
Cre
dit R
isk
and
the
oblig
atio
n of
the
heal
th in
sure
r onc
e ag
ain,
and
risk
of l
osse
s due
to c
hang
es in
mar
ket l
evel
s ass
ocia
ted
with
var
iabl
e M
arke
t Ris
k pr
oduc
ts w
ith g
uara
ntee
s.
Bus
ines
s Ris
k C
–4
This
is th
e ris
k of
gen
eral
bus
ines
s.
A c
ompa
ny’s
ris
k-ba
sed
capi
tal
is c
alcu
late
d by
app
lyin
g fa
ctor
s to
var
ious
ass
et, p
rem
ium
, cla
im, e
xpen
se a
nd r
eser
ve i
tem
s. Th
e fa
ctor
is
high
er f
or t
hose
ite
ms
with
gre
ater
un
derly
ing
risk
and
low
er f
or le
ss r
isky
item
s. Th
e ad
equa
cy o
f a
com
pany
’s a
ctua
l cap
ital c
an th
en b
e m
easu
red
by a
com
paris
on to
its
risk-
base
d ca
pita
l as
dete
rmin
ed b
y th
e fo
rmul
a.
Ris
k-ba
sed
capi
tal s
tand
ards
will
be
used
by
regu
lato
rs to
set
in m
otio
n ap
prop
riate
regu
lato
ry a
ctio
ns re
latin
g to
insu
rers
that
show
indi
catio
ns o
f wea
k or
det
erio
ratin
g co
nditi
ons.
It al
so p
rovi
des a
n ad
ditio
nal s
tand
ard
for m
inim
um c
apita
l req
uire
men
ts th
at c
ompa
nies
shou
ld m
eet t
o av
oid
bein
g pl
aced
in re
habi
litat
ion
or li
quid
atio
n.
pose
of t
his
epo
t
This
repo
rt pr
esen
ts th
e N
AIC
Life
and
Fra
tern
al R
isk-
Bas
ed C
apita
l for
mul
a in
an
inst
ruct
iona
l for
mat
that
shou
ld b
e he
lpfu
l to
anyo
ne re
spon
sibl
e fo
r sub
mitt
ing
data
. Thi
s for
mul
a is
an
impo
rtant
tool
for r
egul
ator
s. D
eter
min
ing
accu
rate
and
tim
ely
data
is a
n im
porta
nt p
art o
f thi
s pr
oces
s. Th
is is
mos
t lik
ely
to o
ccur
whe
n ev
eryo
ne, f
rom
the
com
pany
CEO
to
the
indi
vidu
al p
repa
ring
the
data
, has
a b
asic
und
erst
andi
ng o
f the
form
ula.
Whi
le th
is re
port
prov
ides
this
und
erst
andi
ng in
a c
onci
se p
acka
ge, i
t is
stro
ngly
reco
mm
ende
d th
at th
e pe
rson
or p
erso
ns c
ompi
ling
and
ente
ring
the
info
rmat
ion
be s
enio
r com
pany
off
icia
ls w
ith a
goo
d un
ders
tand
ing
of th
e fin
anci
al a
spec
ts o
f Life
insu
ranc
e an
d H
ealth
insu
ranc
e, if
ap
plic
able
. It i
s als
o re
com
men
ded
that
com
pani
es se
ek th
e as
sist
ance
of t
heir
inde
pend
ent a
ccou
ntan
ts a
nd/o
r act
uarie
s whe
n pr
epar
ing
this
repo
rt. P
leas
e co
mpl
ete
the
Jura
t sig
natu
re
requ
irem
ents
in a
ccor
danc
e w
ith th
e re
quire
men
ts o
f the
dom
icili
ary
stat
e. D
irect
any
que
stio
ns c
once
rnin
g si
gnat
ure
requ
irem
ents
to th
at st
ate.
hat
s in
the
epo
t
Cer
tain
term
s rel
atin
g to
risk
-bas
ed c
apita
l use
d in
this
repo
rt ar
e de
fined
in th
e R
isk-
Bas
ed C
apita
l (R
BC
) for
Insu
rers
Mod
el A
ct.
Gen
eral
ly, e
ach
narr
ativ
e pa
ge d
iscu
sses
a d
iffer
ent s
egm
ent o
f eac
h ris
k cl
assi
ficat
ion
(e.g
., th
ere
is a
nar
rativ
e fo
r Bon
ds, M
ortg
ages
, Pre
ferr
ed a
nd C
omm
on S
tock
s, et
c. w
ithin
the
Ass
et R
isk
Sect
ion)
. The
form
ula
is p
rese
nted
in w
orks
heet
form
follo
win
g al
l of t
he n
arra
tive
sect
ions
.
Mos
t na
rrat
ive
page
s ha
ve a
brie
f su
mm
ary
of t
he b
ackg
roun
d of
the
dev
elop
men
t of
the
fac
tors
, ca
lled
the
“Bas
is o
f th
e Fa
ctor
s.” D
evel
opm
ent
of c
erta
in f
acto
rs r
equi
red
soph
istic
ated
mod
elin
g te
chni
ques
but
the
basi
c co
ncep
ts a
re n
ot c
ompl
icat
ed.
Each
nar
rativ
e pa
ge a
lso
has
a se
ctio
n on
“Sp
ecifi
c In
stru
ctio
ns fo
r App
licat
ion
of th
e Fo
rmul
a.”
This
sec
tion
shou
ld s
erve
as
a gu
idel
ine
for t
hose
who
ass
embl
e th
e da
ta o
r ana
lyze
th
e re
sults
. It i
nclu
des
defin
ition
s an
d ex
plan
atio
ns f
or s
peci
fic it
ems
that
sho
uld
be c
alcu
late
d, c
larif
icat
ion
on th
e in
tent
of
the
stru
ctur
e of
cer
tain
sec
tions
of
the
form
ula
and
inst
ruct
ions
on
reco
ncili
atio
n of
cer
tain
tota
ls.
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
4
Ann
ual s
tate
men
t sou
rces
ref
erre
d to
in th
is r
epor
t and
on
the
RB
C s
oftw
are
do n
ot u
se p
aren
thes
es, i
.e.,
a re
fere
nce
to th
e cu
rren
t yea
r’s
tota
l Ass
et V
alua
tion
Res
erve
on
the
Liab
ilitie
s pa
ge in
the
annu
al s
tate
men
t will
read
as
Page
3 C
olum
n 1
Line
24.
01. A
nnua
l sta
tem
ent r
efer
ence
s w
ill b
egin
with
a p
age
num
ber o
nly
for P
ages
2 a
nd 3
. Oth
erw
ise
the
refe
renc
e w
ill b
e an
exh
ibit
num
ber (
e.g.
, Exh
ibit
6), a
sche
dule
lette
r (e.
g., S
ched
ule
D) o
r a n
ame
of a
n ex
hibi
t or s
ched
ule
(e.g
., Ex
hibi
t of L
ife In
sura
nce
or E
OLI
).
Ris
k-ba
sed
capi
tal r
efer
ence
s in
this
rep
ort w
ill u
se p
aren
thes
es a
roun
d th
e lin
e an
d co
lum
n nu
mbe
r. Fo
r ex
ampl
e, a
ref
eren
ce to
the
LR00
2 B
onds
pag
e Li
ne 8
Col
umn
2 in
this
re
port
will
read
, “B
onds
Lin
e (8
) Col
umn
(2).”
Neg
ativ
e va
lues
can
som
etim
es a
ppea
r in
the
Stat
emen
t Val
ue, B
ook/
Adj
uste
d C
arry
ing
Val
ue o
r RB
C S
ubto
tal c
olum
ns o
f thi
s re
port.
The
se n
egat
ive
valu
es in
the
Stat
emen
t Val
ue
or th
e R
BC
Sub
tota
l col
umn
are
reta
ined
to f
acili
tate
cro
ss-c
heck
ing
of a
mou
nts
repo
rted
in th
e an
nual
sta
tem
ent a
gain
st a
mou
nts
repo
rted
in th
e R
BC
fili
ng. H
owev
er, w
hen
a ne
gativ
e nu
mbe
r app
ears
in th
e St
atem
ent V
alue
, Boo
k/A
djus
ted
Carr
ying
Val
ue o
r in
the
RB
C S
ubto
tal c
olum
ns, t
hat v
alue
will
be
conv
erte
d to
zer
o be
fore
det
erm
inin
g th
e R
BC
R
equi
rem
ent.
For e
xam
ple,
a n
egat
ive
$10,
000
for a
sset
NA
IC 1
long
-term
bon
ds [B
onds
, pag
e LR
002
Col
umn
(1) L
ine
(2)]
will
pro
duce
a z
ero
($0
times
0.0
04) i
n C
olum
n (2
), R
BC
R
equi
rem
ent,
rath
er th
an a
neg
ativ
e $4
0 (-
$10,
000
times
0.0
04).
Sim
ilarly
, a n
egat
ive
$50,
000
in a
ffili
ate
life
rese
rve
cred
its [
Rei
nsur
ance
, pag
e LR
016
Col
umn
(3)
Line
(8)
will
pr
oduc
e a
zero
($0
times
-0.0
08) i
n C
olum
n (4
), R
BC
Req
uire
men
t, ra
ther
than
a p
ositi
ve $
400
(-$5
0,00
0 tim
es -0
.008
).
anag
een
t is
ssio
n an
na
lysi
s
Each
com
pany
has
the
oppo
rtuni
ty to
pre
pare
a w
ritte
n an
alys
is o
f th
eir
com
pany
’s r
isk-
base
d ca
pita
l res
ults
. Thi
s an
alys
is is
not
a r
equi
rem
ent.
A c
ompa
ny m
ay e
xpla
in s
peci
al
situ
atio
ns a
s it
deem
s ne
cess
ary.
Com
pani
es s
houl
d al
so g
ive
expl
anat
ions
whe
re l
ine
item
s do
not
rec
onci
le w
ith a
mou
nts
refe
renc
ed t
o an
nual
sta
tem
ent
sour
ces.
How
ever
, m
odifi
catio
n of
the
risk-
base
d ca
pita
l for
mul
a is
not
acc
epta
ble.
Fac
tors
, RB
C a
mou
nts
that
go
to th
e C
alcu
latio
n of
Aut
horiz
ed C
ontro
l Lev
el R
isk-
Bas
ed C
apita
l pag
e (C
-0, C
-1cs
, C
-1o,
C-2
, C-3
a, C
-3b,
C-3
c, C
-4a,
C-4
b), a
nd th
e To
tal A
djus
ted
Cap
ital a
mou
nt sh
ould
not
be
over
writ
ten.
Thi
s writ
ten
anal
ysis
shou
ld n
ot b
e co
nstru
ed a
s the
“R
BC
Pla
n” re
quire
din
the
Ris
k-B
ased
Cap
ital (
RB
C) f
or In
sure
rs M
odel
Act
.
ppli
abili
ty o
f
ife a
n
ate
nal
ep
ot
The
NA
IC L
ife a
nd F
rate
rnal
RB
C R
epor
t has
bee
n de
velo
ped
for
U.S
. Life
and
Hea
lth in
sure
rs a
nd F
rate
rnal
Ben
efit
Soci
etie
s w
ho f
ile th
e N
AIC
Life
and
Acc
iden
t and
Hea
lth
com
pani
es/F
rate
rnal
Ben
efit
Soci
etie
s ann
ual s
tate
men
t “bl
ue b
lank
. In
som
e st
ates
, U.S
. ins
urer
s tha
t writ
e on
ly a
lien
busi
ness
may
be
excl
uded
from
risk
-bas
ed c
apita
l req
uire
men
ts.
In a
dditi
on, s
tate
s in
whi
ch B
lue
Cro
ss a
nd B
lue
Shie
ld a
nd s
imila
r org
aniz
atio
ns fi
le th
e bl
ue b
lank
may
dec
ide
to e
xem
pt th
ese
com
pani
es fr
om fi
ling
an R
BC
repo
rt ba
sed
on th
e ex
tent
to w
hich
thei
r ope
ratio
ns a
re d
iffer
ent f
rom
con
vent
iona
l ins
urer
s’ in
divi
dual
and
gro
up h
ealth
insu
ranc
e op
erat
ions
alth
ough
this
form
ula
is n
ow g
ener
ally
con
sist
ent w
ith th
e N
AIC
hea
lth ri
sk-b
ased
cap
ital f
orm
ula
desi
gned
for h
ealth
ent
ities
incl
udin
g B
lue
Cro
ss a
nd B
lue
Shie
ld p
lans
.
T
T T
LR
017
Basi
s of F
acto
rs
The
pote
ntia
l for
risk
exi
sts
in o
ff-b
alan
ce s
heet
item
s. Fo
r ite
ms
othe
r tha
n de
rivat
ive
inst
rum
ents
, a 1
.26
perc
ent f
acto
r was
cho
sen
on a
judg
men
t bas
is. T
he 1
.26
perc
ent p
re-ta
x fa
ctor
will
diff
eren
tiate
bet
wee
n th
e co
mpa
nies
that
hav
e sm
all a
nd la
rge
expo
sure
s to
this
risk
. Sin
ce th
ere
is n
o fir
m a
ctua
rial b
asis
for a
ssig
ning
the
1.26
per
cent
pre
-tax
fact
or to
th
ese
risks
, off
-bal
ance
she
et it
ems
are
incl
uded
in th
e se
nsiti
vity
ana
lysi
s us
ing
a fa
ctor
of
3 pe
rcen
t, an
d le
ases
are
add
ed a
s an
add
ition
al o
ff-b
alan
ce s
heet
item
. For
sec
uriti
es
lend
ing
prog
ram
s, a
redu
ced
char
ge m
ay a
pply
to c
erta
in p
rogr
ams t
hat m
eet t
he c
riter
ia a
s out
lined
bel
ow.
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
5
etai
l li
inat
e T
o on
see
pae
Spec
ific
Inst
ruct
ions
for A
pplic
atio
n of
the
Form
ula
Col
umn
(2)
Ass
ets d
irect
ly fu
ndin
g gu
aran
teed
sepa
rate
acc
ount
s or s
ynth
etic
GIC
con
tract
s sho
uld
be e
xclu
ded
from
the
nonc
ontro
lled
asse
ts c
ompu
tatio
n.
Line
(1)
Secu
ritie
s len
ding
pro
gram
s tha
t hav
e al
l of t
he fo
llow
ing
elem
ents
are
elig
ible
for a
low
er o
ff-b
alan
ce sh
eet c
harg
e:
1.A
writ
ten
plan
ado
pted
by
the
Boa
rd o
f Dire
ctor
s tha
t out
lines
the
exte
nt to
whi
ch th
e in
sure
r can
eng
age
in se
curit
ies l
endi
ng a
ctiv
ities
and
how
cas
h co
llate
ral r
ecei
ved
will
be in
vest
ed.
2.W
ritte
n op
erat
iona
l pro
cedu
res t
o m
onito
r and
con
trol t
he ri
sks a
ssoc
iate
d w
ith se
curit
ies l
endi
ng. S
afeg
uard
s to
be a
ddre
ssed
shou
ld, a
t a m
inim
um, p
rovi
de a
ssur
ance
of t
hefo
llow
ing:
a.D
ocum
ente
d in
vest
men
t gui
delin
es, i
nclu
ding
, whe
re a
pplic
able
, tho
se b
etw
een
lend
er a
nd in
vest
men
t man
ager
with
est
ablis
hed
proc
edur
e fo
r rev
iew
of c
ompl
ianc
e.b.
Inve
stm
ent g
uide
lines
for c
ash
colla
tera
l tha
t cle
arly
del
inea
te li
quid
ity, d
iver
sific
atio
n, c
redi
t qua
lity,
and
ave
rage
life
/dur
atio
n re
quire
men
ts.
c.A
ppro
ved
borr
ower
list
s and
loan
lim
its to
allo
w fo
r ade
quat
e di
vers
ifica
tion.
d.H
oldi
ng e
xces
s col
late
ral w
ith m
argi
n pe
rcen
tage
s in
line
with
indu
stry
stan
dard
s, w
hich
are
cur
rent
ly 1
02%
(or 1
05%
for c
ross
cur
renc
y lo
ans)
.e.
Dai
ly m
ark-
to-m
arke
t of l
ent s
ecur
ities
and
obt
aini
ng a
dditi
onal
col
late
ral n
eede
d to
ens
ure
that
col
late
ral a
t all
times
exc
eeds
the
valu
e of
the
loan
s to
mai
ntai
n m
argi
n of
102%
of m
arke
t.f.
Not
subj
ect t
o an
y au
tom
atic
stay
in b
ankr
uptc
y an
d m
ay b
e cl
osed
out
and
term
inat
ed im
med
iate
ly u
pon
the
bank
rupt
cy o
f any
par
ty.
3.A
bin
ding
sec
uriti
es l
endi
ng a
gree
men
t (s
tand
ard
“Mas
ter
Lend
ing
Agr
eem
ent”
fro
m S
ecur
ities
Ind
ustry
and
Fin
anci
al M
arke
ts A
ssoc
iatio
n) i
s in
writ
ing
betw
een
the
insu
rer,
or it
s age
nt o
n be
half
of th
e in
sure
r, an
d th
e bo
rrow
ers.
4.A
ccep
tabl
e co
llate
ral i
s de
fined
as
cash
, cas
h eq
uiva
lent
s, di
rect
obl
igat
ions
of,
or s
ecur
ities
that
are
fully
gua
rant
eed
as to
prin
cipa
l and
inte
rest
by,
the
gove
rnm
ent o
f the
Uni
ted
Stat
es o
r any
age
ncy
of th
e U
nite
d St
ates
, or b
y th
e Fe
dera
l Nat
iona
l Mor
tgag
e A
ssoc
iatio
n or
the
Fede
ral H
ome
Loan
Mor
tgag
e C
orpo
ratio
n an
d N
AIC
1-d
esig
nate
dse
curit
ies.
Aff
iliat
e-is
sued
col
late
ral w
ould
not
be
deem
ed a
ccep
tabl
e. In
all
case
s the
col
late
ral h
eld
mus
t be
perm
itted
inve
stm
ents
in th
e st
ate
of d
omic
ile fo
r the
resp
ectiv
ein
sure
r.
Col
late
ral i
nclu
ded
in G
ener
al In
terr
ogat
orie
s, Pa
rt 1,
Lin
e 24
.05
of th
e an
nual
stat
emen
t sho
uld
be in
clud
ed o
n Li
ne (1
).
Line
(2)
Col
late
ral f
rom
all
othe
r sec
uriti
es le
ndin
g pr
ogra
ms s
houl
d be
repo
rted
Gen
eral
Inte
rrog
ator
ies,
Part
1, L
ine
24.0
6 an
d in
clud
ed in
Lin
e (2
).
etai
l li
inat
e T
o on
see
pae
Line
s (32
) and
(33)
Thes
e lin
es a
re n
ot a
pplic
able
to F
rate
rnal
Ben
efit
Soci
etie
s
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
6
App
ly a
one
-per
cent
(1%
) cha
rge
in th
e R
BC
form
ula,
pla
ced
outs
ide
of th
e co
varia
nce
adju
stm
ent,
to a
dmitt
ed a
djus
ted
gros
s de
ferr
ed ta
x as
sets
(DTA
s) a
s de
scrib
ed in
SSA
P N
o.
101,
par
agra
phs
11a
and
11b
(less
er o
f par
agra
ph 1
1b(i)
and
11b
(ii))
. Fo
r the
per
iod
for w
hich
the
para
grap
h 11
a co
mpo
nent
is d
eter
min
ed, t
he c
harg
e is
redu
ced
to o
ne-h
alf p
erce
nt
(0.5
%) w
hen
the
insu
ranc
e co
mpa
ny e
ither
file
d its
ow
n se
para
te F
eder
al in
com
e ta
x re
turn
or i
t was
incl
uded
in a
con
solid
ated
Fed
eral
inco
me
tax
of w
hich
the
com
mon
par
ent
is a
n in
sura
nce
com
pany
. Th
e so
urce
for t
he D
TA a
mou
nts t
o us
e in
the
calc
ulat
ion
is fo
und
in th
e A
nnua
l Sta
tem
ent,
Not
es to
Fin
anci
al S
tate
men
ts, N
ote
9, P
art A
, Sec
tion
2, A
dmis
sion
C
alcu
latio
n C
ompo
nent
s for
SSA
P N
o. 1
01.
Para
grap
h 11
a is
foun
d in
Sec
tion
2, su
bpar
t (a)
, Par
agra
ph 1
1b is
foun
d in
Sec
tion
2, su
bpar
t (b)
.
T
an
T
LR
019,
LR
023
and
LR02
4
Basi
s of F
acto
rs
Ris
k-ba
sed
capi
tal f
acto
rs f
or h
ealth
insu
ranc
e ar
e ap
plie
d to
med
ical
and
dis
abili
ty in
com
e, lo
ng-te
rm c
are
insu
ranc
e an
d ot
her
type
s of
hea
lth in
sura
nce
prem
ium
s an
d Ex
hibi
t 6
clai
m r
eser
ves
with
an
offs
et f
or p
rem
ium
sta
biliz
atio
n re
serv
es. F
or h
ealth
cov
erag
e th
at d
oes
not f
it in
to o
ne o
f th
e de
fined
cat
egor
ies
for
risk-
base
d ca
pita
l, th
e “O
ther
Hea
lth”
cate
gory
is to
be
used
.
etai
l li
inat
e T
o on
see
pae
Pre-
Tax
and
Post
-Tax
Fac
tors
Th
e fo
rmul
a us
es p
re-ta
x fa
ctor
s for
all
type
s of h
ealth
insu
ranc
e. B
ecau
se m
any
insu
rers
of s
ome
type
s of h
ealth
insu
ranc
e w
rite
very
littl
e ot
her b
usin
ess,
it w
as d
eter
min
ed th
at th
ere
wou
ld b
e no
diff
eren
ce b
etw
een
pre-
tax
and
post
-tax
fact
ors
exce
pt w
here
sub
stan
tial i
nves
tmen
t inc
ome
is a
ssum
ed a
s pa
rt of
the
prod
uct p
ricin
g. T
hus,
for d
isab
ility
inco
me,
the
pre-
tax
fact
ors i
n th
e ta
ble
belo
w a
nd in
LR
023
Long
-Ter
m C
are
will
be
adju
sted
to p
ost-t
ax b
y ap
plyi
ng a
tax-
effe
ct c
hang
e to
RB
C in
LR
030
Cal
cula
tion
of T
ax E
ffec
t for
Life
and
Fr
ater
nal R
isk-
Bas
ed C
apita
l. Fo
r rea
sons
of p
ract
ical
ity a
nd s
impl
icity
, cre
dit d
isab
ility
is in
clud
ed w
ith o
ther
dis
abili
ty in
com
e an
d ad
just
ed to
pos
t-tax
. The
pre
-tax
RB
C v
alue
s for
ot
her t
ypes
of h
ealth
insu
ranc
e w
ill n
ot b
e ad
just
ed.
Spec
ific
Inst
ruct
ions
for A
pplic
atio
n of
the
Form
ula
The
tota
l of a
ll ea
rned
pre
miu
m c
ateg
orie
s LR
019
Hea
lth P
rem
ium
s, Li
ne (3
1), C
olum
n (1
) sho
uld
equa
l the
tota
l in
Sche
dule
H, P
art 1
, Lin
e 2,
Col
umn
1 of
the
annu
al s
tate
men
t. Ea
rned
pre
miu
m f
or e
ach
of th
ese
cove
rage
s sh
ould
be
from
und
erly
ing
com
pany
rec
ords
. Ear
ned
prem
ium
may
be
repo
rted
in S
ched
ule
H f
or A
dmin
istra
tive
Serv
ices
Con
tract
s (A
SC)
and/
or th
e Fe
dera
l Em
ploy
ees
Hea
lth B
enef
its P
lan
(FEH
BP)
and
/or
Wor
kers
Com
pens
atio
n C
arve
-Out
, whi
ch a
re in
clud
ed in
ord
er th
at L
ine
(31)
will
equ
al th
e to
tal i
n Sc
hedu
le H
. As
such
, the
re is
no
RB
C fa
ctor
app
lied
to a
ny p
rem
ium
repo
rted
on L
ines
(18)
, (28
) or (
29).
For s
ome
of th
e co
vera
ges,
two-
tier f
orm
ulas
app
ly. T
he c
alcu
latio
ns fo
r th
ese
cove
rage
s sho
wn
belo
w w
ill n
ot a
ppea
r on
the
RB
C fi
ling
softw
are
but w
ill a
utom
atic
ally
be
calc
ulat
ed b
y th
e so
ftwar
e.
Line
s 10-
13, 1
7-20
, 23-
27, 3
1, 3
4 an
d 35
are
not
app
licab
le to
Fra
tern
al B
enef
it So
ciet
ies.
Line
(1)
Hea
lth p
rem
ium
s fo
r us
ual a
nd c
usto
mar
y m
ajor
med
ical
and
hos
pita
l (in
clud
ing
com
preh
ensi
ve m
ajor
med
ical
and
exp
ense
rei
mbu
rsem
ent h
ospi
tal/m
edic
al c
over
age)
writ
ten
on
indi
vidu
al c
ontra
cts
are
ente
red
in C
olum
n (1
) for
this
line
, but
no
RB
C R
equi
rem
ent i
s ca
lcul
ated
in C
olum
n (2
). Th
e pr
emiu
ms
are
carr
ied
forw
ard
to L
R02
0 U
nder
writ
ing
Ris
k –
Expe
rienc
e Fl
uctu
atio
n R
isk,
Col
umn
(1),
Line
(1.1
).
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
7
etai
l li
inat
e T
o on
see
pae
T
T
T
LR
020
The
unde
rwrit
ing
risk
gene
rate
s the
RB
C re
quire
men
t for
the
risk
of fl
uctu
atio
ns in
und
erw
ritin
g ex
perie
nce.
The
cre
dit t
hat i
s allo
wed
for m
anag
ed c
are
in th
is w
orks
heet
com
es fr
om
LR02
2 U
nder
writ
ing
Ris
k –
Man
aged
Car
e C
redi
t.
etai
l li
inat
e T
o on
see
pae
Lin
e (1
) thr
ough
Lin
e (1
8)
Ther
e ar
e fo
ur li
nes
of b
usin
ess
used
in th
e lif
e an
d fr
ater
nal R
BC
form
ula
for c
alcu
latin
g th
e R
BC
requ
irem
ent i
n th
is w
orks
heet
. Oth
er h
ealth
cov
erag
es w
ill c
ontin
ue to
use
the
fact
ors
on L
R01
9 H
ealth
Pre
miu
ms.
The
four
line
s of
bus
ines
s ar
e: C
olum
n (1
) C
ompr
ehen
sive
Med
ical
and
Hos
pita
l; C
olum
n (2
) M
edic
are
Supp
lem
ent;
Col
umn
(3)
Den
tal &
V
isio
n; a
nd C
olum
n (4
) Sta
nd-A
lone
Med
icar
e Pa
rt D
cov
erag
e. E
ach
of th
e fo
ur li
nes
of b
usin
ess
has
its o
wn
colu
mn
in th
e U
nder
writ
ing
Ris
k - E
xper
ienc
e Fl
uctu
atio
n R
isk
tabl
e.
The
cate
gorie
s lis
ted
in th
e co
lum
ns o
f thi
s w
orks
heet
incl
ude
prem
ium
s pl
us a
ll ris
k re
venu
e th
at is
rece
ived
from
ano
ther
repo
rting
ent
ity in
exc
hang
e fo
r med
ical
serv
ices
pro
vide
d to
its m
embe
rs.
T
T
LR
021
Line
s (1)
and
(2)
In a
dditi
on to
the
gene
ral r
isk
of fl
uctu
atio
ns in
the
clai
ms e
xper
ienc
e, th
ere
is a
n ad
ditio
nal r
isk
gene
rate
d w
hen
insu
rers
gua
rant
ee ra
tes f
or e
xten
ded
perio
ds b
eyon
d on
e ye
ar. I
f rat
e gu
aran
tees
are
ext
ende
d be
twee
n 15
and
36
mon
ths
from
pol
icy
ince
ptio
n, a
fact
or o
f 0.0
24 is
app
lied
agai
nst t
he d
irect
pre
miu
ms
earn
ed fo
r tho
se g
uara
ntee
d po
licie
s. W
here
a ra
te
guar
anty
ext
ends
bey
ond
36 m
onth
s, th
e fa
ctor
is in
crea
sed
to 0
.064
. Thi
s cal
cula
tion
only
app
lies t
o th
ose
lines
of a
ccid
ent a
nd h
ealth
bus
ines
s tha
t inc
lude
a m
edic
al tr
end
risk
(i.e.
, co
mpr
ehen
sive
med
ical
, M
edic
are
supp
lem
ent,
dent
al,
Stan
d-A
lone
Med
icar
e Pa
rt D
Cov
erag
e, s
top-
loss
and
min
imum
pre
miu
m a
nd o
ther
lim
ited
bene
fits
antic
ipat
ing
rate
in
crea
ses)
. Pre
miu
ms
ente
red
shou
ld b
e th
e ea
rned
pre
miu
m f
or th
e cu
rren
t cal
enda
r ye
ar p
erio
d an
d no
t for
the
entir
e pe
riod
of th
e ra
te g
uara
ntee
s. Pr
emiu
m a
mou
nts
shou
ld b
e sh
own
net o
f rei
nsur
ance
onl
y w
hen
the
rein
sura
nce
cede
d pr
emiu
m is
als
o su
bjec
t to
the
sam
e ra
te g
uara
ntee
.
Line
(3)
A s
epar
ate
risk
fact
or h
as b
een
esta
blis
hed
to re
cogn
ize
the
redu
ced
risk
asso
ciat
ed w
ith s
afeg
uard
s bu
ilt in
to th
e Fe
dera
l Em
ploy
ees
Hea
lth B
enef
it Pr
ogra
m (F
EHB
P) c
reat
ed u
nder
Se
ctio
n 89
09(f
)(1)
of T
itle
5 of
the
Uni
ted
Stat
es C
ode.
Cla
ims i
ncur
red
are
mul
tiplie
d by
2 p
erce
nt to
det
erm
ine
tota
l und
erw
ritin
g R
BC
on
this
bus
ines
s.
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
8
Line
s (4)
thro
ugh
(6)
Thes
e lin
es a
re n
ot a
pplic
able
to F
rate
rnal
Ben
efit
Soci
etie
s. Se
para
te ri
sk fa
ctor
s ha
ve b
een
esta
blis
hed
for W
orke
rs’ C
ompe
nsat
ion
Car
ve-O
ut b
usin
ess.
The
RB
C fa
ctor
s fo
r the
Wor
kers
’ Com
pens
atio
n C
arve
-Out
was
pha
sed
in o
ver t
hree
ye
ars
in e
ven
incr
emen
ts b
egin
ning
in 2
004
and
conc
ludi
ng in
200
6. A
fact
or o
f 0.3
64 is
app
lied
agai
nst n
et p
rem
ium
s w
ritte
n as
sho
wn
in th
e W
orke
rs’ C
ompe
nsat
ion
Car
ve-O
ut
Supp
lem
ent.
A fa
ctor
of 0
.347
is a
pplie
d ag
ains
t tot
al n
et lo
sses
and
exp
ense
s un
paid
as
show
n in
Sch
edul
e P,
Par
t 1 o
f the
Wor
kers
’ Com
pens
atio
n C
arve
-Out
Sup
plem
ent.
Thes
e fa
ctor
s are
take
n fr
om th
e in
dust
ry c
ompo
nent
use
d in
the
P&C
RB
C fo
rmul
a fo
r wor
kers
com
pens
atio
n re
insu
ranc
e as
sum
ed.
A fa
ctor
of 0
.060
is a
pplie
d ag
ains
t rei
nsur
ance
reco
vera
ble
bala
nces
on
rein
sura
nce
cede
d to
non
-aff
iliat
ed c
ompa
nies
(exc
ept c
erta
in p
ools
), as
sho
wn
in S
ched
ule
F, P
art 2
of t
he
Wor
kers
’ Com
pens
atio
n C
arve
-Out
Sup
plem
ent.
This
fact
or re
pres
ents
the
diff
eren
ce b
etw
een
the
tota
l cha
rge
for r
eins
uran
ce re
cove
rabl
es in
the
P&C
RB
C fo
rmul
a an
d th
e ef
fect
ive
post
-tax
fact
or a
lread
y re
flect
ed in
the
Life
and
Fra
tern
al fo
rmul
a on
LR
016
Rei
nsur
ance
. The
follo
win
g ty
pes
of c
essi
ons
are
exem
pt fr
om th
is c
harg
e: c
essi
ons
to S
tate
Man
date
d In
volu
ntar
y Po
ols
and
Ass
ocia
tions
or t
o Fe
dera
l Ins
uran
ce P
rogr
ams,
cess
ions
to q
ualif
ying
Vol
unta
ry M
arke
t Mec
hani
sm P
ools
and
Ass
ocia
tions
(whe
re th
ere
is jo
int l
iabi
lity
for
pool
mem
bers
alo
ng w
ith a
dequ
ate
spre
ad o
f ris
k, s
uch
that
the
risk
of th
e po
ol c
olla
psin
g fr
om o
ne o
r a fe
w in
divi
dual
mem
ber s
olve
ncy
prob
lem
s is
imm
ater
ial),
and
ces
sion
s to
U
.S. P
aren
ts, S
ubsi
diar
ies a
nd A
ffili
ates
. ua
lifyi
ng V
olun
tary
Mar
ket M
echa
nism
Poo
ls m
ust b
e m
anua
lly e
nter
ed o
n Li
ne (6
.1) t
o re
ceiv
e th
e ex
empt
ion.
LR02
5
Basi
s of F
acto
rs
The
fact
ors
chos
en re
pres
ent s
urpl
us n
eede
d to
pro
vide
for e
xces
s cl
aim
s ov
er e
xpec
ted,
bot
h fr
om ra
ndom
fluc
tuat
ions
and
from
inac
cura
te p
ricin
g fo
r fut
ure
leve
ls o
f cla
ims.
For a
la
rge
num
ber o
f tria
ls, e
ach
insu
red
eith
er li
ves
or d
ies
base
d on
a “
roll
of th
e di
ce”
refle
ctin
g th
e pr
obab
ility
of d
eath
from
bot
h no
rmal
and
exc
ess
clai
ms.
The
pres
ent v
alue
of t
he
clai
ms g
ener
ated
by
this
pro
cess
, les
s exp
ecte
d cl
aim
s, w
ill b
e th
e am
ount
of s
urpl
us n
eede
d un
der t
hat t
rial.
The
fact
ors c
hose
n un
der t
he fo
rmul
a pr
oduc
e a
leve
l of s
urpl
us a
t lea
st a
s m
uch
as n
eede
d in
95
perc
ent o
f the
tria
ls.
The
mod
el w
as d
evel
oped
for p
ortfo
lios
of 1
0,00
0, 1
00,0
00 a
nd o
ne m
illio
n liv
es, a
nd it
was
foun
d th
at th
e su
rplu
s ne
eds
decr
ease
d w
ith la
rger
por
tfolio
s, co
nsis
tent
with
the
law
of
larg
e nu
mbe
rs.
Net
am
ount
at r
isk
was
cho
sen
as a
bas
e be
caus
e ex
pect
ed c
laim
s are
diff
icul
t to
calc
ulat
e on
a c
onsi
sten
t bas
is fr
om c
ompa
ny to
com
pany
.
Spec
ific
Inst
ruct
ions
for A
pplic
atio
n of
the
Form
ula
Line
s 3, 4
and
9-2
1 ar
e no
t app
licab
le to
Fra
tern
al B
enef
it So
ciet
ies.
Ann
ual s
tate
men
t ref
eren
ce is
for t
he to
tal n
et a
mou
nt a
t ris
k fo
r the
cat
egor
y (e
.g.,
Indi
vidu
al &
Indu
stria
l is o
ne c
ateg
ory)
. The
net
am
ount
at r
isk
is th
en fu
rther
bro
ken
dow
n by
size
as
in a
tax
tabl
e to
refle
ct th
e de
crea
se in
risk
for l
arge
r blo
cks o
f life
insu
ranc
e. T
his b
reak
dow
n w
ill n
ot a
ppea
r on
the
RBC
filin
g so
ftwar
e or
on
the
prin
ted
copy
, as t
he a
pplic
atio
n of
fact
ors t
o am
ount
s in
forc
e is
com
plet
ed a
utom
atic
ally
. The
cal
cula
tion
is a
s fol
low
s:
etai
l li
inat
e T
o on
see
pae
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
9
TT
LR02
6 Ba
sis o
f Fac
tors
Pr
emiu
m s
tabi
lizat
ion
rese
rves
are
fund
s he
ld b
y th
e co
mpa
ny in
ord
er to
sta
biliz
e th
e pr
emiu
m a
gro
up p
olic
yhol
der m
ust p
ay, f
rom
yea
r to
year
. Usu
ally
, exp
erie
nce
ratin
g re
fund
s ar
e ac
cum
ulat
ed in
suc
h a
rese
rve
so th
ey c
an b
e dr
awn
upon
in th
e ev
ent o
f poo
r fut
ure
expe
rienc
e. T
his
redu
ces
the
insu
rer’
s ris
k. A
mou
nts
held
as
prep
aym
ents
from
the
fede
ral
gove
rnm
ent f
or re
insu
ranc
e co
vera
ge o
r low
-inco
me
subs
idy
(cos
t-sha
ring
porti
on) u
nder
Sta
nd-A
lone
Med
icar
e Pa
rt D
Cov
erag
e ar
e no
t con
side
red
prem
ium
sta
biliz
atio
n re
serv
es
as th
ey re
late
to a
n un
insu
red
plan
. Fo
r gro
up li
fe a
nd h
ealth
insu
ranc
e, 5
0 pe
rcen
t of p
rem
ium
sta
biliz
atio
n re
serv
es h
eld
in th
e an
nual
sta
tem
ent a
s a
liabi
lity
(not
as
appr
opria
ted
surp
lus)
are
per
mitt
ed a
s an
off
set u
p to
the
amou
nt o
f ris
k-ba
sed
capi
tal.
The
50 p
erce
nt fa
ctor
was
cho
sen
to a
ppro
xim
ate
the
porti
on o
f pre
miu
m s
tabi
lizat
ion
rese
rves
that
wou
ld b
e an
app
ropr
iate
off
set i
f the
form
ula
wer
e ap
plie
d on
a c
ontra
ct-b
y-co
ntra
ct b
asis
, an
d th
e re
serv
e of
fset
was
lim
ited
to t
he a
mou
nt o
f ris
k-ba
sed
capi
tal
requ
ired
for
each
con
tract
. Li
fe a
nd h
ealth
cov
erag
es a
re
aggr
egat
ed d
ue to
man
y co
mpa
nies
com
bini
ng th
ese
cove
rage
s.
No
cred
it sh
ould
be
give
n he
re fo
r any
pre
miu
m s
tabi
lizat
ion
rese
rves
hel
d in
con
nect
ion
with
sta
nd-a
lone
Med
icar
e Pa
rt D
Cov
erag
e (i.
e., a
mou
nts
held
as
liabi
litie
s to
the
fede
ral
gove
rnm
ent u
nder
the
risk-
corr
idor
mec
hani
sm),
sinc
e M
edic
are
Part
D C
over
age
prem
ium
is a
lread
y su
bjec
t to
a lo
wer
fac
tor
in th
e un
derw
ritin
g ris
k ca
lcul
atio
n to
ref
lect
the
redu
ced
net l
evel
of r
isk.
As s
uch,
the
com
pany
mus
t exc
lude
all
amou
nts r
elat
ing
to st
and-
alon
e M
edic
are
Part
D C
over
age
in d
eter
min
ing
the
amou
nt o
f res
erve
s to
be re
porte
d he
re.
Spec
ific
Inst
ruct
ions
for A
pplic
atio
n of
the
Form
ula
Line
s 1-6
are
not
app
licab
le to
Fra
tern
al B
enef
it So
ciet
ies.
Ther
e is
som
e va
rianc
e fo
r rep
ortin
g lia
bilit
ies t
hat a
re a
ppro
pria
tely
con
side
red
prem
ium
stab
iliza
tion
rese
rves
. The
se p
ossib
le a
nnua
l sta
tem
ent s
ourc
es a
re n
oted
. Th
e su
m o
f the
se v
ario
us ty
pes
of p
rem
ium
sta
biliz
atio
n re
serv
es e
qual
s th
e pr
elim
inar
y pr
emiu
m s
tabi
lizat
ion
rese
rve
cred
it. T
he fi
nal p
rem
ium
sta
biliz
atio
n re
serv
e cr
edit
is li
mite
d to
the
risk-
base
d ca
pita
l pre
viou
sly
calc
ulat
ed. S
ince
the
limita
tion
is a
pplie
d on
an
aggr
egat
e ba
sis,
ther
e is
no
need
to d
iffer
entia
te th
e pr
emiu
m st
abili
zatio
n re
serv
e be
twee
n lif
e an
d he
alth
.
T
TT
T
T
(I
nclu
ding
Tot
al A
djus
ted
Cap
ital T
ax S
ensi
tivity
Tes
t) LR
033
The
follo
win
g in
stru
ctio
ns fo
r the
Cal
cula
tion
of T
otal
Adj
uste
d C
apita
l will
rem
ain
effe
ctiv
e in
depe
nden
t of t
he s
tatu
s of
the
suns
et p
rovi
sion
, Sec
tion
8, o
f AG
48
in a
par
ticul
ar
stat
e or
juris
dict
ion.
Thi
s ins
truct
ion
will
be
cons
ider
ed fo
r cha
nge
once
the
amen
dmen
t ref
eren
ced
in A
G 4
8, S
ectio
n 8,
rega
rdin
g cr
edit
for r
eins
uran
ce, i
s ado
pted
by
the
NA
IC.
etai
l li
inat
e T
o on
see
pae
Atta
chm
ent 5
© 1
993-
Nat
iona
l Ass
ocia
tion
of In
sura
nce
Com
mis
sion
ers
10
Spec
ific
Inst
ruct
ions
for A
pplic
atio
n of
the
Form
ula
Line
s 10.
1-10
.4, 1
3, 1
4 an
d 18
are
not
app
licab
le to
Fra
tern
al B
enef
it So
ciet
ies.
Line
s (3)
and
(4)
Whe
n re
insu
ranc
e is
inv
olve
d (c
oins
uran
ce,
mod
ified
coi
nsur
ance
, co
insu
ranc
e w
ith f
unds
with
held
, or
any
sim
ilar
arra
ngem
ent)
the
divi
dend
lia
bilit
y cr
edit
incl
uded
in
Tota
l A
djus
ted
Cap
ital b
y th
e ce
ding
com
pany
sho
uld
not b
e al
low
ed in
the
even
t the
ced
ing
com
pany
can
not r
ealiz
e th
e fin
anci
al b
enef
its a
ssoc
iate
d w
ith a
red
uctio
n in
the
divi
dend
lia
bilit
y. A
t the
sam
e tim
e, th
e re
insu
rer
shou
ld n
ot b
e al
low
ed a
cre
dit t
o To
tal A
djus
ted
Cap
ital f
or a
ny o
f th
e di
vide
nd li
abili
ty, e
ven
if th
e di
rect
writ
er c
anno
t tak
e th
e To
tal
Adj
uste
d C
apita
l cre
dit,
unle
ss th
e re
insu
rer c
an d
emon
stra
te c
ontro
l ove
r the
div
iden
d de
cisi
on o
f the
dire
ct w
riter
.
Atta
chm
ent 5