2013 financial statement - mike kreidler · 2019. 12. 31. · stated a )jove,
TRANSCRIPT
11!1111 ~Ill ~II~IIIIJIII ~II~IIII!IIIIJIII~IIIIjlll!lllljlllljllll !1111,11111!111 ~111!11 ANNUAL STATEMENT
NAtCGroupCocie ..... 1189, 1189
For fh$ Year Ended December a1, 2013 oflhe Oond'!tion and Affairs of tho
Vision Service Plan NAtO Company Coda ..... 47317 Employels lD Number ..... 91-6056925
(Curraflt Perlo<l) {PrlorParlod) Or~anlzed under !he Laws of Washington State of Dotnlclle or Port of Entry. WaShington Country of Domicile us licensed as Business Type ..... Other Is HMO Federally Qualified? Yes 1 1 No [X 1 lncorporaW.I/OrtJaniZed ..... Maroh 6, 1969 Commenced_ Business ..... March 6, 1959 Statutory Home Office One Union Squ0re Btds., 600 University St., Suite 2ddL .. Seattle ..... WA ..... us,, .. 98101-1129
'(Sirefll ®d Number) (City or Toll'n, State, Cmrnlryrmd Zip Codf!) Main Administrative Office 3333 Quality Drive ..... Rancho Cordova ..... bA ..... us .... 96670
Mall Address (Street tmd Ntttn~er} (City Qr Town, Stare, Country f!M tlp OQWJ) 3333 Quailty DriVe ..... Rancho Cordova ..... OA ..... US .... 95870 (Sireelimd Nlimbet 01' A 0. Bo:t) (C/Iy Clr tov11~ Sta/a~ .Count1y- and Zfp Ollde)
Primary LodllUon of BMks and Records 3333 Quality Drive ..... Rancho Cordova ..... CA .. , .. US .... 95670 (Sireel Md Number) (Oily or Town, Stale, Country ana Zip Ox!e)
lnlemat Web Site Address Statulilry Statement Contact
N11me 1, James _Robinson Lynch 3. Lester Earl Passuello
Cheryl Artn Johnson
Jame·s Robinson Lyhr.ih leS!Elr l:arl Passuello
Stale of. ...... , Caflfomia COLmty of..... Sacramento
www.vsp.com Laura OI$M (N11me) [email protected] (EMaH Addros!:)
President TraasurerfC'FO
l'i!IO OFFICERS
Name 2, James Michael McGr~nn 4,
OTHER
DIRECTORS OR TRUSTEES -James Michael Mc;GraM Richard Winthrop S-teere
Donald JoSeph tla!l, Jr, Cheryl Ann Johnso~
916-851-5000 (Afml CorM (Telephon~ Numb9r}
916-851-5000 (Area Code) (releph011e Num'Wr)
916,851-5000 (AreR ¢pdej (Telephone Numbpr) (nxlrmsion)
9164\58-5388 (FaJc Nutrber)
1'itlc Secretary
Kate Renwick-Esplnosa
The ofllcers of this reporting llnfity being Puly :SwOrh, (:)ach depose and aBYihat they are theide~qNbe~ Officers Ofs~fd rEt potting etlllty, and thai on the reporting period stated a )Jove, <111 Of the IH3rain dr;iscribed a~si;li~Were tho obsolute property of m1rsafd reporli~ entity,_iroe snd clear 'from 11ny liens or claims !hereon, except as herein Sl<lletl_, and that this 5tatement, together with related exhibits, schedula~ and explanations therein oonla1ned, annexed or referred to, ts a fUll and true statement of ell fhe assets and llabtllfles and Df the condlllon and affairs of th13 said reporllng e~lityas df the rep<:irtlng· period_ Stiit&l above-, a:n9 of Us incotne·and:de"ductkms therefrom lor the ~erlod e/li'tEla, and l1aVc b.een completea in aecorda.hce Wllh the NAIC _Anrlttal st?femrml {rlstnwffons aiid AocounHng Pract/CBs f!!Jd Procedures manual e>:C:f;liJliO th-e extenJ that:. (1).ttate law may differ; 6~, (2) !hat-state rures or re~t:aUons require dlffetenoes In reporting not retaled to accounting practices and procsdures, accdtdlng to the best of their lnformallon1 knowl_edge and belf.ef, respectively. Furtherinore, the soope of this attes\ali6rl by thG deso~bed _officers also lncllldes the related correspond. i.n g efecf. ronic flllng With the NA!C, wheh req~lre.d, that. Is an. exMt copy (except for_ fOrmatting differences due~to elec:tronlc111ing) of the enclosed tatement The oteo~onio1tllng mny ne roque by oariOLo regnl!toro In lieu of or In addition to lhe on closed statement. !r(J
w.,..~~ lffl_ {S]Snillllre)_ (Sign, ure} -----I.!.,(S;;~-,"'Io-o7) -----
__ __::::,Jar ~Oblnsoh Lynoh James Mlchii~l McGrann Lestei'Earl Passuetlo . (Prltlte~ Nama) 2. '(Print~ Name) 3, (Printed Namlil)
Pte'sld!int Secreta))' l'reasurer(CFO ~ltle) {Tilll) (ritlo)
Sub'scribed and sworn to belore. me a. rs· 1hl$ an ori~tneJ lltlng'i YC$[Xl No [ I Thffi ~ d,yol ."'\A'-"l>..IZJJ !014 By: Jams~ Robinson Lytith ,-Jam(Js M!Z~--=--:t-
Leste. f Earl Pa~suelln . Q , t/ -· IC.C'O\ r<Yll ~4 'TY::l1f'b
b. If nQ 1. B!ala lheaman\(ment number
ft Date tlfed
3. Number 01 pBges aUaohed
S!alementasorDeoomllar31,2013ollhe Vision Service Plan
1. Bonds (Schedule D) ...
2. Stocks (Schedule D):
2.1 Preferred stocks.
2.2 Common stocks.
3. Mortgage loans 011 real estate (Sclledule B):
3.1 Firstliens ..
3.2 Other than first liens.
4. Real estate (Schedule A):
4.1 Properties occupied by the oompany (less$ ........ 0 encumbrances) ...
4.2 Properties held for the production of income (less$ ......... 0 encumbrances) ........ .
4.3 Properties held for sale (less$ ......... 0 encumbrances).
6. Cash ($ ..... 10,070,310, Schedule E·Part 1), cash equi~alents ($ .......... 0, Schedule E·Part 2) and short.term in~estments ($ ..... 13,064, Schedulll DA) ...
ASSETS
Assets
............. 36,241,662
.. ~ .... 1(1,083,374
Current Year
Nonadmitted Assots
3 Net Admitted
Assets _jCols.1· 2
PriorY ear
Net Admitted Assets
................ 36,241,662 ........... 313,567,7;!1
.. .............. 0
. ...... 0
.. .. 0
.0 ....................... ..
.. ....... 0
.. .............. 0
.0
.. .• 10,083,374 ...... 14,541,022
6. Contract loans (lnctuding $ ......... 0 premium notes)... • .............. . ......... . .. ...... ,.0
---------+r~DeliVa"ilv--e81f>Ch'edli!eDB)C::::CC:C::::"""""":=======c+=====h====~lc==~=·~ ... ot· =====·1~----~-------Other Invested assets (Schedule BA). ,
9. Receivables for securities ...
10. Seculities lending reinvested collateral assets (Schedule DL) ..
11. Aggregate write-Ins for invested assets ...
___ !~~~ubtot~l~, ~-a~ ~d inves~ !s~~J~nes 1 ~~1) ......
13. Title plants less$ ........ 0 charged off (forTitlo Insurers only) ..
14. Investment income due and accrued.
15 Premiums and considerations:
15.1 Uncolklcted premi.lms andagoots' balances In the course of collection ...
16.2 Deferred premiums, agonts' balances and Installments booked but deferred and not yet due (includi119 $ .......... 0earned but unbilled premiums) ......
15.3 Accrued retrospective premiums ... .
16. Reinsuranoo:
16.1 Amounts recoverable from reinsurers ..
16.2 Funds held by or deposited with reinsured companies.
16.3 Other amoun~s receivable under reinsurance contracts
17. Amounts receivable relating to uninsured plans ...
1 8,1 Current federal and foreign income lax recoverable and interest !hereon ..
18.2 Net deferred tax asset... .•
19. Guaranty funds reteivable or on deposit
20. Electronic data processing equipment and software ....
21. Furniture arld equipment, including health care delivery assets($ ....... 0).
22. Net adjustment in assets and liabi\Wes due lo foreign exchange rates
23. Receivables from parent, subsidiaries and affiliates ...
24. Health care($ ....... 0) arld other amounts receivable ...
25. Aggregatf.l write·lns for other than Invested assets .....
26. Total assets excluding Separate Accounts, Segregated Accounts and Protected Cell Accounts (Lines 12 to 25).......... .. ........................ ..
27. From Separate Accounts, Sl.lgregated Accounts and Protected Cell Accounts .....
28. TOTALS (Unes 26 and 27) ...
............ 0 .... 0
.. ..46,325,036 ........... 0
..................... 241,956
...... 862,131 .... ........ 8,916
... 6,101,892 ....................... 102
............. 95,921
. ................... 364,245
.. .... CI ................ 0
.. ........ 53,991,181 , .. 9,018
.. ......... 63,991,161 ........... ~.018
DETAILS OF VVRlTE·lNS
1101 ........................................ .
1102 ............................ ..
1103.
1198. Summary of remainingw~te-1115 lor Line 11 from ovet11ow page ...................... ..
1199. Totals /Lines 1101 thru 111)3 olus 1196 Line 11 above\...
251)1 ...
2602.
251)3,
2598. Summary of remaining write·lns lor Line 25 from overnow page ...
2599. Totals !Lines 2501thru 2503 olus 2598\ lUna 25 above\... .....
2
.... 0
.................. 0
. ....... 0
........... 0
........ 0
.... 0
.... 0
............. 0
......... 0
.. ........................... 0
.. .............. 0
...... 0
.. .. 46,325,036
.. .......... 0
.. ........ 241,956
.......... 653,215
..0
...0
.. .......... 0
.. .... 0
.... 0
.6,11)1,790
.. ............... 95,921
... 364,245
...... 0
.0
.. .. 0
...... 0
.. ......................... o .. ........... 0
... 0
...... 53,982,163
...... 0
.53,982,163
' ....... 0
... 0
..0
.. ...... 1)
....... 0
.............. 0
.. ............... 0
. ... 0
.... 0
..0
.. ........... 0
.......... 51,108,743
......... 305,924
.. ............. 824,237
...... 4,153,600
...... 308,672
" ....... 0
.. 56,701,176
....... 56,71)1,176
......... 0
' ..... 0
................... 0
.0
Statementaso1December31,20i3ofthe Vision Service Plan
LIABILITIES CAPITAL AND SURPLUS
1. Claims unpaid (less $ .....•... 0 relnsuranoo C€ded) ...•..•.
2. Accrued medical inC€n~ve pool and bonus amounts ....
3. Unpaid claims adjustment expenses.
4. Aggregate health policy reserves, Including the liablllly of$. . .. 0 for medicaiii)SS ratio rebate per the Public Health Servlce Acl ... , ...
5. Aggregate life policy reserves ...••.....••......•••........ , •.
6. Property/casualty unearned pramlum reserve ...
7. Aggregate healtli claim reserves.
B. Premiums received in advance ........................... .
9. General expenses dua or accrued
1 0.1 Current federal and foreign Income lax payable and Interest thereori (including $ .......... 0 on realized capital gains ~osses)).
10.2 Net deferred tax liability ..•.
11. Ceded reinsurance premiums payable ..................................... .
12. Amounts withheld or retained for the account of others •.•.
13. Remittances alld items not allocated ........................ .
14. Borrowed money (Including $... . ... 0 current) and interest thereon$ ..•..... ,0 (includlllQ $ ...•.... 0 current) ...
1() Amounts due to parent, subsidiaries and affiliates ..
16. Derlvatlvas.
17. Payable for securities
18. Payable for securities lending
19. Funds held under reinsurance treaUes with($ ....... 0 authorized reinsurem, $ .......... 0 unauthorized and $ ..•....... 0 certified reinsurers) .. .
20. Reinsurance In unauthorlled and certified{$ ........ 0) oompanies ......... .
21. Net adjustmenfs in assets and liabilities due to foreign excha11ge rates.
22. Liability lor amounts held under uninsured f'lans ..
23. Aggregate write-Ins lor other liabilities (including$. ..0 current) ..•
24. Total liabilities (Lir.es 11o 23) ...
2!:>. Aggregate write-Ins for s~clal surplus funds.
Z(l. Common capllal stock
27. Prafermd capital stock ...
28. Gross paid In md cOitrUlted suq::lus
29. Surplus notes
30. Aggregate write-Ins lor other than special surfllus funds ...
31 Unassigned funds (surplus) ...
32. Less treasury stock at cost:
32.1 ..... 0.000 shares common (value Included in Line 26$ .... 0)
32.2 ..... 0.000 shares preler're\1 {Vall1e ir.cluded In Line 27 $ ......... 0) ... .
33. Total capital and surplus (Lines 25 .to 31 minus Line 32) ......
34. Totalliabilltlas, capital and surplus (Lines 24 and 33) .......
2301. Taxes, licenses and fees due or accrued
2302. Escheatable checks
2303.
2398. Summary of remaining wrile·lns for Line 23 from overflow page ....
.
1 Covered
.................. 1,901,961
............. 23,912
•........ .413,730
. ....... 159,224
............... 98,667
......•.•• 501,231
....••. 1,339,342
.....•.... 130,892
. ........ 188,970
...•.. 4,757,929
... XXX .. .
XXX .. .
............. XXX
........... XXX.
............. XXX.
............ XXX.
. ..........• XXX •.•
......•• XXX ...
.......... XXX.
. ........ .XXX.
............ .XXX.
DETAILS OF WRITE-INS
...... 110,932
......... .78,036
2399. Totals !Lines 23011hru 230_3 plus 23981 !Uno 23 above)..... . .....•....... ., ...... .
.0
........ 186,970
2501.
2502.
2503.
2598. Summary of remaining wrlte·lns for Uoo 251rom overflow page •.
2599. Totals (Unes2501 thru 2503 plus 2598) {Line 25 a!Jow) ..
3001. Statutory Reserve.
3002.
3003.
3098. Summary of remaining write-ins for Lir.e 30 from overflow page ...
3099. Totals fllnes 3001lhru 3003 plus 3098l !Line 30 above) .....
............. XXX .. , ...
.......... XXX.
..XXX.
............ XXX ....
.. .. XXX
..... .XXX. ..
..... XXX.
........... .XXX •.•
. •.......... .XXX ......
............. XXX.
3
Current Period 2
Uncovered 3
Total
. ..•.......... 1,901,961
. ..... 0
Prior Year 4
Total
.. 1,696,933
.23,912 .......•.......••... 21,990
. .....••. .413,730 •.......•.••.......•. 387,730
. ..... 0
.0
.. .... 0
..................... 159,224 ....................... 74,462
.......... 98,667 ........•.......••. 65,447
. ....• 0 .••.........•..... 1,606,447
. ..... 0
. .••. 0
. .... 0
... 501,231
• .... 0
................. 1,339,342
. ..... 0
.............................. 0
.....• 0
. ..... 0
. ... o . ..... 0
. ................... 130,892
. ...... 135,665
.1,181,474
.157,493
...... 0 ................... 188970 ..................... 13iJ,575
. ...•......... 0 ............... .4,757,929 .5,458,236
..XXX ... . . .. 0 ............................... 0
........... J()(X .......................... .
. .... XXX .
..... XXX ...
....... XXX
. ......• XXX. .
............. xxx ...
XXX .XXX .•.
. ........... xxx .. . . .XXX .. .
.. 0
............. 0
.......... XXX
.XXX .
. . .xxx .. . . .... XXX .. .
.... XXX ..
............. XXX
. .•.......... XXX.
...... .XXX .. .
.. ........... XXX .. .
, ......... XXX •••
..................... 300,000 . ................. 300,000
.48,924,234 .50,942,940
. .............. .49,224,2:>4 ......•........• 51,242,940
.., ..... 53,962,163 .....•.......... 56,701,176
........ 110,932 .52,059
..................... 78,038 ....................... 78,516
.... 0
. ..... o .............................. 0
. ....... 188,970 ......... 130 575
• ..... 0 .....•..... 0
.... 0 . ........... o . ..... 300,000 .................... 300,000
...... 0 . .............................. 0
. ......... 300,000 .300,000
Sta1emen1asofD!IOOllll>er31,2013ofUla Vision Service Plan
STATEMENT OF REVENUEAND EXPENSES
1.
2.
Membsr monlhs
Net premium i'loome Uncl.Jdlng $. ....... Onon-heallh premium lnoome~ ......
3. Ghangs In unearned premium reserves and reserve for rate credits ...
4. Fee-lor-service (net of$ .... 7,125,880 medical expenses).
5. Risk revenue ...
B. Aggregale wrlle-ins for other health care related revenues ......
7. Aggregate write-Ins for other non-health revenues ...
8. Total rovonuos (Lines 2 to 7) ...
Hospital and Medica\:
9. HI)SpllaVmedical benefits.
10. Other professional services ...
11. Outside referrals ..
12. Emergency room and ottl-ol-area ...
13. Prescripdondrugs .................................... .
14. Aggregate write-ins lor other hospital and med!Clll...
15. Incentive pool, wilhhokf adjustments and bemus amounts.
Current Year 2
Uncovered Total
........ XXX.
.. .............. XXX
.. ... XXX.
.. .. JO(X.
..... XXX.
.. .............. XXX ... ,
. ............... XXX .. .
. ......... XXX ...
........................ "0
............ 7,909,899
• ...................... 32,973,g97
..................... 1,559,888
.. ...... (96,989)
..... 0
.. ............ 0
....... 34,430,896
...26,371,142
.............. 0
Prior Year 3 Total
.. ....... 7,509,807
... 30,315, 113
... 1,454,439
..... 1BUl38
..... 0
............................. 0
.. ......... 31,931,490
... 23,892,604
....... 0
----------ld""·~'""""'''"'ai{Unas9Jo15)~···~~~~~~=~·~···~ .... ~···~· .. ·~···~ .... ~.,·=~===i~=,==~·~··~···~ .... , .. oclc~·~··~···~··~ ... ,~ ... "'.26",3"71",1"'42'+==··:c···"·:··"'·2"'3,0o;9"'''"'''"'1~--------~--Less:
17. Net reinsurance recoveries ....
18. Total hospital and mOOical (Lines 16 minus 17).
19. Non-health claims (net) ....
20. Claims adjustment expenses, Including$ ........ 0 oost containment expenses.
·21.-- Grureral admlnlslratlve e~ponses:;;;;;;;;;;;::::~.~-~ .. ;.-;;;=~.;;;.~ ... ~.:
22 Increase In reserves for life and accident and health contracts Including$ ...... ..(}
Increase In reserves for life only),
23. Total underwriting deductions (Lines 18 through 22).
24. Neluflderwriling gain or (loss) (Lines 8 minus 23)
25. Net investment income earned (Exhibit of NetlflVBslment Income, Line 17) .....
26. Net realizecl capital gains or {losses) less capi1al gains tax of $ .... .7,545 ....
27. Net investment gains or{losses) (Lines 25 plus 26).
28. Nat gaifl or~oss) from agents' or premium balances charged olf[(amount reoovered $ ........ 0) (amount charged off $ ..... 34,429)) ......
29. Aggregate write-ins forotller Income or expenses ..
30. Net income or (loss) alter capital galtJs tax and before all otherfederallncome taxes
(Lines 24 plus 27 plus 28 plus 29).
31. Federal and foreign income ta~es Incurred .....
32. Net income (lossl (Lines 30 minus 31) .....
.-:-:.;:-
..... XXX.
............ XXX.
. ............... XXX.
. ............... XXX ..
........ 0 ...26,371,142 ..................... 23,692,604
.......... 364,039
...... .. .... :;;:c:;,;;: .. -;:;.3,608,074
... 0 ....................... 30,343,255
.A,093,641
..... 599,518
..... 14,012
........ 0 .......... 613,530
......... (34,429)
. ......... 0 ................. 0
.... .4,072,742
.. ................. 1 &15661
... 3,027,081
.. ........................ 309,798
.... 3,(}94,-310-
.. .......... 27,296,712
.. ................. 4,634,778
..806,977
267,3&i
.. ........ 1,074,362
. ...... {1,556)
.................. J50 500
.. ... 5,057,084
.. ... ..14 255 552
.. ...... 9,912,630
DETAILS OF WRITE-INS
0601.
0602.
0603.
0698. Summary off'{lmalnlng wlite-ins for Line 6from overnow page ..
0699. Totals iunes 0601 thru 06~ olus 00981/Line 6 abovel...
0701. .. ................... ..
0702, .
0703.
0798. Summary of remaining write-Ins for line 7 from overflow page .... ..
0799. Totals runes 0701 thru 0703 olus 0798\ llifle 7 above\... ................................ ..
1401. ...................................... ..
1402.
1403.
1498. Summary of remaining write-ins fm Line 14 from overnow page ..
1499. Totals !Lines 1401 thru 1403 Dlus 1498\ ILine 14 abovel.. ...
2901. Regulatory charge
2902 ..•
2903.
2998. Summary of remaining write-Ins lor Line 29 from OVBrflow page
2999. Totals {Lines 2901 thru 2903 plus 2998\IUne 29 above\ ...
4
............... XXX .. .
.. ............ XXX .. .
.. ............. XXX
.. ..... XXX ....
........ XXX ...
....... XXX. J()()(.
. ............... XXX.
............... XXX ... .. .............. XXX.
.......... 0
............................. 0
..... 0
..... o
.. ................. 0 .......... 0
..0 ............... 0
.. ..... 0
. ' ................................ 0
.. ................. {!
........... 0
....... 0
............................ 0
........... 0
. ....... 0
....... {50,500)
....... 0 .................................... 0
' ................................. 0 ......... .150500
statementasofDecember31,2013oflhe Vision Service Plan
STATEMENT OF REVENUE AND EXPENSES Continued)
CAPITAL AND SURPLUS ACCOUNT
33. Capital and sur~ us pr"1or reporting period
34. Net lnoomeor (loss) from Line 32.
35. Change In valuation basis of am~regate policy and claim reserves.
36. Change In net unrealized capital gains and (losses) less capital gains tax of$ ....•.•. 0
37. Change In nat unrealized foreign exchange capital gain or (loss) .....
38. Change In net deferred Income tax
39. Change In nonadmitted assets ..•.
40. Change In unaulh<Jrized and certified relnsuranoo
41. Change In treasury stock .......•........•.........•........•...
42. Change In surplus notes.
43, Cumulative effect of changes in accounting principles ••.
44. Capital changes:
44.1 Pakt ln ...
44.2 Transferred from surplus (Stock Dividend) ............................ .
44.3 Transferred to surplus
45. Surplus adjustments:
45.1 Paid ln ••.
45.2 Transferred to capital (Stock Dividend)
45.3 Transferred from capital..
46. Dividends to stockholders ...
47, Aggregate write-ins ftlr gains or(lt~sses) In surplus ..
48. Net change In capital and surplus (Lines 34 to 47)
49. Capital and surplus end of reporting period (Line 33 plus48) ...
DETAilS OF '1/RITE·INS
4701.
4702.
47(}3.
4798. Summary of remaining write-Ins lor Llne47 from overflow page ...
4799. Totals (Lines 4701thru 4703 Ius 4798) (Line 47 1\bove)... ..
5
Current Year PrbrYear
....... 51,242,940 ...... 71,359,753
. ............•..... 3,027,081 •.........•.........••. 9,912,636
..... .55,573
............ {1,360)
. .. ~29,353)
. ....• (96)
. ••..... : .••......•..... (5,100,000) .........••....... (30,000,000)
. ....•......... 0 .............. 0
...................... (2,018,706) •......•••• (20,116,813)
.. 49,224,234 •............••....... 51,242,940
.......... 0
...................... 0
.. ............. 0
. ............. 0
statemlln1aso!December31,2013oflha. Vision Service Plan
CASH FLOW
CASH FROM OPERATIONS 1. Premiums collected net of reinsurance.
2. Net IIIV(}S(menl income .. .
3. Miscellaneous Income .... .
4.
5.
6.
7.
8.
Total (lines 1througt\ 3) ..
Be11eflt and loss related !Ji1Yments ...
No! transfers te~ Separate Accounts, Segregate<! Accou11ts and Protected Cell Accounts. ....
Commissions, expe115es P<~ld and aggrega!ewrlle·ills fordeduclions ........
Dividends paid to policyholders ........
9. Federal and foreign income taxes paid {recovered) Jlelof$ ........ 0 lax on capital gains(losses) ...
10. Total {Lines 5 throttgh 9) ........
11. Net cash from e~pemtions (Une 4 minus Une 10) ........
CASH FROM INVESTMENTS 12. Proceeds from lnvostments sold, matured or repaid:
12.1 Bo11ds
12.2 Stocks ...
12.3 Mortgage loans ....
12.4 Real (}Slate.
12.6 Other IIIVOsled assets ....................... .
Current Year
............. 33,028,503
......... 1,200,167
Prior Year
...•.... 29,908,548
""'"" ............ 1,785,217
.. ........... 1462,899 ........................ 1,616,371
.. .. 35,691,569
.. ............. 26,100,114
5,861,899
.. ....... 3,355,574
..... 33,310,142
........ 24,046,115
.. .. .4,324,906
.. .. 1,555951
.. ...... 35,3.83,587 ...................... 29,926,972
........... 307,982 ........ 3,383,170
....... 8,643,286 ..... 29,175,023
------------+-~ 12:6~Net·galiis=or(tosses)trn-tash~cash·equlvalents and·shorHerm·lnv(}Stmentsc. =========~+·~ .. ·=""''-""'"
12.7 Miscellallem.lsproceeds ....
12.8 Total Investment proceOOs (Lines12.11o 12.7).
13. Cost of investments acquired (long-term only):
13.1 Bonds ......... .
13.2 Stocl<.s.
-------13.3 Mortgage loans ............................... "'"""'~~ ... , ..... , ..
13.4 Real eslate
13.5 Other Invested (}SSels ...
13.6 Miscellaneous applications.. .. ..................... .
13.7 Total investments a!Xlulred (Lines 13.1 to 13..6) ...
14. Net!norease (decrease) In contract loans and premium notes.
15. Net cash from lnve~tments (Line 12.8 minus Lines 13.7 minus Line 14)
CASH FROM FINANCING AND MISCELLANEOUS SOURCES 16. Cash provided (applied):
16.1 Surplus notes, cai)ilal notes ...
16.2 Capital and paid In surplus, less treasury stock ....
16.3 Borrowed funds.
16.4
16.5
16.6
Net deposits on deposlt-type contracts alld other insurance liabilities.
Dividends to siO<:kholders. ........
Oilier cash provided {applied).
17. Net cash fromflnancing ;md miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6).
RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT·TERM INVESTMENTS 18. Net change In cash, cash equivalents and short·term investments (Line 11 plus Lioo 15 plus Line 17) ........................ .
19. Cash, cash equivalents ami short-term Investments:
19.1 Beginning of year...... . ...................... ..
19.2 Endolye!lr(Line1B lusllne19.1) ...... ..
Note: S~ lemental disclosures of cash ~ow inlonnation for non·cash transactions: 20.1){101 ....................... .
6
.. ........... 8,643,286 .. .... 29,175,023
. ......... 8,832,350 .. 4,371,565
.. ...... 8,832,350 ...... .4 371,566
... {189,064)
.5,1()0,0()0
................ 523434
.......... {4,675,566
.................... (4,457,648)
..... 14,541,022
. .............. 10,083.3.74
... 24,803,458
.. ........... 30,000,000
.......... (215 225
..................... (30,215 225
... (2,028,597)
.. ..... 16,569,619
.. 14,541,022
statament~sofOecember31,2013oflhe Vision Service Plan
ANALYSIS OF OPERATIONS BY LINES OF BUSINESS
Total
1. Net premium income... ...... .............•.••••.. ............................. ........................ . ... 32,973,997
2
Comprehensive (Hospital
and Medical)
Change in unearned premium reserves and reserve for rate cretflt ................... ............. . ......................... 0 1 ............................ .
3. ~s:::~~:.::.~~-~f $::.·_·:~:~~:-~~-~-=:~~~-~ ~~-~-~-~::::: .. :=::··::: ......... ::::::.~:=::: .... ·:······ .. ::::·:::::::~:~::::::) :::: .... ·:::::::::::::::=::::
2.
4.
5. Aggregate write-ins iorotherheaHil care raal.ed revenues ............................................................................ .0 ···- .................... .0
Medicare SupQ[_ement
... 0
.. Dental O!l!i'_
........ 0
Vision Ooly_
32,973,997
1,559,888
• Federal Employees
Health Benefits Plans
7
T•o XVIII
Medicare
.. (96,989) 1--· ......................... .. 0 ... 0 ... 0
T•• XD< Medicaid
... 0
Othoc Health
10
Other Non-Health
.... XXX. ...
. .. .XXX.. ... .XXX ... .
6. Aggregate write-ins for other non--hel.'ll!h care related revenues ..... ···I ............................. 0 ... .XXX ... . . .... .XXX. .... XXX .... . .. XXX. ... ... .XXX ... . .. .XXX. . .. .XXX ... . .. ..XXX ... . .......... 0 7. Total revenues (lines 1 ro 6)....... . .......... . .34A36,896 ...0 ... 0 ........... .. ............ 0 .34,436.896 ... 0 ... 0 ... 0 8. Hospit:atrmedical benelits...... . ..................... . . .. .0 ........... .. ............. .. .............. ................ .................. ...................... .............. . ....................................... ...XXX .. 9. O!ller professional services... ....... .......... .................. ............... . ..... . .. .26,371,142 ............. ........... ........... ........ ......... ..... . ............. 26,371,142 ................. . ......... ...... . ...... ..................... . ......... .XXX .. . 10. Outside referrals ............ ·---·· ..... ........... ........ ........................... . ......................... 0 ................ ...... ......... ..................... ............................. . ···-- ........... .......... ................. ................. . . .... -...... . ......... .XXX. .. . 11. Emergency roam and out-of-area... . ....... .......... .... .............. ........ . ..... _ ........ .0 .............. ........ ..... . ............... --- ..... . ..................... _..... ........................ ..... ..................... .................. .. ................ .. ........ .XXX ... .. 12. Prescription drugs ............. ............... ......................... .............. ...... . ................. 0 ..................... .............. .... ........... ................ .............. ........... ......... ..... ....... .......... .. ................................ .XXX .. 13. Aggregate write-ins iorother hospital and medical ....... .......... ..... ............... . ................... 0 ................ 0 ······-··· ................ 0 ............. 0 ........... 0 ......... . ....... 0 .......................... 0 ...• 0 ...... . .................... 0 .......... .XXX. .. . 14. Jm:entive pool, wilhhold adjustments and bonus amounts .......................................................................... 0 ... ................. .... .................. ....... ..... ..... ................... .. .................. -... --·-- .......... ....... ......... ................ .. .. ...... ...XXX ··········-· 15. Subtotai(Unes8to 14) ............................................................................................................... .213,371,142. ..... . ................. 0 .............................. 0 ........................... 0 ......... .26}71,142 ......... 0 ....... . ...... 0 ..................... 0 ..................... 0 ....... .XXX ........... .. 16. Net reinsurance recoveries ........................... ....................... ......... . .................... -- • .. ... 0 ..... .............. ............... ........ ...... . ............. ....... ....................... .... ........... ..... ....................... .. ..................................... .XXX. ...... _ .. . 17. Total hospltal and madir:al (Lines 15 minus 16)... ..................... ......... ... ............... ....... .. .. 26 371,142 .................. 0 .... . .............. 0 ......................... 0 ....... 2.6,371142 ........................ 0 ........................... 0 ..... ·····--·- .... 0 ............................ 0 .......... .XXX ............ . 18. Non-heal!ll claims (net).. .................. ..................... . ............................ ___ .................................. 0 .......... XXX... . ......... .XXX... . ......... .XXX... . ........ ))()'-.... .. ..... .XXX....... . .... .XXX... . ......... XXX... .. ........ XXX ........... .
-..1 I 19. Claims adjustment expenses including $ .......... 0 cost containment expenses ............ -----~---... . ...... .364,039 1...... .. ................ . 20. General administrative expenses... ....................... •.•... . .................. 3,608,074
21. Increase in reserves for accident and health contracls... .. ....................................... -··· ................. 0
. ............. 320,567 ....... ....... ................. . .......... ...... .. . .................. 43,472 ............. 3,179,153 ..................... •. . ... ······- ............ ....................... . ....... .428,921
..... .XXX .. 22. Increase in reserve for nfe contracts .... ............... .. .... I -- -------·---···--·0 ............................ _ .. 23. Total underwriting deductions (Lines 17 to 22) .... I ... 30,343,255 ................ 0
24. Net underwriting gain or(loss) (Line 7 minus line 23) ... . .... 4,093,641 ...... .. ................ 0
0501. 0502.
0503.
0598. Summary of remaining write--ins for Une 5 from overflow !Jolge .. 0599. Total (Lines 0_501 thru 0503 plus 05S8) (Line 5 abovel
0601. -----· ..................................................................... . 0602. ...... . 0603 ........ ..
0698. Summary of remaining write-ins for Line 6 from overflow page ..• 0699. Toi§L(Unes 0601 thru 06~1us 009~e 6 ab~e) .......... . 1301. .................... .
1302
DETAILS OF WRITE-INS ___ o
... 0 ~--·-·········
-.-... ~ ·:.·.·-~-~~::.·.-~- .............. 0 0
·······- .. o I .......................... o 1 ........................... o ........................... o ........................... o ............................. o I .... ............. • .... o .................. .
.•.. XXX. .. . . .. .XXX .. . o 1-- ------~- _:::::::::: ::::::::::::=: :::::::::: : :=:::::::: .. :::::···· ··::::::::~::··:::.. ·· ::::::~:::::::: ... --1- ...... .xxx. ...... ---.. ·1- ...... .xxx. .. . ........ ................ 0
............ ................ 0 .... 0
0 . ........................ 0
......... , ........................... 0 ] •.
.. .. .XXX.... ····- .. .XXX... .......... . ......... .XXX....... . ........ .XXX... .......... . ......... XXX. .. . .. XXX ... . . .. .XXX. .. .
~::.·::::::::::1:::::::~~:::······ ...• .XXX. .. ..XXX ...
.XXX............ . ......... .XXX............... . ......... .XXX. ............ ····- .. .XXX ..... . . .... .XXX............... . ........ ..XXX................ . .. .XXX. ............ . ........ XXX ..... .
.0 .......... 0 ....... 0 .... 0 ... 0 ... 0 ~~:: s·~-~~~~-;;-;;rr:;;~;~~-:;;;~~~~-;;;·L;~;·;:;·rrom ~~-~~~-~ag~--:::::~~::..... . ......... :::::::::: 1·::::: .... :::::=·--··-:::::~ 1399. Total rL1nes 1301 thru 13ll3 plus 1398) ILrne 13 above).... ................. ........... .... . ......................... 0 ..... 0 ......... 0 .... 0 ... 0 ... 0 I ....... .. ............................ 0
.. ... XXX. . .XXX. .. . .XXX. .. . . .XXX .. .
.......... XXX .. .
0
0
... 0
0
.. . .XXX ....
. .. .XXX .. . ... XXX .. . ... .XXX ...... . ... XXX ... .
. .......................... 0
. .. .XXX ............ .
... .XXX ........ . XXX. .. .
•. XXX ... . .... .XXX ... .
StatementasofDecember3t.2013o!the Vision Service Plan
Une of Business
1. Comprehensive (hospital and medicaQ ...
2. Medicare supplement.. .....
3. Dental only .•.
4. Vision only ............ .
' "
UNDERWRITING AND INVESTMENT EXHIBIT PART 1 ·PREMIUMS
Direct Business
··········T-·--···
... _, __ 32,973,997
l r
2
Reinsurance Assumed
·r······················
i" l .. 5. Hlderal employees hea~h benefl!s plan .•••....
6. Tille Xvlll- Medicare ...... .
7. Trtle XIX - Medicaid ...
8. Other health .... . --~-~~~ ~~~- ~~~-~-1~" ~----l~-1 r o::t) 9. Health subtotal (Lines 1 through B)............. ......... ...... ......................... ................................ . .......... -·j---.......... ~ ..................... 32,973,997
Reinsurance Ceded
··-···-··· .................... 0 '··~···
4
Net Premium Income
Cols.1 +2.:1)_
. ........ 0
.0
.32,973,997
. .. 0
.0
..... 32_$3,_997
;: :~:::::::;)mm 0 ~-:·.·········· ::•mm Om : m :: :··: ··t········ ::~;;;;;;;t{· mmmmmm··t···mmomm•• mm,mom mm •••••••••••.mm••oi
10. Life ...
... 0 ' ...... .. .............. 0
...0
................ 32,973,997
statementasofDecem~rS1.2013al!he Vision Service Plan
1. Payments during !11e yesr:
1.1 Direct ................ ~ ............................................... . 1.2 Reinsurance assumed ... 1.3 Reinsuram:e ceded ......... .. 1.4 Net.. .. .................. ..
2. P:aid medical incenfive pools and bonuses ..... 3. Claim liabilrty December 31, currentyeariTom P:art2A:.
3.1 Direct ..... 3.2 Reinsurance assumed ............ . 3.3 Reinsurance ceded .......................................... _ ...................... . 3.4 NeL._.. ................................ .. ......... ..
4. Claim reseJVe December31, currentyeariTom Part2D: 4.1 Direct...... .............. .. ............................... . 42 Reinsurance assumed ... 4.3 Reinsurance ceded .............. .. 4.4 Net... .. ...................................................... ..
tel 5. Accrued medical incentive poots and bonuses, currentyear .......... .
Total
UNDERWRITING AND INVESTMENT EXHIBIT PART 2 ·CLAIMS INCURRED DURING THE YEAR
Comprehensive (Hospital
and MedicaO Medicare
Sup~Jiement
4
Dental Onlv
VISion Onlv
6 Federal
Employees Health
Benefits Plan
7
TIUe XVIII
Medicare
Titre XIX
Medicaid
2616:·::: I :: : 1.. ···········!.:= : I
26,166,114 1 .............................. -!--.. .. ... 1... .. ................. .. .. ....................... ,.. .. ............... .
I ..... ·············· I ······· ·············· 1 ..... ... 25,155,114 ......... 0 .. ..... 0 ... 0 .... 26,166,114 ... 0 ... 0 1..... .. ................. 0
.......... , ............. 1,901.961 1 ............................. ,.... .. ...................... ,
. ................ ····I····· ................... ···I····· .................. ···I
.. .. ~.1,901,961 ....... 0 \ ......................... , ................................... , .............................. . ....................... 0 \ ..................... + ................................ \ ................ .
Other Healfh
... 0
..1,901,961 0 1........... .. ... 0 1....... ... .. .. 0 1,901,961 ... 0 1 ............................. 0 ............................. 0 1 ............................. 0
.0 1··""""""''"""'''"""""+"""""'""""""""""1"·· .. ···· .. ·-.......... ··1 ...................... . o I ............................... 1
...o j ............................. j. ............................... j ............................... I
........ ..................... o I ....................... o ... _ .... 0 .. ........ 0 .... -0 , ..... .. .. 0 , ..... ..... 0 1..... . ................. 0 1 ............................. 0
~: :::n~!hr~;v:r::::: ;:;~~urers ~~~~-;;;~~;·~~. ~~~;-~~~~:~.::::::::: ..... ::::::: 1::· ·::::::::::::: ....... :::::~ ..... ······\····· ..... ·····\··· ......
. ..... ·····I ..... ···I····· .....1
B. Clalm liabirrty Decamber 31, prior year from Part 2A:
8.1 Direct .................................... .- .......................... . 8.2 Reinsurance assumed ... 8.3 Reinsuranca caded ............. .. SA Net.. ......................... ..
9. Claim reseJVe December 31, prior year from Part2D: 9.1 Direct. ..... ~ .. ~ ......... ..
92 Reinsurance assumed. 9.3 Reinsurance ceded ......
9.4 NeL.. 10. Accrued medkal incanfive poo's and bonuses, prioryeer ... _ ... . 11. Amounts recoverable from reinsurers Decamber 31, prior year .. . 12. Incurred benefits:
12.1 D'rrect .... 12.2 Reinsurance assumed ................... ~ ............. .. 12.3 Reinsuranca ceded ............... .
... 1>96~33 1 ............................. ~ ................................ ~ ................................ 1 1896!)33 , ................................ , ................................. , ................................ , ................. .
. .. 1.696;;: 1••••••- : ~, ........ ·············· ........ , ................................ , ................... . ................... .u .. ....... .0 ...... .0 ... 1 ,696,933 ....... .0 ....... .0 .. ... .0 ...... .0
................. 0 D ,.... - •••.••••. ,
............................. 0 .0 ·I· ·----·--1······ ....... I - ··················\····· .................... ···1····· ·····················1--.. -
... -................... 0 .0 .......... 0 ............. 0 ........ 0 ......... o ... .0
26,371,142 ... -.0 , ..... .. . .0 .0 ......... 26,371 ,142 ............................. 0 ........................... .0 D D
........................... 0 I .............. .. .. ~ ..... ::::: .. ::~:::·-.. :::~ ......... ~ .::::::::: .. ::~:::~ ............. :::::::::~.::::::~ :::::::::::::::::::~ ..................... ::~:~ I: .......................... 0 ......... .. ............... 0 ............................ 0
...0
TO
oth" Non-Health
... ~0
............................ 0
..... 0
........ .0
..... 0
D ......... .. ............. 0
... 0
12.4 Net... [13. Incurred medical incentive p90ls and bon~s .................................... .. ..... ::~ 1.... .. ...... ~::371 :~~~ ::::: :::::::~:::::~:::· ::~ ......... ::::::::~:::. :::~ ::::~::: ... :::::~:.:::::~::~ ............. :~:~~-~ ~~ :::: .......... :::::::::::::::::~ :::::~ ..... :::: .. :::~ .. :::::~ :~:::::: ...... :: .. :::~_:::::~ ............................. 0 ........... ............ 0 I
.D D
(a) Excludes$_, .... 0 loans or advances to proVIders not yet expensed.
~
C>
' "
StoterrentasofDeCfrnOOr31,2013ofthB Vision Service Plan
1. Reported in pm~ess of adjustment
1.1 Direct. ................ .
1.2 Reinsurance assumed ................ _ ..... .
1.3 Reinsurance ceded .....
1.4 Net.. ..................... .
2. Incurred but unreported:
2.1 Direct.......... . .. ........................... - .. .
2.2 Reinsurance assumed ............................................... .
2.3 Reinsurance ceded ...
2.4 Net ...
3. Amounts withheld from paid claims and capitations:
UNDERWRITING AND INVESTMENT EXiHIBIT PART 2A. CLAIMS LIABILITY END OF CURRENT YEAR
2 4 " Federal li!le
: XVlll Tot>l
Comprehensive {Medica!
and HospitaO Medicare
Supplement Dental On!y
Vision Do"
Employees Health
Benefits Plan I' ' Med1~are
. ...... 35'9,976
. ..........................•. o !····························· .. ........................ 0
.35'9,975 .............. 0 ...... 0 ............ 0
. .. 1,541,985 ,... .. ................... , .............................. +..... .. ............. .. 0
.. ....... 0
.. ..... 1,541,985' ... 0 ........ 0
li
'~'~I==~·· ) .L ........ .
.0 1.1 ....... .
li
.35'9,97~ , ..
.359,97~ ........... 0
........... 1,541,985
.......... 0
.0
li~e X~
Medicaid
... 0
................. 0
3.1 Direct ................. .
32 Reinsurance assumed ............... .
.. ... 0
.0
.. .......................... I................. . .......... 0
.. .... 0
3.3 Reinsurance ceded ...
3.4 Net ................... .. ........... 0 ............ 0 ....... 0 . ;1 :: :: ••••·If ~•: ••••••••1:....,
·1: ... • ..... 0 ... 0
4. Totals:
4.1 Direct .....
42 Reinsurance assumed ......
4.3 Reinsurance ceded. ...
4.4 Net...
.. ................................... 1,901,961
.. ...... ,_ ................ 0
.. .. , ................................ 0
1,901.961
... 0
0
... 0
... 0
0
... 0
... 0
...... 1,901,95r
... 0 ' 0
........... 1,901,95~
.a :c:~~ ..... : It ...........
.0
0
... 0
.......................... 0
.0
other Health
.... 0 ........ ..
........... 0
... _o
............. 0
.......................... 0
... 0
10
Other Non-Health
.0
..... 0
..... 0
............. 0
... 0
.. 0
StatementasofDecemberS1,201Sof!f1e Vision Service Plan
1. Comprehenstve (hospital and medical) .....
2. Medicare supplement... ........... .
3. Dental only.
4. Vision only ...
5. Federal employees health benefits plan •.
0. Tffie XVIII· Medicare .....
7. Tffie XIX- Medicaid ................. _ ........... .
8. Other health ....
9. Hea~h subtotal (Lines 1 to 8) ...
~ 110. Heal!hcare receivables (a}--
11. Othernon-heal!h .....
12. Medical incentive pools and bonus amounts ...
13. Totals[Unes9-10+11+12) ...
Une of Business
(a) Excludes$ .... ___ o loans or advances to provkiers no! yet expensed.
UNDERWRITING AND INVESTMENT EXHIBIT PART 28 ·ANALYSIS OF CLAIMS UNPAID· PRIOR YEAR· NET OF REINSURANCE
Claims Paid Durin_q !he Year
2
Claim Reserve and Claim liability December31 of Current Year -,-- ,-- --,
On Claims Incurred Prior to Januruy 1 of Curren! Year
On Claims Incurred During
the Year
On Claims Unpa-id December31 of
PriorYsar
On Claims lnclll'J'ed During
the Year
..1,601,817 .•......................... 24,$4,297 ~. ................................................ ~. ...................... . .. ... 1,901.961
.. .................. ..
....................................... + .......................................... ,................... ············I···················
I mmm• mmm mmmlmmm mm• •••I••• m
.......... 1,601,817 .24,564,297 1,901.961
• •.•. ···········I·· ••. ·········I
. .. 1,601,817 ... 24,564,297 I"" ...... 0 1·--· ... 1,901_961 I""
5
Claims Incurred in Pr!orYerus
[Columns 1 + 31
Estimated Claim Reserve and Claim Liabifrty
December 31 of Prior Year
. .. o I············ .............. ················I .0
... 1,601,817 ... 1,696,933
...0
- ...... 0
• ..... 0 I mmm """""'""'"'I
....................... 1,601,817 ........................... 1 ,696,933
.. .............. 0
... 1,601,817 ... 1,696,933
strtementascfDecemt>er31.2013ofthe Vision Service Plan
1. P~or .. --................. ..
2. 2009 ............. .
3. "2010 .......... .
4, 2011 ........................... .
5. 2012............. .. ................................ .
0. 2013 .................................... .
Year in Which Losses Were Incurred
' "
UNDERWRITING AND INVESTMENT EXHIBIT PART 2C. DEVELOPMENT OF PAID AND INCURREDjCLAIMS
(ooo omttted) ,
SECTION A· PAID HEALTH CLAIMS· GRAND TOTAL
1 2009
......................... 19,414 I•""'• ..
.............. . ................. 19,470
............. .XXX. ...... ..
.. ........ .XXX. .. .
.... XXX .. .
...... ................................... .XXX.. .. .
2 ' 2010
.XXX. ... ' ....
.XXX ...
.XXX. ....
.19,414
20,081
.... 21,471
SECTION B -INCURRED HEALTH CLAIMS· GRAND TOTAL
CumulatNe Net Amounts Pald -1, 3 i 2011
1:
J ..... 19,414
.. 20,681
j --.................... 23,015
J: ········ ........ ~893 . ... L.xxx ........ .
Lxxx .
4 2012
..19,414
. .......................... .20,681
.. ... 23.015
.. 24,426
..22,513
... .x:oc .................... ..
Sum ofCumula~ve Net Amount P-aid and Claim U.abilitv, Claim Reserve and Medicallncan!ive Pool and Bonuses Outstandinr< at End of 'fear
5 2013
19,414
.... 20,681
.... 23,015
.......... .24,426
...24.115
.. ....... 24,564
I Year in WhiGh Losses 1 2 II 3 4 i;;:';: Were Incurred 2009 2010 1 1 2011 2e12 2013
~~ ~ ~~-=-~~~~~=~~~=-~.;~~-~~~ ~~~ ~;~~~ ~~}JS? ~~.~~ =-~~~~ Years in Which
Premiums were Earned and Claims were Incurred
1. 2009 ...
i I
SECTION C • INCURRED YEAR HEALTH CLAIM AND CLAIM ADJUSTMENT EXPENSE RATIO • GRAND TOTAL 2 4
Claim and Claim
Mjustmen! I 1
Premiums Claim Claim Adjustment Percent Expense Payments Percent palms Earned I Pavments I Expense Payments I (CoL 3/2) I (CoL 2 + 3) (Col. 5/1) I lunpaid
........ 26,281 ............................ 20,681 ..... - ......................... (140) . .. ....................... (0.7) ........ .. .............. 20,541 .............. 78.2 .... . .. ...1
Unp.aid Claim Adjustment
Expense
9 Total Claims and
Claims Adjustment Expense Incurred rcot.5+7+Bl
2. 2010 ... I'
1: ::~:::-- 1 :-~::r::~iL :Il~ -::_:_:~:i~;~ :::_:~:1r:_-_·:~::E~ ,::·t~I -~t __ ;;;;l :::J~: :::::: 3. 2011 ......................................... ..
............. 20,541
.22,798
........................ 24,533
II h
10
Percent (Col. 9111
.. ................. 78.2
76.5
79.7
. ... 84.0
.... 86.9
statemen1asotDewnber31,2013oflhe Vision Service Plan
U & I Ex.-Pt.2C-Sn A-Paid Claims-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Hospital & Medical NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicare Supp. NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Dental NONE
U & I Ex.-Pt.2C-Sn 8-lncurred Claims-Dental NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Dental NONE
12.HM, 12.MS, 12.00
StatementasorDecember31,2013orthe Vision Service Plan
1. Prior ...••.•
2. 200!L ....
3. 2010. ..
4. 2011 ......................... .
5. 2012. .. .
6. 2013 .. ..
~
"' <I' 0, P~or ........ .
2009 ...
201L ......
2011... ...
3.
4.
5.
6.
2012 ...
2013 ...
YearslnWhld\ Premiums were Earned and
Claims were lnCLrred
1. 2009.
2. 2010 ................. ..
3. 2011 ...
4. 2012. ...
5. 2013 .... ______ __
Year in Whtc:h Losses Were lm:urred
........................................................
UNDERWRITING AND INVESTMENT E1HIBIT PART 2C- DEVELOPMENT OF PAID AND INCURRED CLAIMS
(000 Dmited)
SECTION A- PAID HEALTH CLAIMS- VISION ONlY
1 2009
19,414 I"'""
" 2010
19,414
Cumutatl\le NetAmounts Paid
I
' 3 : 201'1
)'_ ................ 19,414
4 2012
..... • ................. 19,414
.. .......................... 19,470 I' ........... 20,681 ... . !. ............ 20,681 ...................................... .20,C81
... .XXX.! ............ -~.:~-~~~- .............. .1 .. ·:::::::::~.~~::::::::~;: .... . : .. ::::::::::::::::~~-~ .. ::::::~::~~: ...XXX. ...
.. . .XXX ......................... ' ..
. ... .XXX ..... ..
. .. .XXX ..................... . .::::-!:::............ . . .... ::::~:.:::::::::J .::: ::::::::~ .. :~::: .. :~.. .. ... ~~~-~~·.·~---~.·~--~--·_;;;_~_ ........... 22,513
SECTION B -INCURRED HEALTH CLAIMS -VISION ONLY
5 2013
......... 19,414
... 20,681
.~23,015
.. .... 24,426
.24,115
.. ... 24,564
Sum or cumulative Net Amount Paid and Claim Uability, Claim Reserve and Medical Incentive Pool and Bonuses Outstandinq at End of Year Year in Whicll Losses
Were Incurred
Premiums Earned-
... 26,281
.... 29,816
30,766
...................... 30,315
1 2009
= .. 19,414
, .. 20,717 1 ---·
XXX.. ......... ..
" 2010
·--j ............ 19,414
......... ! .............. 20,681
22,891
I
3 I 2011
. ..I ...................... 19,414
t ........... 20,681
... , ....................... 24,744
4 2012
.19,414
. ...20,681
. ...23,015
...24,426
• ....... ....XXX. ........ .
.. .. .XXX ...
. .. .XXX.~-
... 1 .................. 23.015
.... ~ .. .XXX. ,_ ..................... 24,210
..... • . ...... 1 ... - .......... XXX ........... .c ........ 1 .................. = ........... 1 ................ ! .... XXX. ...... .. .. ... XXX. ....
SECTION C - INCURRED YEAR HEALTH CLAIM AND CLAIM ADJUSTMENT EXPENSE RATIO - VISlN ONLY 2 - I 3 I 4 5 1 6 -~,
Claim and Claim 1 •
Adjustment 1
• Uni)Sid Claim Adjustment Expenses
Claim Pavrnents
""-'"'" ..... 20,681
. 23,015
.24,426
.... 2.4,115
Claim Adjustment Expense Payments
(140)
(217)' ......
Percent (Col. 312)
Expense Payments Percent Claims [Col. 2 + 3) rcol. 511) uhoaid
(0.7)1'"'"-""-"'"'"" .... 20,541 ... (0.9) ........ _ ........... _ .... 22,798
.. + ............... .78.2
.................... .76.5 ............. +-····........... ! .......... _ .. _ ...................... . 101 I._ .. _ ........................... 0.4 .79.7 ............... +................ ! .................................... _.,
5.5 ............... - ... 84.0
Total Claims and Claims Adjustme~t Expense lnCLrred
CoL5+7+6
... .20,541
22,798
,._ ... 24,533
.. 25,452
... 32,974 ........................... .24,564
.. .... 1,337
.2,16fl .............. .B.B
24,533
25,452.
26,733 ... .:. .............. 8t.1 ~ a1 ................. .. .. ... 24 1 .............................. 28,659
5 2013
10
Percent Col. 9/1
19,414
20,681
23,015
... 24,426
::.24,115
...26,466
.................................. 78.2
.............. _______ ....... .16.5
................... ______ 79.7
,_ .......................... 84.0
................................. 86.!!
statementaso1Dacember31,201Jollho Vision Service Plan
U & I Ex.-Pt.2C-Sn A-Paid Claims-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn B-lncurred Claims-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Fed Emp Health NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicare NONE
U & I Ex.-Pt.2C-Sn B-lncurred Claims-Medicare NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicare NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Medicaid NONE
U & I Ex.-Pt.2C-Sn B-lncurred Claims-Medicaid NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Medicaid NONE
U & I Ex.-Pt.2C-Sn A-Paid Claims-Other NONE
U & I Ex.-Pt.2C-Sn B-lncurred Claims-Other NONE
U & I Ex.-Pt.2C-Sn C-Expense Ratio-Other NONE
12.FE, 12.XV, 12.XI, 12.0T
statementaso!Decemb~31,2013of!he Vision Service Plan
'--!...!.-
UNDERWRITING AND INVESTMENT EXHIBIT PART 2D ·AGGREGATE RESERVE FOR ACCIDENT AND HEALTH CONTRACTS ONLY
Total
' Comprehensive
(HospHal and MedicaO
Medicare Supplement
4
Dental OoW
Vision Onlv
j6 Federal
Eniploy-ees ~ealth
Benefits Plan
Trtle XVIII
Medicare
Title XIX
'
Medicaid I Other
1. Unearned premium ressrves ............. . ···-········ ..••.••.••.. . .. 0 ··-~············--···--··
................................. !:·::: ::J: ....................... 0 ... 01.::=;1 :41''~: A ............. OI ................................. OI ................... 01 .................... 0
2. Additional poncy reserves (a) ...
3. Reserve for fLrture conllngent benefits ...
4. Reserve for rate credils or experience rating refunds (including $ .......... 0) for investment income ............... .
5. Aggregate write-ins for other policy reserves ....•••.••••.•• _.
. ................... . --~----·0
.413,730
7. t II '1- 'I I Reinsurance ceded ....... ~::::--····--···----::·::::::::~::::::::~::::~ ............... :::::::::::::: l::::::::~:: .... :::·~~~~~: -·--····----····--·:~:::~ ·::::::~. ~:-:::~ .................. ::::~ .. :: ~:::::::::::::::: .. ::::::~:::~. -------·- .............
413
,
730
......... ::: .. l ... :::::::::~::~J :::: .. ···--···:--:::::::::::::::::~. I:::::::::~ :::::::::~:: ::::~::~ __ c:::::: :::::::::::::::: .. ::::::~ .. 1 6. Totals (gross) ...
B.
9.
I . ..413,73o ................................ o .......... ~---~·-····--···-- ... o 1..... . ............... _ ... ~o ...................... .413,730 ............... f • I Totals (neQ (Page 3, Une4) ......... .
Present value of amounts not yet due on daim$ ..... .
. .. 0 ...... 0 ......... 0 ... 0
10.
11.
1Z.
~113.
Reserve for future contingent benelits ...
Agaregalewrtte-lns for other claim reserves. .....
To!a!s (gross) ...
Reinsurance ceded ...
14. Toia!!; (net)_(Page 3, Line 7) ....
0501.
0502.
••••m•••••m•••>m>>>>>>>>o I m.mmmm > •m•O l•m••>•>>>>>>>>>>>>>>>>>>>>"••••o lm>>>•••
o I
•••l•mmm••••••••••>•••••••m•o lm mmmmlmmmm •••
.. ................... •·· •• ····--····----·~···0 ....................... 0
DETA.ILS OF WRITE--INS
. .... 0
.. .... 0
0503. ... ... ....................... --········~·-······-··· . . .............................. 1......... . .......... 0
... 0
... 0 I·········· ...................... , .... w ........... .
T ' "I -T 'I "I ...... 'I . 'I l 0 ............ o 0 ~---............ 0
0.. . . -··; II .. ~- : m ::: o • • . ... o I ~ -~-0
---~---..
.................................. 1··--···-··-··· 1101.
1102.
1103. . ....... o I···································· I .....•••.................•...•••• , ........ -
119B. Summary of remaining write-ins for Une 11 from overflnw paQl"l •• ~ ..•
11BB. Totals_(_Lfnes 1101 ttru 1103 okJs 119B) £Une 11 aOOve),~-···-----·--· .. , ..
(a} Includes$ ........ 0 premium deliciency reserve.
...... ~0
................................. 0
.... 0
•• 0
.. .... 0
...0
............................. 0
··-~----.0
--~--0 "'"""'n"""'"'"-- ............... Q
----·--··0 .. 0
statemenlasoFDecember31,2013ofthe Vision Service Plan
UNDERWRITING AND INVESTMENT EXHIBIT PART 3 ·ANALYSIS OF EXPENSES
Claim Ad'ustment E enses 1 2
Cost Other Claim Containment Adjustment
Expenses Expenses
1. Rent ($ .......... 0 lor ocCUtJancy af own tJuilding) ............. .44,132
General Administrative
Expenses
..... 357,Q64
4
Investment Expenses Total
...... .401.196
2. Slllaries, wages and other benefits .. .. ........... 701,534 ............ 5,673,337 ................... 2,71)8 ............ 6,377,579
3. Commissions (less$ ......... 0 ceded plus$ ......... 0 assumed)
4.
5.
Legal lees and expanses .......................................... .
Certiflcallons and accreditation fees .. , ................................. .
6. Auditing, actuarial and other consulting services ...
7. Traveling expenses
a. Marketing and advertising ...
9. Postage, express and telephone ... .
10. Printing and otnce supplies ......................... .
11. Occupancy, depreciation and amortization., ..................... ..
12. Equipment.. ..
13. Cost or def)reciatlon ofEDP equipment and ooftware.
14. Outsourced services Including EDP, claims, and other services ..
15. Boards, bureaus and association fees ...
16. Insurance, except on real estate.
17. Collection and bank service charges ............................................................. ,
18. Group service and administration fees.
19. Reimbursements by uninsured plans ................................................... ..
20. Reimbursements from flscellntermediaries ..
21. Real estate expenses.
22. Roul estate taxes ........................................................... .
23, Taxes, licenses alld fees:
23.1 State and local Insurance taxes .................................................. .
23.2 State premium taxes ............................................... ..
23.3 Regulatory authority licenses and fees ......................................................... .
23.4 Payroll taxes ...
23.5 Other (excludin~ federal income and real estate faxes) ...
24. Investment expenses not inGluded elsewhere ..................................................... .
25. Aggregalewtite-ins for expenses.
26. Total expenses incurred (Lines 1 to 25)
27. less exP!Jnses unpaid December 31, current year ..
28. Add expenses unpaid December 31, prior year.
29. Amounts receivable retaUng to uninsured plans, prloryoar. ..
30. Amounts receivable relating to uninsured plans, current year.
31. Total expenses paid (Lines 26 minus 27 plus 28 minus 29 plus 30) ......
....... 0
............... 0
..... 0
DETAILS OF WRITE-INS
2501. OlherExpenses ......................................................... .
25()2,
251)3.
2598. summary of remaining write-Ins for line 25 from overflow page ... 0
2599. TOTALS (Lines 25011hru 2503 Ius 2598) /Uhe 25 abovo) ........... , ............... .. ..... 0
(a) Includes management fees ot $ .... 9,744,829 to affiliates ami$ ........ 0 to non-affiliates.
14
... 1,238,835
.. ............... 17,847 ............... 182,501
................. 26,017 ............... 210,505
.. ....... 62,030 ............... 501,879
.20,475 ............... 165,663
................... 8,977 ................. 72,632
.. ............... 59,697 ............. 483,002
................. 51,409 ..415,325
.. 47,859 """"""" 387,219
................ 12,477 "" ....... ..100,952
................. ..4,595 " .. 37,175
. ............ (707,893) ........... (7,022,578) .
.. ............. 679,676
.. ................ .4,471
.. ... 14,883 ......... 120,416
.... 1,238,835
. ................... 0
. ................... 0
""'"''" ... 200,348
..... 236,522
............. 563,909
.. ...... 186,138
' "" 81,609
....... 542,699
.62ll ........... .467,354
.. .. 0
. .......... 435,078
.. .... ..113,429
.. ........ 41,770
''""'"""""'""'0
. .... 0
.. ......... (7,730,471)
.. ... 0
.. ........................ 0
. .............. 1}
.. ............ 0
... 679,676
................... 4,471
.. ............ 0
.. ............ 0
.. ............ 0
............ 0 ............... 135,299
.... 364,039 ..... 3,808,1}74 ................... 3,328 (a) ..... 3,975.441
..... 23,912
.. ..... 21,990
. ... 4,153,600
.. 6101,892
.. 98,666
.. 65,447
,,,. ... 2,310,409 ............ 3,574,855
. ......... 14,883 ............... 120,416
......... 0 '"""""""'""'0
.. ........... 14 883 ... 120,416
.. ............. 122,578
............ 4,153,600
............ 6,101,892
............. 3,328 ........... 5,888,5S2
... 0
'"' .......... 0
.............. 135,29S
.......................... 0
.. .................. 0
................... 0
......... 135,2S9
~tatementasofDeC€mber31,20t3of~~e Vision Service Plan
EXHIBIT OF NET INVESTMENT INCOME Collected
Durinll Year 1. U.S. governmenl boJids ........................ (a).... . ............... 23,393
1.1 Bonds exempt from U.S. tax. . ....................................................... .,.. .............................. {a) ... 1.2 other bonds (unaffiliated)... (a)... .. ....... 663,101 1.3 Bonds of affiliates ......................................................................................................................................... (a). 2.1 Preferredstocks(unaffillated) .............................................................................................................. (b)
2.11 Proferrod slocks of affiliates..... ...................................... ...... ... (b) .......................... .. 2.2 Common stocks (unaffiliated)... ..... ....... ......... ........ ........ . ... .... .. ........ 80
2.21 Common slacks of affiliates. 3. M()r!gage loans ... (o) 4. Real estale ................. (d) 5. C()JI!ract loans
Earned OurlrmYear ..................... 23,393
.................... 59B,693
......................... 60
6.
7. s.
Cash, cash equivalents atW short-term investments. . ..................................... . (e) ................................... 38 ..................................... .46 Derlva~ve Instruments..... .. ................................................ .. Other invested assels... ......... ................... .. ....................................... ..
9. Aggregate wrlte-lns lor investment income. ...... . .......... ...... .. ...... , .......... . 1 0. Total gross investment Income... . .... .... . . ...................................... . 11. Investment expenses.
"(Q.
.. ................... 0 .. .. 686,612
.......................................... 0 .............................. 622,214
(g). .. ........ 3,326 12. lnvestmentlaxes, licenses and fees, excluding federal income taxes .......................................................................................................... (g). 13. Interest expense ...... 14. Doproclatlon on real estato and llther Invested assets ........ 15. Aggregate write-IJ'IS fo_rdedllc~ons from Investment lnco_me 16. Tolaldedu(,:[ions(Lines11lhrough15) .......................... ..
-17..- -Nelinveslment.income.(Line 10-minus Line ~6~ ...... -.-................................. =• .. •·
0901. 0902. 0903.
DETAILS OF WRITE-INS
0996. Summary of remaining write-ins for Line 9 from overflow page... . ....................... .. 0999. Totals /lines 0901 !hru 0903 Ius 09981/Line 9 abovel... ........................................ .. 1501. Equity Managemont Foo ........................................................................................... .
- 1502.---:::.;::.-.:::.-.-:-.::.: ..................... . 1503. 1596. Sumrooryofremalnlng write-Ins lor Line 151rom overflow page. ............. ......... .. .. ..................... ..
. ........ (h). (1) ..
.. ................ 0 .. ......... 0
. ............... 0 . ...... : .... 19,366
. .................. 22,696 .... 599,5.18.
.0 ............................ 0
.... 19,368
.. ........... 0 1599. Totals (Lines 15011hru 1503 Ius 1598) (Line 15 above)........... .......................... ............................. .. ......................... .. .. .............................. 19,368
(a) Includes $ ..... 20,940 accrual of diScount less$ .. ,557,620 amorttzatlon of premtum and less $ ..... 13,317 paid for accrued Interest on purchases. (b) Includes $ .......... 0 accrual of discount less$ ........ 0 amortization ()f premium and less$ ......... 0 paid for accrued dividends on purchases. (c) Includes$ ......... 0 accru~l of discount less$ ......... 0 amorUzaUon of premium and less$ ........ 0 paid for accrued interest on purchases. (d) Includes$ ......... 0 for company's occupancy of its own buildings; and oxcludes $ .......... 0 In~ rest on encumbrances. (e) Includes$ ......... 0 accrual of discount less$ ........ 0 amortization of premium and less $ .......... 0 paid for accrued interest on purchases. (f) Includes$ ........ 0 accrual of dlsooun! less $ .......... 0 amorlizati()n of premium. (g) Includes$ ......... 0 Investment eKpenses and $ .......... 0 investment taxes, licenses and fees, excluding federal income taxes, attributable to Segregated and Separate Accounts. (h) Includes$ ......... 0 interest on surplus notes and $ .......... 0 interest on capital notes. (i) Includes$ ......... 0 deprecialion on real estate and$ ........ 0 depreciation on other Invested assets.
EXHIBIT OF CAPITAL GAINS (LOSSES)
1. U.S. government bon-ds .............................. .. 1.1 Bonds exempt from U.S. tax 1.2 Other bonds {unaffiliated)... . .. ......................... . 1.3 Bonds of affiliates ....................................................... .. 2.1 Preferred stocks (unaffiliated) .. ..
2.11 Preferred stocks of affiliates ... . 2.2 Common stocks (unaffiliated)
2.21 Common stocks of affiliates ........................ . 3. Mortgage loans .. 4. Real estate. 5. Contrac! loans. 6. Cash, cash equivalents and short-term investments ...... 7. Derivalive Instruments 8. Other invested assets. 9. Aggregate write-ins for caf)ilal gains {losses) .. 10. Total ca ital aalns nosse~l... ........................... .
0901. 0902 ......................................................... .. 0903. 0996. Summary of remaining write-ins for line 9 from overflow page ... 0999. Totals !lines 09011hru 0903 Ius 0998) !Line 9 above\ ............ ..
Realized Gain (Loss)
on Sales or Maturitv
Other Realized
Ad'ustments
.. ..... 21,557
.... 0 ....................... 0 ...... 21,557 .0
DETAILS OF WRITE-INS
3
Tolal Realized Caf)llal Gain (loss)
r6olumns 1 t 2).
.. .......... 0 ' ............................ 0
....... 21,557 .................... 0
. ................................ 0 . ........................ 0
.. 0 .. .......... 0
.. .................... 0 . ............ 0
.. 0 .. .......... 0 ............. 0
...0
... 0 .21,557
.. 0 .0
. .............................................. 0 .0 .0 ........... 0
.... 0 .0 ......... 0
15
Change in Unrealized
Ca ital Gain (loss)
...... 0
Change In Unrealized
Foreign Exchange Capital Gain (Lo~s)
.. ........... 0 .... 0 ................................ 0
................................. 0 ...... 0
" .0 .... .. .... 0
Statamentasotoacamber31,2013otthe Vision Service Plan
EXHIBIT OF NONADMITTED ASSETS
1. Bonds (Schedule D)
2. Stocks (Schedule D):
2.1 Preferred stocks ........................ .
2.2 Common stocks
3. Mortgage loans on real estate (Schedule B):
3.1 First liens .................................................................................................... .
3.2 Other than first liens ........................................ .
4. Real estate (Schedule A):
4.1 Properties occupied l>y the company.
4.2 Properties held for the production of income
4.3 Properties held for sale. .. ......................................... .
6. Cash (Schedule E-Part 1), cash equivalents {Schedule E-Part2) and short-term Investments (Schedule DA).
6. Contract loans ...
7. De~vatives (Schedule DB) .................................................................. ..
8. Other Invested assets (Schedule BA).
9. Receival>les for securities.
10. Sectlrities !endir19 reinvested collateral assets (Schedule DL) ...
11. Aggregate write-ins for Invested assets....... ..... .. .................... .
12. Subtotals, cash and invested assets (Lines 1 to 11) ............................... .
13. Title plants (for Title insurers Only) .......
14. Investment income due and accrued
15. Premiums and considerations:
15.1 Uncollected premiums and agents' balances in the course of collection ...
15.2 Dffierred premiums, agents' balances and Installments booked but deferred and notyetdue ...
15.3 Accrued retrospective premiums
16. ReillSUrance:
16.1 Amounts recoverable from reinsurers ...
16.2 Funds held by or depostled with reinsured companies ..................................... ..
16.3 Other amounts receivable under reinsurance contracts ....
17. Amounts receivable relating to uninsured plans.
18.1 Current federal and lorolgn Income tax recoverable and Interest thereon
18.2 Net deferred tax asset.. ....
19. Guaranty funds receivable or on deposit
20. Electronic data processing equipment and software.
21. Furniture and equlpmcf]t;lncludlng health care delivery assets.
22. Net adjustment In assets and liabilities due to foreign exchange rates ........................... .
23. Receivables from parent, subsidiaries and affiliates.
24. Health care and other amounts receivable ..
Current Year Total
Nonadmilled Assets
............................................. 0
. " ...... 0
Prior Year Total
Nonadmitted Assets
Change In Total No.~admiUed A~ts
!Coi.2-Col.1l
........ 0
.. ........................................... 0
... o
............................................ 0
.. .................... 0
. ......................................... 0
........................................... 0
...... 0
"' ... " .. " ........... 0
.. ........................................... 0
............ 0
.. ..... 0
.. ........................................... 0
.. ........................................... 0
.. .......................... 0 ........................ 0
' ............ 0 ............................................. 0
.. ........................................... 0
............. , .... ; .......................... 0
.............. 8,916 ..................... .7,658 ...(1,256)
.. ... 102
.. ................................. 0
............................................. 0
.. ................................. 0
................................. 0
.. ............................... 0
............................ (102)
.......... 0
.. ............................... 0
................................. 0
.. .............. 0
. .......... 0
................................ 0
.. ................................ 0
.. ............................. 0
25. Aggregate wrlllt-lns lor other than ln~oste<J assets ............................................................. f"'=="'"'"""'""'"""""""""'"'''""'"'''J-'======="·o···"'f"=====· """' ""'""""''-J 26. Total assets excluding Separate Accounts, Segregated Accounts and Protected
Cell Accounts (Lines 12 through 25)... .. ............................ .. .. 9,018
27. From Separote Accounts, Segr~aled Accounts and Protected Cell Accounts .. .
28. TOTALS(Lines26and27)..... ..., ............. . .. ................... 9,018
DETAILS OF WRITE-INS
1101 ..
1102 ..
1103 ...................................................................................................................... .
1196. Summary of remaining w~te-lns lor Line 11 from overflow page ...
1199. Totals tUnes 1101 thru 1103 olus 1198) I Line 11 above),.
2501."
2502.
2503.
2596, Summary of remal11lng write-Ins lor Line 25 from overflow page.
2599. Totals tUnes 2501 thru 2503 olus 2596) I line 25 above).
16
.. ......................... 0
.... , ..... 0
.. ....... 0
................... 0
........ 7,658 .. .................................. (1,360)
.. ..... 0
.................................... 7,658 ..................................... (1,360)
. ..... 0
.. .......................................... 0
...... 0
... 0 ...... 0
.. 0 ............................................ 0
. ............ 0
........... 0
.,..0
........................................ 0
.. ........... 0
. , .. 0
.... 0
' "
Statement as of December 31, :2013 oftl1e Vision Service Plan ,
1.
2.
3.
4.
HeaHh maintenance organ!zatklns.-•.•
Provider service Organlzalions ... --···
EXHIBIT 1 • ENROLLMENT BY PRODUCT TYPE FOR HEALTH BUSINESS ONLY
Source of Enrollment Prior Year
Rrnt Quarter
Total Members at End of 1
,,!oct 11:. Quarter
I,
.. .......................................................................................................... ·+· ......................................... I .. ..................................... 1------, ......................... .. I-
4 Third
Quarter
5 Current Year
I,
r Preferred provider organizations '··························'················································-··· ·····•··· ·······I····· PoTM of service ..••• --.-··· . ·r - - -- -
Current Year Member Months
... ._ ............................. ········- ••• ; .............. 644.692 ............................ -.658,570 ............................... 656.444 1 ::r~ .. ::::::~::~~::~:-·::~::~-~ :::::::::::::::·::::: _____ ..... 658.054 .............................. ..7.909.899
5. Indemnity only._
0. Aggregate write-ins for other lines of business ••.
7. Total... ·······································- ................................................... ············-· ........................................................................ 644,692 I I
... 058,570 .............................. _ .. 656,4:¥ ~-·· ............................ 654,1971 .................................. 658,054 ···················-···-··· . .7,909,899
DETAILS OF WRITE-INS
10601. Vision Only ·····························································································-··· ...................................................... 644,692 658,570 .664,197 ... 658,054
10602. .......................................................................................................................................................................................... +........................................... . .. , ........................................... .
... sss,444
1
.L
................ J······· ::·:··············; .•.•••...•••.••••..••.••••..• -: .......... 0
'603 ............................................................................................................................................................. - ......................... 1....................................... ......................................... +--·'-·--··-----------··----···------------:::j~698. Summa~ of!"llmainlng wrii!Hns ftlrLTna 6 from overflow page ...
1699. Totals (Unes 0601 thru 0603 plus 0698] (Une 6 above)... . . ........................................................................................... 644,6!1:2 •.. 6sa,57o I ................................ 656,444 I .1 ............................ 604,197 ........ ··········-··-·· .... -osa.os4
7,909,899
. ..... 0
......... _ ................. 7,909,899
-00
staterr.entaso!December31,2013ofthe Vision Service Plan
1~:
N~rth~~i·M;;k~ti~g--IBEW Local191 Health, Association~-<'"'--'·
Washington Association of Washi1 Sea!!le Firefighters U, Colliers lntemalional lJSA, I fTRON "'" ........ . Northwest Marketing Northwest Financial t Washington Counties m~u" Association of Washington ._..,, '· Association of washington Association ofWashin n ,_.,, '· 0299997. G 0299998. p 0299999. T 05'99999. A
··-----~---- --~---~--- ·-·-
EXHIBIT 2- ACCIDENT AND HEALTH PREMIUMS DUE AND UNPAID 2 3
1 -30 Davs 31 -60 Davs
:344 l,780 \n'>4
~:228 l,362 ' .. l,362
4
61 -90 Davs
.. 16,425 I""" •
... .3,940 ....... 20,365 I ..
.. 20,365'
5
Over90 Davs
6
Nonadmitted
....................... u ' .. ..... 8,916
.. ........ 8,910 ..... 8,916
7
Admitted J
StatementasofDeoomber31,2ll13oflhe Vision Service Plan
Ex.3 NONE
Ex.3A NONE
19,20
statementasofDecember31,2013oflhe Vision Service Plan
EXHIBIT 4 • CLAIMS UNPAID AND INCENTIVE POOL, WITHHOLD AND BONUS (Reported and Unreported)
~
N N
StatementasofDecember31,2013ofthe Vision Service Plan
Name of Affiliate
' "
i
EXHIBIT 5 ·AMOUNTS DUE FROM PARENT, SUB$1DIARIES AN!il AFFILIATES 2 I 3 ', 'I, '
61-90 Davs Over 90 Days Nonadmflted
NONE
7 Current
Admitted 8
Non"Current
statementasotDecember31,:2013ofthe Vision Service Plan
~
stJtementasofDecernber31,201Soflhe Vision Service Plan
~vment Method
Capitation Payments:
1. Medical groups .. .
2. Intermediaries .. .
3. All other providers ...
4. Total capitation payments ..................... .
Other Payments:
5. Fee-for-service •••••••.••••.•••• -... ··················-···
fl. Con!rac!ual fee payments ................................... .
7. Bonus/withhold arrangements -fee-for-service_ .............. _ ...... -..................... .
B. Bonus/withhold arrangements- contractual fee payments ........... .
9. Non-oontingent salaries ...
10. Aggregate cost arrangements •..
11. All other payments ...
' "
EXHIBIT 7 • PART 1 ·SUMMARY OF TRANSACTIONS WITH PROVIDERS
Direct Medical Expense Pavment
......... .0
0
........ 0
........................................ 0
2
Column 1 asa%
1
of Total Pavment'
Total Members Covered
• .......................... 0.0 1·· .. ···················+········· . .. 0.0
0.0
.. ........ 0.0
Column 3 as a%
of Total Members
I
.......... ~'~':85: ····················•••••••••:::: ... ::Sf ..••.. : : :::··--······ ..... 3,663,256
... .. ~~:~:::::::::::::::::::::~ :::::~:-·::::::::::.:::-~ __ :::~:~ ::::::::::::::~ .. ::::::::::It:::::=:::: ·····:::~··::::::::::::::~:~·:· -
Column 1 Expenses Paid
to Affiliated Providers
Cnlumn 1 Expenses Paid to Non-Affiliated
Providers
............... 0
... 3,663,256
22,502,858 I··············································
. ...... o ·-·· ............................. ~ .. o.o .................... ..xxx ...... L. ____ ................... .xxx .. ·········- .................................................... ········-········-··· • .•••..•••..•••• ···········-···-0 .............................. 0.0 ................•••.. .XXX .••... !: ............................ .XXX.... . ................................... ·••············ ....... ··•····················· ....•...• I
12. Total other payments ••• ·-··· ·········- ......... ·······- ............................. ··········-···-···-············-················· ... ···-·· .............................. r. ........................... 26,166,114 ······- .•.••• ·······-······- .1ioo.o ................... .XXX. .. J ........ ···- .............. .XXX...... . ................................... 22,502,856 -·-······· ............ .3.663,256
~ L 13. Total IUne 4 Ius Line 121 .................. ········-········· ........................ ················································- ....•.......•.. ~ ....••.•.••.••..•••..••.. 26,166,1~4 ············- ··········- ......... 1~0.0 •...••••.• n ........ XXX.- .. I! ............ ····- .•.•.......... XXX. .......................................... .22.502.858 ···- ............... .3 663,256
EXHIBIT 7 • PART 2 ·SUMMARY OF TRANSACTIONS WITH INTERMEDIARIES
I
1 2 3
I
4 ' 6 Average Intermediary's lnlerrnediarv's
NAJC Name of Capitation Monthly Total Adjusted Authorized cOntrol
"''' Intermediary Paid CapiTation Capiial Level RBC
NONE '
"' "'
Stateme~t~ofDeoember31.2013ofthe Vision Service Plan
Des~ripiion
1. Administrative fumliure and equipment...
2. Medir:al furniture, equipment and fiXtures .................................... .
3. Pharma~eulir:als and surgir:al supplies ................................ ~···········--········
4. Durable medical equipment.. ................................... - ............ .
EXHIBIT 8 • FURNITURE, EQUIPMENT AND SUPPLIES OWNED
C~! Improvements Accumulated
Depreciation
4
Boo~ Value
"" Encumbrances
5
"''"" No! Admitted
-················:························:•:•••••: •••••••::"'•PNE•·········~···················································I··················································· .................................................. .
Net Admitted .,,. "
. .. 0
... 0
5. Other property and equipment.. ...................................................................... . ···I .................................................. 1 .................................. ·-············1······-· ...................................... !·-··- ................ . ......... - ... ··I ........... ................... . .............. 1 ............................................... 0
6. Tot ...... 0 ··········-·····-························-··0 ........ 0 ............ 0 .0 ... 0
StatemelllasofOecember31,2D13ofUm Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
1. Sqmmary of Significant Accounting Policies
A The accompanying financial statements of Vision Service Plan- Washington (Company) have been prepared on the statutory basis of accounting prescribed by the National Association of Insurance Commissioners' (NAIC) Accounting Practices and Procedures Manual.
B. The preparation of financial statements in conformity with the Annual Statement Instructions and Accounting Practices and Procedures manual requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts· of revenues and expenses during the reporting period. Actual results could differ from those estimates.
C. Accounting Policies that Materially Aff13ct Assets, Liabilities, Capital and Surplus or Results of Operations
Premiums are recognized over the period of coverage and are generally based on the number of eligible participants. Receivables and related premiums are estimated based on the most recent eligibility received from clients under the program. Net revenue relating to uninsured plans is recorded as an offset to claims adjustment expenses and general administrative expenses. In addition, the Company uses the following accounting policies:
1. Short-term Investments: Short-term investments are stated at amortized cost. 2. Bonds: Bonds are stated at amortized cost using the interest method. 3. Stocks: The Company has no stocks.
-------~-----~-,4. flreferre-d-Stock:'The~eompany-t,-as-no-prenrrJ'ed--sto-ck.:----------------------------
5. Mortgage Loans: The Company has no mortgaged loans. 6. Loan-backed Securities: The Company has no loan-backed securities. 7. Investments in Subsidiaries: The Company has no investments in subsidiaries. 8. Investments in Joint Ventures, Partnerships and Limited Liability Companies: The Company has no investments
in Joint Ventures, Partnerships and Limited Liability Companies. 9. Derivatives: The Company has no derivatives. 10. Premium Deficiency Calculation:- The Company does not utilize anticpated investment income as-a factor-in the
calculation of premium deficiency. 11. Liabilities for Claims Unpaid and Related Expenses: Claims unpaid and related expenses represents the
estimated liability for claims reported to the Company, claims incurred but not yet reported and unpaid claims adjustment expenses.
12. The Company has not modified its capitalization policy from the prior period. 13. The Company has no pharmaceutical rebate receivables.
2. Accounting Changes and Corrections of Errors- The Company provides for contracts if it is probable that expected future claims, including maintenance costs, will exceed anticipated future premiums and investment income. For purposes of determining aggregate health policy reserves, contracts are grouped in a manner consistent with our method of acquiring, servicing and measuring the profitability of such contracts. Over time, the Company has experienced changes In the manner in which it acquires, services and measures the profitability of insurance contracts. Accordingly, we updated contract groupings during the third quarter of 2013. As a result of this change in estimate, there was no impact to surplus or prior year balances as the Company did not hold health policy reserves during the periods affected.
3. Business Combinations and Goodwill- The Company has no business combinations or goodwill.
4. Discontinued Operations The Company has no discontinued operations.
5. Investments A. Mortgage Loans: The Company has no mortgaged loans. B. Restructured Debt: The Company has no restructured debt. C. Reverse Mortgages: The Company has no reverse mortgages. D. Loan Backed Securities: The Company does not hold any loan"bacl<ed or structured secutities. E. Repurchase Agreements: The Company has no repurchase agreements. F. Real Estate; The Company owns no real estate. G. Investments in low-income housing tax credits (LIHTC): The Company has no UHTC. H. Restricted Assets
( 1) Restricted Assets (Including Pledged)
Restricted Asset Category
On deposit with states Total Restricted Assets
Total Gross Restricted From Current Year $ 660,460
$ 660,460
2 3 4 Total Gross Increase/ Total Current Restricted (Decrease) Year From Prior (1 minus 2) Admitted Year Restricted $ 637,061 $ 23,399 $ 660,460
$ 637,061 $ 23,399 $ 660,460
5 Percentage Gross Restricted to Total Assets
1%
1%
6 Percentage Admitted Restricted to Total Admitted Assets
1%
1%
6. Joint Ventures. Partnerships and Limited Liability Companies- The Company has no joint ventures, partnerships and limited liability companies.
7. Investment Income- The Company has not excluded any investment income.
26
Statement as of December 31, 2013 of the Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
8. Derivative Instruments The Company has no derivative instruments.
9. Income Taxes
A. The components of the net deferred tax asset/(llablllty) at December 31 are as follows:
1. 12/31/2013 Ordinary Capital Total
(a) Gross Deferred Tax Assets $ 364,245 $ $ 364,245 (b) StatutoryValualion PJiowance $ $ $ (c) hljusted Gross Deferred TaxAssets (1a "1 b) $ 364,245 $ $ 364,245 (d) Deferred Tax Assets Nonadmitted $ $ $ (e) Subtotal Net Admitted Deferred Tax Asset (1c" 1 d) $ 364,245 $ $ 364,245
(~ Deferred Tax Liabilities $ $ $ (g) Net Admitted Deferred TaxAsseti(Net Deferred
Tax Liability) (1e "1f) $ 364,245 $ $ 364,245
2. 1\dmission Calculation Components SSPP No.101 (a) Federal Income Taxes Paid in Prior Years
Recoverable Through Loss Carrybacks $ 364,245 $ $ 364,245 (b) hljusted Gross Deferred TaxAssets Expected To
Be Realized (Excluding The Amount ofDeferred TaxAssets From 2(a) above) Mer Application of the Threshold Limitation. (The Lesser of2(b)1 and 2(b)2 Below) $ $ $ 1. Mjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Date $ $ $ 2. Mjusted Gross Deferred Tax Assets Allowed
per Limitation Threshold N/A N/A $ 7,328,998 (c) Mjusted Gross Deferred TaxAssets (Excluding
The Amount of Deferred Tax Assets From 2(a) and 2(b) above) Offset by Gross Deferred Tax Liabilities $ $ $
(d) Deferred TaxAssets Admitted as the Result of Application of SSAP No.1 01 (Total 2(a)+2(b)+2(c)) $ 364,245 $ $ 364,245
1. 12/31/2012 Ordinary Capital Total
(a) Gross Deferred Tax Assets $ 308,672 $ $ 308,672 (b) StatuloryValualion Allowance $ $ $ (c) Mjusted Gross Deferred Tax Assets (1 a "1b) $ 308,672 $ $ 308,672 (d) Deferred TaxAssets Nonadmitted $ $ $ (e) Subtotal Net Mmltted Deferred TaxAsset(1 c" 1d) $ 308,672 $ $ 308,672
(~ Deferred Tax Liabilities $ $ $ (g) Net Admitted Deferred TaxA<lset/(Net Deterred
Tax Liability) (1 e "1f) $ 308,672 $ $ 308,672
2. 1\dmission Calculation Components SSAP No. 101 (a) Federal Income Taxes Paid In Prior Years
Recoverable ThrOugh Loss Carrybacks $ 308,672 $ $ 308,672 (b) .Adjusted Gross Deferred Tax Assets Expected To
Be Realized (Excluding The Amount of Deferred TaxA<>sets From 2(a) above) Mer Application of the Threshold Limitation. (The Lesser of2(b)1 and 2(b)2 Below) $ $ $ 1. Adjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Dale $ $ $ 2. .Adjusted Gross Deferred TaxA<>sets Allowed
per Lim I tall on Threshold N/A N/A $ 7,640,140 (c) .Adjusted Gross Deferred TaxAssets (Excluding
The Amount of Deferred TaxA<>sets From 2(a) and 2(b) above) Offset by Gross Deferred Tax Liabilities $ $ $
(d) Deferred TaxA<lsets Admitted as the Result of Appllcallon ofSSPP No.101 (Total2(a)+2(b)+2(c)) $ 308,672 $ $ 308,672
26.1
Statement as of December 31, 2<11 3 of the Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes (cont.)
1. Change
Ordinary Capital Total
(a) Gross Deferred Tax Assets $ 55,573 $ $ 55,573 (b) Statutory Valuation Allowance $ $ $ (c) Adjusted Gross Deferred TaxAssels (1 a" 1 b) $ 55,573 $ $ 55,573 (d) Deferred TaxAssets Nonadmitted $ $ $ (e) Subtotal Net Admitted Deferred Tax Asset (1 c" 1d) $ 55,573 $ $ 55,573 (Q Deferred Tax liabilities $ $ $ (g) Net Admitted Deferred TaxAsset/(Net Deferred
Tax Liability) (1e" 1f) $ 55,573 $ $ 55,573
2. Admission Calculation Components SSI\P No. 101 (a) Federal Income Taxes Paid in Prior Years
Recoverable Through Loss Carrybacks $ 55,573 $ $ 55,573 (b) Adjusted Gross Deferred Taxfossels Expected To
Be Realized (Excluding The 1\rnpun_tof Deferred
TaX Assets From 2(a) above) After Application of
the Threshold Limitation. (The Lesser.of2(b)1 _ and 2(b)2 Below) $ $ $ 1. Adjusted Gross Deferred Tax Assets Expected
to be Realized Following the Balance Sheet Date $ $ $ 2. Adjusted Gross Deferred Tax Assets Allowed
per lim italian Threshold NIA NIA $ (311,142) (c) Adjusted Gross Deferred Tax Assets (Excluding
--'("he-Amount of Deferred-=rax-Assets-From--2(a)
and 2(b) above) Offset by Gross Deferred Tax Liabilities $ $ $
(d) Deferred Tax Assets Admitted as the Result of
Application ofSSAP No.1 Oi (Total 2(a) + 2(b) + 2©) $ 55,573 $ $ 55,573
3. 2013 2012 (a) Ratio Percentage Used to Determine Recovery
Period and Threshold Limitation Amount 4312% NIA
(b) Amount of Adjusted Capltql and Surplus Used
to Determine Recovery Period and Threshold
Limitation Amount $ 48,859,989 $ NIA
4. There are no changes to ~djusted gross and net admitted DTAs due to tax planning strategies.
B. There are no temporarydifferences for which a DTL has not been established.
26.2
Sta!emen!asofDecember31.2013oflhe Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes <cont.)
c. Current Income taxes incurred consist of the following major components:
(1) (2) (3) (Co11-2)
12/31/2013 12/31/2012 Change 1. Current Income Tax
(a) Federal $ 1,691,046 $ 1,830,623 $ (139,577) (b) Foreign (c) Subtotal $ 1,691,046 $ 1,830,623 $ (139,577) (d) Federal income tax on net capital gains/(losses) 7,545 143,977 (136,432) (e) Utilization of capital loss carry-forwards
(D Other (45,385) (6,086,175) 6,040,790
(g) Federal and foreign income taxes incurred $ 1,653,206 $ (4, 111 ,575) $ 5,764,781
Other at December 31, 2012 includes the rewrsal of tax expense and interest of $6,089,826 related to the Internal Rewnue Service determination that the company had no federal income tax liability for 2006 or 2007 tax years.
(1) (2) (3) 2. Deferred Tax Assets: (Col1-2)
(a) Ordinary: 12/31/2013 12/31/2012 Change (1) Discounting of unpaid losses $ 126,621 $ 119,670 $ 6,951 (2) Unearned premium reserve $ 58,566 $ 32,854 $ 25,712
(3) PoiJcyholder reserves $ $ $ (4) Investments $ $ $ (5) Deferred acquisition costs $ $ $ (6) Policyholder dividends accrual $ $ $ (7) Fixed assets $ $ $ (8) Compensation and benefits accrual $ $ $ (9) Pension accrual $ $ $ (10) Receivables- nonadmitted $ 3,157 $ 2,681 $ 476 (11) Net operating loss carry-forward $ $ $ (12) Tax credit carry-forward $ $ $ (13) Other (Including Items <5% of total ordinary tax
assets) $ 175,901 $ 153,467 $ 22,434 (99) Subtotal $ 364,245 $ 308,672 $ 55,573
(b) Statutory valuation allowance adjustment $ $ $ (c) Nonadmitted $ $ $ (d) Admitted ordinary deferred tax assets $ 364,245 $ 308,672 $ 55,573 (e) Capital:
(1) Investments $ $ $ (2) Net capital loss carry.forward $ $ $
(99) SubtOtal $ $ $ (D Statutory valuation allowance adjustment $ $ $ (g) Nonadmitted $ $ $ (h) Admitted capital deferred tax assets (2e99 - 2f- 2g) $ $ $ (i) Admitted deferred tax assets (2d + 2h) $ 364,245 $ 308,672 $ 55,573
3. Deferred Tax Liabilities (a) Ordinary:
(1) Investments $ $ $ Fixed assets $ $ $ Deferred and uncollected premium $ $ $ Policyholder reserves $ $ $ Other (including items <5% of total ordinary tax liabilities) $ $ $ (99) Subtotal $ $ $
(b) Capital: (1) Investments $ $ $ (2) Real estate $ $ $ (3) Other (including items <5% of total capital tax
liabilities) $ $ $ ----(99) Subtotal
(c) Deferred tax liabilities (3a99 + 3b99) $ $ $ -----
4. Net deferred tax assets/liabilities (2i- 3c) $ 364,245 $ 308,672 $ 55,573
26.3
statementssotDecembar31.2013ofUla Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
9. Income Taxes {cont.) The change in net deferred income taxes is comprised of the following (this analysis is exclusive of non-admitted assets as the Change
in Nonadmitted Assets is reported separately from the Change In Net Deferred Income Taxes in the surplus secllon of the Annual Statement): ·
2013 2012 Change
Total deferred tax assets $ 364,245 $ 308,672 $ 55,573 Total deferred tax liabilities
Net deferred tax asset $ 364,245 $ 308,672 $ 55,573
Tax effect of unrealized (gains)/losses
Change in net deferred Income tax $ 55,573
The provision for federal income taxes Is different from that which would be computed by applying federal income tax rates to income before taxes as follows:
2013 Effective
Amount Tax Effect Tax Rate
Income before federal income taxes $ 4,680,287 $ 1,638,100 35.0% Tax-exempt Income (114,260) (39,991) (0.9%) Change in non-admitted assets (1,360) (476) (0.0%) Other 0.0% Total $ 4,564,667 $ 1,597,633 34.1%~
Federal income taxes incurred $ 1,645,661 Taxon capital gains/(losses) 7,545 Change in net deferred income taxes (55,573) Total statutory income taxes $ 1,597,633
AI. December 31, 2013, the Company had no net operating loss creditcarryforwards, AMT credit carryforwards or capital loss carryforwards.
The following Is Income tax expense for 2011, 2012 and 2013 that Is available for recoupment in the event of future net losses.
Year Ordinary Capital Total 2011 $ 1,938,810 $ 11,028 $ 1,949,838 2012 1,830,623 143,977 1,974,600 2013 1,785,238 143,977 1,929,215 Total $ 5,554,671 $ 298,982 $ 5,853,653
There were no deposits admitted under IRC section 6603.
The Companys federal income tax return Is filed on a consolidated basis and includes the following entities:
Vision·service Plan (CA), Altair Eyewear, Inc., Eyefinity, Inc., Vis lam Service Plan, Inc. (NV), Eastern Vision Service Pian, Inc., Vision Services Plan, Inc., Oklahoma, Vision Service Plan of Illinois, NFP, Massachusetts Vision Service Plan, Inc., Vision Service Plan (OH), V1slon Service Plan Insurance Company(CT), Eastern Vision Service Plan IPA Inc., Vision Service Plan Insurance Company(MO), VSP Holding Company, Inc., l\llarchon Eyewear, Inc., Marchon International Ltd., Marchon BRL Ltd., Alaska Vision Services, Inc., Indiana Vision Services, Inc., Mid-Atlantic Vision Service Plan, inc. (VA), Southwest\'lsion Service Plan, Inc., Vision Service Plan (HI), Vision Service Plan (WA), Vision Service Plan of Idaho, inc., Vision Service Plan of Wyoming, Wisconsin Vision Service Plan, Inc., Marchon France SAS, Marchon Hispana S.L., SXHoldings, LLC, VSP Optical Group, Inc., Plexus Optlx, inc., VSP Labs, Inc., VSP Ceres, Inc., Eyeconlc, inc., VSP Global, inc., Optical Opportunities, Eyefini!yEurope, EyefinltyFrance and Dragon Acquisition Co., Inc.
The method of allocation among companies is subject to a written agreement, approved by the Board of Directors, wherebyallocatlcJn is made primarily on a separate return basis.
26.4
statementasofDecembe;31,2013oflhe Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
10. Information Concerning Parent Subsidiaries and Affiliates A. The company is a wholly owned subsidiary of Vision Service Plan (a California non~profit corporation). B. No assets have been transferred to or from the Company to a related party. C. The Company incurred expenses during 2013 and 2012 of approximately $9,700,000 and $8,500,000 respectively
for such services. D. The amount due to Vision Service Plan as of December 31, 2013 and 2012 is $1,339,342 and $1,181,474
respectively. E. There are no guarantees or undertakings in place between the Company and any related party. F. Vision Service Plan provides the Company with data processing, employee related services and other administrative
services for an agreed upon fee under the Administrative and Marketing Agreement. G. Not applicable. H. Not applicable. I. Not applicable. J. Not applicable. K. Not applicable. L. Not applicable.
11. Debt~ The Company has no capital notes or obligations.
12. Retirement Plans Deferred Compensation Postemployment Benefits and Compensated Absences and other Postretirement Benefit Plans The Company has no retirement plans, deferred compensation, postemployment benefits or compensated balances and postretirement benefit plans.
13. Capital and Surolus Shareholders' Dividend Restrictions and Quasi~Reorganizations (1) Not applicable (2) Not applicable (3) Not applicable (4) The Company declared an ordinary distribution in the amount of $5,100,000 to Its parent company, Vision Se!Vice
Plan on August 7, 2013. The distribution was paid on September 3, 2013. (5) Not applicable (6) Not applicable. (7) Not applicable. (8) Not applicable. (9) Not applicable. (1 0) The portion of unassigned funds (surplus) represented or reduced for cumulative unrealized gains and losses is $0. (11) The Company has no surplus notes at December 31,2013. (12) Not applicable. (13) Not applicable.
14. Contingencies The Company has no contingencies to disclose.
15. Leases -The Company has no leases.
16. Information about Financial Instruments with Off-Balance Sheet Risk and Financial Instruments with Concentrations of Credit Risk The Company has no financial instruments.
17. Sale. Transfer and Servicing of Financial Assets and Extinguishments of Liabilities Including Wash Sales The Company does not sell, transfer or service financial instruments or extinguishments of liabilities. The Company has no wash sales.
18. Gain or Loss to the Insurer from Uninsured Plans and the Uninsured Portion of Partially Insured Plans
The gain from operations from Administrative Services Only (ASO) uninsured plans was as follows:
a.
b.
c. d.
Net reimbursement for administrative expenses (including administrative fees) in excess of actual expenses Total net other income or expenses (including interest paid to or received from plans) Net Joss from operations Total claim payment volume
*The Company has no partially insured plans.
$ 7,730,470 $ 6,913,994
$ (8,226,997) $ (7,030,943) $ (496,527) $ (116,949)
482,006 417,428
19. Direct Premium Written/Produced bv Managing General Agentsffhird Party Administrators The Company has no premiums written by managing general agents or third party administrators.
26.5
Sta\emenlasofDeoomber31,20t3oflhe Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
20. Fair Value Measurements
The Company has no assets or liabllities that are measured at fair value on a recurring basis in periods subsequent to initial recognition.
Aggregate Admitted
Not Practicable {Carrying
Type of Financial Instrument Fair Value Assets (Level1 l (Level 2) .(!,&vel 3) Value) Bonds $ 36,427,575 $ 36,241,662 $ 634,153 $ 35,793,422 $ - $
21. Other Items A. The Company has had no extraordinary events. B. The Company has no troubled debt restructuring. C. The Company has no other unusual items. D. The Company has no business interruption insurance recoveries. E. The Company has no state transferable or non~transferable tax credits. F. The Company has no sub prime mortgage related risk exposure. G. The Company has no retained asset accounts.
------------------~2~2~·--_jE~v~e~n~tstjS~u;bs~e~qi,u;,e~nt - -~ype-J Recognized-Subsequent-Events:-· -------------------------------------------------------------------------
No events have occurred subsequent to the close of the books or accounts for this statement that may have a material effect on the financial condition of the Company.
Type II- Nonrecognized Subsequent Events: On January 1, 2014, the Company will be subject to an annual fee under section 9010 of the Affordable Care Act {ACA). This annual fee will be allocated to individual health insurers as defined in the guidance, based on the ratio of the
_______ c_lmounJ of Jhe eiJ_m~_s __ net prerniu_f!)~_lijr~t~n--~~ril!_g !~e _rr~c~cl_i_ng ~E!Ie~dt:!r_xe_§!C_to t~e arl!<?_unt o_f __ h~~~_ins~r~11c~ fo~--~n_y U.S. health risk that is written during the preceding calendar year. A health insurance entity's portion of the annual fee becomes payable once the entity provides health insurance for any U.S. health risk for each calendar year beginning on or after January 1, 2014. As of December 31, 2013, the Company has written health insurance subject to the ACA assessment, expects to conduct health insurance business in 2014, and estimates their portion of the annual health insurance industry fee to be payable on September 30,2014 to be $659,480. This assessment is expected to impact risk based capital by (1.39%).
23. Reinsurance The Company does not reinsure Its business.
24. Retrospectively Rated Contracts and Contracts Subject to Redetermination A. The Company estimates accrued retrospective premium adjustments for its group health insurance business through
the company's underwriting rules and experience rating practices. B. The Company records accrued retrospective premium as an adjustment to earned premium. C. The amount of net premiums written by the Company at December 31, 2013 that are subject to retrospective rating
features was $1 ,524,535, that represented 4.6% of the total net premiums written for the group health. No other net premiums written by the Company are subject to retrospective rating features.
25. Change in Incurred Claims & Claim Ad!ustment Expenses
Activity in claims unpaid and related expenses is summarized as follows:
2012 2012
BALANCE-January 1 $ 1 718,923 $ 1 873 017
Incurred related to: Current year 28,800,476 25,509,700 Prior years __.(:lJL.lQ§) (340 348\
Total incurred 28,683,370 25,169,352
Paid related to: Current year (26,733, 172) (23,709,362) Prior years (1 743 248\ (1 614,084\
Total paid (28 476 420) (25 323 446)
BALANCE-December 31 $ j 925 8Z3 $ jZj8923
26. Intercompany Pooling Arrangements The Company ~as no intercompany pooling arrangements.
27. Structured Settlements The Company has no structured settlements.
26.6
Slatomsntaso1Decembar31,2013oflhe Vision Service Plan
NOTES TO FINANCIAL STATEMENTS
28. Health Care Receivables The Company has no health care receivables.
29. Participating Policies The Company has no participating policies.
30. Premium DeficiencY Reserves
1. Liability carried for premium deficiency reserves 2. Date of the most recent evaluation of this liability 3. Was anticipated investment income utilized in the calculation?
(1) $ 0
01/24/2014 Yes[ ] No]X]
Premium deficiency reserve of $0 noted here does not tie to page 3, line 4 because Aggregate Health Policy Reserves on page 3 include a liability for premiums subject to retrospective rating features. Refer to note 24,
31. Anticipated Salvage and Subrogation Salvage and subrogation are not applicable to the Company.
26.7
statemsntMorDecembor31,~013oflho Vision Service Plan
GENERAL INTERROGATORIES PART 1· COMMON INTERROGATORIES· GENERAL
1.1 Is the reporting entity a member of an Insurance Hoi<Jing Company System consisting of l'NO orm()re affiliated persons, one or mom of which is an insurer? Yes I X I No I I If yes, complete Scl1edule Y, Parts 1, 1A and 2.
1.2 If yes, did the repllrllng entity register and file with its domiciliary Stale Insurance CommissJoner, Director or Superintendent or with such regulatory official of the slate of domicile of the princi!Jal Insurer In the Holdinrt Company System, a registration stat~ men! provkling disclosure substantially similar to the standards adopted by the NafionaiAssoclatlon oflnsurance Commlssionern (NAIC) in its Model Insurance Holding Company System Regulatory Act and model regulations perlaining thereto, or is the reporting entily subject to starnJards and discbsure requlmments substantially similar to those mqulmd by such Act and regulatbns? Yes [X] No [ l N/A [ I
1.3 State regulatlng? ;/W1''~'/';h;~, ~·~":c.:>c:cc:;;;:c;::co;::;;c;;;;;;;:-;:c:=:;:;;;;;:-;:;;o:;:;co;:'"";:::;;:;;;;;;;-~~~ 2.1 Has any change been made during the year of this statement in the charter, by-laws, articles of Incorporation, or deed of selltementof the
reportingentity? Yes[ No[XJ 2.2 If yes, date of change: 3.1 Slats asofwhatdale the latest financial eJrominatlon of the ropllrting entity was made or is being made. 12131/2010 3.2 State the as ofdats tllat the latest financial examination reporl became available from eith~rthe slate of domicile orlhe reporllng enlily.
This dale should be the date of the eJromine<l balance sheet and not the date the report was completed or release<!. ~1"Ve3"1n,Oc1'0~~~~-3.3 State asolwhatdate the latsstfinancial examination mpoct became avaiiOOleto other stales orths !Jublicfrom either the state of dom·lolle or the
reporting entity. This Js tOO mlease date or completion date of the examination report and not tho date of the examination (balance shoot date). 06/27/2C11.c2~~~~-3.4 By what department or deparlments?
Wash.in9ton Office of the Insurance Commissioner
3.5 Have all flrwnclal st<tement aljuslmerts wXhfn the latest financial examinati011 report beer accounted for in a subsequenllillanc"1al statsment fliOO with departments? Yes [
3.6 Have all of the recommendations within the latest financial examination report been complied witll? Yes [ 4.1 During the period covered b~ this statement, did any agent, broker, sales representative, mn-affiiJated sales/ser'liceor{!anlzatlon or any combination
theroof under common control (otller than salaried employees of the reporUng entity) recei•1e credit or commissions for or control a substantial f)<lrt (mom than 2(1 JJ€rcent of any major line of business measumd on dlroct premlull1S) of:
~~~~~~~~~~~~~~-4:--w--saltiSOfileWbUsirieSs? ··--. - -
4.12 renewals? 4.2 During the period covemd_ by this statement, did any salesiservice organization owned in whole orin part by the mporting entily or an affiliate,
receive credit or commissions for or control a subslan!ial part (more than 20 percent of any major line of business measured on direct premiums) elf 4.21 salas of new buslnsss? 4.22 renewals?
5.1 Has the reportimJ enlity been a party to a merger or consolidation during the period covered by this statement? 5.2 lfyos, provide the name oftheentity, NAIC company code, and stale ofdomldle (use two letter state abbreviation) for any enlity that has cease{]
to exist as a msult of the me er or consolidation.- -
Name of Entity
6.1 Has the mpor~ng entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by anygowmmootal enUly during the reporling p€ciod?
6.2 If yes, giw full irdormation:
7.1 Dooo any foreign (non-United Stales) person or ootily directly or indirectlycontrol10% or more ol the reporUng entlty? 7.2 llyes,
7.21 Slats the percentage offoi"elgn control 7.22 State the nationalit)l(ies) of the foreign person(s) orentlt)l(les); or if the entily is a fiUJiual or mdprocal,
the nations lily of its manager or attorney-in-fact and Identify tOO lype ofentity{ies) (e.g., individual, cor oration, ovemment mana eror attorn ·In-fact
1 National it
S.1 Is the company a subsidiary of a bank holding company regulaled by the Federal Reserve Board? a.2 If response to 8.11s yes, please identify the name of tlle bank holding company.
8.3 8.4
9. What Is the name and address of the lndepoodentcertlfied public accountant or accounting firm retainOO to conduct the annual audit? Deloilte & Touche, 555 Mission Street, San Francisco, CA g4100
10.1 Has the insurer been granted any exemptions to the prohibited non-audit services provided by the certified Independent public accountant requirements as allowed in Section 7H of the Annual Financial Reporting Model Regulation (Model Audit Rule), or substantially similar slate law or regulation?
10.2 If the response to 10.11s yes, provide Information related to this exemption:
10.3 Has the insurer been granted any exemplkms related to the other requirements of the Annual Financial Reporling Model Regulation as allowed fClr In Sec~on 17 A ofthe Model Regulation, or substantially similar s!a!e law or regU ~t"1on?
10.4 If the response to 10.31s yes, provide information related to this exemption:
10.5 Has tile reporting entity established an Audit Committee In compliance with !he domlclliery stale insurance laws? 10.6 If the answer to 10.5Js no or n/a, please expilin
11. What Is the name, address and affiliaUon {officer/employee of the reporling entity or actuary/consultant associated with an actualial consulting finn) ol the lndivklual providing the statement of actuarial opinionlcerlification? FrWerick W. Kilbourne llndependoot Actuary) 15677-G Avenlda Alcachofa, San Diego, CA 9212!1
27
Yes[X]
No[ l NIA[XJ No[X] N!A[ I
Yes [ No[X] Yes [ No[X]
Yes [ No[X] Yos [ No[XI Yos [ No[XI
Yes[ I No[X]
Yes[ No[X]
.............. %
Yes[ ] No[X]
Yes[ I No[X]
Yes[ I No[X]
Yes[ I No[XJ
No[ I N!Af I
Statementasotoecember31,2tl13ottha Vision Service Plan
GENERAL INTERROGATORIES PART 1 ·COMMON INTERROGATORIES· GENERAL
12.1 Does the reporting enffly own any securllles of a real estate holding company or otherwise had real estate indlreclly? 12.11 Name of real estate holding company
12.12 Number of parcels Involved 12.13 T alai book/adjusted carrying value
12.2 If yes, pro\llde explanation.
13. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY: 13.1 What changes have been made during the year in the United States manager or the United states trustees of the reporting entity?
13.2 Does this statement contain ell business transacte<llor the reporllng entity through Its United Stales Branch on risks wherever located? 13.3 Have there been any changes made to any of the trust Indentures during the Year? 13.4 II answer to (13.3) Is yes, has the domiciliary or entry stale approved the changes? Yes [ I 14.1 Are the senior officers (principal executive officer, principal Onanciql officer, principal accounting officer or controller, or persons performing similar functions)
of the reporting entity subject to a code of elhlcs, which Includes lhe following standards? a. Honest and ethical conduct, including the ethical handling of actual or apparent conHI::ts of interest between personal and professional relationships; b. Full, fair, accurate, llmety and understandable disclosure In the periodic reports required to be moo by the reporting entity; c. Compliance with applicable go~~ernmental laws, rules and regulations; d. The prompt Internal reporting of violations to an appropriate person or persons identified In the code; and e. Accountability for adherence to lhe code.
14.11 lithe response to 14.11s no, please explain:
14.2 Has the code of ethics for senior managers been amended? 14.21 If the response to 14.21s yes, provide information related to amendmen~s).
14.3 Have any provisions of the code of ethics been waived for anyofthe specified officers? 14.31 If the response to 14.31s yes, provide the nature of anywalver(s).
15.1 Is the reporting entity the beneficiary of a leiter of Credit that Is unrelated to reinsurance where the Issuing or confirming bank Is not on the SVO Sank list?
15.2 If the response to 15.1 Is yes, Indicate the American Bankers Association (ABA) Routing Number and the name of the Issuing or confirming bank of the Letter ofCrediland describe the circumstances in which the letter of Credit Is lriooered.
1 2 3 American Bankers Association (ABA) Issuing or Confirming Circumstances That Can Trigger Routing Number Bank Name the Letter of Credit
PART 1 ·COMMON INTERROGATORIES· BOARD OF DIRECTORS 18. Is the purchase or sale of all Investments of the reporling entity passed upon elthur by the Board of Directors or a subordinate committee thereof? 17. Does the reporting entlty keep a complete permanent record of the proceedings of Its Board of Directors and all subordinate committees thereof? 1S. Has the reporting entity an established procedure for disclosure to Its Board of Directors or trustees of any material lnterost or affiliation
on the part of any of its officers. directors, trustees or responsible employees that Is In conflict or is likely to conflict with the official dulles of such person?
19. 20.1
20.2
21.1
21.2
22.1
22.2
23.1 23.2
PART 1 ·COMMON INTERROGATORIES· FINANCIAL Has this statement been prepare<~ using a basis uf accounting other than Statutory Accounting Principles (e.g., Generally Accepted Accounting Principles)? Total amount loonOO during the year (inclusive of Separate Accounts, exclusive of policy loans): 20.11 To directors or other officers 20.12 To stockholders not officers 20.13 Trustees, supreme or grand (Fraternal only) Total amount of loans outstanding at the end of year (Inclusive of Separate Acl;ounts, exclusive of policy loans): 20.21 To directors or other orftcers 20.22 To stockholders not olflcers 20.23 Trustees, supreme or grand (Fratornal only) Wore any assets reported in this statement subject to a contractual obligation to transfer to another party without the liability for such obligation bein[l reported in the statement? If yes, stale the amount thereof al December 31 of the current year: 21.21 Rented from others 21.22 Borrowed from others 21.23 Leased from others 21.24 Othel Does this statement Include payments for assessments as described in the Annual Statement Instructions other than guaranty fund or guaranty association assessments? If ahswer is yes: 22.21 Amount paid as losses or risk adjustment 22.22 Amount paid as expenses 22.23 Other amounts paid Does the reporUng en my reporlany amounts due from parent, subsidiaries or affiliates on PEge 2 of tllis statement? II yes, Indicate any amounts receivable from parent included In tho Page 2 amount.
PART 1 ·COMMON INTERROGATORIES ·INVESTMENT 24.01 Were all tho stocks, bonds and other securities owned December 31 of cu1rent year, overwhlcl1 the reporting e11lity has exclusive control,
In the actual possession of the reporting entity on said date (other than securities lending pro[lrams addressOO in 24.03)?
27.1
$ ... $ ..
Yes[ I No(XI
Yes[ No[ Yes[ No[ No[ N/A[
Yes{Xj No[
Yes[ I No[XI
Yes[ I No[XI
Yes[ I Nu[XI
4
Amount
Yes[X] No[ Yes[X] No[
Yes[X] No[ I
Yes[ I No[XI
........ 0 .. 0
$ .................................... 0
.......................... 0 ....... 0
...... 0
Yes[ I No[XI
Yes[ No[XI
Yos[ No[X]
Yes[ I No[XI
S1atsmentasoiD<lcember31,2013ofthe Vision Service Plan PART 1 -COMMON INTERROGATORIES -INVESTMENT
24.02 If oo, give full and complete information retatiniJ tllereto. Secur'ities are held by b<lnks pursuant to safekeeping custodial af!reements
24.03 For security lendliig programs, provide a descflptlon of tile program lndl.ldliig value for oollaleral and amount of loaned securities, and whether ooJiateral is carried on or off-balance sheet (an alternaUve Is to· reference Note 17 where this 'nformation Is also prollided). N!A
24.04 Does the company's security lending pro[lram meet the requirements fora conformilig program as ouUined in the Risk·Based Capllallnslructkins?
24.05 If answer JI)24.Q4 is yes, repotl a.mount of collateral for conformlniJ programs. 24.06 II answer to24.041s no, report amount of collateral for otllor rwograms. 24.07 Does your securities letldiniJ program require tcl2% {domesUc·securilies) and 105% (foreign securities) from the counterparty at the
outset of lhe contract? 24.06 Does the reporting enUty oon-admit when tho collateral received from the counterparty falls below 100%? 24.09 Does lhe reporting entity or the reporting entity's securities londili9 agent ullllw tho Master Securilles Lending Agreement (MSLJ\)
to conduct securities lending? 24.10 For the reporting entity's security lending program, stale the amount oftlle following as of December 31 of the current year:
24.101 Total fair value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2. 24.102 Total book adjusted/carrying value of reinvested co~ateral assets re]l(lrte<l oli Schedde DL, Parts 1 end 2. 24.103 Total payable lor securities lendlniJ reported on tile liability tJaiJe.
25, 1 Were any of the stocks, bonds Of other assels of the reporting entity owne<l at December ~1 ~I the current year not exduslvely undor the control of the reporting entity or has tile reporting entity sold or lransfemxl any assets subject to a put option wntract tllalls currenOy in Ioree?
Yes[ j
Ye>l Yes[
Yes[
No[ I Nlfi[Xj
No[ NIA(X] No( NIA[X]
No[ NIA[X]
(Exclude securities subject to lnterrogaiO(y 21.1 and 24-03) Yes [X) No [ j 25.2 If yes, state the amount thereof at December 31 ortlle current )l&ar:
25.21 Subject to repurchase agreements $.. .. ............... 0 25.22 Subject to reverse repurchase agreements $.. .. ............ 0 25.23 $\Jbject to dollar repurcl\ase agrOOmsnts $... . ... 0 25.24 Subject to reverse dollar repurchase agreements $ .......... 0
------~------~~~2~'~,2~'~Pioo~~~"~"'~l~"~·rn~l':::::::;:::::;;:--------------------------------$ ;;.0-----------25.26 Placed under opllona[lreements $. . ............ 0 25.27 Lellel stock or seculilies restlicted as to sale $. .. ............. 0 25.28 On deposit wltll state 0( other regulatol)' body $ , ..... 000,460 25.29 0\1\er $ .... ,... . ................ 0
25.3 o 25.27 rovido the following: 1
Nature of Restriction Description
-26. 1 - Does the reporting entity have any hedging transactions reported on Schedule DB? 26.2 If yes, has a oomprehenslve descrlption of the hedging program been made a'o'ailable to tlledJnliciltal)' stale?
If no, attach a description with this statement.
27.1 Were any preferred stocks or bonds owned as of Decembor ~1 of the current year mandatorilY CO!IverUble Into equity, ()(,at the option of the issuer, convertible into equity?
27.2 If yes, state tile amounllhereof at December31 of the current year:
·yesn -·No-( XI Yes[ ] No( j NIA[ ]
Yes( J No[XJ
2B. Excluding Items in Schedule E-Part 3-Spccial Deposits, real estate, mortgage loans and Investments held physically In the reporUng entity'$ offices, vau[ls or safely deposit Opxes, were all stoclls, bonds and other securities, owned throughout the current year held pursuant to a custodial agreement with a qualified bank or trust company in accordance wltll SecUon 1, Ill· General ExamiMlion Considerations, F. Outsourcing of Critical Functions Custodial or SafekeopiniJ Agreements of the NAIC Financial Condition Examiners Handbook? Yes( ] No[Xj
28.01 For a reements that com I wilh there ulrements of the NAIC Financial Condition Examiners HandOOok, com le\e the foil owl 1 2
Custodian's Address Union Bank 350 California Sl. 6th lklor San Francisw CA 94104
28.02 For all a[lreements that do not comply will\ the requirements of the NAIC Ffnanclal CondiUon Examiners Handbook, provide the name, locaHon and a wm lete exo!anatlon:
1 2 3 Na~e(s) Location(s) Complete Explanation(s)
Wells Fa a Advisors 620 Coolid e Drl~e Su!te 300 Folsom, CA 95630 The Com an is workl with the OOnk lo obtain a reements that com I withNAIC re ulrements
Yes[ ] No[X]
New Custodian Reason
26.05 Identify all Investment advisors, brokers/dealers or Individuals acling 011 behalf of brokorldeale·s thai have access to the investment accounts, handle securities and have authorit to make Investments on behalf of the re ortln enti
Address
29.1 Does the reporting enH\y have any diversified mutual funds repmted in Schedule D-Part2 (diVllrsified accoroing to the Securities and Excllange Commission (SEC) In the Investment Company Act of 1940 [Section 5 (b) (1)D? Yes[ ] No[Xj
29.21f lthfollowl dl . nyes com e et o NJr.gsolle ue: 1 1 3
BooWAdjusted CUSIP# Name of Mutual Fund carl)'lnq Value
29.2999. TOTAL 0 2g,3 For each mutual fund listed in the table ab011e, wm lete the foliowln schedule:
1 2 3 4 Amount of Mutual
Fund's BookJAdjusted Name of Mutual Fu1~e~ ~arne of Significant Holding carrying Value from the above table of lhe Mutual Fund Attributable to Holdlno Date of Valuation
27.2
statamsntaso1Dscember31,2()13oflhe Vision Service Plan PART 1 • COMMON INTERROGATORIES ·INVESTMENT
30. Provide the following Information for all short.term and long·term bonds and all preferred stocks. Do not subsutute amortized ~alue or statement value for fairvatue. 1 2 3
30.1 Bonds 30.2 Preferred stocks. 30.3 Totals ....
Statement (Admitted)
Value ................. 36,254,726
. , .. 35,254,726 30.4 Descnbe the sources or methods uUIIzed In determ1mng the la1rvalues.
Fair Value
................ 36,440,639
.. 35,440,639
Excess of Statement overFalrValue (-), or Fair Value over
Statement (+) ................... 185913
.. ... 0 ................... 185,913
The fair values were obtained from McGraw Hill· S&P Pricing IQ, a pricing service, or from other rellabl€ Independent sources when oot available from S&P Prlcl IQ
31.1 Was the rate used to calculate fair value determined by a broker or custodian for any of tile securlUes In ScheduleD? 31.2 lithe answer to 31.11s yes, does the reporting entity have a copy of the broker's or custodian's pricing policy (hard copy or electronic copy) for an
brokers or custodians used as a pricing source? 31.3 If the answer to 31.2 ts oo, describe the reporting entity's process for determining a reliable pricing source for purposes of disclosure of fair value for Schedule D.
32.1 Have all \he filing requirements of the Purposes arKI Procedures Mam1al ofthe NAIC Secunlies Valuation Office been followed? 32.2 If no, lis\ exceptions
PART 1 ·COMMON INTERROGATORIES· OTHER 33.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, If any? 32.2 List tile name of the organization and the amount paid if any such payment represented 25% or more of the total payments to
trade associations, service or anizations and statisUcal or ratin bureaus durin tile riod covered this statement. 1
Yes[X] No[
Yes[X] No[
Yes[X] No[ ]
$ ..... .. ........ 1)
34.1 tA;m;.,;,;,;cl~p;,,;m;,;,;.;1,;,;,.,;,;,,;,;,,;"';'~·'~';";'(1;======"='=m=o==================±====""=::j$. .. .................... 0 34.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payments
I fu' IO!JOI "'""~'"'"tho P"riod """"" byfulo oto•mool. "'""'
35.1 Amount or payments for expenditures In connection with mailers bafore legislative bodies, officers or departments of government, ff any? 35.2 List the name of the finn and the amount paid if any such payment represented 25% or more orthe total payment expenditures
In connection with mallets before I lslative bodies officers or de arlments of ovemment durin the eriod co~ered b this statement.
Name
NONE
27.3
Amount Paid
............ 0
StatemenlasofDecomber31,20f3ofU~e Vision Service Plan
GENERAL INTERROGATORIES PART 2 ·HEALTH INTERROGATORIES
1.1 Does the reporting onfi!y hal'll any direct Medicare Supplement Insurance in force?
1.2 If yes, indicate premium earned on U.S. business only 1.3 What porNon of Item (1 .2) is not reportOO on the Medicare Supplement Insurance EXporionoo Exhibit?
1.31 Reason rorexcllldlng
1.4 Indicate amount of earned premium allribulablo to Canadian and/or Other Alien not lncludej In Item (1.2) above. 1.5 Indicate total incurred claims on all Medicare Supplement Insurance. 1.6 Individual policies:
Most current three ye11rs: 1.61 Total premium earned 1.62 TolallncurrOO claims 1.63 Number of covered li~es All years prior to most current three years: 1.64 Total premium earnOO 1.65 Total incurrOO claims 1.66 Number of covered l!ves
1.7 Group policies: Most currant three yuars: 1.71 Total premium earned 1.72 Total incurred ciaims 1.73 Number of covered lives All year~ prior to most current three years: 1.74 1otal premium earned 1.75 Total incurred claims 1.76 Number of ooverOO lives
2. Health test: Current Year PriorY ear
2.1 Premium Numerator........ t~'"'~";'";"·~ ... ~ .. 'i'i''i"j·'!'!'t;~" ... ~ .. ,: .. 2;0;2:15~11131 2.2 Premium Denominator .......... 32,973,997 ......... 30,315,113 2.3 Premium Ratio (2.1/2.2).. .. ..... 100.0 ......................... 100.0 2..4 Re.se{Ve.Numeralor..... .. .. 2,315,691 ...... 2,084,653 2.5 Reserve Denominator... . .... 2,315,691 ................. 2,084,663 2.6 Reserve Ratio (2.4/2.5).. ...... ................. .. .... 100.0 ........................... 100.0
3.1 Has the reporting enti!y receivOO any endowment or gilt from conlracting hospitals, physicians, dentists, orolhers !hat is agreed will be returned wllen, and if the earnings of the reporting entity permits?
32 If yes, give part'1cliars:
4.1 Have copies of all agreemen!s statlng the period and nature of hospitals', physicians', and dentists' care offered to subscribers and dependents betm moo with the appropriate regulatory agency?
4.2 If not previously fi!OO, furnish herewith a copy(ies) of such agreement(s). Do 1hese agreements Include additional benefits offered? G.1 Does the repor~ng enlity have s!op·loss reinsurance?
5.2 II no, explain: The Company solely provides vision coverage. The largest aggregate amount Insured in an'{ one risk Is $200.
5.3 Maximum relainOO risk (see instructions):
5.31 Comprehensive medical 5.32 MOOical only 5.33 MOOicare supplement 5.34 Dental and vision 5.35 Other limited beneat plan 5.36 Other
6. Describe arrangement wllich the reporting enlity may have to protect subscribers and their dependents against the risk of insolvency incl\lding hold harmless provisions, conversion privileges with o1her carriers, agreements with providers to conlinue rendering services, and any o!har agreements: The Company's agreementswl1h Its Member Doctors prohibits them from seeking payment (exceptforcooavmant.if any) from, orbringlnq any legal aclion against the Company's subscribers or theirdeoellden1s for the Company's covered services. The Company mainlains other arrangements of this
e to the extent re uired law.
7.1 Does the reporting entity set up its claim liability for provider services on a service dale basis? 7.2 If no, give details:
8. Provide the following information regarding (JllrHcipating providers: 8.1 Number of pro~klers at sl<lrt of reporting year 8.2 Number of provklers at and of reporting year
9.1 Does the reporting entity have business subject to premium rata guarantees?
9.2 If yes, direct premium earned: 9.21 Business wllh rate guarantees between 15·36 months 9.22 Business with rate guarantees over 36 months
10.1 Does the reportin[l entity have lncen~ve Pool, Withhold or Bonus arrangements In Its provider contracts? 10.2 lfyos:
10.21 Maximum amoun1 payable bonuses 10.22 Amoont actually paid for yoor bonuses 10.23 Maximum amount payable withholds
10.24 Amount aclually paid for year withholds
28
Yes [ I
Yes I I
Yes[X] Yes[ ] Yes[ 1
No[XI
No[XI
No[ ] No[X] No[X]
$.. .. ................ 0 $ ................................. 0 $.. .. ................ 0 $ $. $
Yes[X I
Yes {
Yes[
.............. 200 .......... 0
....... 0
No{ I
' ... 697 ......... 714
No[X]
No[XI
statementaseroecember31,2013ofthe Vision Service Plan
GENERAL INTERROGATORIES PART 2 ·HEALTH INTERROGATORIES
11.1 Is the reporting entity organized as: 11.12 A Medical Group/Staff Model, 11.13 An Individual Practice Association (IPA), or 11.14 A Mixed Model (combination of above)?
11.2 Is the reporting en!ity subject to Minimum Net Worth Requirements? 11.3 If yes, show the name of the slate requiring such net worth 11.4 If yes, show the aml)unt required.
Wasllln ton
11.5 Is this amount Included as !)art of a oontingency reserve In stockholder's equity? 11.6 If the amou11t is calculated, show the calculation:
12.
13.1 Do you act as a custodian for health savings account? 13.2 If yes, please provide the amount of custodial funds held as tlf the re!)orling dale. 13.3 Do you aol as an administrator for health savings accoun\8? 13.4 If yes, !)lease provide the balance of the funds administered as of the reporting date.
28.1
Yes[ No[X] Yes[ No[X] y., I No[ X]
Yes [X] No [ 1
$. ...300,000 Yes [ No[ X)
Yes[ No[X]
Yes[ No[X]
..
Slalementasoloecember31,2013oflhe Vision Service Plan
Balance Sheet Items (Pages 2 and 3)
1. Total admitted assels (Page 2, Line 28).
2. Total liabilities (Page 3,.Line 24)
3. Statutory surplus.
4. Total capilal and surplus (Page 3, Line 33) ...
Income Statement Items (Page 4)
5. Total re~enues (Line 8).
6. Total medical and hospital expenses (Line 18) ...
7. Claims adjustment expanses (Line 20).
8. Total adminlslrnti~e expenses (Line 21) ...
9. NetundeiWriling gain (loss) (line 24)
10. Netin~eslment gain (I()Ssj (Line 27) ..
11. Total other income {Lines 28 plus 29).
FIVE-YEAR HISTORICAL DATA 1
2013 2
2012 3
2011 4
2010
..... 53,982,162
...... ..4,757,928
. ........ 56,701,176 .............. 82,818,355 .............. 77,8];,890
........... 5,458,236 ...... 11,458,602
.................................................... 300,000 ................... 300,000 ................... 300,000
...... 9,916,512
......... 300,000
5 2009
...... 76,519,052
...... 13, 168,449
. ........... 300,000
. ........... .49,224,234 ······ .....• 51,242,940 ............ 71,359,753 ········· .. 67,919,378 ............ 63,350,603
...... 34,436,896 .............. 31,931,490
.................................. 26,371, 142 ......... 23,892,804
.... 32,133,042
..... 24,868,065
................... 364,039 ................... 309,798 ................... 219,059
. ..... 31,320,770
...... 22,854,881
......... 187,607
........ 3,608,074 ······ ... 3,094,310 ....... 2,801,468 ......... 2,421,517
...... ..4,093,641 ............... .4,634,778 ................ 4,266,613 ........ 5,875,573
...613,530 ............. 1,074,362 .............. 1,215,356 ............ 1,286,162
. ...... (34,4L9) ............... (52,056) ...................... (2,133) ...................... {2,798)
....... 27,641,078
. ...... 20,477,258
. ........ 141,237
12. Nellncome or (loss) (Una 32) ........................................................... . ........... 3,027,0C1 ................ 9,912,636 ........ 3,455,121 ....... .4,569,971
. ....... 1,821,185
......... 5,216,598
........ 1,539,138
.......... (28,600)
. .... .4,292,414
Cash Flow (Page 6)
13. Net cash from operations (line 11) ... .................. 307,982 ............. 3,383,170 ................ 6,045,746 ............... 3,524,579 ................ 5,170,042
-----------IRtSit-Based·Capltat·Analysls~· ------------1------1------~ -------1--~--+-----1------------
14. Total adjusted capllal
15. Aulhorlled oontro! leVlll risk-based capital.
Enrollment (Exhibit 1)
16. Tolal members at end of period (Column 5, Line 7) ...
_11-_ TotaL11_10mber IT!Qnl~~-(C_Q.l!JJI1n_6, ~ill§. I),,,.,.=·=·
Operating Per~entage (Page 4) (Item divided by Page 4, sum of Lines 2, 3, and 5) x 100 .0
18. Premiums earned plus risk revenue (Line 2 plus Llnes3 and 5) ...
19. Total h.()Spital and medical plus other non-health (Line 18 plus Line 19).
20. Cost 0011talnment expenses
21. Other cllllms lldjuslmentexpenses ..
22. Total undeiWiitlng deductions (line 23) ...
23. Total undeiWriling gain (loss) (Line 24).
Unpaid Claims Analysis (U&I Exhibit, Part 28)
24. Total claims Incurred for prior years (line 13 C<JI. 5)
25. Estimated liability of unpaid claims- [prior year (line 13, C<JI. 6))
Investments In Parent, Subsidiaries and Affiliates
26. Almiated bonds (Sch.. D Summary, line 12, Col. 1) . ., ...
............. .49,224,234 .............. 51,242,940 .............. 71,359,753 ...... 67,919,377
............. 915,274 ........ 1,133,183 ................ 1,011,006 .......... 988,551
........ 658,054 . ... 644,692 ............... 633,112 ·········· ........ 622,313
.... 7,909,899 ................ 7,509,ijQ_7 ... 7,7I4,2Q2 .... ,._7,3_3_1.~Q7
....................... 100.0 ....................... 100.0 ....................... 100.0 . .. 100.0
. .... .76.2 .... 80.2 ........ 78.4 ....... 80.9
... 1.1 ......•.. 1.0 ....... 0.7 ...... 0.8
... 92.3 ......................... 89.6 . ...... 90.6 ......................... 84.8
.............. 12.5 ...... 15.2 . ..... 13.9 .... 19.6
...... 1,601,617 ............... 1,532,669 ..... 1,543,794 ............... 1,210,212
...... 1,696,933 ......•. 1,850,444 ..... 1,419,612 ................ 1,246,248
27. Affiliated preferred stocks (Sch D. Summary, Line 18, Col.1) ..................................... .
28. Affiliated common stocks (Sch D. Summary, line 24, Col. 1) ....
29. Affiliated short-term Investments {subtotal Included in Sch. DA,
Verification, Column 5, Line 10) ...
30. Affiliated mortgage loans on real estate
31. All other affiliated.
...... 63,350,603
. ........ 884,924
...... 566,177
-~6,6W,j4_4
........... 100.0
.... .77.2
• ...... 0.5
... 84.6
... 19.7
.. 1,002,225
.. 1,241,570
32. Total of aOOve Lines 26 to 31... .............................. 0 .............................. 0 ........................... 0 .............................. 0 .............................. 0
33. Total investment In parent included in Llnes26to 31 above ..... NOTE. 11 a party to a merger, ha~e the two most recent years ollhls exhibit been restated due loa merger In compliance Wllh the disclosure
requirements of SSAP No.3, Accounting Changes and Correction of Errors? If no, please explain:
29
Yes[ 1 No[ ]
statementasofDecernber31,2013ofihe Vision Service Plan
NAIC Group Code ...•. 1189
Total Members at end of:
1. Prioryear...
2. First quarter __ _
3. Second quarter •.•..
4. Third quarter. ..
5". Currentvear ...................................................... .
6. Current year member months .......•....
Total Member Ambulatory Encounters for Year:
Physician ... ~I' 8. Non-physician ...
9. Totals ...
10. Hospital patient days incurred ...
11. Numberof~fien!admissions. ············-···
12. Health premiums written (b) ...
13. Life premiums direct ...
14. Properlyfcasually premiums written ...
1111~111111 ~1111~ ~11111111111111111111111 mu ~~11111111~1 OOJJ ~1111111111111111 * 4 7 3 1 7 2 0 1 3 4 3 0 5 9 1 0 0 *
EXHIBIT OF PREMIUMS, ENROLLMENT AND UTILIZATION (a) REPORT FOR: 1. CORPORATION ..... Vision Service Plan 2. Seattle, WA
BUSINESS IN THE STATE OF GRAND TOTAL DURING THE YEAR
Comorehenstve (Hospital & Medical 2 3
Toial Individual Group
644,092 ···············-·····-···-···
4
Medicare SuPPlement
Vision oow
Dental Onlv
.644,692 ····························-···
Federal Employees Health
Benelils Plan
... 658,570 ·······-···
. ... 656,444
... 658,570 ·························-···
.. .. 604, 197 ······-···--···
.. ...... 65"8,054
... 656,444 ·····························-···
... 664,197 ·······- ··················-···
... 658,054
• .......... .7,909,899 ••••• I••••••••••••••••••••••••••••••••---•• I••••••••••••••••••••••••••••••••••--• I •••• •••••••••••••••7,909,899
147_,-~-: 1 :::::::::::::::::::::::::::::::::::: 1---------------·-····----·-.
147,118
___ 147.118 ..... a ___ a 147,118 .0
. .. 0
... 32,973,997 1 ...................... .. .32,973,997
____ a
(Location)
TrtleXVIII Medit:are
•
NAIC Company Code ... ..47317 ' 10
Ti~e XIX Medicaid
. .. 0
Olh"
15. Health premiums earned.............. ••..•••. .•••• ....................... • .................. 32,973,997 ... 32,973,997
....... a
16. remiumseamed ................................ ············-······--····-····0 ..................................... .. ............................. ............................. .. ............. -... .............................. . ............................. .. 17. Amount paid for provision of health care services _____ .......... . ........ ..... 26, 166,114
18. Amount incurred for provision of health care services... .. ................. 26.,371,142
..... 26,166,114
20,371,142
(a) For health business: number of persons insured under PPO managed care produc!s .......... O and number of persons insured under indemnity only products ........ a. (b) Forhea~h premiums wrillBn: amount of Medicare Tille XVIII exempt-from slate !axes or fees $ .......... 0
·-·- -- --- -· -------~-----~---
staoomsntasofDerember31,2013oflhe Vision Service ·Plan
Sch. S-Pt. 1-Sn. 2 NONE
Sch. S-Pt. 2 NONE
Sch. s~Pt. 3~sn~- 2 NONE
Sch. S-Pt. 4 NONE
Sch. S-Pt. 5 NONE
Sch. S-Pt. 6 NONE
31,32,33,34,35, 36
Stateltlentaso1Dacember31,2013oltlle Vision Service Plan
SCHEDULE S • PART 7 Restatement of Balance Sheet to ldenU{y Net Credit for Ceded Reinsurance
ASSETS (Page 2, Col. 3)
1. Cash and Invested assets (Line 12) ...
2. Accident and heatlh premiums due and unpaid (Line 15)
3. Amounts recoverable from reinsurers (line 16.1) ........................ .
4. Net credit lor ceded reinsurance •.
5. All other admitted assets (balance).
6. Totalsassets{Line28) .................................... .
LIABILITIES, CAPITAL AND SURPLUS (Page 3)
1. Clalmsunpaid(Line1).
8. Accrued medic;allncen!ive pool and bonus payments (Line 2)
9. Premiums received In advance (line B)
10. Funds held under reinsurance treaties with aulholized and unauthorized reinsurers {Line 19,
first Inset amount plus second Inset amount)
tv; Re)Xlrled (Net of Ceded)
.......• .46,325,036
............................... 853,215
.............. XXX .. .
. ........... 6,803,911
......... 53,982, 162
........... 1,901,961
............................... 159,224
Restatement Adlustments
Restated (Gross of Ceded)
. .......•.....•...... ..46,325,036
.................... 853,215
. .......... .J)
, .• .1}
............... 6803911
.. ....................... 0 .......................... 53,982,162
.. ....... 1,901,961
..... 1)
............ 159,224
.......................................... !)
11. Reinsurance In unauthorized companies (line 20 minus Inset amount) ......................................................... .. .. ................................. 1)
12, Reinsurance wllh certified reinsurers (Line 20 Inset amount) ....... .. ........................................ !)
13. Funds held under reinsurance treaties with certified reinsurers (Line 19thlrd Inset amount) ... .. ..................... 0
14. All other liabilities (balance). ............. 2,696743 .. .... 2,696,743
15. Total liabilities (Line 24) ..................... .. .. ....................... ..4,757,928 .......................................... 0 ........................... .4,757,928
16. Total capital and surplus {Line 33) ............................ .. .. ......................................... P"~~ .... ~ ... ~ .... '"'""·'"'""''"'''+~~·~···d··xx""'x.~ .. =~P"==~···~ .... '"49;,..2"'24"'"'''-I 17. Total liabilities, capital and surplus (Line 34).
NET CREOIT FOR CEDE[} REINSURANCE
18. Claims unpaid ........
19. A~X:rued medicallncenlive pool.
21). Premiums received In advance.
21. Reinsurance recoverable on [)<l(d losses ........................................................ .
22. Other ceded reinsurance recoverables ....
23. T<Jtal ceded reinsurance recovarables
24. Premiums receivable.
25. Funds h~ld under reinsurance troaUGS with auth<Jrlzed and unauthorlml rolnsurers ......
26. Unaulhorized reinsurance .......
27. Reinsurance with cor~fled reinsurers ..
28. Funds held untler reinsurance lrealies with certified reinsurers ....
29. Other ceded relnsuranoo payablesloffsets
30. Total ceded reinsurance payablesloflsets .................................... .
31. Total net credit for ceded reinsurance.
37
........... 53,982,162
.. .. 0
.. ................ 0
. .. " .... , ........... 0
.. ................. 0
. ........... 0
.......................................... 0
.. ......... 0
.. ........................................ 0
.. ................. 0
.. ................................... 0
.. ................ 0
................. 0
.. ................. 0
.. ................ 0
.. ..................................... ,,0 .......................... 53,982,162
statamentaso!December31,2013ofthe Vision Service Plan
SCHEDULE T ·PREMIUMS AND OTHER CONSIDERATIONS
State, Etc Active Status
1. Alabama ..................................... AL .... N. 2. Alaska ..................... AK ... N .. .. 3. Arizona .................. .AZ .... N .. . 4. Arkansas .... AR .... N 5. California .. .................. CA ... N .. . 6. Colorado .. .. ...................... CO .... N .. .. 7. Connecticut. .CT ... N. 8. Delaware ......................... . .. DE ... .N .... 9. District of Columbia .. .... DC .... N .. 10. Florida ................... FL .... N. 11. Georgia ........ GA .... N ... 12. Hawaii .......................................... HI .... N. 13. ldahCl ..................................... 10 .... N .. .
A&;ident & Health
Premiums
14. Illinois.......................... . ..... IL .... N ..................... .
Allocated bv States and Territories
Medicare Title XVIII
Medicaid Title XIX
Dime! Business Onl
5 ' Federal Employoes Life & Annuity Health Premiums and
Benefits Plan Other Premiums Considerations
Property/ Casualty
Premiums
' Total
Columns 2 Thr~·{~~ii 7
.0 . ... 0 ... 0
..................... 0 .. .................. 0 . .................... 0
.. 0 . .. 0
. ..... 0 ... 0
. ......... 0
. ......... 0 . ........... 0
······· .0 15. .Indiana ......................................... IN ...• N. .. . ............. ..... . ............ 0 16. Iowa ..........•................ lA ...• N... . ....... 0 17. Kansas... . ......................... KS .. ,.N .. , ............ 0 16. Kentucky. . ...•................... KY .... N. . .......••••.......•.•......•.. , ......................... ,... . .•.. 0 19. Louisiana. • .........•...... .LA ...• N.. .......... .. ... . ......... . ............. ...... . .... 0
DeposiiTyi"
Contracts
20~Maine ........................ ME- =Nb ... "·· ~"1"=~~~1~ ... ": .. ~ ... ~ .. ~~1~~~="1~=~~~=11===~···1~==~~1~ .. " . .-.~ ... ~ .. ~ ... ~ .. ·"···~ .... 0 l~=~"=d------------21. Maryland .................................... MD ...• N ..... 0 22. Massachusetts ....... MA .... N 23. Michigan... . Ml .... N ........................ .. 24. Minnes.ola .................................. MN .... N .......................... . 25. Mississippi... .. .... MS .... N, 26. Missouri.... MO , .. N 27. Monlarm........ .. .............. MT .... N ........................................................ .
-2!k- Nebraska ......................... ~.:;:~NE .-;;;N 29. Nevada ...................................... NV .... N. 30. New Hampshire ......................... NH .... N ... 31. New Jersey ................................. NJ .... N 32. Now Mexico.. .. ............. NM .... N 33. NewYork. .. .......... NY .... N 34. Nmlh Carolina ............................ NC .... N. 35. North Dakola. .. ............... NO .... N ............................................. . 3G. Ohio........ . .............. OH .... N 37. Oklahoma......... . .. OK .... N 3!J. Oregon.... .OR .... N 39. Pennsylvania.. .. ....... PA .... N 40. Rhode lslafld ............................... Rl .... N .. . 41. SCIU!h Carolina .......................... SC .... N ................................ .. 42. South OakClla.. . .... SO .... N 43. Tennessee.... .. ............. TN .... N 44. Texas .................................... TX .... N 45. Utah .......................................... UT .... N. 45. Vermont ................. VT .... N 47. Virginia... . ... VA .... N 4!J. Washington .......................... WA ... .L... ... 32,973,997 49. WestVirglnla .......... WV .... N 50. Wiswnsin.... . .................. WI .... N 51. Wyoming.......... ..WY .... N ........................ .. 52. American Samoa ..................... AS .... N 53. Guam, ............ GU .... N 54. Puerto Rico. .. .................. PR .... N 55. U.S. Virgin Islands ...................... VI .... N M. Northern Mariana Islands ......... MP .... N 57. Canada.... . .................... CAN .... N. 5!J. Aggregate Other alien .............. OT ..... XXX..... . ........ 0 ................... 0 59. Subtotal.. .............................................. XXX...... ...32,973,997 ................. 0 60. Repmling entity contributi011s for
............ 0 ........................... 0 ... 0 ............. 0
............. 0 . ............ 0
. .... 0
..... 0
..... 0
. .... 0
. :.0 .............. 0
. .. 0 ..... 0 ..... 0 ..... 0 . ... 0 . .. 0
...... 0
... 0 .... 0 ..... 0 . ... 0
........................ 0 ... 0 ..... 0 ..... 0 .. .. 0
...... 0 .. 0
. ... ..32,973,997 .... 0 ..... 0 . ..... 0 ...... 0 ..... 0 ... 0 ..... 0
............ 0 . .... 0
......... 0 .. 0 ...... 0 .................... 0 .................. 0 ........ 32,973,997
.... 0 61. ~::~~~~~~e;~:~~:~:~~- ::::::::::::::::: f~i·.~-~::::1 ... 32,973,997 ..........•.•.. 0 ................... 0 ........•.........•........ 0 ...••.......•....... 0 •............•..... 0 ........ 32,973,997
58001. 58002. 58003 .................................. ..
DETAILS OF WRITE-INS .... 0 . .. 0 .... 0
..... 0
..... 0
.... 0
58900. Summary of remaining write-ins for line 58......... .. ................. 0 ................... 0 ........... 0 ...................... 0 ..... 0 ................... 0 .............. 0 .... 0 58900. To~t-iunes58001 thru 58003 + 5ami81.·......... .. .............. 0 ................... 0 ............... 0 .................... 0 .................. 0 .................. 0 ..................... 0 ..... 0 (L)- Licensed or Chartered- Licensed Insurance Canieror Domicil led RRG, (R)- Reglsh>red- Non-OOm1clled RRGs, (Q)- Qualified. Qualified or Accredited Reinsurer, (E)- Eligible- Reporting Entities eligible or approved to write Surplus Lines in the state; (N)- None of the abCl\le- Not allowed to wril€ business in the state. Explanation of basis of allocation by states, premiums by state, etc.
The Company allocates based on lhe situs of the contract.
(a) Insert t11e number of L respClnses except for Canada and Other Alien.
38
statemenlasofDecember31,2013oflhe Vision Service Plan
Alabama ..
SCHEDULE T ·PART 2 INTERSTATE COMPACT· EXHIBIT OF PREMIUMS WRITTEN
Slates Etc.
Allocated by States and Territories
.. AL
1 life
(Group and lndividu~il-
Annuities (Group and Individual
Direct Busmess Ont 3 4
Disability lnoome Long-Term Care {Group and (Group and Deposit-Type Individual lndivldu8i) Contracts Totals
.. ................ 0 1.
2. Alaska ................................................... .. .. ................... AK ...... 0
3. Arizona
4. Arkansas ....
5. California.
6. Colorado.
7. Connecticut.
B. Delaware ........
.. ............ AZ
...... .AR .
.... t:A .. ..co
............... CT
....... 0
.. .............. 0
.. ............ 0
.. ... 0
.... 0
....... 0
9. District or Columbia ...................................... ..
..DE
.... DC
........ FL
.. ......... 0
10. Florida ... ..
11. Georgia ....... .
12. Hawaii
13. Idaho ... .
14. Illinois ... ..
15. Indiana ....... ..
16. Iowa ...
17. Kansas ........
18. Kentucky
.19. Louisiana .....
20. Maine ...
21. Maryland ...
22. Massachusetts
23. Michigan.
24. Minnesota ...
25. Mississippi... .... ..
26. Missouri ........ ..
27. Montana
28. Nebraska ........
29. Nevada
30. New Hampshire .........
31. NewJersey ....
32. New Mexloo.
33. New York ........................ ..
34. North Carolina.
35. North Dakota ....
...... GA ........................ .
.............. HI
.. .... ..ID
.. ............................. IL .
...... .IN
.. ... lA ....
......••.•........•.•.........•........ KS •.•............•.......•••...
. ......•......... KY
.....•.••........••....... .LA
......•••. ME
.... MD .
....... MA ..
. ..................... MI
.......... MN
. •. MS
..... ·.·.·.·.·.·.·.······~~. Kl~jKI··· E .. NE •... 1": .. \.. ·····"···
....................... NV .. .................. NH
...... NJ
. ... NM.
........ NY. ............. NC
NO
.. ... 0
. ....... 0
...... 0
..... 0
..................... 0 ...0
...0
... 0
.0
.. ........... 0
.. .............. 0
. ....... 0
.. ... o ....... 0
.. ... 0
............... 0
"' ........ 0
....... 0
........ 0
....... 0
. ....... 0
. ..... 0
.... 0
. .. 0
36. Ohio ....................................................... . ................... OH ............ OK
.............. 0
. .. 0
37. Oklahoma.
38. Oregon ............................................... .
39. Pennsylvania.
40. Rhode Island
41 South carolina ..
42. South Dakota .....
43. Tennessee.
44. Texas ...
45. Utah
• .... OR ................................................... ..
.. .......... PA.
................. .Rt
.... SC
................... SD
.. .... TN
.TX .
.. .................... UT ..... ..
. ...................... 0
.0
. .... 0
.... 0
......... 0
. ...... 0
... 0
46. Vermont.. .... ............................... . ........... VT
....................... 0
........ 0
. .. 0
47. VIrginia ...
48. Washington
49. West VIrginia.
50. Wlsoonsin.
51. Wyoming .....
52. Am orlean Samoo ...
53. Guam ...
54. Puerlo Rico ..
55. US Vl'gln Islands. .........
........................... VA
..... WA ............................. .
.. .......... wv.
..0
.............. 0
. ....•.. 0
. ........ WI .....•.•• •...........•... ........... ........................ . .... 0
. .. WY ........................... .........•..........•... . ..... 0 . .... N3 ......• 0
.......... GU .......... ........... .. ............ ......... .. ....................... 0
.. ... PR .. ...................... . ................ 0
.. .................... VI .. ...0
56. Northam Mariana Islands .................................... , .................. MP ............... ......... .. ...... 0
57. Canada... .. ....... CAN ............... ........... . ........... 0
58. Aggregate other Atlon .. OT i=====i=====1=====1=====1=====1====·"j0
69. Totals. .. ........ 0 ...... 0 .... .. ... 0 ...... 0 .... 0 ..... 0
39
~
' "
Slalementaso1December31,2013oflhe Vision Service Plan
SCHEDULE Y -INFORMATION CONCERNING ACTIVITIES OF INSURERi MEMBERS PART 1-0RGANIZATIONAL CHART
Or:ganizational Chart, Vision Seryjce--Pran
t:;~tl
~ ~ j ' :
.. .,. ~ -· "-~ --~
-~ ~ -
.• ...,~~ipK..y
::I:=~· I -"""" --~""'J'JI":m>: ,_,.._,..
.t:K-=~- ·---~-- -""'=-···
A HOLDING COMPANY GROUP
--;;.~ ... -. ti .... ~•' . ··-~~ .. . .. .
vspglobal ~o;!r)lo-~PI::In
~""""'~ -=-""--~, ......... ~~-
~ :..,.
S!<ltementasofDscembsrS1,2013ofthe Vision Service Plan
SCHEDULE Y -INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP PART 1- ORGANIZATIONAL CHART
Organizational Chart, Mar chon Eyewear ,.- Inc. w"' ~
~~
1:_-gggm!l
1----~ ,_,_, ~__.,.,"""'P""l' -Ocr.-.~
l:::acro..m.ly.S1W"X.~'byrl!;
_.,m .. ,~..ti:R•rom, ••• ~ AD--..."""IlS~""""""""
~~l'>T""' .... .,...~
-';-~~ .... ~'\...
=~ ·'·····-~ ~L= .... f ----- -- v~~-=::: vsp· .global Pmpri<>lay""'<f~
·l"'u t.,~>,.o,.u,...cnly __ . -~"·c·· .
statementasorDecernller31,2013or!he Vision Service Plan
2
Group Name
3 4
I NAIC I Federal Company ID
Code Number
5
Federal RSSD
I
I
' Name of Securities Exchange if Publicly Traded (U.S. or
CIK lnternationaD
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING
s e 10
Names of Parent, Subsidiaries
orAffiliate1 I Domiciliary Location L--'!"'-_J
··•••••••~~ ~~:_ :: :: ill~.··~~~~~::- •••••••·····•••···• :: ~~1I~~:::~~::7~~~:~~;~i·~;;,j ~[: ~··•· •••••••••••IE~~:~;,, Service
vice • -~" , ~~" ,g Company, I
..... viC!:l "'·- ,,.._, ..
......... ... .... .......... ......... ........ 00000 .... 99-{1247673 Vrsion Service Plan (Hawan) ................................. USA..... tA. ilision Service
.............. ....... 54682 .... 39-124964!) ........................................................ Wisconsin ViSion Service Plan, Inc. (Wisconsin) ..... USA....... !A ... . Service
.............. .......................... ..................... 53031 ...... 23-70896!)8 ................... .......... . ... ........ Mid-Mantic Vision Service Plan, Inc. (Virginia) .... USA ........ . Service 47317 .... 91-6056925 ...... ...... ... ................... .......... .. ....... Vision Service Plan (Washington) ·--···-··-- .......... USA .. . ---·- .SeNice
.............. ..................... 4m3 ...... 82-0339119 .... ................... ..................... Vision Service Plan of idaho, Inc. (Idaho).............. USA ........ .
............................................................... 47201 ...... 92-{1078509 ......... ........ ....... Alaska Vision Services, Inc. (Alaska) .................... USA .. . Vision Servict! Vision Service
............ -----·--··-··· 52050 .... 35-6062307 ....... ...... .............. ... ... .... ......... Indiana Vision Services, Inc. [Indiana)... USA .. . Service 47097... .. 73-1004909 ............................................................ VISion Services Plan Inc., Oklahoma (Oklahoma) ... USA ... . Service
................................. ................. 47093 ...... 04-2718308 ..... (Messachusel!s) USA ... .. Service .............. ........ .................... ......... .. ...... 54380 ...... 31-D725743 ...... _ ......................... ·············--··-··· Vision Service Plan (Ohio)... USA .. . Service
12 I ,~ Type of Control
Board, If Control is (Ownership I
llnfiuence_~~--· "-----·-
Management Ownership Attorney-in-Fact. Provide
................. 1 v1~ion Service ............ Vision Service
'"·····-··--··· Vision Service ............. Vision Service ................. Vision Service
Vision Service ""---Service
Service Service Service Service Service
14" "
New Hampshire Vision Services Corporafion (Nev.· 1 1 ~
.,... . ·--···--···--·············-----··-··· 00000 .... 23·7375685 ................... ···------· Hampshire) USA. ....... lA.......... Vision Service l'lan (C~Tiiorni~j ........................... Doard ..... . Service Plan (California) ...................... ., ........ . - ........... ............ ................. 00000 .... 75-1769288 ................. ····--···--·------ ............. SOulllwestVision Service Plan,lnc. (Texas) ......... USA ....... !A ............... 'ftsion Service Plan (Caliiorniaj ....................... , Board ............. ..
.......... .... ......... 00000 .... 83-{1212963 ....... .......... ......... .. ....................... VJSion Service Plan of Wyoming [Wyoming)... USA... lA... Vision Service Plan (Ca1iiomiaj ........................... Board .. . 00000 20-1949500 .................................... ·················--·--- Eastern Vision Service Plan IPA, Inc .... ---- ...... USA. ......... !A ............... Vision Service Plan (Caliicrnia) ........................ Board ............ ..
--··:::::~--- ___ --::·:~. ·::::~ .. :::~~:~ _ ................ ·· ~~~~::: : :_~:~~~~~ ................... ····--··----------- :=::=--................ ~=~~ ~:~: ~::~ ~~;:;~o~~~=- ·::~ ... :~.=::·.~----- ~~-::::-· ~DP:........... t::~~ ~:~: ~::~ i~::::~::t::~: :::::=--~~---· :n~;;ip::·_------.......... .... ............. .... ···········--·-- ......... 00000 .... 27.06210B4 ................... ................... . VSP Optical Group,lnc... USA.... NIA........... Vision Service Plan (Caliiornia) ....................... Ownership ..... ..
Service Plan (California) ..................................... . Service Plan (California) ... . Service Plao (California) .............................. . Service Plan (California) ................ .
... 100.000 !Vision Service Plan (California) ................................... ..
.. .. .50.000 Vision Service Plan (California) .............................. .
I - - ......... - ........................... ::::: .... ~~:;;::: ··············••• -- _ _ ~;:g~:~:~~:::::~ ::: : :: ~~········· ~~ •••••••••••• ~~:::~~r:::l:::,::0
:i~~:.;oy )rsh!p ·······1·--··10.000 IV!s!on Serv!ce Plan (Cal_iforn!aJ ...................................... j •rsh1p ....... . .... 10.000 , VISlon Service Plan (California} .. .
MassachllSel!s VIsion Service r" .··············-!·········: .....•••....• : VSP Opt~cal Group,lnc. ..... ............................. .. USA ....... NIA. .............. ~~assach~sel!s~ . . . . ___ ..... . VSP Opllcal Group, lnc...... ..... .......... ........ USA... NIA. .............. M1d-Man!ic Vis1on Service Plan, me. (Virg1ma) .. .
7-il621064 VSP Optical Group,lnc ..................... • USA ......... NIA. .............. \riSion Services Plan I -·. I. '
Plexus OptiX, Inc.... .. ............. USA... NIA. ............. VSP Optical Group .. Eyeoonic, Inc .............................................. - ... USA ......... NIA. ··-·-· ... \lsp Optical Group,
.............. ........................ ........... ., ...... .
.............. ---···--···- .............................. .
.............. .................... ··········- ···-···
.............. ........ ............ ...... .......... ... ..... ..
........................................................ VSP Ceres Inc. .................................................. USA....... NIA ............ ysp Optical Group,
.............. ................. ......... ........ ......... .. .. :::~==:=:::::~ -........................................... ~~~ ~~~~~.n~~~~--.-··_-_·_-~_ .. _-_ .. _·~----~----~~------···--·---· ......... ~~:::·-"· ~~:::·"'"" ::: ~:~~:~IDGroup, .. ............... _ .............. ... . .............. VSP\IisionCare- UK, L!IL ............... _ ............ GBR ......... N!A ............. VSP Global, 1 ........ .
.............. ................. ............... ·---·--· ······- ...... ................... .......................... VSP Canada Vision Care Insurance... ......... . ... CAN_, .... !A... Vision Service I ................... .......... ...... VSP Vision Care Association (canada).... . ......• CAN ......... lA... Vision Service 1 ................... ....... ........... ........... .............. VSP Holding Company, Inc .................. USA... NlA.... _ ,_ . Vision Service
Vision Service
~---······-··- 00000 __ . 26•1998745 ...........
1
........................ vsP Holding company, Inc...
1
usA.... NtA ............. ~~:~e::e Pian lnsurancerompany
00000 .... 68-0450459 ............... ... Eyefinity, Inc ................................................... USA....... N!A ............. (Connec!ic:ul) ; I Ownership ... 00000 .... 68-0295156 ................... ............... .. ................... Altair Eyewear, Inc. ............ USA.... N!A ............. ~P Holding Company, Inc .... : ......................... Ownership ...... ..
.. ... 10.000 VIsion Service Plan (California). .. ................ ..
1
..... 10.000 Vision Servire Plan (California) ... ..... 10.000 Vision Service Plan (California) ................................ . . .. 100.000 Vision Service Plan (California) ...... . ... 100.000 I Vision Service Plan (California) ___ _ .. 100.000 Vision Servie;e Plan (Cali!Cimia) ... · ... 100.000 VIsion Service Plan (Califomia). . .. ., ........ , ................ .. ... 100.000 Vision Service Pl!in (California)..... .. ........................ . _ 100.000 Vision Servire Plan (California) ......... _ . ... 100.000 Vision Service Plan (Califomia) .. . ... 100.000 Vision Service Plan (California) .................................. ..
... 55.000 Vision Service Plan (California) .. .
... 45.000 jvision Service Plan (Califomla). -··············--·······I··
... 100.000 !Vision Service Plan (California) ..
... 106.000. ViSion Service Plan(California) .. ·••I :
:!:: ~
StatementasofDecember31,2013oftne Vision Service Plan
Group Code
2
Group Name
4
NAIC I Federal Company ID
Code Numtrer
00000 ...... 120-4044711 00000 ...... 26-2448948 00000 ...... 98-1024150 OOOOL 99-0370707 00000. 00000 00000 .... 11-2617364 00000 .... 11-3233690
'
Federal RSSD
00000 .... 23-29411851 ................ , .. . 00000 ...... 11-3180867 00000 ...... 98~201338
::::: .. ::1 •••••••••••••1•• 00000 ...... ( ............... / .. . 00000 ..... . 00000 ... 00000,_ .. , ................ .
~~~~~ ::::I::~:::~ :::::::: 1.. ----- .... -· 00000 ...
CIK
Nam10of Securities Exchange if Publicly
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
"' TI 13 14
Traded Names of Relationship (U.S. or Parent, Subsidiaries ·Domiciliary to Reporting Directly Controlled by
lnierrwtionan or Affiliates location ''"" ,· L-1---_j"N•'m"'""'""'""'""IP"''"~'""----l"'"""-'"""'"'"'"'l-----'"""'"'"""" ..... 1 Perfect Optics LLC... USA ........ / NIA. .............. Vision Service Plan (CafriorniaQ ........................ Ownership._... .. .. .80.630 Visitm Service Plan (Caflfomia) .. .
~~~;;~~:;;~ ............................................ ~:: ::::::: :::::::::::=::: ~:fi~;~~~~::: ............... ::.:.·.:::.·::::::::.~:::~- .:: =~~:~::: :·:;~~:~~ ~:~~ ;:~:: ~:~ i~:~~~::t::· .. E'{Efinlly France... FRA.... NlA ............. Eye!inity Europe... .. ..................................... Ownership...... . .... 87.000 Vision Service Plan (Calfforni!i) .. . Eyefintty/Officemate Pty.. • ............................. AUS ....... NIA... Eyefintty Inc ..................................................... Ownership...... • .. 100.000 Vision Service Plan (California) .. . Man~ Software ................................................. AUS .......... NIA.._, ...... Eyefinity/Officemate Ply... Ownership... . .. 100.000 Vision Service Plan (California) ............... - ..... ..
15
Marchon Eyewear, Inc... .. ...... USA... NIA ............. VSP Holding Company, Inc. ..... '*"" ...... ..... Owroership... . .. 100.000 Vision Service Plan (california) ......................... 1
... ..
Mamhon International, Ltd .................................... USA..... NlA .............. Marchon Eyewear, Inc ........ ....... ................ Ownership......... . .. 100.000 Vision Service Plan (California) .......................... .. Eye Designs LLC .............................................. USA.. ..... NIA. .. ....... Mamtlon Eyewear, Inc... Ownership... .. ... 50.000 Vision Service Plan (California) ........ .. R.B. Mexico, Inc.... .. : MEX ......... NIA ............. Mamhon Eyewear, Inc .................................. Ownership......... ...100.000 Vision Service Plan (California). Mamhon Europe BV ........................................... NLD....... NIA. ............ Marchon Eyewear, Inc... Ownership... ...100.000 VISion Service Plan (California) ....... .. Mamhon Japan lnternafional YK ........................... JPN ......... NIA .... ... Mamhon Eyewear, Inc ....................................... Ownership...... ...100.000 Vtsion Service Plan (California) ... Marchon Japan KK... . .. ................................. JPN .......... NIA. ........... Mamhon Europe BV ............... ........................ Ownership... ...100.000 VISion Service Plan (California) ..... _ .... ..
. ...... , ........................ , Marchon UK W'd.............. ...... ............ GBR... ........ NIA.. ........... Mamhon Europe BV............ .... ..... ......... Ownership... ...100.000 Vision Servlee Plan (California~ ........................ , .. Marchon Hispania SL... ...................... ............. ESP... NIA. ............ Marchon Eyewear, Inc...... Ownership... ...100.000 Vision Service Plan (California) ......... .. Marchon l!alia SRL..... ............ . .. .. ITA ......... NlA ............. Marchon International........ . ........ _... Ownership... .. ... 99.500 Vision Serviee Plan (Cafriornia) .. . Marchon ltalia SRL ........ .. ....................... ITA ......... NIA ............. Marchon Europe BV... Ownership... .... .. ..... 0.500 Vision Smice Plan (California) ......... . Marr:tlon MB SRL.. ITA ......... NIA .............. M.archon Europe BV... Ownership... . .. 100.000 Vision Service Plan [California) ....... . Marchon Eyewear (Hong Kong) Ltd .................... HKG . NIA.... .. .. Marchon Europe BV ............................ A ....... Ownership ....... • .. 100.000 Vision Service Plan (California)_ ................
1
.... ..
Mamhon Eyewear (Far East) Ltd ...................... HKG ........ NIA .............. Marchon Europe BV..... ......................... Ownership. ...... • .. 100.000 Vision Service Plan (California)... . ..... ..
.. ............ _.~ .............. ~::::I:==::::::::::::::::: : I~:~~~~;:::~~~~~---~-- .................................. ~~-~_ ....... ~~: .::::: .. ::::: ~:~:~ ~=~~n~ .... --... ~ .. :~~~:-.~~: ................ g:~::~:~=:---· :::~~~:~~~ ~=~~ ;:: ~::~ i~::~::i::: 00000 ... . ooooo .... I 93~542o1s 00000 ..... . 00000 .. . 00000 .... ..
00000 ...... 183-4627457 00000... ... 11-3435695 ooooo_ ... _____________ ,. 00000 ..... .
~~~~~:~::: ~::::~:::~:::J:~ ..... :::::: ["' OOOOL .. 56-2355483 00000 .. . 00000 ..... . 00000 .. . 00000 .... . 00000 .... .. ooooo.._ .. 00000 ... 00000 ...... 27-3493284
DJQ..Mamhon Swilzartand SA ................. _... . CHE. ....... NIA. ............ Marchon Europe BV ................ Ownership ........ • .... 49.000 Vision Service Plan (California) ... Mamhon Portugal, Unipessoal, Lda ...................... PRT ........ NIA ............ Marchon Europe BV... Ownership.. ...100.000 Vision Service Plan (California) ........ .
~:~~~~ ~~~~.~~p~::. .. :::= .. :::::--~.::: ..... :.:.::::.: ~~::: ..... ~~-~--::::::::: ~:~~~~ :Or:u~~~~ Lw::: ..................... ~~::~:~:=... ::1~~:~~~ ~=~~ ~:;: ~::~ ~~:::::;--: ............ ::::::::::I::· .. Marchon BRL LtcL USA.... NIA ........... Marchon Eyewear, Inc......... OWnership... ...100.000 Vision Service Plan (California) ..... . Mamhon Brasn Ltda... . BRA ...... NIA. ............. Mamhon Eyewoor, Inc. .............. - .................. Ownerr;hip....... ...100.000 Vtsion Service Plan (California) ·--- ........
1
.... .
FC 18 Comertco e Representacoes Uda .............. BRA.... NIA. ............ Mamhon Brasil Ltda ......................................... Ownership... ...100.000 Vision Service Plan (Caliiornia)... .. ...... .. Corporation Optica lntemacional Sri... ................... MEX ........ NtA ........... R.B. Mexico, Inc ........................................... Ownership... ...100.000 Vision Service Plan (Cafrfornia) Coordinadora Administraliva de Personal.. ......... MEX ........ NlA...... R.B. Mexico, Inc... Ownership ....... • .. 100.000 Vision Service Plan (California)... .. ..............
1
....... ..
Mamhon Europe Sa~............. .. .......................... NLD ........ NIA ............... Mamhon Eyewear, Inc ........... ........ Ownership... . .. 100.000 Vision Service Plan (California) ........................ .. Allure Eyewear llC ............................................ USA... NIA .............. Mamhon Eyewear, Inc. ........ ............. ......... Ownership...... . .... 51.000 VISion Service Plan (California) .... . General Optical Pty Ltd... ...... ..... AUS... NIA .............. I Enterprises (Pty) lld ... -... Ownership......... .. ... 51.000 Vision SeNice Plan (California) ............... - ... .. I Enterprises Ply, Ltd... .................. ........ . AUS... NIA. ............ Mamhon Eyewear, Inc......... ....... Ownership... ...100.000 Vision Service Plan (California) .......... .
.. ...................... 1 ::~~ ~~:~;~u~:li~-~~-~ ................... ~~- -~~~-~.: ~~ .:::::::: .. :: ~:~:: g::: ~ ~:~ .. ::::::::~:: ......... :·=:::::.... :::~t:·---· :::~~~:~~~ ~=~~ ;:~:: ~::~ ~g:::~::J::: ::::::::::::~::::::~:I::· .. Viva Eyewear Australia ......................................... AUS ......... NIA. ............. General Optical Ply Ltd ........ m .......... Ownership... .. .. .50.000 Vision Servite Plan (California) ... REM Eyewear Australia Ply Ltd..... .. ................ AUS ........ NIA... . ... General Optical Pty Ltd... ................... ....... Ownership...... .. .. .50.000 Vtsion Service Plan (Caflfomia) .............................. . SX Solar Express Australia Pty Ltd ..................... AUS ......... NIA. .......... SX Holdings llC.............. Ownership... . .. 100.000 Vision Service Plan (Caliiornia). MEl 3D, LLC..................... ............ ................. USA. ....... NIA. ...... _ .. Mamhon Eyewear. Inc. ................ ., ............ OWnership... . .. 100.000 Vision Service Plan (California) .. .
00000 .... 88-0465774 ................. 1 .................. 1.. .. ...... 1 Optical Opportunities, LLC ................. ........ USA...... NlA... . ..... Marchon Eyewear, Inc.... • ......................... Ownership... ...100.000 Vision Service Plan (Caflfornia) ............................ . 00000 .... 27-1700596 ...................... 1MVO Licensing, UC... .. ............................... USA. ....... NIA. .......... Marchon Eyewear, Inc ........ Ownership.... .. ... 13.650 Vision Service Plan (Caflfornia) .. .
"' -;.,
Sla!ementasofDetember31,2013of!he Vision Service Plan
Group Cod•
Group Name
4
NAIC Federal Company ID
Code Number 00000 ..... 27-1700596 00000 .. .
Federal RSSD CIK
7 Name of
Securities Exchange if Publicly Traded (U.S. or
lntemationa~
1··········-····-···································1 00000~ .... 27-0229593 00000 ...... 37-1691104 00000 .... 26-2691541 00000 .. . 00000 ..... 26-2696876 00000 ••.• 33-0549048 00000 .... AppiTed For. 00000 .. . 00.000 ••.••• ----~---
~~~~-~::: : .................. 4 :::::::::I::::::::::::::::: I::--ooooo .. . 00000 .. . 00000 .. 00000 ...... 1.
lllll .= ·!.····~ ···•••••••·!••• ············••I : -000004••• 00000 ........ . 00000 ...•.
' "
SCHEDULEY PART 1A- DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
8 9 10 TI 12 Type of Control
(Ownership
13 14
Board, ltfControlis Names of Relafionship ' I' Management Ownership
Parent, Subsidiaries I OomicJliaryl to Reporting 11
; Directly Controlled ~Y . IAttomey-ir~-Fact, Provide Ultimate Controlling or Affillates Location Entity 1 (Name of En!itV/Per$1{1})_ _ lnftuence, Other) Percentaoe __ En!i!y(ies)/Person(s)
MVO Licensing, LLC ... - ...........•... USA ........ NIA... . ..•.. OPtical Opportanifies, Ll.C ........ -r-·· ........ Ownership ...••. • ... .58.860 Vision Sel\liCe Plan (Carrfomia) .... . Mcleod Optical Company, Inc ............................... USA. ......... NlA ........... ~P Essilor Holdlng Company u:.c ....... . Ownership..... . .... 28.000 Vision Sel\lice Plan (Califomla) ................... . VSP Essilor Holcfing Company LLC. --~·--· ............ USA.... NlA .............. VSP Optical Group, Inc.... • •. J ......... Ownership..... . .... 35.000 Vision Service Plan (CaiTiomia) .... . Dragon AcqulsiHon Co., Inc ..... ~··· USA... NIA ............. Marchon Eyewear, Inc...._ ....•. 1 Ownership... . .. 100.000 Vi~ion Sel\lice Plan (Califomia)... .. . ......... 1 ••
Dragon Alliance, LLC .......................................... USA...... NIA. ...........• DragonAIX(uisi!ion Co., lnc ........ !.... Ownership ..•... ...100.000 Vision Service Plan (Califomia) .... . Dragon Alliance SoLJth Pacffic Ply U:d •...••...••...••... AUS... NIA. .... ,. ...... Drilgoo Amance LLC .................. j···· ................. Owne!Ship........ . .. 100.000 Vision SeNice Plan (Califomia) ... .. Dragon Alliance Inc ........................................... USA. ....... NIA..... . .. Dr~gon Alliance LLC ....................................... Ownership... . . .100.000 VisiM Service Plan (California) ............. . Barter Optical, Inc. ........................................... USA. ....... NIA... . ... Dragon Alliance LLC................. ... Owiiership........ . .. 100.000 Vision Sewice Plan (California) .... .
!~~;!~~~~,::::~t~':i :;:_ : :~ ~:- ~~--: ~· i~~l;fi~~~:~:·····-J i_:i:~-- : ~~[:~·~:- "!11111 [;~ i~~i~ ~~~; i!jt~~i~! -·· :_ ......... ' .. Ska,ga Oy... .............. ~IN... NIA. ........... ScandirJavian Eyewear... . .... J.................... Ownership... • .. 100.000 Vision Sel\lie;e Plan (Califomia). Scandinavian Eyswear LLC ............................... JSA. ....... NIA.... Sdmdinavian Eyewear. ............ J .................... Ownership... . .• 100.000 Vision Service Plan (California) .... . Marchon Sports (Shenzhen) LtrL... C:HN ........ NIA. ............ Marchon Eyewear (Hong Kong) tl!d.... Ownership........ ..100.000 Vision Sal\lie;e Plan (California) .... . Marcrum Hallas SA ...................................... 3RC ....... NlA. ............. Marchon Europe BV..... ·······+ ............ Owners~ip,....... . .... eo.ooo Vision Sewice Plan (California) .............. . Eyecare lnnovafion Partners, LLC .............. ~SA ........ NIA. ............. VSP Optical Group, Inc..................... Ownership... ..50.000 Vision Sewice Plan (California) ...... .. Entemasyon al GozluK Sanayi vd licaretAS TUR... NIA ............. Mabhon Europe .. _ .•.........•...... L.............. Ownership... • .. 1.000 Vision Service Plan (Calrfomia) .... . Car1ada Inc. ......................................................... CAN_ ....... NJA ............. VSP Canada VISion care lnsura~ce ............... Ownership... . .... 50.000 VISion Sel\liee Plan (Carrfomia) .. Marr::hon Mauritius ................................ ., .. ., ....•.. MUS..... NIA ............. Marchon Sports (Sbenzh~n) Ltd l!::hina .............. Ownership --·-· ... 100.000 Vision Sel\lica Plan (California) .... . S1erling Meta-Ptant India Private Ud .........•... I~D... NIA ............. Ma:rchon Maurltius ..................... J.................. Ownership... 49.000 Vision Service Plan (Califomia) .... . GENOP P_!y_Ltd (Australia) ............................ ., •• AUS, ....... ,. NIA. ............. I Ente_r]Jrise ?zy Ltd .............. ...J .................... _ Ownreship... . ..... 0.534 Vision Service Plan (California) ... ..
15
statementasofDecemlter3t2013of!he Vision Service Plan
SCHEDULEY PART 2- SUMMARY OF !NOIIO<'O'O.
1 ' 3 , -s--1 s
N~C Company
______fQde
Federal ID
Number
Names of Insurers md Parerrt, Subsidiaric
orAffmates Shareholder DMdends
.43,000,000 4702\? ................ 22-2777159... . .... Eastern Vision Service Plan, Inc. (New York) ................................................ .
_____ • __ ·····- ..... _-~ion Service Plan Insurance Com]Wny (a Connecticut stockl .••
1
32395......... 36--3560825... . .... Vision Service Plan Insurance Company {a Missouri stock co .. • ... .7,400,000 41332L ............. 94--3034073 ............ Vision Service Plan, Inc. (Nevada) ...•
99-0247673 ............ Vision Service Plan (Hawaii) ... ~.,~~....... .. ....... 39-1249540 ............ Wisconsin Vision Service Plan, In 53031.. 23-70139668 .............. Mid-Atlantic Vision Service Plan, I 47317...... 91-6056925. .. ..... Vision Ser~ice Plan [WashinatonL 47783... A?-ll::l".Q11;1 \/i.~im '
"
.......... 10,000,000 5,100,000
C~pi~l
47201... ....... --I i;i~a Vt;;I~~ -s~;.;;~.-i~~-'(l;~~~~i:::::~:::::::: .::.:~::·~ __ :::::: :::::::~ ·:::::~::;;:;;oo:ooo· ... ::::: ........ .
1~50.1;;.~ 9~478.................. . $Plan Inc., Oklahoma (Oklahoma)... • ............................ .. 4-7093... .............. . ___ llSVtsion Se-rvi~e Plan (Massachusetts)...... ....... . ---- ........... .
1sion Service Plan (Ohio)... .. ................ 4,2:00,000 ....... .. ·nwestVision Service Plan, inc. (Texas) .............................................. .. •n Service Plan of Wyoming [Wyoming)................... . ................................ ..
54380 ................ .. ............... )75-1 .............. R".--
em \I" iS ion Servi~e Plan IPA. Inc................ .. .......................... ..
I
VISIOn Servroe Plan of IIITn01s NFP .. .. ............................................................. .. -~ .... Vis1on Servrce Plan (Carrfomia) • .. .. .. • .. • • .. ........... . ................ (69,7DO,OOO) ....... .. 7.4~ \I~P "old1ng Company, Inc. • • • .. .. __ ................................. (7,400,000) ..
-•J· 10 Comoanv.lnc.......... .. .................. 3.000.000 9999999-l Control"
Purcllases, Sales or Exchanges of
Loans, Securities, Real~.
3 WITH ANY AFFILIATES 7 8
Income/ (Disbursements)
Incurred in Connection with Management Guarantees or Agreements Undertakings '"' ior the Benefit Service
nf :=~nv Affili!rl~rsl Contracts
""""'"'""'"'"""""""""" 1 ................ 21,503,674 .... 30,742,425
'0 1,0
::::::::::::::::~:::::::::::::::::::I :::::::=::::::_:;~:~~·~ .... 2:q7
31,742 ::?.<m<;
9 10
Income/ (Disbursements) Incurred under Reinsurance Agreements
1
...... .
.......
.-1:o,tll::.)::::::::::::::::::: :::: ....... n"'.2.54Q
IXXl
Any Other Material Activity
Not in the Ordinary
Course oithe Insurer's Business
"
T"""
21,S03,S74 .. 38,142,425
13
Reinsurance Recoverable/ (Payable) on Los~s and/or Reserve Credit
Takerlf [Liability)
------- :~:~~~~ I :::::::::::::::=::: .............. .
.. ........ 7 ,243,74-1 .. .. 20,931,314
.. .. 3,5913,168 1,165,597
125,815 2.S49 '
.....................................
.. ............................... ..
SlatementasofOet:embar31,2013of!he Vision Service Plan
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES The lolkming supplemental rop<Jrts are required IQ be filed as partolyourstatement filing unless speciFically waived by Ute domiciliary stale. However, In the event that your domiciliary stale waives tlle filing requlroment, your response of WAIVED to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar oode will be printed below. lithe supplement is required of your company but is not being lllmllorwhatever reason en lor SEE EXPLANATION and provide an explanation lolklwing the Interrogatory questions.
MARCH FILING 1. WIU tile Supplemental Compensation Exhibit be filed with the smte of domicile by March 17 2. Will an actuarial opinion 00 filml by March 1? 3. Will the CO!l!identiat Risk-Base<i Capital Report be filed with the NAIC by March 1? 4. Wilt the oonfidential Risk-Based Capital Report be filed with the state of domicile, If required, by March 1?
APRIL FILING 5. Will the Management's Discussion and Analysis be filed by April17 6. Will the Supplemenlalln\lestment Risk lnterrogalorles be filed by Aprll1? 7. Will the Accident and Health Policy Experience Exhibit be filed by Aprll11
JUNE FILING 8. Will an audited financial report be nlml by June 11
Will Accountants Letter of Qualificati<lns be filed wi!llthe stale of domldte and electronically with the NAIC by June 1?
AUGUST FILING 10. Will Communication Clf lnlornal Control Related MaUers Noted In Audit be filed with the stato of domicile t.y August 1?
------------rtwfOJklwiOg sUpplemental reporls are required to be" filed as part Or yOur slatonient filing. However, In the -event that your OO~pany does nc>l transact the type ~~ business for which the special rept~rl must be filed, your respoose of NO to the sp;:cinc interrogdorywill be acce!1ed In lieu oJfding a"NONE' report aOO a barwclo will be printed below. lithe supplement is required of your company but is not being filed for whatever reason, enter SEE EXPLANATION and provide an explana~on following the inlerrogatoryqueslions.
MARCH FILING 11. Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March 1? 12. Will the Supplemental life data due March 1 be tiled with the state ofdomlclleand the NAIC?
... 13. _Will tile Supplemental Properly/Casualty data due March .1 be filed with the slate of domicile and the NAIC?
14 Will Schedule SIS (Stockholder ln!Onnatlon Supplement) be filed with the: state of domicile by March 1? 15. Will the actuarial opinion on participating and non-parliclpaling policies as required In Interrogatories 1 and 2 on Exhlblt51o Life Supplement
be li!ed with the state of domicile and electronically with the NAIC by March 1? 16. Will the actuarial opinion on non-guaranteed elements as required in Interrogatory 3 ro Exhbit 51o Supplement be filed with the stale of
domicile and electronically with the NAIC by March 1 1 17. Will the Medicare Part D Coverage Supplement be filml with the state of domicile and the NAIC by MarCh 1? Ill. Will an approval from the reporHng entity's state of domicile for rolla! related to the fwe-year rotation requ!remP.nt for le~d audit partoors be filed
electronlcaliywlth the NAIC by Man:;h 1? 19. Will an approval from the roporllng entity's stal\l of domlcije !Clr rollefrelatOO to the one-yearcoo!lng off period for independent CPA be filed
electronically with the NAIC by March 1? 20. Will an approval from the reporling entity's stale of domicile [Of relief relatOO to the Requlroments for Audit Committees 00 filel:l electronically
with the NAIC by Marcll1 1
APRIL FILING 21. Will tile Long· Term Care Experience Reporting Forms be fllel:l with the state of domicile and the NAIC by April1?
22. Will the Supplemental Life data due April! be filed with the stale of domicile and the NAIC? 23. Will the Supplemental Property/Casualty Insurance Expense Exhibit due Apri11 bo filel:l with ~ny stale that requires It, and, If so, the NAIC? 24. Will the Supplemental Health Care Exhibit (Paris 1, 2 and 3) be filed with the state of dClmiclle and the NAIC by Aprll17 25 Will the regulator only (non-public) Supplemental Heal!ll Care Exhiblrs Expense Allocation Report ba fiiOO with the state of domicile
and tha NAIC by April f?
AUGUST FILING 26. Will Management's Report of Infernal Control Over Financial Reporllng be filed with the state of domicile by August 1?
43
Responses YES YES
YES YES
YES
YES
YES
YES
YES
YES
NO NO NO -·
NO
NO
NO NO
NO
NO
NO
NO NO
___ No __ _
NO
NO
NO
Statementaso1December31.2{]13oflhe Vision Service Plan
EXPLANATIONS:
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SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
43.1
BAR CODE:
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 3 6 0 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 *47317201320500000•
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 *47317201320700000•
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 4 2 0 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 •47317201337100000•
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 • 4 7 3 1 7 2 0 1 3 3 7 0 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 3 6 5 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 2 2 4 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 2 2 5 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 • 4 7 3 1 7 2 0 1 3 2 2 6 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 0 1 3 3 0 6 0 0 0 0 0 ~
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 *47317201321100000•
11!1111~111 !IIIJIIIIJIIII!IIIJIII IIIIIJIII~IIII JIIIJIIIJIIII IIIII IIIII IIIII IIIII 11111!11
11111111111111111111111111111111111111111111111111111111111111111111111111111 m11111111111111 • 4 7 3 1 7 2 0 1 3 2 1 6 0 0 0 0 0 *
1111111111111111111111111111111111111111111111111111111111111111111111111111111~11111111111111 * 4 7 3 1 7 2 0 1 3 2 1 7 0 0 0 0 0 *
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 * 4 7 3 1 7 2 ·0 1 3 2 3 9 0 0 0 0 0 *
StatemsntasofDe<:emOOr31,2013ofUle Vision Service Plan
Overflow Page NONE
Overflow Page NONE
44P,44L
StatsmentaaofDacsmbsr31,2013ofthe Vision Service Plan
SUMMARY INVESTMENT SCHEDULE
Investment Cate~orles
1. Bonds: 1.1 U.S. treasury securities ...
1.2 U.S. governm€ht agency obligations {excluding mor!gage-backe<l securities): 1.21 Issued by U.S. gwernmenl agencies. 1.22 Issued by U.S. gr>Vernment sponsored agencies ....
1.3 Non-U.S. government {including Canada, excluding mortgage-
backe<l securiUes) ......................................... .. 1.4 Securil!es Issued by slates, territories end poosessions and political
subdivisions In the U.S.:
1.41 States, lerrltorles and possessions general obligations .. 1.42 Political subdivisions of stales, territories and possessions and
political subdivisions general obllgatkms ........................ .. 1.43 Revenue and assessment obligations. 1.44 Industrial development and similar obligations
1.5 Mortgage-backed securities {includes residential and commercial MBS): 1.51 Pass-through securities:
1.511 Issued or guaranteed by GNMA ...
1.512 Issued or guaranteed by FNMAand FHLMC ......................... .. 1.513 All other. • .................................................................... ..
1.52 CMOs and REMICs: 1.521 Issued or guaranteed by GNMA, FNMA, FHLMC or VA.. 1.522 Issued by non-U.S. Government issuers and collateralizetl
by mortgage-based securities Issued or guaranteed
by agencies shown ln Line 1.521 .............. .
1.523 All other ................................................................. . 2. Other debt and other fixed income securities (excluding short-term):
2.1 Unafliliatetl tlomestic securities {Includes credit tenant loans and hybrid securities)
2.2 Unaffiliated non-U.S. securities (Including Canada) ...
2.3 Affiliated securities.. . .......................... .. 3. Equity Interests:
3.1 Investments In mutual funds ..... 3.2 Preferred stocks:
3.21 Amiated .......................................................................................... ..
3.22 Unaffiliated 3.3 Publicly traded equity securities {exclutling preferred stocks):
3.31 Affiliated ....
3.32 Unaffiliated ............................................... . 3.4 Othoroqulty securltles:
3.41 Affiliated .. 3.42 Unafnliated ..................... ..
3.5 Other equity Interests lnclutling tangible personal property under lease: 3.51 Affiliatetl ..... 3.52 Unaffiliated
4. Mortgage loans: 4.1 Construction afld land de11elopm(lnl...
4.2 Agricultural... .......
4.3 Single family rosklr:m~al properties. 4.4 Multifamily resltlential properties ...
4.5 Ct>mmercialloans ..... 4.6 Mezzanine real estate loans.
5. Real estate investments:
5.1 Property orxupl(){] by oompany. 5.2 Property h(lld for production of lnoome {lnclutling $., ....... 0 of
property acquired In satisfaction of debt) ....................... .. 5.3 Property held for sale (Including$ ........ 0 property acquired In
satisfaction of debt) ............................................................ .. 6. Contraot loans. 7. Derivatives. 8. Receivables for seouritles ..
9. Secllritles lending {Line 10, Asset Page rolnvoslod collatoral) .. .. 10. Cash, cash B<JUivalenls and sOOrt-term ln\leslments ...................... ..
11. Other Invested assets..... . ................................................................... .. 12. Total invested assets .................................................................. ..
Gross Investment HoldlnQs
1 2
Amounl PercenlaQe
.. .......... 583,014 ..... 1.3
. .... 0.0
Amount
.............. 583,014
.............. 1(},450,750 . ... 22.5 ............. 10,450,750
............ 0.0
" ...... 1,741,562 ...... 3.8
................ 2,227,838 .......... .4.8 ..2,009,832 .......... ..4.3
............ 0.0
............ 0.0
............ 0.0
............ 0.0
............ 0.0
.. .... 0.0
.. ......... 0.0
.. 1,741,562
.......... 2,227,838
.... 2,00~,832
.. 14,623,202 .......... 32.0 .............. 14,823,202 .. . ..4,405,465 ............ 9.5 ............... .4,405,465
.......... 0.0
.. ......... 0.0
......... 0.0
............ 0.0
............ 0.0 .0.0 ................... ..
.0.0 ............................. .
.. .......... 0.0
............ 0.0
.0.0
........... 0.0 .0.0
.. .......... 0.0
............ 0.0
.. 0.0 ............ 0.0
....... 0.0
............ 0.0
............ 0.0 ..0.0
. ........... 0.0
............ 0.0
............ 0.0 .. ... 10,083,374 .21.8
............ 0.0
.... 10,083,374
........ .46,325,037 ........ 100.0 ............. .46,325,037
5101
Admitted Assets as Reporte<l In the AMual Statement
4 Securities Lending
Reinvested Collateral Amount
......... XXX
5 Total
{Col.3+4) Amount Percentage
................... 583,014 ............ 1.3
....................... 0 ............ 0,0
...... 10,450,750 .... 22.6
.. ... o "'"'" .... 0.0
.. ....... 1,741,562 ............ 3,8
. ...... 2,227,836 .......... .4.8
.......... 2,009,832 ........... .4.3 ............. 0 ............ 0.0
. ............................. 0 ............ 0.0
.. ............................ 0 .0.0 .. ........ 0 .0.0
.. ........... 0 ............ 0.0
.............................. 0 ............ 0.0
.......................... 0 ............ 0.0
.............. 14,823,202 .... 32.0
............... .4,405,465 ........ 9.5
. ..... 0 ............ 0.0
...... 0 ...... 0.0
• ..... D .......... 0.0 .............................. (} ............ 0.0
.. ........................... 0 ........... 0.0 .... 0 ............ 0.0
.. ............. 0 ............ 0.0 ....... 0 ........... 0.0
.. ............................ 0 ......... 0.0
.............................. 0 ............ 0.0
...... 0 .. 0.0
. ..... 0 ............ 0.0
..... 0 .. 0.0
. ..... 0 .. 0.0
.. ..... 0 .. 0.0 . ............................. 0 ............ 0.0
...... 0 ..0.0
.. ... 0 ........ 0.0
....... 0
..... 0
..0.0
.. 0.0 ......................... 0 ............ 0.0
.. ............................ 0 ............ 0.0 ..... XXX., .. ... XXX ..
........ 10,083,374 .......... 21.8
...0 ' ....... 0.0 .. ............ 0 .............. 46,325,037 ........ 100.0
statementasGI"Deoomber31,2013oflhe Vision Service Plan
SCHEDULE A· VERIFICATION BETWEEN YEARS Real Estate
1. Book/adjusted carrying value, Deoomber 31 of prior year ...
2. Cost of acquired:
2.1 Actual cost at lime of acquisition {Part2, Column 6).
2.2 Addltlonal lnv(lStment made after acquisition (Part 2, Column 9).
Current year change in encumbrances:
3.1 Totals, Part 1, Column 13 ...
3.2 Totals, Part 3, Column 11 ......
4. Total gain (loss) on disposals, Part3, Column 1!1 ......................................................... .
Deduct amounts received on disposals, Part 3, Column 15 ....
G. Total foreign exchange change In boQk/adjusted carrying value: ··NONE 6.1 Totals, Part 1, Column 15 ...
6.2 Totals, Part~. Column 13 ... ····························----7, Deduct current year's other-than-temporary Impairment reoogntrod:
7.1 Totals, Part 1, Column 12 ......
7.2 Totals, Part 3, Column 10 ...
B. Deduct current year's depreciation:
8.1 Totals, Part 1, Column 11.. ..
8.2 Totals, Part 3, Column 9 ...
9. Book/adjusted carrying value a tend of current po~od (Lines 1+2+3+4-5+6-7-8)
10. Deduct total nonadmitted amounts ..
11. Statement value at end of current period (Une 9 minus Line 10) ... ····························---·
SCHEDULE B ·VERIFICATION BETWEEN YEARS Mortgage Loans
1. Book valuo/reoorded lnvestmentexcludlrlQ accrued Interest, December 31 of prior year .....
2. Cost of acquired:
2.1 Actual cost at ~me of aiXJUisillon (Part 2, Column 7)
2.2 Additional Investment made after acquisition (Part 2, Column 8).
3. Capitalized deferred Interest and other:
3.1 Totals, Part 1, Column 12 .....
3.2 Totals, Part 3, Column 11 .. ,.
4. Accrual of discount..
5. Unrealized valuation increase (decrease):
6.1 TotE Is, Part 1, Column 9 ....
5.2 ToOOis, Part 3, Column 8. NONE .................................... . 6. Total gain (loss) on disposals, Part 3, Column 1B ....
7. Deduct amounls reooived on disposals, Part 3, Column 15.
8. Deduct amortization of premium and mortgage Interest points and commitment fees ....
9. Total foreign exchange change In book value/recorded lnvastmentexcludlng aoorued Interest:
9.1 Toffils, Part 1, Column 13 .......
9.2 Totals, Part 3, Column 13 ..................................................... ..
10. Deduct current year's other·tllan-lemporary impairment recognized:
10.1 Totals, Part 1, Column 11 ....................................................... ..
10.2 Totals,Part3,Column10 ...
11. Book valueirecorded Investment excluding accrued Interest at end of current peliod (lines 1+2+3+4+5+6-7-6+9-10) ...
12. Total \llllualion allowance.
13. Subtotal (Line 11 plus Line 12) .................................................................................. .
14. Deduct total oonadmiUed amounts ..
15. Statement value at end of current period (Une 13 minus Line 14).
5102
Statementaso1Decamber31.20t3oflho Vision Service Plan
SCHEDULE BA ·VERIFICATION BETWEEN YEARS Other Long-Term Invested Assets
1. Book/adjusted carrying value, December 31 of prior year ....••.
2. Cost of acquired:
2.1 Actual oostat lime of acquisition {Part2, Column 8) ........................... .
2.2 Additional investment made after acquisition (Parl2, Column 9).
3. Capltallzsd deferred Interest and other:
3.1 Totals, Pmt 1, Column 16 ...
3.2 Totals, Part 3, Column 12 ...
4. Accrual of discount. ................................. ..
5. Unrealized valuation lncreasa (decrease):
5.1 Totals, Parl1, Column 13.
5.2 Totals, Part 3, Column 9.
................... N .... 0 ..... N ... e .. . ........................ ~ .. ..
6. Total gain (loss) on disposals, Part 3, Column 19.
7. Deduct amounts received on disposals, Parl3, Column 16.
8. Deduct amortization of premium and depreciation ..
9. Total foreign exchange change In bo()kladjusted canying value:
9.1 Totals, Parl1, Column 17... .. .................................... .. .. ......................... ___ _ 9.2 Totals, Part 3, Column 14 ...
10. Deduct current yea~s other-than-temporary Impairment recognized
10.1 Totals, Part 1, Column 15... .. ............................................................................................................. ..
10.2 Totals, Part 3, Column 11.. ................................................................................................................................. ___ _
11, Book/adjusted carr0ng value at end of current period (Lines 1+2+3+4+5+6-7-ll+0-10) ....
12. Deduct total Mnadmit!ed amounts ......
13. Statement value at end of oorrent period (Line 11 minus Line 12) ............................ .. . ................................. -------"-
SCHEDULED· VERIFICATION BETWEEN YEARS Bonds and Stocks
1. Book/adjusted carrying value, Deoombar 31 of prior year ....................................................................... .. 36,567,723
2. Cost of bonds and stocks acquired, Part 3, Column 7 8,832,350
3. Accrual of discount ....................... . 20,940
4. Unrealized valuation Increase (docreaso):
4.1 Part1,Column12 ... . ....................................................................................................... ___ _ 4.2 Part 2, Sec11on 1, Column 15 .. .
4.3 Part 2, Seclion 2, Column 13 .. .
4.4 Part4, Column 11.. .... , ... ...................... ___ _ 5. Total gain (loss) on disposals, Part 4, Column 19. 21,557
6. Deducl cons!deralk>n for bonds end stocks disposed of, Part4, Column 7. 8,643,28fi
7. Deducl amorUza~on of premium ......... 557,620
8. Total foreign exchange change In bookladjuslod carrying ~aluo:
8.1 Part1,Column15
8.2 Parl2, Seclion 1, Column19 .. .
8.3 Part 2, Section 2, Column 16 ... ..
8.4 Part4, Column 15 ...
9. Deduclcurrenl year's olher-than-temporary lmpalrmenl reoognized:
9.1 Parl1, Column 14 .....
9.2 Part 2, Section 1, Column i7.. ... .. 9.3 Part 2, Section 2, Column 14 .. .
9.4 Part4, Column 13 .......
10. Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5-6,7+8-9) .. 36,241,663
11. Deduct total nonadmitted amounts ...
12. Slalemant value at end ofcurrenl period (Lin~;~ tO minus Line 11) ..................................... .. 36,241,663
5103
statemsQtasofDecembar31,2013oltl19 Vision Service Plan
SCHEDULE D- SUMMARY BY COUNTRY Long-Term Bonds and Stocks OWNED December 31 of Current Year
Descri lion
BONDS
Governments (Including all obliglllions
guaranteed by governments)
U.S. Slates, Territories and Possessions Direct and r~uaranteedl
U.S. Political Subdivisions of States, Territories and Posoossions {Directllnd guarnnleed)_ U.S. Special Revenue and Special Assessment Obligations and All Non-Guaranteed Obligations of Agencies llnD Authorities of Governments and Their Polillcal Subdivisions
Industrial and Miscellaneous and HybriD
Securities (Unaffiliated)
~~ ... Subsidiaries and Affiliates
PREFERRED STOCKS
Industrial and Miscollaneous (Unaffiliated)
Parent, 'Subsidiaries and Almiates
COMMON STOCKS
Industrial and Miscellaneous (Unaffiliated)
Parent Subsidiaries aociAfliliates
1. United States •.
2. Canada .••.....•
3. other Countries .•...
4. Tolals ..•
6. Totals.
6. Totals ...
7. Tolals ..
8. United Sillies.
s. Canadll ....
10. Other Countries ....
11. Totals ...
12. Totals ...
13. Total Bonds
14. United Stales
15. Cllrtada
16. Other Countries .......
17. T(l\als.
18. Totals ....
19. Total Preferred Stocks ......
20. United Stales ..
21. Canada
22. OtherCountries ......
23. Totals.
24. Totals ...
25. Total Common Stocks .......
26, Total Stocks ..................... ..
Book/Adjusted
Carrvlnr~ Value
... 583,014
Fair Value
. ... 634,153
Actual Cost
.. 587,245
Par Value
of Bonds
.........•. 581,000
.... 583,014 ........................ 634,153 .........•.........•..... 587 245 .. ................ 581 000
.1,741,562 ,1,772,907
.2,227,838 .2,246,935
.......... 12,460,582 .................... 12,452,390
................... 14,823,202 ................... 14,872,614
............. 1 ,222,526 ... .. .............. 1 ,245,384
.3,182,939 ................... 3,203,193
......... 19,228,668 ................... 19,321,191
. ..
............... 1,791.063
....... 2,396406
........ 12,747,0(19
.......... 15,313,504
...... 1,244,150
.......... 3,263,000
... 1,715,000
.......... 2135 000
............. 12,26il,OOO_
. .. 14,520,000
....... 1,200,000
. ............ 3,160,000
. ............. 19,820,654 .................... 18,800,000
"===·=·····~·r=,=··· ===ci=====-·=====j .................... 38241663 .................... 36427615 ........ 37 342 376 ... 35,571 000
................................... 0 .0 . .... 0
............................... .... 0 ................................. 0 .. .. ........ 0
.............................. 0 ............................ 0 ..0
................................... 0 .................................. 0 ...0
................................... 0 .. ...................... 0 .0
27. Total Bonds and Stocks.... .. .......... 36,241,663 .... 36,427,575 .... 37,342,376
5104
en ;s
"'
smtementaso!December31.2013oithe Vision Service Plan
SCHEDULE D • PART 1A ·SECTION 1 Quality and Maturity Distrib~tion of All Bonds Owned December 31, At Book/Adjusted Carrying Values By Major Types of Issues and NAIC Designations
NAJC Dssi nation 1. U.S. Govemmerrts
2.
1.1 NAJC 1......................... . ................................ . 12 NAJC2 ......................... . 1.3 NAIC3 .. . 1.4 NAIC4. 1.5 NAIC5 .... 1.6 NAIC 6 ................... . 1.7 Totals ............ .
All Other Governments 2.1 NAIC1 .. 22 NAIC 2 ............................................................. . 2.3 NAIC 3 .................................................................................. .. 2.4 NAIC 4 .. _ .................................................................. .
2.5 NAIC 5 ............. ·······-·-···-·····-·-··········---·· ....... . 2.6 NAIC 6 ................................... ..
. .. 13,064 ... 583,014 .....................
...............
13,064 .583,014 ... 0 ... 0 ............ 0
.. 596,078 . ···-·----0
............ 596,078
.0
.0
.0
.0
···-····_--u; ~--·········-··--583,914 ... 0.0 ....................... .
. ......... 0.0 .
······--···········-0.0 . ..... 0.0 . .... 0.0 ... 1.6
. .. 0.0 .0.0 .0.0
. .. 0.0
.... 583,914
... 1.6 0.0
----.. 0.0 ... 0.0 ... 0.0
.d2. u
•••. 0.0 ...•••. 0.0
... 0.0 ................... 0.0
............ 0.0 ........................... 0.0
.. 596,078
............. 596,078
•••m !••···········••••••••• ............................... I ....................... .
2.7 Totals .......................... . . .. 0 ..................... 0 ................ 0 ___ o;;-rl ... = .. ~ .. ==· ........... o
... 0.0
... 0.0
... 0.0 .................. 0 1 ........................... 0.0 I ..... .
3. U.S. States, Territories ami Possessions, e!t:., Guaranteed 3.1 NAIC 1 ....... -.................................................. .......... .......... ................. . ............... 1,741,562 ................. . 32 NAIC 2. ...................................................... ............... . ....... . 3.3 NAIC 3..................................... ............... ................ .. .. . 3.4 NAIC 4.............................. .......... .......... .•... . ..................... . 3.5 NAIC 5................. ........ .............. .......... ....................... . ............................ . 3.6 NAIC 6 .......... . 3.7 Totals ... ........................ 0 ] ................ 1,741,562 ... 0 ].......... . .........•..•. 0
4. U.S. Political Subdlv!slons of States, Territories and Possessions, Guaranteed
.90e'
... 1,741,562 .0
............................ 0
: 1..
... .4.8 ..................... 0.0
... 0.0
... 0.0
. .. 0.0 0.0
.4.105,565 1 ......................... 11.5 ... 0.0
. ........... 0.0 . ...... 0.0
. ........... 0.0 . ........ 0.0
... 1,741,562 . ..................... .4.8 I ................ 4,205,565 ..... 11.5
4.4 NAIC 4 .............................. ······--·- .................. ............. ... ................................. ................................. .................... ........... ..... • . .........•................... 0 ........................... 0.0 ............. .••• .... ........ . ....................... 0.0
1,741,562] ...
... 1,741,562
4.5 NAIC 5 ................... --·-- ......................................................... ......• .... ........... ...... ................................. ......................... . ............................. 0 ......................... 0.0 .......... ..•••• ..... . ......................... 0.0 ........................ . ........ . 4.6 NAIC 6............ ................ ........................ ........................... ................................. .............. .•.• ........... ..... .................. ....... . ....................... 0 ........................... 0.0 ................................. ................ .. •. 0.0
... 0
... 0
4.7 Totals.......................................... . ............. 1,322.486 ................... 905,352 ............................ 0 .............................. 0 ............. 0 ............... 2227,838 ........................... 6.1 ................ 2.414.635 ..................... 6.6 ................ 2,227,838 ......... .. ........ 0 5. U.S. Special Revenue &Special Assessment Obligations, I I
etc., Non-Guarnrrteed 5.1 NAIC 1 ......................................... . . . .4,234,670 ...... 8,225,906 52 NAIC 2 ........................................... . 5.3 NAIC3 ... 5.4 NAIC4 ... 5.5 NAIC 5 ...................................................................... .. 5.6 NAIC 6. .. .................................. 1 ................ 4,234,676 5.7 Totals ......... . 8,225,906 ......... 0 ... 0
... 12,460,582 . .. 0
. ..... 0 .. ...... 0
. .. 0
'lli-:-':·'-:'S'I : ~- :~J! --''·;~·SB'I:•••••••••••-••••••••••••
StatementasofDecemberS1,201Softhe Vision Service Plan I
SCHEDULE D • PART 1A- SECTION 1 (continued) Quality and Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Carrying Valu~s By Major Types oflilssues and NAIC Designations
1Year OverSYears Over10Years Over20 Total , , I , I , " NAIC Desionation I or Less Throu~:~h 10 Years Throu~:~h 20 Years Years PubliclyTr.:lded
n Tot.al
Privately PlaC"ad (a)
,_ li ~~E"-'~·~~·:·:::'':''~i~~~:.:·: .. --~::'·~::~: ;-;-:'''-':'=': :-: :; ::::•••••·•:: ::···----------------- •••-!'··:::~:i :::.:••::: ... __ l•~li .... : ::·:.:::::: ··•••:•••••·•••·;11 ~ .:·_::.~::::!_ ••••• : __ .•••••••••••.......
7.
cn.a. 5 0>
::: ::~ :~:-·:::::~::: .. ::::::::~::::.:::::::::~:::.:::::::::::: .. :::::::::: .. :::::: .. :::::::: : .. :::~~--- ·····:::::::~:::. ......... ............ ..... . ·:::::::~::: ........... -... ...:::::::~ :::~ __ : ........ :~ :::=:::~ :::::::::1:::~:~ .... :::::.::~::::·::::::=::~ .... ~:·:::::::::::::.:::~:~ ::::::::::.:~:::::: .... ::::= I:~ :::::::: ..... :::::::::: ... 1
6.7 Totals ................................................................................................... .7,484,914 .............. 11.743.754 ........................... 0 ............................. 0 .............................. 0 1 .......... ~ .. 19.228,668 ................... .1.53.0 .............. 19,022,236 ...................... .52.0 .............. 19,228,668 Hybrid Securities
I o o .......................... . .......................... 0.0 ................................. . .......................... ..
"~L I - --I--== 1::::::=~::::::: I == ~ = li I ~~ ~~~H~~= ; ~-= 7.1 NAIC 1............................................ . ...... ~ ... 7.2 NA!C 2 ..................................................................... ..
7.4 NAlC 4 ............................................................... .. 7.5 NAlC5 ...
7.6 NAlC 6 ...... - ................... ..
7.7 Totals ... ... 0 . ...... 0 Parsnt, Subsidiaries and Affiliates
8.1 NAlC 1 .................................... - ... 8.2 NAIC 2 ............................................. ..
........ 0
0
.... 0
l .... O.O I ............................. Q ....................... ~0.0 ................ .......... 0
I o o I .... 0.0
I 00 I
8.8N~C8 =:1:·--··········1:-·::1 :1:::::.:::.:~:~:: ... ~ :;:.: .... ,,,,, .1:!!~:··· :: :••:: "::::::: : .. ::: 8.3 NAJC 3 ................ .. - · · -I· - - · I········· ·· ··············I · 1- - · - · · · I - - - - ]
,., .. 0,0
..... 0.0 8.4 NAlC4 ...
8.5 NAlC5 .......... .
8.7 Totals ...................................................................................................................... 0 ................. . .... o ! ................ ~ ..... ~ ... 0 ......... ~ ................... 0 .............................. 0 ......... ..:. ................ 0 .................. ..l ... o.o .......................... 0 ......................... o.o ............................ o ............................ o.l ,,
(/l ;s ....
9.
statementasofDecember31.2013ofths Vision Service Plan
SCHEDULED· PART 1A ·SECTION 1 (continued) Quality and Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Canying Values By Major Types of Issues and NAIC Designations
NAIC Designation Total Bonds currennear
1 Year or Less
, I , I , , Over 1 Year Over 5Years Over 10 Years Colum116 as a
Through SYears Through 10 Years Through 20 Years % ofUne 9.7 Total from Column
6 Prior Year %fromCol.7
Prior Year
10 Tornl
PubliclvTraded
9.1 NAIC 1 ................................................................................... (d) ........ 12,451,453 .............. 23,199,587 ............................ 0 .............................. 0 ............................ 0 ............ 35,051,039 ....................... 98.3 .......... .XXX...... .... .. ...... XXX.......... .. ...... 35,651,039 92 NAIC2. ............................. , .. ,_ .............................................. (d) ............. 603,687 ......................... - .. 0 ___ .................. 0 .............................. 0 .............................. 0 ................... 603,687 ........................... 1.7 ............. .XXX... .. ........... .XXX. ........ _ .................. 603,687 9.3 NAIC 3 ...... .. ..................................................................... (d) ...................... 0 .......................... 0 .......... .. .......... 0 .............................. 0 ............................. 0 .............................. 0 ........................... 0.0 ............. .XXX... .. ........... .XXX.... .. ............................ 0 9_4 NAJC 4 __ .................................................................................... (d) ........................ 0 .............................. 0 ......................... 0 ........ .. ............. 0 ........................ 0 .............................. 0 ....................... 0.0 ... _ ..... .XXX ........ .. .......... ..XXX.......... .. ............................ 0
11 Total
Privatelv Placsd fa)
""'''''''0
... 0
... 0 ~:~ :~ ~:::::~:.::: ............................................................................ ~~i::~: :::::::::::· : .. =~ .......................... ::~ ::::::::: ....... :::::"""'::~ :::::::::::--:::::::::::::::::6 ::::::::::::::=:.:::::::::::~ ~~i: ::::::~:::::::::::::::~ ::::::::::::::::::::::::~:6:6 ::::::::::::~:::"""'" :~::::::::::~:::· :::::::::::::::::: .. :::~:::~ti ......................... 0 9.7 Totals.... .......................................... ...... ..................... .. ............ 13,055,139 ............. 23,199,587 .................... 0 ............................. 0 .............................. 0 [b) ......... 36,254,726 ....................... 100.0 ............ JO:X. ...................... ..XXX. ....................... 36,254,726 ........................... 0 9.8 Une 9.7 as a% of CoL 6...................... ....... ................ ............ .. ...................... 36.0 """""""'"""""64.0 ........................... 0.0 ...................... 0.0 ........................... 0.0 ....................... 100.0 ....... .XXX ........................ .XXX .•. _ ............. )(XX...... . ................. 100.0 ......................... 0.0
10. Total Bonds Prior Year 10.1 NAIC 1 .. -..................... ............................ .......... ................... .. ............ 7,920,306 ............. 28,437,229 .................... ............ .. ......... .XXX.... .. ........... .XXX... .. ............ 36,357,535 ........................ .99.4 ............ 30,357,534 10.2 NAJC2.. ..................... ........... ......... ......... ........................ ............... ....... .. .............. 210,188 ........ ....................... ........ ........ .. ............................. .XXX ........................ .XXX... .. ................. 210,188 ........................... 0.6 ................ 210,188 10.3 NAJC 3....................................... ............... ....... .. ......... .... .. ............ .................... .......................... ......................... ..... . ......... .XXX.... .. ........... .XXX ...................................... 0 ... .......... ..0.0 ........................................................ . 10.4 ~C4.... ..... . ........................... ------ ....... ....... .......... ............... ................. ............ ................. ........... .. ........................................... XXX. ...................... .XXX... .. ............................ 0 ......................... 0.0
~ ~:~ ~~~ ~---::::::::::= .. ::::::::::::~ __ :::::::~ __ :::::~ __ :::::::::::::::::::=:::·--------· ::::~ __ :::::::::::::::~_:::-· ::::::::::=:~::· :.::::::: ::~::::::·:.... i~L::: ::::· ::::::: .. ::::~ :::~: .. : ..... ·:::::--:.:~:~ ..... ::.:.:: ............ . 10.7 Totals ....... ................ 7,920,306 .............. 28,647,417 .......................... 0 ............................ 0 ............................ 0 ............. .XXX.... .. ........... .XXX... (b) ...... .36,567,723 ..................... 100.0 .............. 36,567,722 ............................ 0 10.8 Une 10.7 as a% of Col. 8. ............... ............................ ..... .. ...................... 21.7 ....................... 78.3 ....................... 0.0 ......................... 0.0 ....................... 0.0 ........... .XXX... .. ........... .XXX... .. .................... 100.0 ............. .XXX..... • .................... 100.0 ......................... o.o
11. Total Publicly Traded Bonds 11.1 NAIC 1.. ..... -...... ......... .................................. .. ............ 12,451.4S3 .............. 23,199,587 ................................. ............. ................. . ......... 35,651,039 ................... 98.3 .............. 36,357,534 ......................... 99.4 ............ 35,651,039 ........... .XXX .. . 11.2 NAJC 2 ......... --................................ ............... ......... ......... .. ............... 603,687 ........ ............... . ................. 603,687 ........................ 1.7 .... _ .......... .210,188 ......................... 0.6 ................... 603,687 ............. .XXX ... . 11.3 ~C3 ......... ....................... ................................. .................. ..... .. ........................... 0 ......................... 0.0 ............................. 0 ......................... 0.0 .............................. 0 ............. .>(XX ... 11.4 NAIC4.-..................... -................. .... ............ ................. ...... ...... ............ ......... ..... ........ .. ........................ 0 ....... _ .. ______ ... 0.0 .......................... 0 ........................... 0.0 ............................ 0 ........... .XXX .......... .. 11.5 NAIC5 ..................................................................................................................................................................... '"""' .... ....... .................... ............ .............. .. .......................... 0 ........................... 0.0 .............................. 0 ......................... 0.0 ............................. 0 .............. XXX ... 11.6 NAIC6 ............ .......... .......................... .............................. ............. ................................. .............................. . ........................... 0 ....................... 0.0 .......................... 0 ........................ 0.0 .................... 0 ............. .XXX .. . 11.7 Totals ... .. ............ 13,055,139 11.8 Une11.7asa%ofCol.6 ... .. .............. 36.0 11.9 Une 11.7 as a% of Line 9.7, Col. 6, Section 9 .......... ........................ 36.0
... 23,199,587 1 ....... - .................... 0 .... 64.0
64.0 .... 0.0
.0.0 ... 0.0 ... 0.0 --·::::::::::::::::~::::::~:~ I :: :::~:::::~~~~~~~~ ::::·:·::::·::-::~:·:·:~~-~~~ _:·:·::::·:·:::~:~~~~=- :-::::·:-::::·:·:·:~::_:100.0 :::::~:::::::~~:~~!~~~ :::::::::::::B::::
12. Total Privately Placed Bonds 12.1 NAIC 1 ..................................................................................... ~ .......................... - ... !··························· 12.2 NAIC2 ... 12.3 NAIC 3 ... 12.4 NAICL ... 12.5 NAJC5 ...
::. :::::::::::::::::::::::::::::::::::::::::::::::::I::::::::::::::::::::::: :: I: : :
......... 0 .0
. ....... 0
0.0 ...... 0
1
.. .. ................ 0.0
....................... ~:6 ...................... ::::::~ :: .... ~:::~::::::::::::~:~ ' ...... 0.0 .............................. 0
. ...................... 0.0 .............................. 0 12.6 NAIC 6 .................................. .. 12.7 Totals ................................. . 12.8 Une12.7asa%ofCo1.6 ....... 12.9 Une 12.7 as a% ofUne 9.7, Col. 15, Section 9 ...
0 ... 0.0
0.0
(a) Includes S .......... O freely tradable under SEC Rule 144 or qualified for resale under SEC Rule 144A
0 .... 0.0 ... 0.0
____ , __ o ... 0.0 ... 0.0
...... 0 .0.0
... 0.0
.0 ............ 0.0
....... 0.0
..... o 1 ...................... o.o
................ ::=::::6:~ I:::· ---::=~: ::::·;:;: I=::~ :::::~: .. [b) Includes s .......... D current year, $ .......... 0 prior year of bonds with Z designations and $ .......... 0 current year, $ .......... 0 prior year of bonds with Z: designations. The letter'Z" means the NAIC designation was not assigned by the
Securities Valuation Offics (SVO) at tile date of tile statement. "Z .. means tile SVO could not evaluate the obligation becauss valuation procedures for the security class are under regulatory review. [c) Includes 5 .......... 0 current year, S .......... O prior year of bonds with 5• designations and $ .......... 0 current year,$ ........ 0 prior year of bonds with s• designations. '5 .. means tile NAIC designation was assigned by the SVO in reliance on
the lnsurets certific:afion that the issuerls current in all principal and intarest payments. "6 .. means tile NP-JC deslgnafion was assigned by tile SVO due to inadequate certification of principal and Interest payments. (d) ln~ludes tile iollowing amountoinon-rated short-term and cash equtvalent bonds by NAIC designation: NAIC 1 $ .......... 0; NAIC 2 S .......... O; NAIC 3 $ .......... 0; NAIC 4 $ .......... 0; NAIC 5 $ .......... 0; NAJC 6 $ ........ 0.
----------- -----~-.
.0 ... 0
... 0.0 0.0 .0.0
...... 0.0 .. . .XXX. .... ... .XXX..
• .XXX............ _____ ,........ • ........... 0 ... .XXX... ---· ....................... 0
.XXX... . ............................. 0 ... .XXX... .. ...................... 0 ... .XXX... ... .......................... 0 ... .XXX ........................................ 0 ... .XXX... .. ............................ 0 ... .XXX... .. ......................... 0.0
.. ........... .XXX............ • ........................ 0.0
C/)
25
"'
1.
'
J j_l __
statementasotDecerrner3U013oflhe Vision Service Plan SCHEDULE D • PART 1A ·SECTION 2
Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Carrying Values By Major Type and Subtype of Issues
1 Year Over 1 Year OverS Years Over 10 Years Over 20 i Tntal Column 6 as a Total !rom Column 1 , , I 4 I , I , 7l , Distribution hyTYJ)e I or less Through 5Years Through 10Years Through 20 Years Years Ctirren!Year %of lin 9.5 6 Prior Year
%fromCol.7 Prior Year
10 Total
PubllQly_Traded U.S. Governments I
j~ ~~2§~~~=!~~=;~~: :. ~ ::~. -_-·:· -13,064 .':~014 ~~ ::.... ........... •••••. : :.:.::.= ~·:~· ............... ············= 59~~0~! •••·••••••••••• =!~-!! : : 56~914 ••••••••••• :•!! ...... . ... 596,078
11 Total
PrMltely Placed
1.5 Totals............................... ........ .......... .................... ......... .. ............... .-.13,064 ................. 583,014 ......................... 0 ...... ..... .. ....... 0 ........................ 0 ................. .596,078 ................... 1.6 ................... 583,914 ....................... 1.6 ................ .59&,078 ............................ 0 All Other Governments I
~:~ E::s::;~:~s;:~~~.~~:·.::···.:~~~.·~.~:::~~:.~~:::=:::.·::.~.·~~··· ..... ................ ......... ....................... ·········::::::··::~··~:::..... ::::::=:::::~:::··~~:.::::: ···::::::~.::=:::=::=:·:... :::::~::~::~ .. :::~:::::=:~ ::~:::· .. ::::~~1~·::::~:~ :::::::::=::::~ .. :::::::::.. ::~:::::::::::::::::::::~:~ ·····.::~:::.::.:::::::~... ·····················-···-··· 2.4 other Loan-BaCked and Structured Securities .................. ........ ...... .................... . ................ ........... .......... .. ................ R........ ....... ... ............. ...... .... ...,., .... ~ ... ;., ............. 0 ................. J .... 0.0 ..... ................. .. ....................... 0.0 2.5 Totals.................................................. ........... ......... ....... ............... .. ..................... 0 ....................... 0 .......................... 0 .......................... 0 ......................... 0 .......... ~ .................. 0 ................... J .... o.o ........................ o ......................... 0.0 ..... . ................. o ............................ 0
3. U.S. States, Territories and Possessions, Guaranteed 1 I
!1~~l~~§f~~~~:t:~L~•::::~::::::~~:I :·········· - :1
::41
:~~ ••••• :.:._: _····· ............... -· ~':1
':4
:;.] :::t~!-! :·_ :4
,
0556
:
... 11.5 .0.0
1,741,562
4.
5.
6.
7.
3.s Totats ............... _ ................... _ .. -.... -* .. - ................. _ ........................................... o ................ 1.741,562 ......................... M ... o ........................... o ... ~ ....................... 0 ......... L .... 1,741.562 .................. !.. .... 4,8 1 ................ 4,2-D5,s6s u.s. Political Subdivisions of States, Territories and I
Possessions, G1111ranteed
!~ r:;;:;:~;::~~! s;:~~~: .~~.~.·~~::.·~::....................... . ... ~·.·.:········1,322,486 ................. 905,352 ... ~:~··:::::::::::~:::-··· .............................. I ::::::::::::::::~:~~~:~~~ :::::::::::~=~~J:~:~i~ !:: ~!r~ ~~~~~.~.~~.k-~~-~.~.~.~.~~~~-ct :.~.~~~:~::: ..................... :::::::~I :.·.·:::.:·:::.·.·:::1':322.4861:~ ...... " :.·.·::s·o_s:352 1·.·:~. :::.·::::.·:::.·.·::::.·:~::0 I :::.·.~:.·.·.~:.·.·.:·:::.~:.·.·.·:::o·l ........................... o l .......... c .... 2,227,s-3sl ......... -·d· .. 6.1
U.S. Special Revenue & Speci:al Assessment Obligations, el1:., Non-Guaranteed
5.1 Issuer Obligations ........................................................ .. 52 Residential Mortgage-Sacked Securities ................ . 5.3 Commercial Mortgage-Backed Securities ................. . 5.4 Other Loan-Backad and Structured Securities .............................. . 5.5 Totals ........................................ .
.. i ............... .4,234,676 1 ................ 8,225,906
4,234,676 ... 8,225,906
...12,460,582 0
. .. 0 0
..... 12,460,582
__ 1_34.4 ..J .... 0.0 L .. o.o
..... .J .... 0.0 -. J 344
... 2,414,635
.2,414,635
... 10.341,375
... 10,341,373
!~ ~~~@f~~f,;;;:,;,~;"'1
: " : 7:'~'"914 :·: 11:7~:754 ···~····. "····· ···•••••••·•••••••··••••••••••• : : •• ;';'::~! ::. ~~.:!.'::: 1··········.19,022,36 6.4 Other Loan-Backed and structured Ser:uri!ies ......... ~...... .... .... .. ............................................... , .......... .. ............... ~ ........ ....... ........ .................. .. ............................ 0 .................. J .... 0.0 6.5 Totals........................................................................................... . ........... 7,484,914 ............ 11,743,754 .......................... 0 ........... . .... o ............................ 0 .............. 19,226,668 .................. J .. 53.0 19,022,236
~~ ~:~~~~;r:ge-sac~:edsecurffies .............. ::::::::::::·.::::::::::::::·1:::::::::::: ................... 1::::::: ................ :::::: 1:::::::::::::::::::::::::::=: 1::::::: I I -~I :::::::.~ .. ::::[::~:~ 7.3 Commercial Mo~ge-Backed Ser:urities .................... -................. ......... ................ ....... ...... ....... ...... .. ................. -......... ....... ................. • • • • .. • • 0 ................ L ... o.o 7.4 Other Loan-Backed and structured Securities...... ...... ................ ............ ......... ........ .. .............................. -............................ ....... ............ ......... .... ................ .. ......................... 0 ................... 1.. ... 0.0 7.5 Totals............................................... ............. . .................................................. 0 ............................. 0 .......................... 0 .......................... 0 ..... .. ............. 0 ............................. 0 .................... 1.. ... 0.0 ... 0
,_,, __ , .. 0.0 .0.0
.......... 11.5
... 6.6 .0.0 0.0 .0.0
....................... 0.6
... 28.3 ... 0.0 ... 0.0 ... 0.0 .28.3
.520
... 0.0
... 0.0 0.0
.52.0
...... 1.741.562 ..... 0
... 2,227,838
... 2,227,836 .................. 0
... 12,400,582
.......... 12.460,582 ......... 0
.. ....... 19,228,668
........ 19,228,668 I .......................... o
. .. _::1 " . ... 0.0 ... 0.0
..... 0.0 ... 0 8. Parent, Subsidiaries and Affiliates I
6.1 lssuerObliga~ons ......... - ................................................................................................................ u ................. '""*' ............... • ............................................................................... 0 ................ .,.. ... 0.0 .................. ......... .. ...................... 0.0 ........... ..
i~ g:~£~~~:~=~~=£~::;;~:.··.·~~.·.·.·~~.·.·~.·.·~·······.·.·~·~··:~-·· ::.:::::::::~~::: .............. ::::=:·::::::=:.:··········-·· .... :::::::::~::: ............... · -···· :::::::::::::=:::::~::: ...... ::::::=:·:~:::=:::::::::=~ ::~:::~~··:::=::t::=:~:~ :::::::::::.:·::::::~::~:··· ::::::::~::=:::~:·::::~:~ :::::::::~=:::::~:::::::::::~ ::::::::::~· :::::::::::::I 8.5 Totals. ................ ............................................... ................ . ............................. 0 ............................ .ll ....................... 0 ................. .. ...... 0 ......................... 0 ..... .. .............. 0 .................. L ... O.O ............................ 0 ....................... 0.0 ......................... 0 ........................... 0
rJ)
0
"'
s:atementasofDecemoor31,2013of!he Vision Service Plan
SCHEDULE D • PART 1A ·SECTION 2 (continued) Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Carrying Values By Major Type and Subtype of Issues
Distribution bvTVPe 9. Total Bond$ Current Year
9.1 Issuer Obligations ........... .
92 Residential Mortgage-Ba~ked Se~uriiies ...................... .. 9.3 Commercial Mortgage-Backed Securities ........ .
1 Year or Less
13,055,139 0
.... 0 9.4 Other Loan-Ba~ked and Structured Securifies ......... _ .......... . ......... 0
2 Over 1 Year Over 5 Years I Over 10 Years
Throuqtl 5Years Throuqh 10 Years Throuoh 20 Years
... 23,199,587
..... 0
............. .0
0 .......................... 0
...0 ............................ 0 .. ...... 0 ................. 0
... 0 ........................... 0
9.5 Totals ................................................................................................. 13,055,139 ............ 23,199,587 0 ............................ 0
9.6 Line 9.5 as a% of CoLli.. .. .................... .36.0 ......................... 64.0 .......................... u.u ............ 0.0 10. Total Bom!s Prior Year
Over20 y~,
................ 0 .......................... 0
................ 0
................ 0
........ ....... ....... 0.0
Total Curren! Year
... .36,254,726
0 ............... 0
................ 0 ... 36,254,726
............. 100.0
Column a as a Total from Column %ofline9.5 6 Prior Year
.. ................ 100.0 ............. .XXX. ...
...... ...... ....... 0.0 ........... .XXX. ... - .....
... ·-- --- --·-- ..... 0.0 ............. .XXX .......
.......................... 0.0 --- ....... .XXX. ... ...................... 100.0 ............. .XXX. ...
........ .XXX ... .. ........... .XXX. ...
%fromCol.7 Prior Year
...... .XXX ...... ........... .XXX ...
........ .XXX .......
........ .XXX ... ........... .XXX ........
........ .XXX .•. -
10.1 lssuerOhligations ........................ . .7,920,306 .... 28,647,417 ... .XXX... . ............ .XXX... .. ............ 36,567,723 ................. 100.0
10 Total
Puhrit':l Traded
. ............ .36,254,7213
............................ 0
. ........................... 0
........................... 0
. ............ .36,254,7213
....................... 100.0
... .36,567,722 10.2 Residential Mortgage-Backed Securilies ........................... ............................... ................ .. .......... .XXX. ....................... .XXX .......... .. ...................... 0 ..................... 0.0 ................. .
11 T""l
Prtva~W-Piaced
.......................... 0 ..................... 0
.......................... 0
.......................... 0
........... . .......... 0
......................... 0.0
~~~ ~h:~~=B~~:~::~:~~:~~=;~ .. ::.:::::.:::::.::::.:::::~::: .... ::::::::: .. :::::::--:· .............. :::::::::--:::.:::~.::--· .... :::::::::·:::.............. ............. ............... ~::~~--..................... :::::::::::::::::· ....... :::::::::::::~::: ::::::::::::::::::::::::~::::~ :::::::::::::::~::::~:~ .... ·::::::::: .. ::::::::::::::: 1 ..
~~:! ~=~~~:~·~;-~·~·~~-;~;:·~~----~-~-~---~-:~~---·_·:~~---~·:........................................ ::::::::::::::::~:~~~~~~ ::::::~ .. :::~2~:~~~1-~ ::::::::::::::::::::::::::~:~ :::~:::~::~--:::::.:::~:~ .......... :~:~:::::::~:~ :::::::::::::~::~ ........ :::::::::~::::~:........ ::~~-~ .. ::~~:~~~~~~ .::~·.--... :·.:·;;_~_oo.o ....... :::::~~:~~~~ 1· ........................ o ... 0.0 11. Total Publicly Traded Bonds
11.1 lssuerOhligetions ........................... ........... ................... . ............. 13,055,139 ............. 23,199,587 ......................................... 36,254,726 ..................... 100.0 .............. 36,567,722 ................. 100.0 .............. 36,254,7213 ............. .XXX. .. .
112 Residential Mortgage-Backed Securi'Jes ............................ ...... . ................ .......... ......... ........... ..................... ....... ........ ........ ........... . ............. .. ........................... 0 .......................... 0.0 .............................. 0 ..................... 0.0 .............................. 0 ........... .XXX. ....... .. 11.3 Commercial Mortgage-Backed Securities .................................. .... ..... ...................... ........ ............. ............. . ............................. 0 ..... .. ........ 0.0 ............................ 0 ..................... 0.0 ............................ 0 ............. .XXX. ...
11.4 Other Loan-Backed and Structured Securities .......... _ .............. .... ................................. .......................... ...... .. ................ -........ ....... .......... .......... .................. .. ......................... 0 ...................... 0.0 ............................ 0 ................... 0.0 .......................... 0 ............. .XXX ....... .
11.5 Totals .................................. -........... ................ ................. ...... . ............ 13,050,139 ............. 23,199,587 ........................... 0 ..................... 0 ................ 0 .............. 36,254,726 ....................... 100.0 .............. 36,567,722 ................. 100.0 .............. 36,254,726 ............. .XXX. ....... .. 11.6 Line11.5asa%ofCol.6 ...................................................................................... 36.0 ......................... 64.0 .......................... 0.0 ........................ 0.0 ............ 0.0 ...................... 100.0 .......... .XXX.... .. ......... .XXX ................. .XXX ........................... 100.0 ............. .XXX. .. .
I 11.7 Line 11.5 as a % oiUne !!.5, CoL 6, Section 9 ..................... ........... . ........................ 36.0 ........................ 64.0 .......................... 0.0 ..... ..... ..0.0 ............. 0.0 ....................... 100.0 ............. .XXX... .. ........... .XXX......... .. ......... .XXX... .. ..................... 100.0 ............. .XXX. ....... ..
12. Total Privataly Placed Bonds ... 0 ........................... 0.0
122 Residential Mortgage-Backed Securl'Jes......... .......... ...................... .. ......................... ,.... ..................... ........... ....... ............ .......... .. ............. ! .......................... 0 ......................... 0.0 .............................. 0
~~ ~h:~~=~~~::~::~~~~:~~:r~~~ .. :::::::::::::::··:::::: .. :=::: ...................... ........ .... .................... ...... :~:::~--:::::::~::· .......... ::::::::: .. :=:::......... . ............. ::::::::::::::: ::::::::::: .... ~ .. ::::--:::~ ::::::--::::::::=--~ .. :::~:~ :::::::::~ .. :::::::::::::::::~ ..................... 0.0 ............. .XXX. .. .
12.1 lssuerObflgations-..................... .
:: l==.s:::l::::.: : I. il~ ~~:~~~:::: ~ =~;:~ ~~-.·~;; ;;;~;;;····· ························ ····················•••• :•: : •••.•••.•.•••••.•.. ::.: .••••.•••••.•• :· ·:·: •••••..••..••••••• :::: •••••..••..••••.•• :: I······ :: ::: . ~ ~
00
••••••••••.••. ~ •.••...... O .. ·:·~0
: : 2 .... .. ..... 0 ... 0.0 .. 0.0
"' :::;: 0
' "
statementasofDecernber31,2013oflha Vision Service Plan !
SCHEDULE DA ·VERIFICATION BETWEEN YEARS Short-Term Investments !
2
Total Bonds
1. Bookladjusted carrying value, December 31 of prior year_... ... o I························································
2. Cost of short-term invesbnents acquired ......... . ... 14,871,572. --·- ................................ 14,871,572
3. Accrual of discount................................................... .................... .. ............................................................. !.. . ........................................ 0 1---········--··--- ...................... .
4. Unrealizedvalu:afion increase (decrease) ........................................... .
5. Total gain (loss) on d'tsposals ........ . ·············---·-·---·-··-·---·----·------ ················- ·························! ........................................................ 0 1···--·········································-·····
S. Deduct consideration received on disposals... . • ........... . ........................ .. 14,858,508 .... 14,858,508
7. Deduct amortization of premium ........ . ....... 0
3 I
Mortgage Loans I
4 Other Short-term
Investment Assets fal
~:=: -- ---1
I
r I
·--····-·r-···--· ·----·--··--· ~------·····----···
8. Toml fure•o e~h.oge ~'~ lo boo"'""'"'~~ wl"' .................................... . . . -I - - -- •................. 0 ~- : • . . - ~........ • • • J. . ~-- . 11
•• --•• -•• ·-__ •• _._ .. __ ·_··· ... •• .. ···_·--_··_···_·_-__ ·_·_·_·_···_·_···_············
9. Deduct current year's other-than-temporary impairment recognized ... ..... 0
5 lnveslrnents in
Parent, Subsidiaries and Affiliates
::• ::::::~:,::::,~:::,:do::=~'-''-''d[~,:~:·~'-3~:::::-::···) _________ •••••••••••••••••••••••••1••·----- _ 13,0: 1 .. ____________________ _ 13.0641-- : -----------t- ________ ----1-------------- ______________________ ------1--- _________________________________ _
I
...................................... 0 ........................................................ 0
-
12. Statement value at end of current period (Line 10 minus Line 11) ............................................... _ ..• .............. 13,064 1 ............................................ 13,064 1 ................................ --···--····--·- .... 0
(a) Indicate the category of such assets, furexample,jointventures, transportation equipment... •••.
statemenlaso1December31,2013oflha Vision Service Plan
Sch. DB-Pt. A-Verification NONE
Sch. DB-Pt. B-Verification NONE
Sch. DB-Pt. C-Sn. 1 NONE
Sch. DB-Pt. C-Sn. 2 NONE
Sch. DB-Verification NONE
Sch. E-Verification NONE
Sch. A-Pt. 1 NONE
Sch. A-Pt. 2 NONE
Sch. A-Pt. 3 NONE
Sch. B-Pt. 1 NONE
Sch. 8-Pt. 2 NONE
Sch. 8-Pt. 3 NONE
Sch. BA-Pt. 1 NONE
Sch. 8A-Pt. 2 NONE
. Sch. 8A-Pt. 3 NONE
8111, 8112, 8113, 8114, 8115, E01, E02, E03, E04, E05, E06, E07, EOS, E09
' "
statementasotDeeember31,2013ol!he Vision Service Plan
SCHEDULED • PART 1 Showing all Long~ Term BONDS Owned December 31 of 9urrent Year
"''"' FalrValue 10 11 I ChanqeinBooi</Adius!~dCorrYiiT!lVol~e 4T-5 e ~ 1"1"1'1 Rate I I Current
""' to
CUSIP tdentificalion Descrlption
NAIC
' I '""" l'~~·-1 Code! n CHAR nation ActullfCost
Ob!ain Fair
Value Fair
Value
U.S. Government· Issuer Oblitmicns 9128.2S FQ & US"TREASURYtJIB .•
9128.2S NP 1 USTREASURYNIB .•.
0199999. U.S. Govemment -Issuer Obioalions .•.•...
0599999. Total- u.s. Government.-...... - .............. - ......... --......................... _ .... . U.S. Slal:es. Tell"itorias & Possessions Direct and Guararrteedl·lssuer{lbli!llllions 13062R SJ 6 CALIFORNIA-REF .................................. .
130638 A8 B CAST.·-·-··--·-····-·····-···-·····-·-······-··· 93974A YT 5 WASHINGTON ....•.....•.•...
1199999. u.s. Slates, Territories & Pos$esslons -lss~et ObUgations ..•. - .................. .
~w:~:::~:1 ..... 1
""""1""1"" ··~·- ....
.. 1FE ~1FE
.,.1FE
1799999. Total- U.S. States, Territo~as & ~ssessioJ1s (Direct and Guaranteedl-~-- ·~·-.. • .. -·-·-·-·---·-·"-·-·· U.S. Politieal Subdivisions of States, Terr!tories & Possessions (Direct and Guaranteed) ·Issuer Obliqations
OS239B RP 5"1 AUSTIN .PUB PPTY ---·-·---·---····--·-·-·-·-··--···· .. 1FE ()83763 GJ 5 BERGEN CNTY -A_ ........... .
• .•.. 455,796 ···--·-··-··502,145 131,449 ·····- ....... 132,0011
. ....... 587.245 .... _,_._ .. 634,153
.... 587.245 ············-·.S:l4.153
..... 522,9~ 1 ...... 106.713 ... .485.544
~.-.. 4S3,2441 ...... 10S2511-·---.. -.433,004 -~-.llil4,S27 •..• _99.344 ···-·-······854,358 .... 1.791.0631 .. .xxx. ...
..... 1,791,063 .. .XXX._ ....
-~--..451,968 1 ...... 103228
... tm.9o7
... 1,m,9o7
418,073 . .499.379
.. 1FE ......... 174,547 ...... 104.1&8
Par Value
•.. 452,000 •.. 129,000
.581,000 .... .581.000
... .455.000
Book/Adjusted Carryin~ Value
.453,209
.129,805 .583,014
...... .583,014
..• 476.525
.... =:~:=;~~:~: I=::~~=:::::: 1.715.000
.1.715.000 .......... 1,741.562
···~--1.741.562
.. 415.283
.. 495,582 15"4.B7B
Umeal~ ValllatioN
'"""'" (Decressti'
........... ! .....
...... 0 _,
C:urrent Year's
(Amortiza~on)l
Accretion
•...•..•...•..•.. (SilO)
414004 ES 3 HARRIS REF-PERM IMPT ..•. 508:136 CQ 5 U< CNTY SITAX-BERA •. - ......
m I oo24o9 FP 4 MILWAUKEE SWR-REF-A .. 0 60374Y Q7 5 MINNEAPOLIS.IMPT ..•.•
.. 1FEI .......... 516,0781 ...... 101..'!14
.. 1FE ·----108,708 ..•.. 103256
.. 1FEI··
.1FE • .•.. 173.869 1·-··103..'!97 ~-~ . .118.360 .. _.105.126
"'"' .... 103,256 15"5,996
.. 405.000 .490.000 150.000
. .. 100,000 .. 100.000
. .... 110,000
... 102,023 1----··-··-·-······
... 154.71"9
···-.-.. (15.433) .(6.658) (6,472]
... (2.193) (6.2a7)
..... 115,639 .. 113.2a9 64965J NN 2 NEW YOR~ER S ......... ~··· -"' ... 110.328 ······- ....... 551,640 •.. 500,000 ................. 549,756 876315 RZ 7 TARRANTCNTYREL .... . .. 1FE . 107248 . -·-·-··-··245,570 .23~000 ·-·--·- .... 241,327
1a99999. U.S. Political Subd'rvisions of Slates, Territories & Possessions -Issuer Obngations ..... ····~·-··~ ······~···
24£l9999. Total- U.S. PoijVcal Subdlllisilll'lS of States, Territorios & Possessions...-·-···-······-···
676,500 26(1,377
·--.2.396A06 2.39a.406
•. .XXX.-.... ·---.2.246,935
... :>'»:... ··~·····~··.2.246.935
,..2,135,000 ····--.. .2.227,638 .. V35.000 .... ..2.227.838
U.S.S ialRevenue&S eciaiAssessmentObn, 1tions and all Non-Guaranteed Ob!i~alicns of A en~ies and Authorities of GDVI!ITlmenls and Their U.S. ~ofdical Subdivisions -Issuer Obligations 011a32 P4 S AKHSG 1ST SER-VETS ........ 250039 JH 6 DOVER B.EC-REF ..•.....•.•...
312SX3 L7 61 FREDDIE MAC ................. . 3130All F5" 4 FEDERALHOMELOANBANK.. .. ~··· 31331K HW 3 FEDERALFARMCREDITBANK..
.... - ............. _, __ , .......... 1 .. -- 1··1 :=:::::~: : ~ ~~ :::: :::::~:::~:~ ::=: ~~~= :~~:: :::~:::~:: ::::::: :::~::~~~~~~ ... :::~=:~:~~~:~: .1 ___ 1 ..•..•. - .. Ms,2oa .. - .. 104.145 ···-·- •..•.. 41t;m ...... .395,ooo .........•..•.. 406.475
.. _ ... 1 ... _1 ...•...•.•. .500,000 ........ 99.570 ...•.•...... .497,650 ······~ ... ~ .. 500,000 ................ .500,000 •.•. 1 ..... ···~-~..710.423 .. ~ .. 101.267 ···~·-·· ..... 708,Ba9 .............. 700,000 ............ 702.5!2
-·-·--·-·(1,675) .. (13,495) ·--17,875)
_ ...... ..'...0 1··--·-.. (60,066' . .La ............ 160.066
,(21,387) (13,11)4)
.............. [2,992)
---.·-··959,1751 ..•.. 101.8&11 .........•... 1,018,1!10 ... 1.117.445 ...... 106.693 ·········~···1.066.930
.496.950 ····~·.98200 ··~·--···~·.491 ,000 ..... 1
• ... 11 ..... 1
313'371 NW 21 FEDERAL HOME LOAN BANK. ......... . 313372 C3 6 FEDERALHOMELOANBANK.. .... .. 313382 3B 7 FEDERALHOMELOANBANK. ... - ...
.. ... - .• 11 ... _11 ................ 999,750 1 ...... .97.381
1,000,000 ~1,000,000
... .500.000 ... 1,000,000 .. 1,000,000
983,4451·~· : ,:: ...• 1,086.592 .. 4.96.993
... .999.796
999.798
··~·~ ···~··8,2.73 ... (21,577)
•.. 43
3133EC DE 1 FEDERAL FARM CREDIT BANK.. ···--···-·~·-··-·····~··-··~-····-....... 3133EC JQ B FEOERALFARMCREDITBANK.. ... 3134A4 VC 5 FREDDIE MAC ... . 3134~ SD 7 FREDDIE MAC ... ·-··-- .. -·-·. 3134~ liS 2 FREDDIE MAC .. . 3136FP WZ 6 FANNIEMAE. .......... . 3136GO SB 5 FANNIEMAE.. .. . 3136G1 1'R 0 FANNIEMAE. ....... . 3136G1 VQ 9 FANNIEMAE. .......... . 3t398A 7:1 7 FANNIEMAL.~·~··· 575577 EB 3 MA BAY"ffiANSN-ASSMT-A ...
60036P N4 Bf MO ENVIR-B-ST REVOLVI. .... ~.
973,810 .. _ ..... 1 -·-1 ....... ___ .99!:1,750 ..... _99.22.1 . ...... 992,210
··-·····~· ~--·1 ···~·-··--.. 505.413 ..... 106236 . ... .478,062
·~···11~.-·1 1 ... ~·-··~·-.500.000 1 ..... ,_982161 •. --.. -·-·.491,080 ··~·-···1 ..... .1 .. ........ 1 ...... 1
1 -·-1 .1 .... 1
··-·-· 1 ...•. 1
.750.000 1 ..... _99.0271···-·-·····-··742,11)3 ...... 802.980 ...... 100..'!76 ............. ~ .. 807,808 ___ soo.ooo •. - . .97.17ii ................ 41.!5,880
500,000
1
•...... 100.263
500.000 ...... 100.098 -·1-·-1
1
. _ ...... _260.063
1
..... 102.150
_1FE . . .. - .•. .257,272 ..... .102.548 .1FE . ···~·-·.154,138 -~-101..'!13
.... 501,315 •.. 500,490 •.. 2S5,375 ...• 230,733
........ 152,&70
..... 450.000 ............... .471,843
... ..500.000 ............ 500.000 I •••••••• : = •.. 7S0.000 ............. 750,000
~ .. 800.000 ······~ ...... .800.759 .... ~00,000 ······-·- .... 500,000
.500.000 ······~·-- .. 500,000 . - . .500,000 ······- ...•... 500,000 ~.2SO,OOO
•..•. .225,000 .. 150.000
252.387 .229,584 .152,030
" -" ... (13,953)
... (856)
•..• [2.667]
--·-·---[9,087) (4,Q22)
Yea~s Other-lj)lanTemporary lmpairo/len: Re~zed
I
,J_ ..... .o J. ........ o -~,-
15
Total Foreign
Exchange Chai"IQein BJA.C.V.
16
"" " ..... 1.750
.. 0 ... .XXX.
lntere..t 17 ~
Effective '"' I..,, of Paid
Admitted Amount Due and Accrued
.. 0 ... .XXX. •.•...... .XXX..... .XXX ...
···~··-··8,323 _94S
9,268 ... .9,258
" AmDilnt Received Du~ng
Y~c
Dates ~
Stated Contractual
Maturity Acquired Date
•.. 12,035 11012012000 I 0811512016 2,258 OS/3012tl10 I 0713112015
··~ 24.293 :::::::~I::::~~~
. 5.ooo .. - ... aD4 JD ..... ....... .5.000 ······~·1.n0 AD~···
........ ....... . .. - ... 1.452 NIA ...
... 1,896
1
....... - ... .22.750
1
1110112010 I 06101/2015 .... -.5,000 .......... ..2!l,OOO 09/1~12010 1010112015
.. ............................................ ~. 1110112010 0610112015 ... - ... 0 .•. .XXX..... • ... XXX.. .... .XXX .••
.. 0 ... .XXX ...... . .. .XXX.... .XXX ..• . .... .6.896
B.896
.5.000 ....... 1.1431MS...... 6.750 .. 2.500 __ .1.119 MN...... . 2.042 .. 5:rso . 1.358 AO.. .. . 2.156 ... U50 ........ 1.5D7IMN... . .......... 323
..... 5".500 ....•. 1.2541AO ...... ·-·--- ... 2.053
:::=:~:~:~~~ :-·- :::: ~~:::::- :~::::=:::::::~: ......... 0 .. ..XXX •• - ..... ..XXX... •• .XXX... • ...... 27,244
.c ... .XXX .......•. .XXX. ... I .XXX ..• -··- •..•.. 27.24
~~~~~[~ .. 1.150 ......... 1.300 FA .. - .. . 0.940 __ .fL945 JJ
... 0.7SO ........ .C.756 MS .. . .... 4.375 ......... 1.192. JJ .. .
.. .1200 .....•.. 1.200 MS .. .
... 1.000 ..... ~ .. 1.000 MS .... 1.300 ····-···1.191 MN- ...
1.050 ......... 1.050 AO .. . .2.000 .... -.2.000 MS.~ ...
... 1.100 ......•. 1.100 MS ...
.. .2..825 .•...•... 1.533 MN ..
.... 0.250 ......... 1.152 JJ ...... . ...•... ..4.000 ......... 1.275 JJ .. .
2.060 . 4.152
. ... 2.104 8,969 1,6113 2,271 1,2.71
. •. 890
.3,000 • .. 1,451
. .. 747
,.5,900 .3,000
.42.750
1
.... .xxx.~ ... 1
.... XXX. ..•
.. .. 42.750 .... .XXX..... . .. .XXX.. .••.
... ..20.250 1210612010 0910112014 .. 12.250 11/1612010 11101/2014
..... 8.S25 1112912010 10/0T/2014 .... 3,750 1112412010 1113012014 .8.250 1112412ll10 1010112014
~--·3,300 1112912010 121011:2015 ... .20,000 011D412ll12 09101!2017
...... 11.500 111:2412010 0711512015
·-····87.92.5 .... :>'»: ...... .... .XXX.. .•. ·-····87.92.5 .... .XXX...... . ... .XXX.. ....
..... 12,S50 0210312010 06101/2014 .. .. 30,000 1110812010 0710112015
•.•.. 19,750 0212412011 11/1312:014 1210912013 1211812017
...... ··--11,375 0511712011 1111912014 . .. 13.750 1212912010 1211112.015
31,250 07/2512ll12 1210812017 ..... ·- 12/0912ll13 02122!2018 4.700 0111512013 01122!2018 3.7.50 03/1912013 03120/2017
19,686 07127/2011 07/17!2tl15 . ........ 3,000 02/25"12013 03120/2:018
7,500 0812812012 09/1212017 ... 10,400 Off/Hl2011 1111712014
5,250 1010412012 04130/2018 0811512013 0911312018 0911012013 0912.612.010
01/2812011111/20/2014 1210112010 07/0112014 12113120101 07101!2014
5,063
.11,813 6,000
StatementasofDecember31.2013oftfle Vision Service Plan
SCHEDULE D • PART 1 Showing all Long-Term BONDS Owned December 31 of Current Year
CVSIP ldentifli:afion
snoss xo 92817L EY
9.28170 R9
25SB999.
319S999.
~ 0D200R AV 020000 PG 025870 ~ 02587D CB 025B7D KR G5515BP 5N 06738J KK
06739F fZ 06740K EX
I ~·" IT ~ 1013SM AG
0 165764 AA ~ 17l.84A F3
221SOK AE
"""' '" 25467tl RB
36160X ST 36962G LF
36962G X4 381425 M9
426236 AT
459200 GJ 46625H BJ 46525H HN 476160 AQ
59156R AH 594918 AB
7800SK BS 786580 w 7954511 KD
795450 NT
806605 AJ B857BY M'
8!!114Q AB 002331' ss 89235JJI CM
92!l76G AA
'
Descri!llion
6
I ' 1!1 '
~ NAIC
I Bond Desig.
CHAR na~on Acl!!aiCost
B
'"" Used
" Obtain Blir
Value
,,,_, _________ ..,_:=:=:~~===:=~~~~~: I:=~ I •• I .. 104.;(18
117266 .. 102361
IAmeritanl
I
BARCLAYS BANK r>LC ...... -----
~CLA~SBANKPLC .. _ ·--·-·
CHEVRON 1
CITBanL
COSTCOI DIAGED F
HEWLETT-PACKI\RD CO ....... - ..... IBM CORP ................... .
.... - ... --· .......... 1 .. 1FE - ......... 1,081,050 ...... 102.690 _________ , _________ , ___ s..... .. ...... _ ....... 1 ................ .254,4SQ ...... 102.520
$..... . ..... 1 ·-- 50,000 __ 100218 S--- ____ 1 ................. 50,109 ...... 100.312 s ..... - ·- ...... """1 , ______ , .. ,150,000 ·--100.207
S ..... R ...... . ..... 1 .......... 250,000 ...... 100.750 R __ ........ 1FE .............. 1,000,000 ...... 100.903
·--· ·--· R --·-·-· .. 1FE --.. --... 727,300 ...... 102.350 .......................... $ .... R . . ...... 1 ........... - .. .250,000 ..... 101.607
.......... 1FE ---.......... 562,755 ...... 107.848
....... ·---1 .. 1FE --·---.288,763 ---110.376 ____ 1 .1FE __ 1.000.000 ___ 97.631
s.... .. .......... 1 _____________ 250,000 ...... 100.471
....... .. .......... 1FE .............. 1,005,940 ..... -98.147 R ........ _ ... 1FE .............. 288,735 ...... 108.377
.......... 250,000 ...... 100.953 .250,000 -.100294
....................... 1F.E ............... 344.430 ...... 110.346 . """' ,_ ......... 1FE ............. ..335,031 ---102.359
s..... ·-·--·- ----1 ---·-- ... .258,090 ...... 100.440 ....... .. .... 1 ..2FE ................ .453,225 ...... 100.958
---------------- .1 .. 1FE __ ...... .579,105 .. 115.081 .......................... --· .. -----·- .. 1FE ---------..544.805 ...... 100.909
JPMORGANCHASE&CQ ______ ·-----·---.. ----·---·- --· .. ---·- .. 1FE ......... - . ..374,757 .. _.101.S<:8 JOHNSON & JOHNSON--.... - .... - .................... --........... -... ....... .. ........ 1 .. 1 FE .............. .304.535 ...... 114.540 MEiliFEINC......................... ..................... ........................... ........ ....... .. ............ 1FE ............ 222,885 ..... 10l.352
MICROSOFTCORP............ ........................ ............................ ........ .. ............ 1FE ........ 2.571,505 ...... 101.1413
RnVAI RMIIK'n~~A~IAnA """'"'" ---------"""""'"" ... _, __ _
____________ ::~.=.: ______ .. ____ -~- !=:= I ~ 1.= .. :--:: I==:~ I ::==:=::=:::::~ 1 .. :.: :~~:: , ___ ,55,000 ___ 100.741
......... 308.500 ...... 115.582
...... 1,003,890 ....... .98.912 ..... 720.150 ...... 103.572
... - ... 4-96,965 ........ 98.150 .. _ . .263,4S3 ...... 100.708 ........ 549,755' ...... 106.851
'
Blir ~
....... 255'.300 50,109
.... .50,158
·--150,401 ........... 251,875
.......... 1,009,030
----......... 575,510 254,015
............ 539,240 ... 275,940
978.310 .... 251,178 .... 981,470 ... 270.943
252,383
"'·"' 314,486
·---307,077
10 11
~alue __ Book!Ati)Usted Call)lingValue
... ..251,250
...... 660,000 .............. .571,692
..... 250,000 ............... ..250,000 ___ ,500,000 ........ ..528,922
... 250,000 ------- . .274,287
.1,000,000 -1,000.000 ,_250,000 ,_, _____ .250,000
.1,000,000 ............ 1,004,828
...... 250,000
..... 250,000 .285,000
...... .300,000 ....... 246,078 _________ .245,000
.403,832 ............... 400,000 ............ .402,332 575,405 ................ .500,000 ............ .577,7fH
........ .504,545 -----------..500,000 ............ .502,60>! ...... 356,468 ................ .350,000 ............... 352,579
... 286,350 .............. .250,000 ................ 289,906 - 2ll4,704 - -- .. ...200,000 - __________ ..202.833
2,528,700 ............ 2,500,000 ............ ..2,507,123 ...... 520,380 .............. .S1JO,OOO .............. .511,6il1 -- 251,058 - _____ 250,000 -- --- ___ 250,000
...... 196,851 ----------190,000 ............... 196,SS9 ·------.55,408 ........ - ....... 55,000 ......... - ....... 55,000
288,955 ................. 250,000 .............. 293,249 ... 989,120 .......... _.1,000,000 .............. 1,003,078
.. 725,0ll41 ................. 700,000 ..... .490,750 ................ 500,000
... 249,756 _________ .. .246,000
... 534,255 ................ .500,000
------ .... 710,925
"I ............. 497,0" .............. 249,6 ............ 517,330
12
Unrealized Valuation
""""' (Decrease)
13
,_, 1
Year's {Amortization)!
Ar:cretlon
.,. ,- ..... ,
.... J9461
1-
------\''
14 15
I 1S
I H
curmnt Year's ToWJ
Other· Than- Fotllign Tempora~ Exchange Efleclive lmpaii'I'I'ISnt Change in '"" Rate Recognized BJAC.V "
,, .......... 5.000 ......... 1.134
------------------ ·-------5.000 ,_ ..... o.ats
------.. 1.900
------- _.1.629
......... 1.1
... 1.090
I " I 18 I _,. Amount
"""" Due and
"' -· "'· . -·-· ..... 1,042 AD ...... ___ , _______ 3,575
IM, ..
FA, __
MIL .• ·-·-·--·---663 MN .... ........... ........ 72 FA. ..... ------------..235 FA.. ... ----------1,0(12 MS ...... . ......... 1,306 AO _____ .............. ..4,SOO JJ... .............. 16,302 JO_ ... ______________ .325
AO __ ___ 4,490
AO ... .. ........ 3,438
JD ... .797 MN .... ·- .......... ..525 JD ....... .. .......... ..500 AD ...... ____ .... ...2,319
FA.. ..... -------.. -1,336 .!J, .. ,_ ................ 1,2a2 MS ... ....... - ...... 0,790 JD .... _ ________ 1,006
MS ... ......... ...2,796
20 " I " Amount -· Received Conlrar:tual During Maturity 'Nf AcqUii'S~ '"' ,_, .... 12,500 11/2412010 12101/2014
.............. 14,300 OS/2012012 1010112017 12100/2010 1110112014
---·-"-",._._." 0012312011 Oa/1512015 --------.5,500 0812212011 05/1812016
·-------------725 0511!!12011 0512712014 ___________ .. sno 08/11i12011 Oa/1112014
---------2.550 0712512012 0810212017 ................. 09120/2013 10IOt/20ta
............. 21,000 1010412010 1010712015 _,, ___ 34,320 0611612011 071101201~
........ - ..... 4,77li 1112Bi2011 12107/2016 .... ___ 28,500 11101/2010 1013012015
--------13,750 0812012012 0410112016 -- 11,040 01128J2013 11/0S/2017
.......... 3,625 11108/2011 1111012014 ______ 11,500 0112212013 1211512017
___ , ___ ,13,250 0910712010 1012812015
. .3,750 0812212tl11 0812412015 ... 3,000 07127/2011 07/29/2014
. .. _ ... 19,665 11/08n.D10 OS/1512015 ____ 16,950 0611312011 001!1912014
................ 8,575 0712712011 0310412014 ---·----24.~0 0411312010 0310112014 ----- ............. 1210412013 0911412011 --------24.375 0811312010 0311512014 ______ ... 16,275 04113/2010 0610112014
.......... ,_.13,875 0812012012 OS/1512011
..... - ...... 11,000 0812612010 0611512014 ........ 13,750 02103/2010 0610112014
....... - .... 13,125 11/0812011 121151201: ___ , __ ,2,000 11/0812011 1111712014
.... , .. ,_,_,7,020 Oa/1612011 0511312014 ................... 605 08101/2012 08/10/201E .............. 15,000 0812812012 0911512017 ............ 10,000 0111812013 0612612017
·--·-· .17,&10 10114/2011 071141201E ...... 1112012013 1010512017 8,5'56 0810912011 0411612014
......... .25,000 10101/2010 OS/15/201:
m ~
c N
StatementasofDecember3t,2013oftM Vision Service Plan
CUSIP Descrtplion lderrtificalion
931142 CX 9iWAL-MARTSTORESINC ...................... _. .• 95980Z AJ SIWESTERN UNION CO/THE... ....... ................. 98458P AB 11 YALE UNIVERSITY.-~·~·-·~ .. -·~ ...... ~ ....... - .... - ..... ~·-· 89120 14 4 WORLDS FOREMOST BANK NE.H .. ·~-·--..... ~ .. .. El9122 BZ 7 WORLD F!Nl NETWORK NATL ...
3299£199. lndusl!ial & Miscellaneous IUnaffirialedl-lssuer Obliaations __
3B99S99. Total Industrial & Miscellaneous lllnaffiliatedl .. ~ .. -~ .......
Totals
7799£199. Total-Issuer Oblit!alions--............ . 8299999. Grand TDhll- Bends. ........... ..
$ ... .. $ .. ..
Codes
"' F
.. 1FE
.. .... 1
• ..... 1
I II
SCHEDULED • PART 1 Showing all Long-Term BONDS Owned December 31 of Current Year
Fair Value 10 I 11 Chanae in Book/Aai
"" u.~
~ 12 I 13
Actual Cnst
• Obtain
~' Value
. ........ .498.000 1 ...... 101.937
Fliir Value
.509,085 .... .229,953 . .. 100.904( ................ 21l1,60B
Par Value
... .500,000 .............. .200,000
.... 615.387 ................ 1iS2,00D .. .... 200,000 ............... ..200,000
..... - ... - . ..200,000 --------.200,000
............ .,,OLU,Oo<l 1-.N'oA..---- I ............ 19,3~1.191 I .......... 18,880,000 . 1s.1120.a54 l .... xxx ...... I .......... 19,321.191
..37.342,376 ....... .36.427,575
.. .. 37,342,376 ........ 36,427,575
.. ta.aao.ooo
.... ..35.571,000
... ..35,571,000
Book/AOjusted Carrying Value
.... 499,353
.201.3551. .. SSB,S77 -
..200,000 • .200,000
Unrealized I Current Valuation I Year's lntreastJ\ (Amortizafion)l
IDemease) ACG!!!Iion
...... .349
... : .. = .. ;::~:I==::: - :-~::~~~ ..................
...... 19,228.668 --- ............ .:...0 ... 217,714' 19,.228,666 ...... -.... -~ .. 0 .. 217,714:
. .30,.241,663 1--·----.36,24t.663 _._ ... :::~~::~ 1 ........ ::_;~:::;
>ledCa~inqValue 14!·
cuJm Yeats
Dther-\han-
1~;~~~ ~(Uzed
.L ..... 0
" Total
Foreign Exchange Change in BJA.C.V.
ffi
Rore of
.......... 1.500 ....... S.500
lntera;t
" 18
.2.0031 FA .....
" ADmitted Amount Due and Accrued
..... 1.375 .4,514
.. 3,S24 ................... 44
............. .. ...... - ......... 197 .......... 0 ............ 132,815
.... xxx. ..... l ... .xxx .... I .XXX ... .. 132,815
o ... ~ " "
Amount '""' Rec~ived Contractual During Maturity
''" A(X1uired Dore
.... 7,500 06/2312011 1012512015 ... 13,000 09107/2010 0212612014 .17,168 1212B/2010 10/15/2014
........ .3,200 05/1912011 0512712014 .. 4,000 0910&2011 0911412016
... 535",275 .... .XXX _ __ .XXX
... 535.275 ] .... .XXX. ..... .. .. .XXX.._ ..
·'1=1=1= ... .XXX.. ......... .XXX. ..... .XXX. .. .241.945 1 ............ 918,430 l .... xxx .... I .. .X>C< .... I 241,945 1 ............ 91~,420 I .... xxx. ..... .xxx. ...
S1a1emen1asofDecemller31,2013olthe Vision Service Plan
Sch. D-Pt. 2-Sn. 1 NONE
Sch. D-Pt. 2-Sn. 2 NONE
E11, E12
m ~
"'
StatementasafDecemberSt,20tSofthe Vision Service Plan
; CUSIP
ldenlblion
3130AO F5
313382 3B
3133EC DE
3133EC JQ
313400 SD 3136G1 TR 3136Gt VQ
' Desortplion
FEDERAL HOME LOAN BANK ····-·····-·-··· FEDERAL HOME LOAN BANK. ...
FEDERAL FARM CREDIT BANK.-··-·-··· FEDERAL FARM CREDIT BANK._ ...
~~~~~~~~
I ,,
----1 ....
~= : ~I ~~=~ ~~NR~.~:::~~:=:::~~:~~:~~:~~:~··::~~:~ ··--··-···-····-................... .. 22160K AE
.moo ru 8B579Y AE
OS
9009999.
·!~~~~~~~~-~~:.:::.:.~::~::~~ :: :=:::::::::::~:1 ::~:
, .. Atauire
Showing all
' "
SCHEDULED- PART 3 m-T""rm Bonds and Stocks ACQUIRED Duri~g Current Year
' • n~ nfV, _ Numb~r_ol " ,, • e
"'
o,wo
OMO
..... 4,250
..•.. B,750
~
StatementasofDeoernber31,2013oflhe Vision Service Plan
SCHEDULE D ·PART 4 Showing all Long~ Term Bonds and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year
Num!leroi
I "'""""'" I CLJSIP ~~~ D~:ar I I Shares ,.
"''' ldentffication Descril)tion Name of Purchaser oiStock Value "" Bonds .u.s. States, Territories and Possessions
20772G PS 1 CT SERA. ... ~·-··········~--·····~·····-··---··--·~···· .... 300.000 ..•.•.•. 3il0.000 .......... .331,094
452151 JZ 7 ILST--···-·-·-·····--······-····~·····-- ·····~·· ...................... ····I·····- ·················I 882722 DX 6 1)( ST-8-WTR FINLASST .•.• ···········~ ·····~·····~·
... 525,000 ..•.•... .525,000 ···-·- .568.738
... 345,000 ........... 345.000
92.4258 WN 2 VTST-3ERE .. ~····~·~·····~-·-~·····~ ············~·-··~ 17999BS. Total- BonOs- U.S. States, Territn~es & Possesslons •.•.•..•.•..•.•.
Bonds- u.s. Pollllcal Subdivisions of st<rtes
210161 DB 0 COOK ETC.~·~·-··-~··~·~ 940642 AW 1 WA HLTH El.ECi"IONA.._ ..
·-·1···112101/2013.1Maturlty ... __ -· 08101/2013. Matu,·
24999BS. Total- Sonds- U.S. Political Subdivisio!l$ of Stoles ...
1 011ss2 P4 161045 GS 3133XS P9 3136FR S3
I S4S902 GK
:0:1 0641laH SK
318495 EA
AKHSG1ST
.
1
CHARLOTIE 'IYI~--~ I FEDERAL HOME LOAN
:~~~ : ~I~~~~ ~~;'"~~~UP INC~ -~--:..:::::::=: 4426CR "AA 5 HOWARD HUGHES MEDICALIN •• 46620H AT 7 JPMORGAN
I !>4B746 FJ
" .
979BS96 S7BBSBS
~~~
I o;~;~~;~
:1;;row.
·-·110,000 .1.280,000
..•. 250,000
···~·910.000
. .. 1,160,000
. ····-···382,855 _____ 110,000 ---···122,019 ·-····1.280.000 ··--·1.404.81S
1
·_·_·--··220.000 1"""~·~··244,113 ···-·-··-·100.000 ---110.533
-·-··1,000.000 ···~--1.000,387
···--··.750,8:J.B ·~·.274.028
.....•.. 300,000 1······ ... ~,M1 ·····~ .200.000 ......... 200,000
·····- • .250,000 ·-·- .. .250,000 548,120 .532,105
·····~····500.000 ······~--.500.000
-·~·-····500.000 •.•..•.. 1.QQOMO
···-·~··541,305
·--- ~--·~1.080.505 ..... 593.000 ····~·-···617,041
·~-.9279,631
" 11
Prior Year eoo< I"~" .. I Ad- valuation
Carrying Increase/ Value (Decrease)
···~···-~·.309,344 _.531.453
···················~
...•..•..•. .303.271
.•.•.•..•• 112.805
······~-~1.306.674 ............. 0
C~n BockfAd"usted Ca i Value 12 " " " Cuuent
Year's Total Current O!her-Tllan- '"'' Foreign Year's Temporary Change in Exchange
(Amorli.ationy lmparnnent BJA.C.V. Cflangein Accretion Recognized (11+12-13) BJAC.V.
..•. (9,344)
----1'"''' ..... (0,403)
::::~:~::::::::~:: ::= :::=~~~:~1:: ···-·-····-·· ··- ..... (8.271)
·····"'"· ·-·· 28,874 ··-······-··-!!.l- ·-· 26,674) -·---0
1 ~:~al~ :~ ~~=~;~!~~I=:~=~~
" eoold
Adjusted Gafl;'ing
Value atDispoS<ll
"" ~-~.300.000
·--025,000 _.345,000
•. _.110.000
·-·····-1.28\l.OOO
12
Foreign Exchange
Gain tw•l
00
DiSPOS!II
.0
'" Rear!Zed
Gain I'= I
00 Disposal
···~··0
" ! - 20 I " Bond ln!eresV
Total
~d I' Gain Dividends Stated (Lrlss) Received Contractual
00 Dllring Matun1y Dis osal Year Date
.. 0 ·····-.12.000 ,.,~011 0 ·····-·13,125 06101/2013. 0 ·····~-17.250 0810112013.
.. 0 ...... ~..5,500 OBJ1512013.
... a ..... _.47.S75 =-~ .. a ..... _.t2,soo 121011201~
a .. _ . ....ss.1so 0810112013. ~-····-~·····~
··-·····-·-··· ............. 0 ·-.OJ..: ..... 71,050 .. ~.XXX. ...
~20.000 ~------···1·····-····-·-·0 1····------0 _100,000 ·-········ ··-···--····- ·~··~~·····~·0
--····-··1,000,000 ·-·· .. --.- -·-····~-~-·~ ····-~·····~·0 .750,000 ···········-·-··· --········-·····- ··-··-······0
.. - . .3,722 06101/2014.
··-··5,000 07101/2013. ........ 31,250 121'!312013. - -··~·10.500 0910012015.
-~...1!.375 1211512013 . .. ~.XXX •..•
1--~~~-=-~~~~~-~ I =:~:=::~==: I~==:::~~~) I:::::==:~:::: I::::: ==~~:~~~ ! :=~ ···-~-D ...... ~ . .3.375 1111!!12013.
··~·(137,658; -····0
... ~.0 ..... -2S,250 1011512013. .7,344 ........ 16,532. 1}9/01/2014.
...•...... a ..... _.14,375 01/0212D13.
·····-~·····~·0 ·····~-49,500 1011612013. .14.212 ~-~·-·.8.984 1011512014.
. .....21.557 I ~~· .21.557
-·~.XXX •...
:dS2: ... .XXX. •• ...XXX •••• ...• .XXX.
-=
- --·--···- ·-··-·- ·-· --·------~-------~----
m ~
"'
statementasofDecember31,2D13oflhe Vision Service Plan
'
CUSIP ldenlificalion
'
Descrifrlion
12~:~~ : ~I ~~7L~;~~~;~~~-~;;;~~~----93999S!
9799998.
ls9Ss9Ss.
'
I ""' ~
Jl
SCHEDULED ·PART 5 Showing all Long-Term Bonds and Stocks ACQUIRED During Year and Fully
5 6 7 I B 9 10
illame of Vendor Disposal
"" ooH•••-•••••oHo•H•o•••••·:= I ::::~~ I
f'arVall!Ei (Bonds)
" Number of Shares
'"" A~~ I Co!l!lidera~or
"'" !Adjusted
ie:~~~~ 1~---
'--
. ' OF Durmg purrent Year H '" " , I , , I I" " " '" c~rrent Interest
Yea~s Total Foreign Realized Total and Paid!or Unreal!zed Current Olher-Than- Total Foral£n Exchange Gain ~in Dividends Accrued Valuation I ~ear's Temporary Change In Exchange Gain ''""' (Loss) Received 1 Interest ln~re;~sE!I (Arrimti2>!Uon)/ lm)l'lirmenl BJAC.V_ Change in (Loss) on '" '" During I ~" (Decrease) Abuon Recoqnized (12+13-141 BJAC.V. Dtsoosal Disposal Disposal Year DiVIde:
... :~:=:=~:~- ---~--:-~.: .. ~ I :::~::::::::~:::~ I ::~::~~:::;~ I~~::~:~::::::
....... .so . •.• 0
statementaso1December31,20i3oflhe Vision Service Plan
SCHEDULE D • PART 6 ·SECTION 1 Valuation of Shares of Subsidiary Controlled or Affiliated Companies '
I 2 3 4 5 • 7 • Stock ofSUcll NAIC NAIC Yai•JaUon O!linSUrll~S Company Owned by
Company Method Assets Include IIISIJrllr on Statement Date Code or Allen {See&/0 Intangible Assets Totall\mOUllt 9
I '" CUSIP Oesctlpllon ~~- Ptlrposesalld Connecled with o!Such Book/Adjusted ldentlfi· Name ol Sllbsldiery, Controlled or ldentlficatiOII Prooodures c~~~n~~ :~~~ Intangible Cenylng Number of %ol
~'"' Affiliated Com Fore! n Number Manual Assets Value Shares Oulatandino
1. Amount ollnsurer's capital and sl{fllus from lha p!ior period's statutory statement reWced by any admitted EDP~ goodwlll and net del81md tax assets locluded therein:$ ........ 0.
2. Tolalamounl of intangible oosets nonadmitted $ .......... 0.
NONE
. . SCHEDULE D PART 6 SECTION 2 I 2 3 4 ~~:J~~ ~~~!ro~:en~=e T otet Amount of
Name of Company Usted In lntangiblellssets
N"'b" :ISh"'" I • CUSIP Section 1 Included in
ldenliij- Which COntrols Lower-Tiei Amount Shown In cation Name oflower-Tlar Com Com Column 7, Section 1 % ol Outstandltl!l
NONE
E16
m ~ ....
StatamentasofDecernber31,2013oflhe Vision Service Plan
SCHEDULE DA ·PART 1 Showino all SHORT-TERM INVESTMENTS OWned December 31 of Current Year
CUSIP Identification Descrip1ion
Exempt Monev Markellllutual Funds
233BOW 52 3j DAILY INCOME US GOVT-AO ...
I Cedi 4
'I ''" Ccdeln ~ireoi Name of Vendor
...... ,_, 12121l1201~.1 Direct •.. _ ........... ·-·--.. -·----·
Cha!l!!e in S~ck!Adiu!ited Cartvinq Value 10 11 12
Maturity , .. Yoo' Adjusted Carrying
Value
.XXX. •..• 1 ................. 13.064
Unrealized Current Valuation Yea~s · lncrea~ (Amortization)/ I Decmse Accretion
Current Years
Ot~ar-ThanTamporary Impairment RefQ@[_zed
·-.... :=~-:=:==I::::::::::::~~~:: 1.:::::: .. ::: :::~ I:: ::::::: :::~:~ I:~:~:~::=~~~::~ I
Total Foreign
&change Cha!lllS in 6JA.C.V.
Q
·----0
"
"' ""
"
"'"' Cost
" Amount Dm:and Accrued
December31 of Current I Yearon8ond
Not in Default
13.de4 '---···-······13,t:l54 '···--······-·-··.11
" Non-
Admitted Due and Al:crued
. ::::~::==::t::_l :::::=:::::::~~::I::::~::::::::::::~~ I~::::::::::::--
Interest -, " " ts 19 20
Amoom Received I Paid for I I '~"'·I Who• I During , Accrued
Rille of Rate of Paid Year _L Interest
.. _0,010 1----·----·1 NIA.. ...
=-1-=-1= .. .XXX... . . • .XXX...... ..XXX .. :::~ 1:: :::;J
statementasofDecernbsr31,2ll13oflhs Vision Service Plan
Sch. DB-Pt. A-Sn. 1 NONE
Sch. DB-Pt. A-Sn. 2 NONE
Sch. DB-Pt. B-Sn. 1 NONE
Sch. DB-Pt. B-Sn 1 B-Broker List NONE
Sch. DB-Pt. B-Sn. 2 NONE
Sch. DB-Pt. D-Sn. 1 NONE
Sch. DB-Pt. D-Sn. 2 NONE
Sch. DL-Pt. 1 NONE
Sch. DL-Pt. 2 NONE
E18,E19,E20,E21,E22,E23,E24,E25
statemen!asCifDecember31,2013oflhe Vision Service Plan
SCHEDULE E ·PART 1 • CA~~S;:-H~-----,--,----;c---,-----,,-----,--,-,
0 en De sitoties
Union Sank of Calffomia- Cher.king ...• BsnkofNilW\'Olk ................................................ , .. .
Walls FargoAdvls001 ... . Union llanlt .............................................. .
0199999. T olal- Open DeposHories .••.
0399999. Total Cashon De sit....
0599999. T ols1 Cash. ...
............................. 9,243,868
.........................•... 9,232,539
...•..........•.•.• .7,534,602
llejXJsltory Codo "''' "' Interest
• Sacramento, CA. ••• Naw\'0111:,~ .•.. . .•...•...•..•..•..•......•........•• SD.
Folsom, CA. .....•....•....•..••..•.....•..• ............................ : .. San Francisco, CA. •....
XXX .•......• XXX ..
. XXX ............. XXX ... .
. XXX .••••.••••.. XXX ••..
Amount of Interest Reooi~ed
During Year
. ....... 7
Amount of Interest A<:wled December 31 of
Current Year Balanoo
. .............. 9,930,293 XXX
. .•.......•....... 71,.446 XXX
• ••... 62,571 XXX . •............. XXX
. ...............•....•. 7 .....•..•....... 0 •..•...•..•. 10,070,310 XXX ..
. •••••.•..••.••••••••••••.•• 7 ............................ 0 •••••.•.••••.•• 10,070,310 XXX ••
. ............................ ] ............................. 0 . ..•. 10,070,310 XXX ••
10.0ctober ... . t 1. November ... . 12. Deoomber ... .
m "' .....
statementaso!December31,2013ofthe Vision Service Plan
Dtlscriotion
SCHEDULE E ·PART 2 ·CASH EQUIVALENTS Show Investments Owned December 31 of Current Year
NONE
Amount of interest Due &AW!Jed
Amount Receiv"d DurlnQYear
stateme~~tasofDecemOOr31,2013ofthe Vision Service Plan
SCHEDULE E ·PART 3 ·SPECIAL DEPOSITS
Slales,E\c, '""" D t 1. i\labama .............................. AL .
2. Alaska .................................. AK .
3. Arizona ............................... liZ .
4. Mansas ........................... AR . 5. California .......................... CA . 6. Colorado ......................... CO 1. CoiVleclirul.... .. ............... CT .
0. Delaware ............................ DE • 9. Diskicl of Columbia. . .... DC .
10. Florida ............................ FL .
11. Georgia ............................... GA . 12. ijavroll .................................. HI ..
13. Idaho ................................... .10 . 14. Illinois .............................. , .. ll
"· 16. 17. 16.
Indiana ... .IN .
Iowa ................................. .lA . Kansas ................................ KS . Kontucky ............................. KY .
19. Looislana ............................... LA .
2ll. Maine ....................................... ME .
21. Marylaod..... .. ..... MD .
22. MassachusaUs..... . ........... MA .. . 23. Mi<:lllgan .......................... MI ...
Purpose of
"" t
Oeposllsforlho Benefit of All Pollc holders 3 4
Book/Adjus1ed Ca · Value
Fair Value
11110\hsrSpoolaiDe sits 5 6
Book/AdjliS!ed Ca · Vakle Value
-------------I-24:--Minnasola.... .. ... MN c. =~h====================l=====•h====cl•=====l=====+-----------25. Mississippi.. .. .............. MS .
28. Missouri ............................... MO ..... . 27. Montana ................................... MT . 28. Nebraska .................................. NE
29 Newda ................................. Nil ...
30 New Hamj)Shire.... • ............... NH .
31. New Jersey ............................. NJ .
~1 . N~M~i@ --·----=·~t!M 33. NewYwk ..... NY ....
34 North Carolina... .. .............. NC •
35 North Oalwla ......................... NO • 3£ Ohio..... .. ........................ Oij •
37 Oklahoma ............................. OK •
38 Oregon ................................... OR •
39 Penns)IVM!a..... . ........... PA ..
40 Rhode lstalld ............................. .RI .. 41. BoulhCaro~IW .......................... liC ..
Sooth Dakota ............................ SO •
43. Tennessae ............................... TN .. . 44. Texas ........ , ....................... TX ..... .. 45, Utah... , ................ UT , 46. 1/ermoot... ........................... VT ,
47, Virginia ................................ VA ...
48. Washingllln ......................... WA ..... 0 ... PledgedloWashinglooOIC .. .
49. West llifllinla ....................... WV .
50. Wisoonsln ............................ WI .
51. WJ'Oml119 ............................. WY .
52. American Samoa-................ AS . 63. Guam ......... .. ..... GU ..
54. Puerto Rioo ......................... PR .
55. USVIrglnlsl~nds. .................... VT .
66. Northern Mariana Islands ........ MP .
57. Ca~da .................................. CM:j . 5B. Aggregate Allen and Olher ........ OT .. .XXX ................................................................ XXX ...
59. Total ................................................ .XXX .............................................................. XXX .. .
5B01.
5802.
5603.
5698. Summary of remaining wrlta-lns !of ~oo 56 from <J\Ielflow page.... . .. XXX... • .......................................................... XXX .. ..
5B99, Total (Unesti801Ul!IJ 5B03+5698)
Line 58abovel.. ................................. XXX ............................................................... .XXX .. ..
. ........... 660,460 .................. 711,598
.. ..... 0 .............................. 0 .............................. 0 .............................. 0
.. ................. 680,460 ................... 711,598 .............................. 0 ............. 0
OET AILS OF WRITE-INS
.. ....................... , .. 0 ............................ 0 ............................. 0 ............................. 0
.............................. 0 ..o ............................. 0 .............................. 0
E28