american mutual insurance association - iowaamerican mutual insurance association john t. fiderlein...

American Mutual Insurance Association

John T. Fiderlein

151 N. 4th Avenue

Eldridge IA 52748

Iowa Company Number: 0126

December 31, 2016 - Annual Statement

J _k

ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

ASSETS

Assets

1. Bonds (Schedule D) ..... . ........................................... 4,513,262 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 by the company (less

$ ................................ encumbrances} .... .

4.2 Properties held for the production of income

.................... 5,815,411

..................... 190,323

(less $ .............................. encumbrances) ....................................................................... .

4.3 Properties held for sale (less

$ ..................................... encumbrances) .................................... .

5. Cash ($ ......... 2,221,166 ,Schedule E-Part 1), cash equivalents

($ ......................... , Schedule E-Part 2) and short-term

Current Year 2

Nonadmitted Assets

3

Net Admitted Assets (Cols. 1 - 2)

...... 4,513,262

...................................................... 5,815,411

Prior Year 4

Net Admitted Assets

..... .4,311 ,484

. ............. 5, 100, 153

.............. 190,323 ................. 199, 114

investments ($ ..... .76,891 ,Schedule DA) ...................................................... 2,298,058 ........... ...............2,298,058 ................. .2 ,547 ,708

Contract loans (including $

Derivatives (Schedule DB).

. ...................................... premium notes) .. .

Other invested assets (Schedule BA) ................. .

Receivables for securities .................................................. .

Securities lending reinvested collateral assets (Schedule DL) ................... .

Aggregate write·ins for invested assets ............... ................................................ . ............................................................. .

6.

7.

8.

9.

10.

11.

12.

13.

Subtotals, cash and invested assets (Lines 1 to 11) .... .... ...... .......... . . .................. 12 ,817 ,054 ..................................................... 12 ,817 ,054 Title plants less $ ........................................ charged off (for Title Insurers

only). . ................................................................................... .

14. Investment income due and accrued ..... .. 35,546 ..... 35,546 15. Premiums and considerations:

15.1 Uncollected premiums and agents' balances in the course of

. ........... 12, 158,460

. ....... 30, 131

collection ........... . ............................................................ . ........................... .8, 718 ................ 310 ......................... .8,407 ....... . ........... 10,380 15.2 Deferred premiums, agents' balances and installments booked but

deferred and not yet due (including $ ........................................ eamed

but unbilled premiums) ......................................................................................... .

15.3 Accrued retrospective premiums ($ ....................................... ) and

contracts subject to redetermination ($ ........................................ ) ....................................................... .

16. Reinsurance:

16.1 Amounts recoverable from reinsurers ................................................................................. 13,694 ................................................ 13,694 16.2 Funds held by or deposited with reinsured companies.. . ............................................................................................................ .

16.3 Other amounts receivable under reinsurance contracts .................. .

17. Amounts receivable relating to uninsured plans ..

18.1 Current federal and foreign income tax recoverable and interest thereon .. . ....................... .45, 000 ........................ .45,000 18.2 Net deferred tax asset .................. .

Guaranty funds rec~ivable or on deposit 19.

20. Electronic data processing eqUipment and software . ................................................................. .8 ,416

21. Furniture and eqUipment, including health care delivery assets

($ ......... ) ................. 18,312 22, Net adjustment in assets and liabilities due to foreign exchange rates ..........

Receivables from parent, subsidiaries and affiliates ............................. .

Health care ($ ......... ) and other amounts receivable .. .

23.

24.

25. Aggregate write-ins for other-than-invested assets ................................................................ 1 ,575 26. Total assets excluding Separate Accounts, Segregated Accounts and

Protected Cell Accounts (Lines 12 to 25) ............... . ................. 12,948,313 27. From Separate Accounts, Segregated Accounts and Protected

Cell Accounts .... ... _ .. _ .. _ ......................................................................................... _ ...................................... .

28. Total (Lines 26 and 27)

DETAILS OF WRITE-INS

1101.

1102.

1103.

12,948,313

......................................... .8,416

... 18,312

. .......... 500 .......................... 1 ,075

.... 64, 122 .... 12,884,191

64,122 12,884,191

1198. Summary of remaining wnte·ins for Line 11 from overflow page ................................................................................... .

1199. Totals (Lines 1101 throuah 1103 plus 1198) (Line 11 above)

.. 4,061

....... 1,286

............ 12,204,317

12,204,317

• ~501. IMT Overwrite Fee Receivable..... . .......................................................... 1,000 .................. . . .......................... 1 ,000 ...................... 1,170 ~502. Supp lies... . ..................................... 500 .............. 500 ~503. Investment Proceeds Receivable..... ...................... . ............................... .15

~598. Summary of remaining write-ins for Line 25 from overflow page ..

12599. Totals (Lines 2501 throuah 2503 Dlus 2598) (Line 25 above)

See Independent Accountant's Campi lation Report.

1,575

2

......................................................... .15

500 1,075

.... .116

1,286


LIABILITIES, SURPLUS AND OTHER FUNDS Current Year

2 Prior Year

1. Losses (Part 2A, Line 35, Column 8) .. ...................... .434,748 ....................... 807,886

2. Reinsurance payable on paid losses and loss adjustment expenses (Schedule F, Part 1, Column 6) .....

3. Loss adjustment expenses (Part 2A, Line 35, Column 9) .......................................... ........................ 27,632 ......... 54,102

4. Commissions payable, contingent commissions and other similar charges .. ........... 36,490 ........................ .41,297

5. Other expenses (excluding taxes, licenses and fees) ................... __ .. .

6. Taxes, licenses and fees (excluding federal and foreign income taxes) ....

7.1 Current federal and foreign income taxes (including $

7.2 Net deferred tax liability.

8. Borrowed money $ . ________ ... ____________ ........... and interest thereon $

on realized capital gains (losses)) ....

9. Unearned premiums (Part 1 A, Line 38, Column 5) (after deducting unearned premiums for ceded reinsurance of

$ ................................... and including warranty reserves of $ ........................ ___ .. ' ... ___ ... and accrued accident and

................ .7 ,080

............... _ ...... 1,194

.. ...... 10,655

.. .... .906

health experience rating refunds including $ ........................................ for medical loss ratio rebate per the Public Health Service Act) ............................................. .. ............................................................................................... 1,071,735 ................... 1,048,811

10. Advance premium .....

11. Dividends declared and unpaid:

11.1 Stockholders .. ..

11.2 Policyholders ............................................................................. ..

12. Ceded reinsurance premiums payable (net of ceding commissions) ....................................................... . .. ..................................................... (4,458) .......................... .4,628

13. Funds held by company under reinsurance treaties (Schedule F, Part 3, Column 19) ..

14. Amounts withheld or retained by company for account of others .................................................. .

15. Remittances and items not allocated ................................... .

16. Provision for reinsurance (including $ ............................ certified) (Schedule F, Part 8).

17. Net adjustments in assets and liabilities due to foreign exchange rates ..................................................................................... .

18. Drafts outstanding ........................ ..

19. Payable to parent, subsidiaries and affiliates .............................................. .

20. Derivatives

21. Payable for securities.

22. Payable for securities lending

23. Liability for amounts held under uninsured plans .................... ..

24. Capital notes $ ................... and interest thereon $

25. Aggregate write-ins for liabilities ....................................................................... .. ........................................................... .43,238 ............ 36,280

26. Total liabilities excluding protected cell liabilities (Lines 1 through 25) ............................................................................................................. 1,617,660 ................... 2 ,004 ,565

27. Protected cell liabilities .....

28. Total liabilities (Lines 26 and 27) ...................................................................................................... .. . .................. 1,617,660 .................. .2,004,565

29. Aggregate write-ins for special surplus funds ......................................................................... .

30. Common capital stock ....

31. Preferred capital stock .................................. .

32. Aggregate write·ins for other-than-special surplus funds

33. Surplus notes ............................................................................... .

34. Gross paid in and contributed surplus ......................................................................................................................................................... .

35. Unassigned funds (surplus). ................................................. 11,266,532 ..10,199,752

36. Less treasury stock, at cost:

36.1 shares common (value included in Line 30 $ .......... ) .......................................................................................................... .

37. ::':PIUS as regards POliCYhOlder::~:: ::::;; ~::~u;~~~;:ge: ~~ ~~: :;)~ ........................... ·············)·::·:::1WL .. f. ___ ..:.1.!.,1,"'2"'66"',"'53"'2'-1-___ ..:.10"',"'1"'99"',.!.,75"'2:-

38. Totals (Paoe 2, Line 28, Col. 3) 12,884,191 12,204,317


2501. Accounts Payable· IMT. .......................................................................................................................... . ........................ .43,238 .. ...................... 36,280

2502.

2503.

2598. Summary of remaining write-ins for Line 25 from overflow page ............................................................................................................................................................................... ..

2599. Totals (Lines 2501 throuoh 2503 Dlus 2598) lLine 25 above)

2901.

2902.

2903.

2998. Summary of remaining write-ins for Line 29 from overflow page ..

2999. Totals lLines 2901 throuah 2903 Dlus 2998) lLine 29 above)

3201.

3202.

3203.

3298. Summary of remaining write-ins for Line 32 from overflow page ............................................ ..

3299. Totals (Lines 3201 through 3203 plus 3298) (Line 32 above)

See Independent Accountant's Comp' lat Ion Report.

3

43,238 36,280


STATEMENT OF INCOME

UNDERWRITING INCOME 1. Premiums earned (Part 1, Line 35, Column 4) ........ .

DEDUCTIONS: 2. Losses incurred (Part 2, Line 35, Column 7).. .. .................................. . 3. Loss adjustment expenses incurred (Part 3, Line 25, Column 1) . ......... . ............ .. ................ ..

Current Year

.2,543,233

2 Prior Year

........ .2,593,667

................... 1,985,851 .. ............. .200,959

4. Other underwriting expenses incurred (Part 3, Line 25, Column 2) ......................................... .. .............. ..

.............. 1,125,835 ........................ 142,902

................. 859,265 .. .................... .798,630 5. Aggregate write-ins for underwriting deductions ..................................... ........ ................... .. ............................. . 6. Total underwriting deductions (Lines 2 through 5) .................................................................................................... . 2,128,001 2,985,440

7. Net income of protected cells ...... .............................................. ....................... .. ................................................................................... .. 8. Net underwriting gain (loss) (Line 1 minus Line 6 plus Line 7).. . ......................................... .. .... ..415,232 ..................... {391,773)

INVESTMENT INCOME

9. Net investment income earned (Exhibit of Net Investment Income, Line 17) ...................................................................................................... 202,349 ....................... )~~', ~~~\ 10. Net realized capilal gains (losses) less capital gains tax of $ ............................... (Exhibit of Capital Gains (Losses)) ...... >-___ -'1.!:13<.!,"-57~0~-----'-"'== 11. Net investment gain (loss) (Lines 9 + 10) ............................................................... .. ................................... 315,918 .......... 96,139

OTHER INCOME

12. Net gain (loss) from agents' or premium balances charged off (amount recovered $ amount charged off $ ........................................ ) .................................................. .

13. Finance and service charges not included in premiums... .. ......... ........................ ............................ . ................... . 14. Aggregate write-ins for miscellaneous income . .. ................... .. .................................................................... .. 15. Total other income (Lines 121hrough 14) ..... ................................ .. ........................................ . 16. Nel income before dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes

(Lines 8 + 11 + 15) ................. ........... ............... ................................................ .. .............. .. 17. Dividends to policyholders.. ... ............................ .. ............................ ..

........................... 6,439 51,510 57,949

..... .789,1oo

.. ............ 6,301 62,454 68,755

... (226, 878)

18. Net income, after dividends to policyholders, after capital gains lax and before all other federal and foreign income taxes (Line 16 minus Line 17) ...... ................................................................................. ......... ....................... .................... .. ...... .789,100 ..... {226,878)

19. Federal and foreign income taxes incurred ...... .. ......................................................................................... I-____ 4::3~,~76,,7+ ___ --,~9~2:.!.,:::36~3':_1 20. Nel income (Line 18 minus Line 19) (to Line 22) ...................................................................................... .......................... 745,333 1319,241i

CAPITAL AND SURPLUS ACCOUNT

21. Surplus as regards policyholders, December 31 prior year (, Line 39, Column 2) .................................... 10,199,752 ................. 10,792,582 22. Net income (from Line 20) ............................ .. ............... . ........................................... ..745,333 ..................... {319,241) 23. Net transfers (to) from Protected Cell accounts. .. .............................................................. .. 24. Change in net unrealized capital gains or (losses) less capital gains tax of $ .................. .. ....................................................................... 347,329 ..................... {327,674) 25. Change in net unrealized foreign exchange capital gain (105s) __ ....................... _ .... __ ..... _ .... __ ..... __ ., ........................................ .

26. Change in net deferred income tax .................................................................. . 27. Change in nonadmitted assets (Exhibit of Nonadmitted Assets, Line 28, Col. 3) .. .. ....................... (25,883) ......................... .86,272 28. Change in provision for reinsurance (Page 3, Line 16, Column 2 minus Column 1) 29. Change in surplus notes--______ __ ______________________________________________________ . ____________________ __

30. Surplus (contributed to) withdrawn from protected celis __ 31. Cumulative effect of changes in accounting principles .... 32. Capital changes:

32.1 Paid in ______________________________________________________ __

32.2 Transferred from surplus (Stock Dividend) __ 32.3 Transferred to surplus ________ ... __________________ .

33. Surplus adjustments: 33.1 Paid in ______________________________ .. __ 33.2 Transferred to capital (Stock Dividend) ______________________________________________ . ______________________ . ________________________________________ __

33.3 Transferred from capital ______________________ . 34. Net remittances from or (to) Home Office ____ . 35. Dividends to stockholders ______________________________ __ 36. Change in treasury stock (Page 3, Lines 36.1 and 36.2, Column 2 minus Column 1) .................................... ...................... .. .................................... .. 37. Aggregate write-ins for gains and losses in surplus ...................... ....................... .. ............................................................. >-______ -+ ____ ~ (:32,-","1~85"-,\ 38. Change in surplus as regards policyholders for the year (Lines 22 through 37) .......................... . 1,066,779 1592,829 39. Surplus as reoards policyholders, December 31 current vear (Line 21 plus Line 38\ (Paae 3 Line 37\ 11 ,266,532 10,199,752

DETAILS OF WRITE-INS 0501. 0502. 0503. 0598. 0599.

Summary of remaining write-ins for Une 5 from overflow page .......... . Totals (lines 0501 through 0503 plus 0598) (Line 5 above)

1401. 1402. 1403. 1498. 1499.

Amer i can Mul ua I Agency - IMT Transact ions. __________________________ ...... __ . ____ .. ________ ... __ .. __ ............... ____ . __________________________________________________________________ .(958) ______________ ... __ {1 , 104) IMT Liabi lily Premiums - Income Less Expenses______ ... ____________________________________________________________________ .. ______ . ____ . __________________ .39,313 ____________________ .43,750 M i sce II aneous I ncome ____ . __ . __ . __________ . __________________________________________ . ________________________ . ________________________ { 190) __________________________ .8,586

Summary of remaining write-ins for Line 14 from overflow page ............ . ____ . ______________________________________________________________ . ________________________ .13,345 ________________________ .11,222

Totals (Lines 1401 throuah 1403 alus 1498\ (Line 14 above\ 51,510 62 454 3701. 3702.

Pr i ior Per iod AdjustmenL __________________________ . __________________________________________________________________ . ____ . ________________________________________ .{32,185)

3703. ____ ....... __ .______________ __ __________________________________ ..

3798. Summary of remaining write-ins for Line 37 from overflow page .... __ __ 3799. Totals (Lines 3701 throuoh 3703 plus 3798\ (Line 37 above\

........................ ·······················732·,·185 - See I ndependen t Accoun I an t ' s Comp I I a t Ion Repo rI .

4

, "',c".,, _____________ .. ,, ________________________________ _


CASH FLOW Current Year

Cash from Operations 1. Premiums collected net of reinsurance ................. . """"""""""""" '''''''' """"""""""""""" """"""""""""""""""" """""""",,,2,559,167 2, 3,

Net investment income .. "'" ''''''''''" " """" """""""""",,226,741 Miscellaneous income 57,949

4. Total (Lines 1 through 3) ... . .................. . 2,843,857 5. Benefit and loss related payments ............................................................................................................................. " .... . ................... 1,512,455 6. Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts. ___ ...... _._._. _____ .. . 7. Commissions, expenses paid and aggregate write-ins for deductions ___________________________ . _____________ .. ___________________ . . ............. 1,036,730 8. Dividends paid to policyholders .......... .......................... .................. ............................................ . ........................ . 9. Federal and foreign income taxes paid (recovered) net of $ ...................................... tax on capital gains (losses). 71,767

10. Total (Lines 5 through 9).. ....... ........... ....... .... ... ... ..... . ...................................................................... . 2,620,952 11. Net cash from operations (Line 4 minus Line 10) ........ " .............................. . 222,905

Cash from Investments

2 Prior Year

................... 2,608,676 . ............ .243,423

68,755 2,920,854

. ..... 1,438,979

................. 958,627

9,863 2,407,469

513,385

12. Proceeds from investments sold, matured or repaid: 12.1 Bonds .. , ... , ..................... , ................ ,... . ................................................. 650,700 ................ , ... 1,005,184 12.2 Stocks ....................... . .................. 1,656,541 ....... 1,646,988 12.3 Mortgage loans 12.4 Real estate ... 12.5 Other invested assets ................. " .. " ... " ................................................................................................................................ .

12.6 Net gains or (losses) on cash, cash equivalents and short-term investments. 12.7 Miscellaneous proceeds ............................................................. " .................................... ..

12.8 Total investment proceeds (Lines 12.1 to 12.7)". . ... , .. """, .... ,, .... ,,",,", ...... , ..................... .. 13. Cost of investments acquired (long-term only):

..2,307,241 ................... 2,652,171

13.1 Bonds" . .. ......... " ............. ".". ....................................... .883,390 ................ 1,118,000 13.2 Stocks ...... , ...................................................................................... " .. .. .. ..................... 1 ,901 ,005 ................... 1,715,621 13.3 Mortgage loans .............................................................................................. . 13.4 Real estate ..... 13.5 Other invested assets ...................................................................................................... .

13.6 Miscellaneous applications .. 13.7 Total investments acquired (Lines 13.1 to 13.6) 2,784,395 2,833,622

14. Net increase (decrease) in contract loans and premium notes ...... .. .................................................. ..

15. Net cash from investments (Line 12.8 minus Line 13.7 minus Line 14) .... , ................................................... " .... """"",, .. ,, .... . (477,154) (181,450) Cash from Financing and Miscellaneous Sources

16. Cash provided (applied):

16.1 Surplus notes, capital notes. ..................................................... .............. . .......... . .................. ,," .... ...................... ................................. , ........ " ............ , ........... " .. 16.2 Capital and paid in surplus, less treasury stock. ...................................................................................................................... . 16.3 Borrowed funds ........................................ . 16.4 Net deposits on deposit-type contracts and other insurance liabilities .. __ 16.5 Dividends to stockholders .................................... .

16.6 Other cash provided (applied)...... ............................................. .. .............................................. ,..... ........................... 4,599 "'("21':'1S2i 17. Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6) .............................. f-_____ 4C!,,::;59"'9+ ____ -" (:2:.:1C!"",15::::2"1)

RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 18. Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17) ........ ", .............................. " .. 19. Cash, cash equivalents and short-term investments:

19.1 Beginning of year .................................................... " .... ", ............ .. 19.2 End of year (Line 18 plus Line 19.1)

See independenl Accountant's Compi lat ion Reporl.

5

(249,650)

........... 2,547,708 2,298,058

... .2,236,926 2,547,708


UNDERWRITING AND INVESTMENT EXHIBIT

Une of Business

PART 1 - PREMIUMS EARNED

Net Premiums Written per

Column 6 Part 1 B

2 Unearned Premiums D~c. 31 Prior Year -

per Col. 3, Last Year's Part 1

3 Unearned Premiums

Dec. 31 Current Year - per Col. 5

Part 1A

4

Premiums Earned During Year

(Cols. 1 + 2 - 3)

1. Fire .... " .. """,, ............................................................... .

2. Allied lines

..... .1 ,252,317

..................... 1 ,252,317

..................... 513,651

...................... 513,651

....... 525,070 """ .. ,,""""" 1 , 240 ,898

" ... "",,.,,"" .. ".525,070 """""""." ... 1,240,899

3. Farmowners multiple peril._

4. Homeowners multiple peril ........................................................................................................................ _ ........... .

5. Commercial multiple peril .................... .

6. Mortgage guaranty ..... .

8. Ocean marine.

9. Inland marine ............. ""."" .. """" .......... "." ..... """" ... ,, .. ,,."" .. " .............................. "" .. " ...... 56,268 """" . .... 19.315 ......................... 19,438 ............ " .. " ... 56,145

10. Financial guaranty ..

11.1 Medical professionalliability~occurrence ..

11.2 Medical professionalliability·claims-made _ ................................................................................... .

12. Earthquake ................................................................... " ......... " ....... "." . .5 , 254 . . " .. ".,,2,194 .......................... 2, 157 ........................... .5 ,291

13. Group accident and health " .. """" .... " ....... " ............................................ "."

14. Credit accident and health (group and individual) ......... " ........................... " ...... "" .......... """."".,,. " ... """"".,,. " ... " .............................. .

15. Other accident and health ................................................................. __ .......................................................... __ .......... __ ......................... ..

16. Workers' compensation ......................................................................................................................................... .

17.1 Other liability-occurrence ........................................................ .

17.2 Other liability-claims-made ..

17.3 Excess workers' compensation ................................. .

18.1 Products liability-occurrence ................................................................. .

18.2 Products liability-claims-made ...

19.1.19.2 Private passenger auto liability ................................................................. __ ................................. .

19.3,19.4 Commercial auto liability

21. Auto physical damage ..

22. Aircraft (all perils)

23. Fidelity

24. Surety ..

26. Burglary and theft ." " ..................................................................................................................................................................................................... .

27. Boiler and machinery ..

28. Credit." ..

29. International

30. Warranty .......... .

31. Reinsurance-nonproportional assumed property ............................... ................................................................. .

32. Reinsurance-nonproportional assumed liability . ...................... .

33. Reinsurance-nonproportional assumed financial lines ..

34. Aggregate write-ins for other Jines of business

35. TOTALS 2,566,157 1,048.811 1.071,735 2.543.233

- DETAILS OF WRITE-INS

3401.

3402.

3403.

3498. Sum. of remaining write-ins for Line 34 from overflow page ..

3499. Totals (Lines 3401 throuoh 3403 Dlus 3498j{Line 34 abov~

See Independent Accountanl's Coopi lat ion Reporl.

6



Line of Business

Fire ..

PART 1A - RECAPITULATION OF ALL PREMIUMS

Amol.,lnt Unearned (Running One Year or

Less from Date of Policy)

(a)'

2 Amount Vnearned

(Running More Than One Year from Date

of Policy) (a)

3

Earned but

Unbilled Premium

4 Reserve for Rate

Credits and Retrospective

Adjustments Based on Experience

5

Total Reserve for

Unearned Premiums Cols.1 +2+3+4

.............................................. 525 ,070 1.

2.

3.

4.

5.

6.

8.

9.

10.

Allied lines.

................ 525,070

...... ......525,070 .. ...................................................................................................... 525,070

11.1

11.2

12.

13.

14.

15.

16.

17.1

17.2

17.3

18.1

18.2

Farmowners multiple peril

Homeowners multiple peril

Commercial multiple peril ........................................... ____ ._

Mortgage guaranty ...

Ocean marine

Inland marine ........................ 19,438

Financial guaranty

Medical professional liability-occurrence .......

Medical professional liability-claims-made .

Earthquake ....................... .

Group accident and health ...

Credit accident and health (group and individual) ....

Other accident and health

Workers' compensation

Other liability-occurrence ..

............ .2,157

Other liability-claims-made .................................................................................................................................................. ..

Excess workers' compensation

Products liability-occurrence ..

Products liability-claims-made ..

19.1,19.2 Private passenger auto liability ......................................................................................................... .

19.3, 19.4Commercial auto liability

Auto phYSical damage .................. .

Aircraft (all perils) ......................... .

Fidelity.

Surety ..

Burglary and theft ..

Boiler and machinery

.... 19,438

. .............................................. .2,157

21.

22.

23.

24.

26.

27.

28.

29.

30.

31.

32.

33.

Credit ................................................................................................................................................................................................................................................................... ..

International

Warranty ......................................................................................................... .

Reinsurance~nonproportional assumed property .... ................................................................................................................................................................................... .

Reinsurance~nonproportional assumed liability .... .......................................................................... .

Reinsurance~nonproportional assumed financial lines ..................................................................................... .

34. Aggregate write~ins for other lines of business ... .

35.

36.

37.

38.

TOTALS

Accrued retrospective premiums based on experience

Earned but un billed premiums .......................................... .

Balance (Sum of Lines 35 throuoh 37)


3401.

3402.

3403.

3498. Sum. of remaining write~ins for Line 34 from

1,071,735

overflow page ........................................................................................................... ..


(a) State here basis of computation used in each case.

See Independent Accountant's Compi lat ion Report.

Dai Iy, pro-rata

7

1,071,735

1,071,735


Line of Business


Direct Business

(a)

PART 18· PREMIUMS WRITTEN

Reinsurance Assumed 2 3

From Affiliates

From Non-Affiliates

Reinsurance Ceded 4 5

To To Affiliates Non-Affiliates

6 Net Premiums Written Cols.

1 +2+3-4-5

1.

2.

3.

4.

5.

6.

8.

9.

10.

...................................... ...................................... .......................... . ......................... 200,432 .................... 1,252,317

Allied lines ................. ..1,452,749 . .................................................................................................................... .200,432 .................... 1,252,317

11.1

11.2

12.

13.

14.

15.

16.

17.1

17.2

17.3

18.1

18.2

Farmowners multiple peril ....

Homeowners multiple peril ..

Commercial multiple peril .....

Mortgage guaranty ........ .

Ocean marine _

Inland marine . .......... __ ... __ . _____ ... .

Financial guaranty ...

Medical professional liability-occurrence ..

Medical professional liability-claims-made ..

....... 56,268 ............. .

Earthquake ...................... ......................... 5,254

Group accident and health ...

Credit accident and health (group and individual) ................................................................................................................ .

Other accident and health ...... .

Workers' compensation ._

Other liability-occurrence ..

Other liability-claims-made ..................................................................................................................................... .

Excess workers' compensation._ ........ .

Products liability-occurrence .....

Products liability-claims-made._ ... __ .......... .

19.1,19.2 Private passenger auto liability ..................................................................................................................................................................................................................................................................... .

19.3,19.4 Commercial auto liability ..

Auto physical damage ..

Aircraft (all perils) ..

Fidelity ................................................................................................. .

Surety ...

Burglary and theft ........................................................................................... .

Boiler and machinery ..

Credit

International ..

.

21.

22.

23.

24.

26.

27.

28.

29.

30.

31.

Warranty .............................................................................................................................................................................................. .

Reinsurance-non proportional assumed property .. . ..................... xxx. .. .

32. Reinsurance-non proportional assumed liability ..... . ....................... XXX .. .

33. Reinsurance~ nonproportional assumed financial lines _ ..... _____ ."._ ...

34. Aggregate write-ins for other lines of business ..

35. TOTALS


3401.

3402.

3403.

3498. Sum. of remaining writeins for Line 34 from overflow page


. ........ xxx. .. .

2,967,020

(a) Does the company's direct premiums written include premiums recorded on an installment basis?

If yes: 1. The amount of such installment premiums $

Yes [ J No [ X J

2. Amount at which such installment premiums would have been reported had they been recorded on an annualized basis $

See I ndependen I Accoun I an I ' sCoop i I a I ion Repo r I .

8

400,863 2,566,157


UNDERWRITING AND INVESTMENT EXHIBIT PART 2 - LOSSES PAID AND INCURRED losses Paid Less Salvage

2 3

1. 2. 3. 4. 5. 6. 8. 9.

10. 11.1 11.2 12. 13. 14. 15.

Line of Business Fire Allied lines_ Farmowners multiple peril .. Homeowners multiple peril .. ___ . ___ .......... __ ...................... __ ........ __ .... _._ Commercial multiple peril .. Mortgage guaranty .................................. .. Ocean marine Inland marine , ____ ,_",,_ .. __ .. . Financial guaranty __ ... ; __ .......... ___ ... _____ . ______ _ Medical professionalliability-occurrence .................... ____ ............. . Medical professionalliability-claims·made .. Earthquake. .. .................................................... .. Group accident and health .................... ___ . Credit accident and health (group and individual) _ Other accident and health ___ ............................................................ .

16. Workers' compensation ..................................... . 17.1 Other liability-occurrence ............................. .. 17.2 Other liabiltty-claims-made .... . 17.3 Excess workers' compensation ... 18.1 Products liability-occurrence ............................... .

Direct Business ............................... 544,592

.......... ..753,708

...... 214,367

18.2 Products liability-claims-made ....... ........................ .. .............. .. 19.1,19.2 Private passenger auto liability.................. ................... . ....................... . 19.3,19.4 Commercial auto liability ........................ .......................... .. ............................ ..

Reinsurance Assumed

21. Auto physical damage ............................ .................. ............................ .. ....................... .. 22. Aircraft (an perils) ........................................... ................... .. ....................... . 23. Fidelity . ......... ................................................ . ......................... . 24. Surety .. _ ._............................ ............................. .. ........................................... . 26. Burglary and theft .. .... ........ .................... .. ............................. . 27. Boiler and machinery.. ....... ............................................. . ................................................. . 28. Credit ... ... ........ .. ........................ . 29. International.. . .................................... . 30. Warranty ....... .. ................................................... . 31. Reinsurance-nonproportional assumed property .... . ............................... ...><XX........ . ........................ . 32. Reinsurance-nonproportional assumed liability ........................... __ .................. XXX .... . 33. Reinsurance-nonproportional assumed financial lines ...................................... XXX ... . 34. Aggregate write-ins for other lines of business .......................... . 35. TOTALS 1,512,666


~~~: ::::::::::::::::::::::::. . .............................. -...................................................................... :.:: .......... .

3403. ............................ .. ........................................... . 3498. Sum. of remaining write-ins for Line 34 from overflow page ...... _ ............................. . 3499. Totals (Lines 3401 throuoh 3403 + 3498) (Line 34 above)

See Independent Accountant's Camp; lat ion Report.

Reinsurance Recovered

.......... 13,694

13,694

4 5

Net Losses Unpaid

Net Payments Current Year (Cols. 1 + 2 - 3) (Part 2A, Col. 8)

.. 530,898 ............................ 240,884 . ..753,708 .......... 169,364

...... __ ..... 214,367 ... 24,500

1,498,972 434,748

6

Net Losses Unpaid

Prior Year .................... 517,493

263,393

................. 27,000

807,886

7

Losses Incurred Current Year

(Cols. 4 + 5 - 6) ........................ 254,289

.............................. .659,679

................ 211,867

1,125,835

8 Percentage of Losses

Incurred (Col. 7, Part 2)

to Premiums Earned ..iCol. 4, Part 11

............................... 20.5 .53.2

... 377 .4

44.3

Line of Business


UNDERWRITING AND INVESTMENT EXHIBIT PART 2A - UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES

Direct

Reported Losses 2 3

Reinsurance Assumed

Deduct Reinsurance Recoverable

4

Net Losses Excl. Incurred But

Not Reported (Cols. 1 + 2 - 3)

5

Direct

Incurred But Not Reported 6

Reinsurance Assumed

8 7

Net Losses Reinsurance Unpaid

Ceded (Cols. 4 +5 + 6 - 7) 1. Fire .............................................................................. . ....................... 230,884

....................... 139,364 ..... 20,000 ...................... 210,884

... 139,364 ... 30,000

......................... 30,000 ........................................................................................ 240,884

2. Allied lines ................................................................. . . .. 169,364 3. Fannowners multiple peril .. __ ............... . 4. Homeowners multiple peril . ___ ... __ ......... ___ ..... ____ ... ___ .. 5. Commercial multiple peril ._ 6. Mortgage guaranty ................................................. . 8. Ocean marine ___ . 9. Inland marine __ _ ...24,500 .......... 24,500 . ............... 24,500

10. Financial guaranty _____ " ____ .... _ ............. ___ . __ . __ _ 11.1 Medical professionalliability-occurrence __ . ___ . _______ . ____ .. ___ .. . 11.2 Medical professionalliability-claims-made .. ___ .......... __ _ 12. Earthquake .................. . 13. Group accident and health ........................................ . (a) 14. Credit accident and health (group and individual) ............................. . 15. Other accident and health .......... . . ................... (a) 16. Workers' compensation .. __ .. _______________________ _ 17.1 Other liability-occurrence _ . ________ .... __ .. _ ... ___ ._._ 17.2 Other liability~claims-made __ .__________ .... _._ ... __ .... __________ . _____________________ _ 17.3 Excess workers' compensation _______ ... ______ ...... ___ _ 18.1 Products liability-occurrence _ ... _ .. __ ._ ..... ____ . _____________________ _ 18.2 Products liability-claims-made ____ . __ _ 19.1,19.2 Private passenger auto liability _______ ._. 19.3,19.4 Commercial auto liability ............................................... . 21. Auto physical damage ......... . 22. Aircraft (all perils) .................. . 23. Fidelity .... . 24. Surety ..................................... . 26. Burglary and theft ...... . ........... . 27. Boiler and machinery ___________ _ _________ . ___________ ._.______ _ ... _._ ... _________ .. _

28. Credit ....... ....................................... . .................... . 29. International __ .___ ..... _ ... _. __ ... _ .... _ .......... _._ .... _ ... __________ . 30. Warranty. .................................. ....... .. ...... . ........ ..... ... .................................. ...................................... .................................... . ................................................ . 31. Reinsurance-nonproportional assumed property ..... _ ... _._ ....... ___ . ___ ._ . __ ..... _ ...... XXX .. _ .. _. _________ .. __ ....... ___ ... __ ._ .. _._._ .. __ . _____ . ___________ ._ .. __ ._._._. __ . _______________ . ______ ... ___ . ________ XXX __ _ 32. Reinsurance-nonproportional assumed liability ______________ ._. _____ ._____________ _ .. _ ............. XXX.. . ... _. __ .. ________ XXX __ _ 33. Reinsurance-nonproportional assumed financial lines ___ _ _ ____ ... _. ___ XXX _ ... _ .. _. ____ ._.___ . __ ..... ___ ._ .. _ ... ______ ._ ..... _ ... _______________ ... _.. ____________ .XXX ... 34. Aggregate write-ins for other lines of business ___ . ____ ... __ .......... _._ .. __ .. ___ .. __ .... __ ..... _____________ . __ .. _ ..... ____________ _ .............. -

35. TOTALS 394,748 20,000 374,748 60,000 434,748 DETAILS OF WRITE-INS 3401. . ................ . 3402. . ................. . 3403. . ................................. . 3498. Sum. of remaining write-ins for Line 34 from overflow page ____ .. ___ _ 3499. Totals (Lines 3401 through 3403 + 3498) (Line 34 above)

(a) Including $ __________________ . ________________ . ____ for present value of hfe Indemnity claims.

See Independent Accountant's Campi lat ion Report.

9

Net Unpaid Loss Adjustment Exoenses

.................... 27,632

27,632



1, Claim adjustment services:

PART 3 - EXPENSES

Loss Adjustment Expenses

2 Other UndelWriting

Expenses

3 Investment Expenses

4

Total

1,1 Direct ___________________________ __ '" (17,620) ___________________________________________________________________________________________________ (17,620)

1.2 Reinsurance assumed ............................................................ .

1,3 Reinsurance ceded _____________________ __ '--------------------------------j-----t-----t-----t---------i 1.4 Net claim adjustment services (1,1 + 1,2 - 1,3) __________________________________________________________________ (17,620) __ ______(17,620)

2. Commission and brokerage:

2,1 Direct, excluding contingent __________ " _______ ,, ____________________ ,, ____ ,, ____ __ _______ 360,267 _______________________________________________________________ 360,267

2.2 Reinsurance assumed, excluding contingent ............................ _ ... __ ..

2.3 Reinsurance ceded, excluding contingent ...................................... __ ...... _, __

2.4 Contingent-direct ___ __ __________________ _

2.5 Contingent~reinsurance assumed

2.6 Contingent-reinsurance ceded _ ...................................... .

2,7 Policy and membership fees ------------------------------------------------------------- ------------f-------+-------f-------+-------J 2,8 Net commission and brokerage (2,1 + 2,2 - 2,3 + 2.4 + 2,5 - 2,6 + 2,7) __ _ __________________________ 360,267 ______ 360,267

3, Allowances to manager and agents __________________________________________________________________________________________________________________________________ _

4, Advertising _________________________________________________________________ 14, 192, __ _____________________ 14,192

5, Boards, bureaus and associations .. ________________________ _ ____ , , __ ,,13,256 __ __ _ . __ .13,256

6. Surveys and underwriting reports ..

7, Audit of assureds' records """ __ ,, ____ """" ____ ,, ____ ,, __________________________________________________________________________________________________ __

8, Salary and related items:

8,1 Salaries _________________ _ _ _ _______ _____________________________________ , ________________ ,_, ____ 94,460 , ______ , ____________ ,_,217,502 __________________________ 36,599 _. _____ . ____ ._348,561

8,2 Payroll taxes ________________________ , __ .7 , 472 __________________________ 17,204 ___________________________ 2,895 __ . _____ 27,571

9, Employee relations and welfare __ ________________ 18,899 _________________________ .43,517 __________ ..7,323 __ ____ ,, __ 69 , 739

10. Insurance ................................................................................................................................................................................ 53,250

11, Directors' fees _______________________ """"''''' __ '''_ ,, __ ,, ____________ __ _________________ _____________________ 2,624 __________________________ .6,043

12. Travel and travel items .......................... . ______________________________________ ______________ . ____ .4,114

13, Rent and rent items ___________________________________ ""_.""""" __ ,,,",, ____________ ,, _____________________________ ,, __ ,, __________________ 673 ___________________________ 1 ,550

",25,652 14, Equipment __________ ________________________ __ __________ , ____ , __________________________ 11,141

15, Cost or depreciation of EDP equipment and software ______________________________ """ ," __________ ,, _________________________________________________________________ ,,_

16, Printing and stationery _______ """"""",," ___ ,, ______________________________________________________________________________________ .4 ,075 ____________________________ 9,384

17, Postage, telephone and telegraph, exchange and express __ _ _________________________ ,,3,086 _____ "..7,106

18, Legal and auditing ___ " 16,078 37,020

______ .. ________________ " ________ 53,250

_______ " . .1 ,017

_____ . _____ 261

________ 4,316

___ ",,9,684

"_,,,,4,114

________ 2,484

______ ..41,109

,,,1,579 ",,_15,038

____ . __ ,, _______ .. __ ,,1,196 .. ______________________ ._11,388

6,229 59,327

19, Totals (Lines 3 to 18) __ ________________________ 158,508 __ ___________________ .449,790 _________ "_""_",,,,,,61 ,415""""""""""",669,713

20. Taxes, licenses and fees:

20.1 State and local insurance taxes deducting guaranty association

credits of $ ______ """'''''' __ """"", . .29 , 735 __ ____ ,, _______ ,, _________________________________ 29,735

20,2 Insurance department licenses and fees, __________________________________________________________ "."_""""""",,,,14,837 __ ,, _________________________________________________________ 14,837

20.3 Gross guaranty association assessments ................................................................................................................................................ .

20.4 All other (excluding federal and foreign income and real estate) __

20,5 Total taxes, licenses and fees (20,1 + 20,2 + 20,3 + 20.4) _________________________________________ _ "..44,572 21, Real estate expenses __ . ____ ,, _____________________________________________________________________________________ .,, __ ,"" __ ,, __ "" ______ ,, _____________________________________________________ ..4,491

22, Real estate taxes ___________________________________ "". ________________________ __________ __ _________________________________________ ,, __ .7 , 493

23. Reimbursements by uninsured plans ............................................ .

___ 44,572

__________ .4,491

"".7,493

24. Aggregate write-ins for miscellaneous expenses .. 2,013 4,635 780 7,428

25. Total expenses incurred ........................................ .

26. Less unpaid expenses-current year ..

27, Add unpaid expenses-prior year "'"

28. Amounts receivable relating to uninsured plans, prior year ..

29. Amounts receivable relating to uninsured plans, current year ..

30, TOTAL EXPENSES PAID (Lines 25 - 26 + 27 - 28 + 29)

DETAtLS OF WRITE-tNS

2401, M i see II aneous Expense_"

2402,

2403, ,, ______________________ '"'''' "" ______________ __

______________________ ,,142,902 """ ____________ ,, ____ 859,265 _________________________ .74,178 (a) _______ : ____ 1,076,345

__________ ._._. __ .. _ ... ".27,632 . ___ ... ___________ . _______ 35,691 ___________________________ 9,072 ______ ..72,396

.. ,,54,102 _____________________ . __ 52,731 _________________ 127 _,,_106,960

169,371 876,304 65,233 1,110,909

__ ___________ 2,013 ____________________________ 4,635 __ _____________________ ..780 __ ____ .7,428

-~ 2498. Summary of remaining write-ins for Line 24 from overflow page ..................................................................... .

2499, Totals (Lines 2401 through 2403 plus 2498) (Line 24 above) 2,013 4,635 780 7,428

(a) Includes management fees of $ ____________________________ __ to affiliates and $ ________________________________________ to non-affiliates,

See Independent Accountant's Compi lat ion Report,

11

'~-~'""~'"'""----'''' __ ~'ffl' __ '''''' ____ '''.''''''_'''' __________________________________ _


U.S. Government bonds .....

EXHIBIT OF NET INVESTMENT INCOME

(a)

1 Collected

Durino Year

2 Earned

During Year

1. 1.1 1.2 1.3 2.1 2.11 2.2 2.21 3. 4.

Bonds exempt from U.S. tax ................................................ .. (a) ............ 109,901 .......................... 114,370 Other bonds (unaffiliated) ... (a) .......................... 20, 793 .. ........................ 20,847 Bonds of affiliates ... (a) .... .. Preferred stocks (unaffiliated) ............................ . (b) .................................... ..

Preferred stocks of affiliates (b) .................................. ..

.......................... 135,964 . ................ .

5. 6. 7. 8. 9.

10.

Common stocks (unaffiliated) Common stocks of affiliates ......... . Mortgage loans Real estate .................. . Contract loans. Cash, cash equivalents and short~term investments Derivative instruments .. . ............................................................... . Other invested assets .................................................................. . Aggregate write~ins for investment income ........................................................... . Total gross investment income

........ 136,077

(e) .. .. .............. (d) ..

(e) ........................... 13,245 .. 14,024 (~ .................. ..

279,902 285,318 11. Investment expenses .......................................................................................... . (g) ......................... ..74, 178 12. Investment taxes. licenses and fees. excluding federal income taxes .. (g) ........................... .

13. Interest expense .... . .............. _ . . ........................................ . (h) ...... . 14. Depreciation on real estate and other invested assets .. (i) .......................... .8,791 15. Aggregate write~ins for deductions from investment income .. 16. Total deductions (Lines 11 through 15) ................ .. 17. Net investment income (Line 10 minus Line 16)

DETAILS OF WRITE-INS 0901. 0902. 0903. 0998. Summary of remaining write-ins for Line 9 from overflow page .. 0999. Totals (Lines 0901 throuoh 0903 plus 0998) (Line 9 above)'

1501. 1502. 1503. 1598. 1599.

Summary of remaining write~ins for Line 15 from overflow page Totals (Lines 1501 through 1503 plus 1598) (Line 15 above)'

.. ......... .82,969 202,349

(a) Includes $ .............. 18,540 accrual of discount less $ ................ 39 ,558 amortization of premium and less $ ................. .4 ,064 paid for accrued interest on purchases. (b) Includes $ ............................. accrual of discount less $ .............................. amortization of premium and less $ ............................. paid for accrued dividends on purchases. (c) Includes $ .............................. accrual of discount less $ .............................. amortization of premium and less $ ......................... paid for accrued interest on purchases. (d) Includes $ ............................ .for company's occupancy of its own buildings; and excludes $ . interest on encumbrances. (e) Includes $ ............................. accrual of discount less $ .. amortization of premium and less $ .... paid for accrued interest on purchases. (I) Includes $ .............................. accrual of discount less $ ......... amortization of premium. (g) Includes $ .............. investment expenses and $ ............................. investment taxes. licenses and fees, excluding federal income taxes, attributable to

segregated and Separate Accounts. (h) Includes $ ....................... interest on surplus notes and $ .................... . interest on capital notes. (i) Includes $ .................. 8,791 depreciation on real estate and $ . depreciation on other invested assets.

EXHIBIT OF CAPITAL GAINS (LOSSES)

1. 1.1

1.2

1.3

2.1

U.S. Government bonds ............ .

Realized Gain (Loss) On Sales or

Maturity

Bonds exempt from U.S. tax.. . ............................ (12 ,432) Other bonds (unaffiliated) ....................................... .. ................... 57 Bonds of affiliates ...................... ..

Preferred stocks (unaffiliated) .. 2.11 Preferred stocks of affiliates ..

2

Other Realized

Adiustments

3

Total Realized Capital Gain (Loss)

(Columns 1 + 2)

.............. (12,432) ............................. 57

4

Change in Unrealized Capital

Gain (Loss)

..... .2 ,480

2.2 Common stocks (unaffiliated) ......................................................... 125,945 ....................... .. ..................... 125,945 ....................... 326,302 2.21 Common stocks of affiliates ............................ .................................... .......... ................. ...................... .. ....................... 18 ,548 3. Mortgage loans.. ............................... ...... .................................. .................. .. .................................. ..

Real estate .... ..................... .......................... ................. .. ................................. ..

Contract loans ..

Cash, cash equivalents and short~term investments ...................... .

Derivative instruments

4.

5.

6.

7.

8. Other invested assets ............................................................................................................................ . 9. Aggregate write-ins for capital gains (losses) ..

10. Total capital gains (losses) DETAILS OF WRITE-INS 0901. 0902.

0903.

0998. Summary of remaining write-ins for Line 9 from overflow page ..................................... .

0999. Totals (Lines 0901 through 0903 plus 0998) (Line 9 above)'

See Independent Accountanl 's Campi latlon Report.

113,570

12

113,570 347,329

5

Change in Unrealized Foreign Exchang~ Ca~ital

Gain (Loss,

'"~--"---~;-"'~-'~"'"~''''''"''~~.''''''''''''-''-''---------'''.''' .. _ ....... _------_ .... _-------------_ .... -------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

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 by the company ...................................................... ..

4.2 Properties held for the production of income .. .

4.3 Properties held for sale ...................................... .

5. Cash (Schedule E-Part 1), cash equivalents (Schedule E-Part 2) and

short-term investments (Schedule DA) .................. ..

6. Contract loans ..

7. Derivatives (Schedule DB) ...

8. Other invested assets (Schedule BA) ............................ .

9. Receivables for securities ..

10. Securities lending reinvested collateral assets (Schedule Dl) ...

11. Aggregate write-ins for invested assets.

12. Subtotals, cash and invested assets (Lines 1 to 11) ...................... ..

Current Year Total Nonadmitted Assets

2

Prior Year Total Nonadmitted Assets

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 ..... .......................................................................................... 310

15.2 Deferred premiums, agents' balances and installments booked but deferred

and not yet due ....

15.3 Accrued retrospective premiums and contracts subject to redetermination ."

16. Reinsurance:

16.1 Amounts recoverable from reinsurers ..

16.2 Funds held by or deposited with reinsured companies ..

16.3 Other amounts receivable under reinsurance contracts

17. Amounts receivable relating to uninsured plans

1 B.1 Current federal and foreign income tax recoverable and interest thereon ..

18.2 Net deferred tax asseL

19. Guaranty funds receivable or on deposit

20. Electronic data processing equipment and software .......................... .

........................... .45 ,000

21. Furniture and equipment, including health care delivery assets .. ....................................... 18,312

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... _ ._ ................................. .

25. Aggregate write~ins for other~than~invested assets .. . ............. _ .. . ....................... 500

........................................ .434

...... 17 ,000

................. .20,305

.. ........... 500

3 Change in Total

Nonadmitted Assets (Col. 2 - Col. 1)

......................................... 124

..... (28,000)

.... 1,993

26. Total assets excluding Separate Accounts, Segregated Accounts and

Protected Cell Accounts (Lines 12 to 25). ............... 64, 122 ................................... 38,239 ................................. (25,883)

27. From Separate Accounts, Segregated Accounts and Protected Cell Accounts ....

28. Total (Lines 26 and 27)

DETAilS OF WRITE-INS

1101.

1102.

1103.


1199. Totals (Lines 1101 throuah 1103 plus 1198)(Line 11 above)

2501.

2502.

2503.

Suppl ies


2599. Totals (Lines 2501 throuah 2503 plus 2598) (Line 25 above)


13

64,122 38,239 (25,883)

...... 500 ......................................... 500

500 500

"'~"~"" __ '''''' ___ 'l<'_'_' _. __ ............. , ..... , ______________________________ _


NOTES TO FINANCIAL STATEMENTS l. Summary of Significant Accounting Policies and Going Concern

a. The accompanying financial statements ofthe Association have been prepared in conformity with accounting practices prescribed or pennitted by the National Association ofInsurance Commissioners as modified by Iowa Administrative Code Section 037lB for insurance companies domiciled in the State ofIowa.

b. The preparation ofthe financial statements ofthe Association in confonnity with Statutory Accounting Principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities. It also requires disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Actual results could differ from those estimates

c. Premiums are earned over the term of the related insurance policies and reinsurance contracts. Unearned premium reserves are established to cover the unexpired portion of premiums written. Such reserves are computed by pro rata methods for direct business and are based on reports received from ceding companies for reinsurance.

Expenses incurred in connection with acquired new insurance business, including such acquisition costs as sales commissions, are charged to operations as incurred. Expenses incurred are reduced for ceding allowances received or receivable.

Asset values are generally stated as follows: Bonds at amortized cost; stocks at market. The pro rata method was used in the amortization of bonds in this statement. This method provides for amortization of the premium or the discount in equal amounts over the life ofthe bond. The pro rata method is applied by dividing the premium or discount by the number of years, or interest periods, over the contract life of the security until maturity.

The Association's electronic data processing equipment is a depreciable admitted asset.

The Association uses the straight line method of depreciation for all of its real estate holdings with the lives varying depending on the type of building.

The Association's 100% owned subsidiary, Springdale Agency, is valued by the equity method as described in Section 4(B)(a)(iv) of the Securities Valuation Handbook.

d. Based on its evaluation of relevant conditions and events, management does not have substantial doubt about the Association's ability to continue as a going concern.

2. Accounting Changes and Corrections of Errors a. The Association had no material changes in accounting principles or corrections of errors.

3. Business Combinations and Goodwill a. The Association had no business combinations accounted for under the statutory purchase method. b. The Association had no statutory mergers. c. The Association had no impairment losses.

4. Discontinued Operations The Association did not have any discontinued operations.

5. Investments a. The Association has no mortgage loans. b. The Association is not a creditor for any restructured debt. c. The Association has no reverse mortgages. d. The Association does not hold any loan backed securities. e. The Association has no repurchase agreements and/or securities lending transactions at year end. f. The Association has no investments in real estate. g. The Association has no investments in low-income housing tax credits. h. The Association has no restricted assets. \. The Association has no working capital finance investments. j. The Association has no offsetting and netting of assets and liabilities. k. The Association has no structured notes. t. The Association has no 5 * securities.

6. Joint Ventures, Partnerships and Limited Liability Companies a. The Association has no investments in Joint Ventures, Partnerships or Limited Liability Companies that exceed

10% of its admitted assets. b. The Association did not recognize any impainnent write down for its investments in Joint Ventures, Partnerships

and Limited Liability Companies during the statement periods.

7. Investment Income a. The Association does not exclude (non-admit) any interest income due and accrued. b. N/A

8. Derivative Instruments The Association has no derivative instruments.

14

, •• --.. <~-~~.-." .. -.--" "'~"-'-',-""-~"",,,----------__ "''''I ______ ------------_____________ _


NOTES TO FINANCIAL STATEMENTS

9. Income Taxes a, The Association is not required to record deferred taxes. b. The Association is not required to record deferred taxes. c. Federal income tax incurred for 2016 and 2015 were $43,767 and $92,363, respectively. The Association is not

subject to recording of deferred income taxes. d. The variation in the relationship between income tax expense and the amount computed by applying the statutory

rates for Federal incoll)e taxes results principally from tax-exempt investment income and statutory adjustments as required by the Internal Revenue Code of 1986.

e. I, At December 31, 2016, the Association had no capital loss carry-forwards. 2, The following are federal income taxes incurred in the current and prior years that will be available for

recoupment in the event of future net losses: 2016 (current year) $ 35,806 2015 (current year-I) $ 80,257

3. The Association does not have any deposits admitted under Section 6603 of the Internal Revenue Service Code,

f. The Association's Federal Income Tax return is not consolidated with any other entity. g. The Association does not have any federal or foreign tax loss contingencies.

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

II. Debt

a. The Association is not directly or indirectly owned or controlled by any other entity, b, There were no applicable transactions, c, There were no applicable transactions. d. There were no amounts due to or from related parties. e, There are no guarantees or undertakings, written or otherwise, for the benefit of an affiliate or related party that

result in a material contingent exposure of the Association's or any related party's assets or liabilities. f. There are no management or service contracts and no cost sharing arrangements, other than cost allocation

arrangements based upon generally accepted accounting principles, involving the Association or any affiliated insurer.

g. The Association is not directly or indirectly owned or controlled by any other entity, h. The Association does not own shares of an upstream intennediate or ultimate parent, either directly or indirectly

via a downstream subsidiary, controlled or affiliated entity, I. The Association does not have an investment in a Subsidiary, Controlled or Affiliated Entity that exceeds 10% of

admitted assets of the insurer. j. The Association did not recognize any impairment write down for its investments in Subsidiary, Controlled or

Affiliated Entity during the statement period. k. The Association does not have any investments in a foreign insurance subsidiary. \. The Association does not have any investment in a downstream noninsurance holding company. m, The Association does not have any SCA investments. n. The Association does not have any investments in insurance SCAs,

The Association has no debt.

12. Retirement Plans, Deferred Compensation, Postemployment Benefits and Compensated Absences and Other Postretirement Benefit Plans

a. The Association does not maintain a defined benefit pension plan. b. The Association does not maintain a defined benefit pension plan. c. The Association does not maintain a defined benefit pension plan. d. The Association does not maintain a defined benefit pension plan. e. Insurance Association employees are covered by a qualified defined contribution pension plan sponsored by the

insurance Association.

Contributions of three percent of each employee's compensation are made each year. The Association's contribution for the plan was $9,303 and $8,541 for 2016 and 2015, respectively.

f. The Association does not have a multiemployer plan. g, The Association does not have consolidated/holding company plans. h, The Association does not have postemployment benefits and compensated absences. I. The Association did not have an impact of the Medicare Modernization Act on Postretirement Benefits.

13. Capital and Surplus, Dividend Restrictions and Quasi-Reorganizations I. The Association has no capital stock. 2, The Association has no preferred stock outstanding. 3. As a Mutual Association, shareholder dividend restrictions criteria do not apply. 4. No dividends were paid by the Association. 5. There are no restrictions placed on the portion of Association profits that may be paid as ordinary dividends to

stockholders. 6. There were no restrictions placed on the Association'S unassigned surplus, including for whom surplus is being

held. 7. The Association does not have any advances to surplus not repaid. 8. The Association has no stock held for special purposes. 9. The Association has no special surplus funds from the prior period.

14.1

-<<<.-,~ ~-<"'~'"-~""'---,-.-.------. ,~----------,,,,,--------------,,,,,------



I O. The portion of unassigned funds (surplus) represented or reduced by cumulative unrealized gains and losses is $347,329.

II. No surplus notes or similar obligations exist. 12. The Association has not participated in quasi-reorganization. 13. The Association has not participated in quasi-reorganization.

14. Contingencies a. The Association has committed no reserves to cover any contingent liabilities. b. The Association does not have any assessments that could have a material effect. c. The Association has no gain contingencies. d. The Association has no claims related to extra contractual obligations or bad faith losses

stemming from lawsuits. e. The Association has no product warranties. f. The Association has no joint and several liability arrangements. g. The Association has no other contingencies or impairment of assets.

IS. Leases a. The Association does not have any material lease obligations at this time. b. The Association does not have any material lease obligations representing a significant

part of their business activities at this time.

16. Information about Financial Instruments with Off-Balance Sheet Risk and Financial Instruments with Concentrations of Credit Risk

The Association does not have financial instruments with off-balance sheet risk or with concentrations of credit risk.

17. Sale, Transfer and Servicing of Financial Assets and Extinguishments of Liabilities a. The Association has no transfers of receivables reported as sales. b. The Association has no transfer and servicing of financial assets. c. The Association has no wash sales.

18. Gain or Loss to the Reporting Entity from Uninsured Plans and the Uninsured Portion of Partially Insured Plans a. The Association has no ASO plans. b. The Association has no ASC plans. c. The Association has no Medicare or similarly structured cost based reimbursement contract.

19. Direct Premium WrittenIProduced by Managing General Agents/Third Party Administrators The Association has no premiums written/produced by Managing General Agents or Third Party Administrators.

20. Fair Value Measurement

A. A framework for measuring fair value has been established which provides a fair value hierarchy that priorities the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (level I) and the lowest priority to unobservable inputs (level 3). The three levels of the fair value hierarchy are described below:

Levell: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets that the Association has the ability to access.

Level 2: Inputs to the valuation methodology include: Quoted prices for similar assets or liabilities in active markets; quoted prices for identical or similar assets or liabilities in inactive markets; inputs other than quoted prices that are observable for the asset or liability; inputs that are derived principally from or corroborated by observable market data by correlation or other means. If the asset or liability has a specified (contractual) term, the Level 2 input must be observable for substantially the full term ofthe asset or liability.

Level3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement.

Following is a description of the valuation methodologies used for assets measured at fair value. There have been no changes in the methodologies used at December 31,2016 and 2015.

Debt and Equity Securities: Equity securities are valued at current fair value based on unadjusted quoted prices in the active investment market at the Statement of Assets, Liabilities and Policyholders' Surplus - Statutory date. Debt securities below investment grade are valued at the lower of amortized cost or fair value at the Statement of Assets, Liabilities, and Policyholders' Surplus - Statutory date. These totaled $6,059,057 and $5,342,934 at December 31, 2016 and 2015, respectively.

The methods described above may produce a fair value calculation that may not be indicative of net realizable value or reflective of future fair values. Furthermore, while the Association believes its valuation methods are appropriate and consistent with market participants, the use of different methodologies or assumptions to determine the fair value of certain financial instruments could result in a different fair value measurement at the reporting date.

14.2


NOTES TO FINANCIAL STATEMENTS (1) The following tables set forth by level, within the fair value hierarchy, the

Association's assets at fair value as of:

Bonds Stocks Total Assets at Fair Value

Bonds Stocks Total Assets at Fair Value

$ $ $

$ $ $

December 31,2016

Levell Level 2 Level 3 0 $ 243,591 $

5,420,021 $ 395,445 $ 4,734,456 $ 608,478 $

December 31, 2015

Levell Level 2 Level 3 0 $ 242,781 $

4,734,456 $ 365,697 $ 4,734,456 $ 608,478 $

0 0 0

0 0 0

Total $ 243,591 $ 5,815,466 $ 6,059,057

Total $ 242,781 $ 5,100,153 $ 5,342,934

(2) The Association does not have any fair value measurements in level 3 of the fair value hierarchy.

B. The Association does not have other accounting pronouncements.

C. Fair Value of all Financial Instruments

Type of Financial Aggregate Admitted Not Practicable Instrument Fair Value Assets (Levell) (Level 2) (Level 3) (Caming Value) Municipal Bonds $ 4,082,534 $ 4,089,810 $ 0 $ 4,082,534 $ 0 $ 0

Corporate Bonds $ 436,307 $ 423,452 $ 436,307 $ 0 $ 0 $ 0

Common Stock $ 5,815,466 $ 5,815,466 $5,420,021 $ 395,445 $ 0 $ 0

D. Not applicable.

21. Other Items a. The Association has no unusual or infrequent items to report. b. The Association did not have any troubled debt restructuring. c. The Association has no other disclosures and unusual items. d. The Association did not receive any business interruption insurance recoveries. e. The Association has no state transferable and non-transferable tax credits. f. The Association has no subprime-mortgage related risk exposure. g. The Association has no insurance-linked securities (ILS) contracts.

22. Events Subsequent Management has evaluated subsequent events through January 30, 2017, the date which the financial statements were available for issue.

23. Reinsurance a. The Association has no unsecured aggregate recoverables for losses, paid or unpaid including IBNR, loss

adjustment expenses, and unearned premium that exceed 3% of policyholder surplus. b. The Association has no reinsurance recoverable in dispute. c. The Association has no commission amounts due and payable to reinsurers if either party were to cancel

coverage. d. The Association has no uncollectible reinsurance written off during the year for Losses Incurred, Loss

Adjustment Expenses Incurred or Premiums Earned. e. The Association had no commutation of Ceded Reinsurance during the year for Losses Incurred, Loss

Adjustment Expenses Incurred or Premiums Earned. f. The Association has no retroactive reinsurance contracts. g. The Association has no reinsurance accounted for as a deposit. h. The Association has transfer of property or casualty run-off agreements. 1. The Association does not have any contracts with Certified Reinsurers whose rating was downgraded or whose

status is subj ect to revocation. J. The Association has no reinsurance agreements qualifying for reinsurer aggregation.

24. Retrospectively Rated Contracts & Contracts Subject to Redetermination The Association has no retrospectively rated contracts or contracts subject to redetermination.

25. Change in Incurred Losses and Loss Adjustment Expenses Reserves as of December 31, 2015 were $861,988. As of December 31,2016, $721,527 has been paid for incurred losses

and loss adjustment expenses attributed to insured events of prior years. Reserves remaining for prior years are now $200,839 as a result of re-estimation of unpaid claims and claim adjustment expenses principally on Fire, Allied Lines and Commercial lines of insurance. Therefore, there has been a $60,378 unfavorable (favorable) prior-year development since December 31,2015 to December 31, 2016. The increase (decrease) is generally the result of ongoing analysis of recent loss development trends. Original estimates are increased or decreased, as additional information becomes known regarding individual claims. Included in this increase (decrease), the Association experienced $0 of unfavorable (favorable) prior year loss development on retrospectively rated policies. However, the business to which it relates is subject to premium adjustments.

14.3



26. Intercompany Pooling Arrangements The Association has no intercompany pooling arrangements.

27. Structured Settlements a. The Association has not purchased any annuities for which a claimant is listed as payee. b. N/A

28. Health Care Receivables The Association has no health care receivables.

29. Participating Policies The Association has no participating policies.

30. Premium Deficiency Reserves The Association has no premium deficiency reserves.

31. High Deductibles The Association has no reserve credit that has been recorded for high deductibles on unpaid claims.

32. Discounting of Liabilities for Unpaid Losses or Unpaid Loss Adjustment Expense The Association does not discount its Unpaid Losses or Unpaid Loss Adjustment Expenses.

33. AsbestoslEnvironmental Reserves The Association has no potential for liability due to asbestos or environmental losses.

34. Subscriber Savings Account The Association is not a reciprocal insurance Association.

35. Multiple Peril Crop Insurance The Association has no multiple peril crop insurance.

36. Financial Guaranty Insurance The Association has no financial guaranty insurance policies.

14.4

,----------~"~<~"------------...... ,--------------------------------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

GENERAL INTERROGATORIES PART 1 - COMMON INTERROGATORIES

GENERAL 1,1 Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of

which is an insurer?

If yes, complete Schedule y, Parts 1, 1A and 2.

1.2 If yes, did the reporting entity register and file with its domiciliary State Insurance Commissioner, Director or Superintendent or with such regulatory official of the state of domicile of the principal insurer in the Holding Company System, a registration statement providing disclosure substantially similar to the standards adopted by the National Association of Insurance Commissioners (NAIC) in its Model Insurance Holding Company System Regulatory Act and model regulations pertaining thereto, or is the reporting entity subject to

Ves [ 1 No [ X 1

standards and disclosure requirements substantially similar to those required by such Act and regulations? Ves [ 1 No [ 1 NI A [ X 1 1.3 State Regulating?

2.1

2.2

Has any change been made during the year of this statement in the charter, by-laws, articles of incorporation, or deed of settlement of the reporting entity?

If yes, date of change:

3.1 State as of what date the latest financial examination of the reporting entity was made or is being made.

3.2 State the as of date that the latest financial examination report became available from either the state of domicile or the reporting entity. This date should be the date of the examined balance sheet and not the date the report was completed or released.

3.3 State as of what date the latest financial examination report became available to other states or the public from either the state of domicile or the reporting entity. This is the release date or completion date of the examination report and not the date of the examination (balance sheet

Ves 1 No [ X 1

..12/31/2015

................... 12/31/2015

date). . ......................... D8/23/2016 3.4 By what department or departments? Iowa Insurance Division .................................................... .

3.5 Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial statement filed with Departments? Ves [ X 1 No

3.6 Have all of the recommendations within the latest financial examination report been complied with? Ves [ X 1 No

4.1 During the period covered by this statement. did any agent, broker, sales representative, non-affiliated sales/service organization or any combination thereof under common control (other than salaried employees of the reporting entity) receive credit or commissions for or control a substantial part (more than 20 percent of any major line of business measured on direct premiums) of: 4.11 sales of new business?

4.12 renewals?

4.2 During the period covered by this statement, did any sales/service organization owned in whole or in part by the reporting entity or an affiliate, receive credit or commissions for or control a substantial part (more than 20 percent of any major line of business measured on direct premiums) of:

4.21 sales of new business?

4.22 renewals?

5.1 Has the reporting entity been a party to a merger or consolidation during the period covered by this statement?

5.2 If yes, provide the name of the entity, NAIC company code, and state of domicile (use two letter state abbreviation) for any entity that has ceased to exist as a result of the merger or consolidation.

1 2 3 Name of Entity NAIC Company Code Stale of Domicile

6.1 Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked by any govemmental entity during the reporting period?

6.2 If yes, give full information .

Ves

Ves

Ves

Ves

Ves

Ves

1 NIA [

1 NIA [

No [ X 1 No [ X 1

No [ X 1 No [ X 1 No [ X 1

No [ X 1

7.1 Does any foreign (non-United States) person or entity directly or indirectly control 10% or more of the reporting entity?

7.2 If yes,

Ves [ 1 No [ X 1

7.21 State the percentage of foreign control

7.22 State the nationality(s) of the foreign person(s) or entity(s); or if the entity is a mutual or reCiprocal, the nationality of its manager or attorney-in-fact and identify the type of entity(s) (e.g., individual, corporation, government, manager or attorneyin-fact).

1 Nationality

15

2 Tvpe of Entity

,"."~_..-"" __ ~~' _________ UII"' ____ ~ __ ""_"" ________________________________ _


GENERAL INTERROGATORIES

8.1 Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board?

8.2 If response to 8.1 is yes, please identify the name of the bank holding company.

8.3 Is the company affiliated with one or more banks, thrifts or securities firms? 8.4 If response to 8.3 is yes, please provide the names and locations (city and state of the main office) of any affiliates regulated by a federal

financial regulatory services agency [i.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Federal Deposit Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify the affiliate's primary federal regulator.

1 2 3 4 5 Location

Affiliate Name (City, State) FRB OCC FDIC

9. What is the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit?

Cain Ellsworth & Company, LLP 3rd Ave, Sheldon, IA 51201 ....................... .............................. .. ................................ .

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 state law or regulation?

10.2 If the response to 10.1 is yes, provide information related to this exemption:

10.3 Has the insurer been granted any exemptions related to the other requirements of the Annual Financial Reporting Model Regulation as allowed for in Section 18A of the Model Regulation, or substantially similar state law or regulation?

10.4 If the response to 10.3 is yes, provide information related to this exemption:

Yes [ ) No [ X )

Yes [ ) No [ X )

6

SEC

Yes [ ) No [ X )

Yes [ ) No [ X )

10.5 Has the reporting entity established an Audit Committee in compliance with the domiciliary state insurance laws? Yes [ ) No [ ) N/A [ X )

10.6 If the response to 10.5 is no or n/a, please explain

No audit required...... ........................................... ...................... .................... .................... .. ............... .

11. What is the name, address and affiliation (officer/employee of the reporting entily or actuary/consultant associaled with an actuarial consulting firm) of the individual providing the statement of actuarial opinion/certification?

12.1 Does the reporting entity own any securities of a real estate holding company or otherwise hold real estate indirectly?

12.11 Name of real estate holding company

12.12 Number of parcels involved

Yes [ ) No [ X )

12.13 Tolal book/adjusted carrying value $ .................................... . 12.2 If yes, provide explanation

13. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY:

13.1 What changes have been made during the year in the United Slates manager or Ihe United States trustees of the reporting entity?

13.2 Does this statement contain all business transacted for the reporting entity through its United States Branch on risks wherever located? 13.3 Have there been any changes made to any of the trusl indentures during the year?

13.4 If answer to (13.3) is yes, has the domiciliary or entry state approved the changes? Yes

14.1 Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing similar functions) of the reporting entity subject to a code of elhics, which includes the following standards?

a. Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships;

b. Full, fair, accurate, limely and understandable disclosure in the periodic reports required to be filed by the reporting entity;

c. Compliance with applicable governmental laws, rules and regulations; d. The prompt internal reporting of violations to an appropriate person or persons identified in the code; and e. Accountability for adherence to the code.

14.11 If the response to 14.1 is no, please explain:

14.2 Has the code of ethics for senior managers been amended? 14.21 If the response to 14.2 is yes, provide information related to amendment(s)

14.3 Have any provisions of the code of ethics been waived for any of the speCified officers? 14.31 If the response to 14.3 is yes, provide the nature of any waiver(s).

15.1

Yes [

Yes [

) No [

) No [

) No [

) N/A I

Yes [ X ) No [

Yes [ ) No [ X )

Yes [ ) No [ X J

." .. --.-"."---".--.~ .. ---------------------------------------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association


15.1 Is the reporting entity the beneficiary of a Letter of Credit that is unrelated to reinsurance where the issuing or confirming bank is not on the SVO Bank List? .

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 of Credit and describe the circumstances in which the Letter of Credit is triggered.

American Bankers

Association (ABA) Routing

Number

2

Issuing or Confirming Bank Name

3

Circumstances That Can Triooer the Letter of Credit

BOARD OF DIRECTORS 16. Is the purchase or sale of all investments of the reporting entity passed upon either by the board of directors or a subordinate committee

thereof?

17. Does the reporting entity keep a complete permanent record of the proceedings of its board of directors and all subordinate committees thereof?

18. Has the reporting entity an established procedure for disclosure to its board of directors or trustees of any material interest or affiliation on the part of any of its officers, directors, trustees or responsible employees that is in conflict or is likely to conflict with the official duties of such person?

FINANCIAL 19. Has this statement been prepared using a basis of accounting other than Statutory Accounting Principles (e.g., Generally Accepted

Accounting Principles)?

Yes [ ] No [ X ]

4

Amount

Yes [ X] No

Yes [ X) No

Yes [ X] No [

Yes [ ] No [ X ]

20.1 Total amount loaned during the year (inclusive of Separate Accounts, exclusive of policy loans): 20.11 To directors or other officers

20.12 To stockholders not officers

L ............................................ .

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

20,13 Trustees, supreme or grand (Fraternal only) $ ..

20.2 Total amount of loans outstanding at the end of year (inclusive of Separate Accounts, exclusive of policy loans): 20.21 To directors or other officers

20.22 To stockholders not officers

20.23 Trustees, supreme or grand (Fraternal only)

21.1 Were any assets reported in this statement subject to a contractual obligation to transfer to another party without the liability for such obligation being reported in the statement?

21.2 If yes, state the amount thereof at December 31 of the current year: $ ....... .

Yes [ No [ X ]

21.21 Rented from others

21.22 Borrowed from others

21.23 Leased from others

21.24 Other

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

L .............................. .

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

22.1 Ooes this statement include payments for assessments as described in the Annual Statement Instructions other than guaranty fund or guaranty association assessments? Yes [ ) No [ X ]

22.2 If answer is yes: 22.21 Amount paid as losses or risk adjustment

22.22 Amount paid as expenses

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

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

22.23 Other amounts paid L ...................................... .. 23.1 Does the reporting entity report any amounts due from parent, subsidiaries or affiliates on Page 2 of this statement?

23.2 If yes, indicate any amounts receivable from parent included in the Page 2 amount:

INVESTMENT

24.01 Were all the stocks, bonds and other securities owned December 31 of current year, over which the reporting entity has exclusive control, in the actual possession of the reporting entity on said date? (other than securities lending programs addressed in 24.03)

24.02 If no, give full and complete information, relating thereto

Custodial account with UMB Bank, Kansas City, MO ...

24.03 For security lending programs, provide a description of the program including value for collateral and amount of loaned securities, and whether collateral is carried on or off·balance sheet. (an alternative is to reference Note 17 where this information is also provided)

24.04 Does the company's security lending program meet the requirements for a conforming program as outlined in the Risk~Based Capital Instructions? Yes

Yes [ ] No [ X ]

Yes [ ] No [ X ]

] No[ ]NA[X]

24.05 If answer to 24.04 is yes, report amount of collateral for conforming programs.

24.06 If answer to 24.04 is no, report amount of collateral for other programs.

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

24.07 Does your securities lending program require 102% (domestic securities) and 105% (foreign securities) from the counterparty at the outset of the contract? Yes

24.08 Does the reporting entity non·admit when the collateral received from the counterparty falls below 100%? Yes

24.09 Does the reporting entity or the reporting entity's securities lending agent utilize the Master Securities Lending Agreement (MSLA) to

No

No

] NA [ X ]

] NA [ X ]

conduct securities lending? Yes No] NA [ X ]

24.10 For the reporting entity's security lending program, state the amount of the 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 adjustedlcarrying value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2 $ ............................ .

24.103 Total payable for securities lending reported.on the liability page $ .......... .

15.2



25.1 Were any of the stocks, bonds or other assets of the reporting entity owned at December 31 of the current year not exclusively under the Gontrol of the reporting entity or has the reporting entity sold or transferred any assets subject to a put option contract that is currently in force? (Exclude securities subject to Interrogatory 21.1 and 24.03).

25.2 If yes, state the amount thereof at December 31 of the current year:

Yes [ J No [ X J

25.21 Subject to repurchase agreements $ ............................................. .

25.22 Subject to reverse repurchase agreements

25.23 Subject to dollar repurchase agreements

25.24 Subject to reverse dollar repurchase agreements

25.25 Placed under option agreements

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

25.26 Letter stock or securities restricted as to sale - excluding FHLB Capital Stock $.

25.27 FHLB Capital Stock $ ...

25.28 On deposit with states $ .....

25.29 On deposit with other regulatory bodies

25.30 Pledged as collateral - excluding collateral pledged to an FHLB

25.31 Pledged as collateral to FHLB - including assets backing funding agreements

25.32 Other

25.3 For category (25.26) provide the following:

Nature of Restriction

26.1 Does the reporting entity have any hedging transactions reported on Schedule DB?

2 Description

26.2 If yes, has a comprehensive description of the hedging program been made available to the domiciliary state? If no, attach a description with this statement.

27.1 Were any preferred stocks or bonds owned as of December 31 of the current year mandatorily convertible into equity, or, at the option of the issuer, convertible into equity?

27.2 If yes. state the amount thereof at December 31 of the current year.

28. Excluding items in Schedule E - Part 3 - Special Deposits, real estate, mortgage loans and investments held physically in the reporting entity's offices, vaults or safety deposit boxes, were all stocks, bonds and other securities, owned throughout the current year held pursuant to a custodial agreement with a qualified bank or trust company in accordance with Section 1, 111- General Examination Considerations, F. Outsourcing of Critical Functions, Custodial or Safekeeping agreements of the NAIC Financial Condition Examiners Handbook?

28.01 For agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following:

1 Name of Custodianisl

UMB Bank ...

2 Custodian's Address

. Kansas Ci Iy, MO ..........

28.02 For all agreements that do not comply with the requirements of the NAIC Financial Condition Examiners Handbook, provide the name, location and a complete explanation:

3 1 Name(s)

2 Location(s) Complete Explanation(s)

28.03 Have there been any changes, including name changes, in the custodian(s) identified in 28.01 during the current year? 28.04 If yes, give full and complete information relating thereto:

2

Old Custodian New Custodian

15.3

3 Date of Change

4

Reason

$.

$ .....

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

$.

3 Amount

Yes No [ X J

Yes [ J No [ J NI A [ J

Yes [ No [ X J

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

Yes [ X J No [

Yes [ No [ X J

""'""_.,,---,'---------------------------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association


28.05 Investment management - Identify all investment advisors, investment managers, broker/dealers, including individuals that have the authority to make investment decisions on behalf of the reporting entity, For assets that are managed internally by employees of the reporting entity, note as such. r ... that have access to the investment accounts"; ~ ... handle securitiesl

Name of Firm or Individual

Charles Scott Kurtz.

2 Affiliation

28.0(;97 For those firms/individuals listed in the table for Question 28.05, do any firms/individuals unaffiliated with the reporting entity (I.e., designated with a "U") manage more than 10% of the reporting entity's assets?

28.0598 For firms/individuals unaffiliated with the reporting entity (I.e., designated with a "U") listed in the table for Question 28.05, does the total assets under management aggregate to more than 50% of the reporting entity's assets?

Ves [ X) No

Ves [ X) No [

28.06 For those firms or individuals listed in the table for 28.05 with an affiliation code of "A" (affiliated) or "U" (unaffiliated), provide the information for the table below.

2 3 4 5 Central Registration DeDository Number

Name of Firm or Individual

Legal Entity Identifier (LEI) Registered With

Investment Management Aareement (IMA) Filed

'"'''' Char les Scot t KurtL NO"""".,.,"".,"""""""""""""'''''".

29.1 Does the reporting entity have any diversified mutual funds reported in Schedule 0 - Part 2 (diversified according to the Securities and Exchange Commission (SEC) in the Investment Company Act of 1940 {Section 5 (b) (1)])7

29.2 If yes, complete the following schedule: Ves [ ) No [ X )

1 CUSIP #

2 Name of Mutual Fund

3 Book/Adiusted Carrvine Value

29.2999 TOTAL

29.3 For each mutual fund listed in the table above, complete the following schedule:

Name of Mutual Fund (from above table l

2

Name of Significant Holding of the Mutual Fund

3 Amount of Mutual Fund's

Book/Adjusted Carrying Value Attributable to the Holdina

4

Date of Valuation

30. Provide the following information for all short-term and long-term bonds and all preferred stocks. Do not substitute amortized value or statement value for fair value.

30.1 Bonds,,,,

30.2 Preferred Stocks",

30.3 Totals

Statement (Admitted) Value

4,513,262

4,513,262

30.4 Describe the sources or methods utilized in determining the fair values:

UMB Bank Custodial StatemenL. """""""""" """." .. "

2

Fair Value

""""""""",,,,,,,,,A, 518,841

4,518,841

3 Excess of Statement over Fair Value (-),

or Fair Value over Statement (+)

5,578

31.1 Was the rate used to calculate fair value determined by a broker or custodian for any of the securities in Schedule 07

31.2 If the answer to 31.1 is yes, does the reporting entity have a copy of the broker's or custodian's pricing policy (hard copy or electronic copy) for all brokers or custodians used as a pricing source?

31.3 If the answer to 31.2 is no, 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 the filing requirements of the Purposes and Procedures Manual of the NAle Investment Analysis Office been followed?

32.2 If no, list exceptions:

15.4

Ves No

Ves No [ X )

Ves [ X) No [



OTHER 33.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, jf any? $

33.2 List the name of the organization and the amount paid if any such payment represented 25% or more of the total payments to trade associations, service organizations and statistical or rating bureaus during the period covered by this statement.

Name

34.1 Amount of payments for legal expenses, if any? $

34.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payments for legal expenses during the period covered by this statement.

Name 2

Amount Paid

Shuttleworth & Ingersoll .................................................... . ................ $ .......................... 1 ,617

35.1 Amount of payments for expenditures in connection with matters before legislative bodies, officers or departments of government,

if any? $

35.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payment expenditures in connection with matters before legislative bodies, officers or departments of government during the period covered by this statement.

Name

See t ndependen t Accoun t an t 's Comp i I at ion Repo r t ,

15.5

2 Amount Paid

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

. S ... .

................................ 13,331

.................................... 1 ,617

>--"'~"-.-----. "<» ... > .. _--------_. -,..,------------------------------------


GENERAL INTERROGATORIES PART 2 - PROPERTY & CASUALTY INTERROGATORIES

1.1 Does the reporting entity have any direct Medicare Supplement Insurance in force? .'_

u If yes, indicate premium earned on U. S. business only ...

1,3 What portion of Item (1.2) is not reported on the Medicare Supplement Insurance Experience Exhibit? ___ _

1.31 Reason for excluding

1.4 Indicate amount of earned premium attributable to Canadian andlor Other Alien not included in Item (1.2) above ............................... .

1.5

1.S

Indicate total incurred claims on all Medicare Supplement insurance.

Individual policies:

1.7 Group policies:

2. Health Test:

2.1 Premium Numerator

Most current three years:

1.S1 Total premium earned ........

1.S2 Total incurred claims ............................... ..

1.S3 Number of covered lives ..

All years prior to most current three years:

1.64 Total premium earned ..

1.S5 Total incurred claims ....

1.SS Number of covered lives

Most current three years:

1.71 Total premium earned.

1.72 Total incurred claims ..

1.73 Number of covered lives ..

All years prior to most current three years:

1.74 Total premium earned ."

1.75 Total incurred claims ..

1.76 Number of covered lives

CUrrent Year

Ves I No [ X I $ ................................ .

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

$

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

$.

$.

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

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

$.

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

$ ...... ..

$ ................................. --.. ..

2 Prior Year

2.2 Premium Denominator

$

$ .................... 2,543,233

$

$ ........... .2 , 593,667

2.3 Premium Ratio (2.112.2)

2.4 Reserve Numerator

2.5 Reserve Denominator

$

$ .... ..1 ,534, 116 $

$ ................... ..1 ,910,799

2.S Reserve Ratio (2.412.5)

3.1 Does the reporting entity issue both participating and non-participating policies? ............................................................................ __ .. __ .............. .

3.2 If yes, state the amount of calendar year premiums written on: 3.21 Participating policies ........................ ..

3.22 Non-participating policies .................................. ..

4. For Mutual reporting entities and Reciprocal Exchanges only: 4.1 Does the reporting entity issue assessable policies? .................. .......................... . ................................... . 4.2 Does the reporting entity issue non·assessable policies?......... . . ............................................. . 4.3 If assessable pOlicies are issued, what is the extent of the contingent liability of the policyholders?

4.4 Total amount of assessments paid or ordered to be paid during the year on deposit notes or contingent premiums .......................... .

5. For Reciprocal Exchanges Only:

5.1 Does the exchange appoint local agents? ........................................................................................................ .

5.2 If yes, is the commission paid:

5.21 Out of Attorney's-in-fact compensation ...

5.22 As a direct expense of the exchange.

5.3 What expenses of the Exchange are not paid out of the compensation of the Attorney-in-fact?

5.4 Has any Attorney-in-fact compensation, contingent on fulfillment of certain conditions, been deferred? 5.5 If yes, give full information

16

Ves I No [ X I

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

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

$ .....

Ves [ I No [ X I Ves [X I No [ I

..... %

Ves I No [ X I

Ves [ I No [ J NIA [XI Ves [ I No [ I NIA [XI

Ves [ I No [ X I


GENERAL INTERROGATORIES PART 2 - PROPERTY & CASUALTY INTERROGATORIES

6.1 What provision has this reporting entity made to protect itself from an excessive loss in the event of a catastrophe under a workers' compensation contract issued without limit of loss: .............. ________ ..... ____ ... ______________________________ . __ ............... ___ . ______ ..... __ ...... __ ...... .

NIL ....................... ........................... .................. . ................ . 6.2 Describe the method used to estimate this reporting entity's probable maximum insurance loss, and identify the type of insured exposures

comprising that probable maximum loss, the locations of concentrations of those exposures and the external resources (such as consulting firms or computer software models), if any, used in the estimation process: .. The association has an aggregate excess loss reinsurance contract with Wisconsin Reinsurance Corporation ..................................... .

6.3 What provision has this reporting entity made (such as a catastrophic reinsurance program) to protect itself from an excessive loss arising from the types and concentrations of insured exposures comprising its probable maximum property insurance loss? ...................................... . The association has an aggregate excess toss reinsurance contract with Wisconsin Reinsurance Corporation ..................................... .

6.4 Does the reporting entity carry catastrophe reinsurance protection for at least one reinstatement, in an amount sufficient to cover its estimated probable maximum loss attributable to a single loss event or occurrence?........ .. ....................................... ..

6.5 If no, describe any arrangements or mechanisms employed by the reporting entity to supplement its catastrophe reinsurance program or to

7.1

7.2 7.3

8.1

8.2

hedge its exposure to unreinsured catastrophic loss The associ at ion has an aggregate excess loss reinsurance contract wi Ih Wisconsin Reinsurance Corporat ion ..................................... . Has the reporting entity reinsured any risk with any other entity under a quota share reinsurance contract that includes a provision that would limit the reinsurer's losses below the stated quota share percentage (e.g., a deductible, a loss ratio corridor,. loss cap, an aggregate limit or any similar provisions)?... . ............... . If yes, indicate the number of reinsurance contracts containing such provisions .... If yes, does the amount of reinsurance credit taken reftect the reduction in quota share coverage caused by any applicable limiting provision(s)?.... ..................................... .................. .................... .. ....................................... .. Has this reporting entity reinsured any risk with any other entity and agreed to release such entity from liability, in whole or in part, from any loss that may occur on this risk, or portion thereof, reinsured? ........................ . ............... . If yes, give full information

9.1 Has the reporting entity ceded any risk under any reinsurance contract (or under multiple contracts with the same reinsurer or its affiliates) for which during the period covered by the statement: (i) it recorded a positive or negative underwriting result greater than 5% of prior yearend surplus as regards policyholders or it reported calendar year written premium ceded or year-end loss and loss expense reserves ceded greater than 5% of prior year-end surplus as regards policyholders; (Ii) it accounted for that contract as reinsurance and not as a deposit; and (iii) the contract(s) contain one or more of the following features or other features that would have similar results:

(a) A contract term longer than two years and the contract is noncancellable by the reporting entity during the contract term; (b) A limited or conditional cancellation provision under which cancellation triggers an obligation by the reporting entity, or an affiliate of the reporting entity, to enter into a new reinsurance contract with the reinsurer, or an affiliate of the reinsurer; (c) Aggregate stop loss reinsurance coverage; (d) A unilateral right by either party (or both parties) to commute the reinsurance contract, whether conditional or not, except for such provisions which are only triggered by a decline in the credit status of the other party; (e) A provision permitting reporting of losses, or payment of losses, less frequently than on a quarterly basis (unless there is no activity during the period); or (f) Payment schedule, accumulating retentions from multiple years or any features inherently designed to delay timing of the reimbursement to the ceding entity. .................... .. ................................................................................................. .

9.2 Has the reporting entity during the period covered by the statement ceded any risk under any reinsurance contract (or under multiple contracts with the same reinsurer or its affiliates), for which, during the period covered by the statement, it recorded a positive or negative underwriting result greater than 5% of prior year-end surplus as regards policyholders or it reported calendar year written premium ceded or year-end loss -and loss expense reserves ceded greater than 5% of prior year-end surplus as regards policyholders; excluding cessions to approved pooling arrangements or to captive insurance companies that are directly or indirectly controlling, controlled by, or under common control with (i) one or more unaffiliated policyholders of the reporting entity, or (ii) an association of which one or more unaffiliated policy~olders of the reporting entity is a member where:

(a) The written premium ceded to the reinsurer by the reporting entity or its affiliates represents fifty percent (50%) or more of the entire direct and assumed premium written by the reinsurer based on its most recently available financial statement; or (b) Twenty-five percent (25%) or more of the written premium ceded to the reinsurer has been retroceded back to the reporting entity or its affiliates in a separate reinsurance contract.

9.3 If yes to 9.1 or 9.2, please provide the following information in the Reinsurance Summary Supplemental Filing for General Interrogatory 9:

(a) The aggregate financial statement impact gross of all such ceded reinsurance contracts on the balance sheet and statement of income; (b) A summary of the reinsurance contract terms and indicate whether it applies to the contracts meeting the criteria in 9.1 or 9.2; and (c) A brief discussion of management's principle objectives in entering into the reinsurance contract including the economic purpose to be achieved.

9,4 Except for transactions meeting the requirements of paragraph 31 of SSAP No. 62R - Property and Casualty Reinsurance, has the reporting entity ceded any risk under any reinsurance contract (or multiple contracts with the same reinsurer or its affiliates) during the period covered by the financial statement, and either:

(a) Accounted for that contract as reinsurance (either prospective or retroactive) under statutory accounting principles ("SAP") and as a deposit under generally accepted accounting principles ("GAAP"); or (b) Accounted for that contract as reinsurance under GAAP and as a deposit under SAP?

9.5 If yes to 9,4, explain in the Reinsurance Summary Supplemental Filing for General Interrogatory 9 (Section D) why the contract(s) is treated differently for GAAP and SAP.

9.6 The reporting entity is exempt from the Reinsurance Attestation Supplement under one or more of the following criteria:

(a) The entity does not utilize reinsurance; or, (b) The entity only engages in a 100% quota share contract with an affiliate and the affiliated or lead company has filed an attestation supplement; or (c) The entity has no external cessions and only participates in an intercompany pool and the affiliated or lead company has filed an attestation supplement.

10. If the reporting entity has assumed risks from another entity, there should be charged on account of such reinsurances a reserve equal to that which the original entity would have been required to charge had it retained the risks. Has this been done?

16.1

Ves [ ) No [ X )

Ves [

Ves

Ves

No [ X )

No [ X )

No [ X )

Ves [ ) No [ X )

Ves [ ) No [ X )

Ves [ ) No [ X )

Ves

Ves

Ves

No [ X )

No [ X )

No [ X )

Ves [ ) No [ ) NI A [X)

____ , __ ~'~' ___ , _____ .~_~_"""'~. ____________ ""> ........ ____________ ,_ ... ,-----------_ .... _----------


GENERAL INTERROGATORIES PART 2 • PROPERTY & CASUALTY INTERROGATORIES

11.1 Has the reporting entity gl,laranteed policies issued by any other entity and now in force: 11.2 If yes, give full information

Yes [ ] No [ X ]

12.1

12.2 12.3

If the reporting entity recorded accrued retrospective premiums on insurance contracts on Line 15.3 of the asset schedule, Page 2, state the amount of corresponding liabilities recorded for:

12.11 Unpaid losses. ......................................... . . ....... . ................................. . 12.12 Unpaid underwriting expenses (including loss adjustment expenses) ................................. _ ................ .

Of the amount on Line 15.3, Page 2, state the amount that is secured by letters of credit, collateral and other funds? .......... . If the reporting entity underwrites commercial insurance risks, such as workers' compensation, are premium notes or promissory notes

L>>o .... >o ........ > .... . $ ........... . $ ....................... .

accepted from its insureds covering unpaid premiums andlor unpaid losses? .............................................. . Yes [ ] No [ ] N/A [X] 12.4

12.5

If yes, provide the range of interest rates charged under such notes during the period covered by this statement: 12.41 From... ..................................... . .................. >0..... ••••••••••••••••••••••••••••••••••• • ••••••••••••••••••••

12.42 To................. . .. > .................. >... . ................................................... >0>0 ••••• >0 •• >0>0 ............ > ... > ............................................... . Are letters of credit or collateral and other funds received from insureds being utilized by the reporting entity to secure premium notes or promissory notes taken by a reporting entity, or to secure any of the reporting entity's reported direct unpaid loss reserves, including unpaid

% %

losses under loss deductible features of commercial policies? ................................................................................................................................. . Yes [ ] No [ X ] 12.6 If yes, state the amount thereof at December 31 of current year:

12.61 Letters of Credil... ........................ ............................ $ .................................................. . 12.62 Collateral and other funds ......................... . $.

13.1 Largest net aggregate amount insured in anyone risk (excluding workers' compensation): $ ................... . 13.2 Does any reinsurance contract considered in the calculation of this amount include an aggregate limit of recovery without also including a

reinstatement provision? ..... ........................ . ................................... . 13.3 State the number of reinsurance contracts (excluding individual facultative risk certificates, but including facultative programs, automatic

facilities or facultative obligatory contracts) considered in the calculation of the amount. .................................................... .. ......... _ ..... .

14.1 Is the reporting entity a cedant in a multiple cedant reinsurance contract? ............................ _. ____ ..... ___ . __ .... _. __ .... _ ....... _ ........ . 14.2 If yes, please describe the method of allocating and recording reinsurance among the cedants:

14.3 If the answer to 14.1 is yes, are the methods described in item 14.2 entirely contained in the respective multiple cedant reinsurance contracts? .... _ .................................. _.......... .. ........................................ .

14.4 If the answer to 14.3 is no, are all the methods described in 14.2 entirely contained in written agreements? ................... . 14.5 If the answer to 14.4 is no, please explain:

Yes

Yes

Yes

Yes

. .. 200,000

No

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

No

No

No

[ X

....... 1

[ X

]

]

15.1 Has the reporting entity guaranteed any financed premium accounts? .... 15.2 If yes, give full information

Yes [ ] No [ X ]

16.1 Does the reporting entity write any warranty business?

If yes, disclose the following information for each of the following types of warranty coverage:

. ........ $

Direct Losses Incurred

$

2 Direct Losses

Unpaid

$

3 Direct Written

Premium

4 Direct Premium

Unearned

Yes I ] No [ X ]

5 Direct Premium

Earned

$ ........................................ $ ......................... > ........ .. 16.11 Home ..

16.12 Products

16.13 Automobile ..

.... $ $ ............. > ...... . $ ........ . . ..................... $ ....................................... . $ ......................... .

16.14 Other' .... > •••••••••••••••••••••••••••

* Disclose type of coverage:

. ........ $ >.> .............................. .

. ...... $

$

$

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

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

16,2

$ .......................... $ ............. > •••••••

.. > .. > .......... $ ........................................ $ ....... ».> .. > ...... .


GENERAL INTERROGATORIES PART 2· PROPERTY & CASUALTY INTERROGATORIES

17.1 Does the reporting entity include amounts recoverable on unauthorized reinsurance in Schedule F - Part 3 that it excludes from Schedule F - Part 5 ..................... .

Incurred but not reported losses on contracts in force prior to July 1, 1984, and not subsequently renewed are exempt from inclusion in Schedule F - Part 5. Provide the following information for this exemption:

17.11

17.12

Gross amount of unauthorized reinsurance in Schedule F - Part 3 excluded from Schedule F - Part 5.

Unfunded portion of Interrogatory 17.11.

Yes [ 1 No [ X 1

17.13 Paid losses and loss adjustment expenses portion of Interrogatory 17.11 $ ............................................... .

17.14 Case reserves portion of Interrogatory 17.11................... $ ............................................... .

17.15 Incurred but not reported portion of Interrogatory 17.1 L $ ............................................... .

17.16

17.17

Unearned premium portion of Interrogatory 17.11 ....... .

Contingent commission portion of Interrogatory 17.11 ... .

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

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

Provide the following information for all other amounts included in Schedule F - Part 3 and excluded from Schedule F - Part 5, not included above.

Gross amount of unauthorized reinsurance in Schedule F - Part 3 17 .18 excluded from Schedule F - Part 5..... $ ...

17.19 Unfunded portion of Interrogatory 17.18 ....

17.20

17.21

Paid losses and loss adjustment expenses portion of Interrogatory 17.18 $.

Case reserves portion of Interrogatory 17.18............... .................. $ .............................................. .

17.22 Incurred but not reported portion of Interrogatory 17.18 ....................... .

17.23

17.24

Unearned premium portion of Interrogatory 17.18 .....

Contingent commission portion of Interrogatory 17.18 ........... .

18.1 Do you act as a custodian for health savings accounts?. . .................... .

18.2 If yes, please provide the amount of custodial funds held as of the reporting date.

18.3 Do you act as an administrator for health savings accounts? .............................................................. _ ..................... _____ ... ____ _

18.4 If yes, please provide the balance of the funds administered as of the reporting date. See Independent Accountant's Compi lat ion Report.

16.3

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

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

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

Yes [ 1 No [ X 1 $... ......................................... .

Yes [ 1 No [ X 1

1M


FIVE-YEAR HISTORICAL DATA Show amounts In whole dollars only, no cents; show percentages to one decimal place, i.e., 17.6.

1 234 2016 2015 2014 2013

pross Premiums Written (Page 8, Part 1 B, Cols. 1, 2 & 3) 1. Liability lines (Lines 11.1, 11.2, 16, 17.1, 17.2, 17.3,

18.1,18.2,19.1,19.2& 19.3, 19.4) ..................................................................... .. 2. Property lines (Lines 1,2,9, 12, 21 & 26) ..................................... .2 ,967 ,020 ......... 3,033,393 ................. .2,981 ,361 .. .. .2,768,134 3. Property and liability combined lines (Lines 3, 4, 5,

8,22 &27)................. .. .................... .. 4. All other lines (Lines 6, 10, 13, 14, 15, 23, 24, 28,

29,30 & 34).... .. ................................................................................................. .. 5. Nonproportional reinsurance lines (Lines 31,32 &

5 2012

.............. 2,463,891

33) ..... .. ...................... 1----:-;=-=+-----;;-=-=::+------::-::::7'7::-:--1----;;-::;:::-:-::-:-+-----:::--=:--="" 6. Total (Line 35) ................................... .. .............. 2,967,020 .................. 3,033,393 ...... .2 ,981,361 ....... 2,768,134 .................. .2 ,463,891

Net Premiums Written (Page 8, Part 1 B, Col. 6)

7. Liability lines (Lines 11.1, 11.2, 16, 17.1, 17.2, 17.3, 18.1,18.2,19.1,19.2& 19.3, 19.4) ...................................................................................................................................................... .

8. Property lines (Lines 1, 2, 9, 12.21 &26) ..................................... 2, 566,157 .............. 2,613,458 ........ 2,598,125 ....... 2,390,146 .................. .2,100,095 9. Property and liability combined lines

(Lines 3, 4, 5, 8, 22 & 27) .. 10. All other lines

(Lines 6, 10, 13, 14, 15, 23, 24, 28, 29, 30 & 34) ........................ . 11. Nonproportional reinsurance lines

(Lines 31, 32 & 33) .................................... 1-------;:-:c:::-=-t-------;:-::-:::-=-j----::--==-=+---;;;-;:=-=+----::-:==", 12. Total (Line 35)........... .. ...................................................... 2,566,157 .. 2,613,458 .. .2,598,125 ................... 2,390,146 ..... 2,100,095

~tatement of Income (Page 4)

13. Net underwriting gain (loss) (Une 8). .. ....................................... .415,232 14. Net investment gain (loss) (Line 11)..... .. .......... 315,918 15. Total other income (Line 15) ............. .. ...... 57,949 16. Dividends to policyholders (Line 17) .............................................................. .. 17. Federal and foreign income taxes incurred

.... (391,773) ...... 96,139

........... 68,755

................ 98,788 ...................... 389,386

.... 58,630

.......... .245,715 ........... .279,377

....... 55,757

................ .446,105 ...... .271,053

..... 68,118

(Line 19) ............................................................... . 43,767 92,363 182,643 172,782 147,900 18. Net income (Line 20).. .. ....................................................... ..745,333 .......... (319,241) ........................ 364,161 .. .... .408 , 067 ....................... 637,377

Balance Sheet Lines (Pages 2 and 3)

19. Total admitted assets excluding protected cell business (Page 2, Line 26, Col. 3) .......................... . . .12,884,191 ............ 12,204,317 .... 12,189,346 .................. 11,776,399 ................. 10,529,183

20. Premiums and considerations (Page 2, Col. 3) 20.1 In course of collection (Line 15.1).. . ......................... .8,407 .................... 10,380 ..... 11,932 .......................... .9,118 20.2 Deferred and not yet due (Line 15.2) ............... ..................................... ............... .. ................ . 20.3 Accrued retrospective premiums (Line 15.3) ..... ................................. .. ...................................... ..

21. Total liabilities excluding protected cell business (Page 3, Line 26) ..................................... 1,617,660 ... 2,004,565 ......... 1,396,764 ..... 1,320,054

22. Losses (Page 3, Line 1) .. .................... ................. ... .. .... 434,748 ....... 807,886 ......... .260,475 ...... .200,692 23. Loss adjustment expenses (Page 3, Line 3). .. ..... .27,632 ............. 54,102 ....... 15,783 .............. 11,598 24. Unearned premiums (Page 3, Une9)....................... .. .. 1,071,735 .... 1,048,811 ................... 1,029,020 ............ 957,687 25. Capital paid up (Page 3, Unes 30 & 31). ..................... . .. ...................................................................................................................................... . 26. Surplus as regards policyholders (Page 3, Line 37) ................... 11,266,532 ..... 10,199,752 ........... 10,792,582 ...... 10 ,456 ,345

Cash Flow (Page 5)

........ 17,328

........ 1,096,541 ........................ 103,877 .......................... .4,821

........... 882,830

........ 9,432,642

27. Net cash from operations (Une 11) ... ........................ .222,905 ..... ............. 513,385 .. ...... .211,742 ...................... .799,043 ....................... 338,975 Risk-Based Capital Analysis

28. Total adjusted capital.. .. ....................... .. 29. Authorized control level risk-based capital

Percentage Distribution of Cash, Cash Equivalents and Invested Assets

(Page 2, Col. 3)(ltem divided by Page 2, Une 12, Col. 3) x 100.0

30. Bonds (Une 1) . 31. Stocks (Lines 2.1 & 2.2) .. 32. Mortgage loans on real estate (Lines 3.1 and 3.2)

.. ........ 11,266,532 ........... 10,199,752 ... 10,792,582 ................. 10,456,345 ................... 9,432,642 ........ 513,729 ...................... .452,693 ...................... .467,472 ........................ 444,176 ....................... 384,034

.......... .35.2 .. ..................... 35.5 ............................. 34.9 ............................. 31.7 ............................ .32.2 ....................... .45.4 .. ............. .41.9 ............ .44.9 ............................ .43.7 .. .. .......... .41.9

33. Real estate (Unes 4.1,4.2 & 4.3).. .. ............................................ 1.5 ............. 1.6 .. ................. 1.7 ............ ..1.9 ....... 2.2

.. ... 23.8 34. Cash, cash equivalents and short-term investments

(Line 5) ........................ .. ...... 17.9 ................ 21.0 ............................ .18.5 ............................ 22.7 35. Contract loans (Line 6) ....... 36. Derivatives (Line 7)......... .. .................. . 37. Other invested assets (Line 8) ................ .. 38. Receivables for securities (Line 9) .. . 39. Securities lending reinvested coJiateral assets (Line

10) ...................................................................... ..

40. Aggregate write-ins for invested assets (Line 11) ...... f-------+-------f-------+-------f--------1 41. Cash, cash equivalents and invested assets (Line

12) ......... ............................. .. ................................. 100.0 ........ .. Investments In Parent, Subsidiaries and Affiliates

42. Affiliated bonds, (Sch. 0, Summary, Line 12, Col. 1) 43. Affiliated preferred stocks

(Sch. 0, Summary, Line 18, Col. 1) 44. Affiliated common stocks

(Sch. 0, Summary, Line 24, Col. 1). 45. Affiliated short-term investments (subtotals included

in ScheduleDA Verification, Col. 5, Line 10) 46. Affiliated mortgage loans on real estate .. . 47. All other affiliated ..... .. .................... .. 48. Total of above Lines 42 to 47 ........................... . 49. Total Investment in parent included in Lines 42 to 47

...... 319,439

319,439

.. ........ 100.0.

............. 300,892

300,892

above ............ __ ........................ __ "." ..... __ ........ __ ... __ ..................................................... __ ........ __ . __ . __ . __ . ____ __ 50. Percentage of investments in parent, subsidiaries

and affiliates to surplus as regards policyholders (Line 48 above divided by Page 3, Col. 1, Line 37 x 100.0) 2.8 2.9

See Independent Accountant'. Campllat Ion Report.

17

. .............. 100.0 ............................. 100.0 ............................. 100.0.

.... 296,788 .. ....... .292,017 ...................... .287,969

296,788 292,017 287,969

2.7 2.8 3.1


~apltal and Surplus Accounts (Page 4)

FIVE-YEAR HISTORICAL DATA 1

2016

Continued) 2

2015 3

2014 4

2013 5

2012

51. Net unrealized capital gains (losses) (Line 24) .................................. 347 ,329 ........ (327 ,674) ....................... 82,759 ......................... 611 ,022 ..................... .226, 126

52. Dividends to stockholders (Line 35) ........................................................................................................................................................................................ .

53. Change in surplus as regards policyholders for the year (Line 38) .....................•............................... 1 ,066,779 ..................... (592 ,829) ................... 336,237 ................... 1 ,023,703 ....................... 882 ,637

Fross Losses Paid (Page 9, Part 2, Cols. 1 & 2)

54. Liability lines (Lines 11.1, 11.2, 16, 17.1, 17.2, 17.3, 18.1,18.2,19.1,19.2 & 19.3, 19.4)

55. Property lines (Lines 1, 2, 9, 12,21 & 26) .. ........................ 1 ,512,666 ...... 1 ,438,440 ................... 1 ,440,781 .................... 1,075,497 ... 1,118,606

56. Property and liability combined lines (Lines 3, 4, 5, 8, 22 & 27) . . .................................................................................................... .

57. All other lines (Lines 6, 10, 13, 14, 15,23,24,28,29,30 & 34) ..

58. NonproPQrtional reinsurance lines (Lines 31,32 & 33) ..

59. Total (Line 35) ................................................................. . . ... 1 ,512,666 ................... 1,438,440 ................... 1,440,781 .................... 1,075,497 .................... 1,118,606

",et Losses Paid (Page 9, Part 2, Col. 4)

60. Liability lines (Lines 11.1, 11.2, 16, 17.1, 17.2, 17.3, 18.1,18.2,19.1,19.2 & 19.3,19.4)

61. Property lines (Lines 1, 2, 9,12,21 & 26) ...................................... 1 ,498,972 ........ 1,438,440

62. Property and liability combined lines (Lines 3, 4, 5, 8, 22 & 27) ....................................................................................................... .

63. All other lines (Lines 6,10,13,14,15,23,24,28,29,30 & 34) ......................................................... .

64. Nonproportional reinsurance lines (Lines 31, 32 & 33) ..

65. Total (Line 35) ..

Ioperating Percentages (Page 4) Item divided by Page 4, Line 1) x 100.0

.................... 1 ,498,972 ............. 1 ,438,440

.......... 1,440,781 .................... 1 ,075,497 ........................ 897,774

.......... 1,440,781 . .... 1,075,497 ...................... 897,774

66. Premiums earned (Line 1) ........................................................ 100.0 ............................ 100.0......... . .... 100.0 .. . .......... 100.0....... . ....... 100.0 ..... .

67. Losses incurred (Line 2) ..................... . ......................... .44.3 ........................... ..76.6 .............................. 59.4 . ..................... 50.6 ........................... 37.9

68. Loss expenses incurred (Line 3) ..

69. Other underwriting expenses incurred (Line 4)

70. Net underwriting gain (loss) (Line 8)

Iother Percentages

71. Other underwriting expenses to net premiums written (Page 4, Lines 4 + 5 - 15 divided by

................................. 5.6

............................ 33.8 ....

........................... .16.3

........... .7 .7 . ............. 30.8

(15.1)

.................... 6.2 .............................. ..7 ,0

. ................. 30.5 ............................. .31.8

................. J.9 ................ 10.6

. ................. ..7,2

........................ 33.1

...... 21.7

Page 8, Part lB, Col. 6, Line 35 x 100.0) .................................................. 31.2 ............. 27.9 ............................ 27.4 ............................. 28.5 ............................. 29.2

72. Losses and loss expenses incurred to premiums earned (Page 4, Lines 2 + 3 divided by Page 4, Line 1 x 100.0) .............................................................. .49.9 .............................. 84.3 ............................. 65.6

73. Net premiums written to policyholders' surplus (Page 8, Part 1 B, Col. 6, Line 35 divided by Page 3, Line 37, Col. 1 x 100.0) ..

pne Vear Loss Development (000 omitted)

74. Development in estimated losses and loss expenses incurred prior to current year (Schedule P, Part 2-Summary, Line 12, Col. 11) ..

75. Percent of development of losses and loss expenses incurred to policyholders' surplus of prior year end (Line 74 above divided by Page 4, Line 21, Col. 1 x 100.0) .................... .

Irwo Vear Loss Development (000 omitted)

76. Development in estimated losses and loss expenses incurred 2 years before the current year and prior year (Schedule P, Part 2 - Summary, Line 12, Col. 12) .............................................. .

77. Percent of development of losses and loss expenses incurred to reported policyholders' surplus of second prior year end (Line 76 above divided by Paoe 4, Line 21 Col. 2 x 100.0)

......................... 22.8 ............................. 25.6 ...................... .24.1

..... 57.6

............ 22.9 .

• NOTE: If a party to a merger, have the two most recent years of this exhibit been restated due to a merger in compliance with the disclosure reqUIrements

........................ .45.2

. ..... 22.3

of SSAP No. 3 - Accounting Changes and Correction of Errors? Yes [ J No [ If no, please explain

See Independent Accountant's Campi lal ion Report.

18

. ___ .... _~,""~.,,~,~"' __ , _______ 4 .... " ______________________ _


Schedule F - Part 1

NONE Schedule F - Part 2

NONE

20,21


2 3 4

NAIC Domiciliary ""'M',

10 Company Number Code Name of Do',

10rized· Wiliates - U.S. II Pooling hOrlZet - Aff i1lates - U.S. Non-Po • (;apt ive IOrlZet - All illates • U.S. Non-po - Uther

thoriz'" • Affiliates - Other (Non· .S.), Captive thorlZ'" - Affll" es· ther (Non· .S. - Other InOrlZet • Uther Inaff, alea nsurers

39·' IWISCONSII REINS . .wl IMMI9!/ - lotal • Other U.S. Unaffiliated Insurers

Authorizea - lOIS - .anlatory POOlS Authorized - Is· VoI"ntary PO<Jis ~- her ",·U.S. Insurers

1399999· ot - olal AuthOrlZea Unauthoriz", • ff' iates • U.S. IntercootOanv Pool ing unauthoriz," • If, lates • U.S. Non-Pool· Caotlve unaulnoriz," • III lates • U.S. "on--pOOl • Uther Unauthorizel - ffiliates· Other (Non·U.S .• Captive ~iZ'" - ff' iates . Othe'. (N IO·U.S .• Other

IZ'" - Uthe u.s. una!; iI lal Insurers Unauthorizel ·.Pools - MandatoryPoo Unauthor iz", - Pool • Voluntarv Poo unaulnoriz", • ther non-U.S. In ,ur Ger' i • ffiliates - U.S. .I'ooling Cer' i - filiates - .S. Non·Po • Caotive cer - I i I iates - .S. N HO . Uther :er '. Alf i Iiaies - tner """ ,Sj • Capl ive :er • Affiliates - Iher Ion· .S.I . Other :er . - Uther .S. Un; Ilatea nsurers :er - Pools - MaMaory po)ls :er ied· Pools - Volunarv Pools :er iea· Other Non-U Insurers

41 009 - 10lal Autnorzea, 'ana cer iliea 9999999 Totals

NOTE: A. Report the fiye largest iii rates included in the cedan!'s I

1. 2. 3 ............................................... .. 4. 5.

Name of Reinsurer

SCHEDULE F - PART 3 Ceded ,as of • 31, Current Year (000 Omitted)

5 6 ,On

7 8 9 10 11 12 13 14

'Known Case Known Case Contingent Special D. ";, Paid Paid IBNRloss IBNRLAE Unearned Commis-Gode Ceded Losses LAE D, D, sions

J4 I 401 14 I I 20 1 I I

401 I 14 I 20 I I I I I

I 40 I 14 2U I I I 1 401 1 14 1 1 201 1 1 1 1

,treaties. The i i rate to be reported is by I ceded premium in excess of $50,000: 2 3

Commission Rate Ceded Premium

, Payable 18 19 15 16 17

Net Amount

~~CF;;;"OO Funds Held

Other By ~nd;r .. ,

Cols. Ceded Amounts Reinsurers 7 through 14 Balances Due to ?10~S~ ~~I- Reinsurance

Totals Payable "0" Treaties

.. 38 . 341 (411 I 38 I

34 (411 I 3<11

I (411

1 341 (411 38 1

B. Report the five largest reinsurance recoverables reported in Column 15. due from anyone reinsurer (based on-the total recoverables, Line 9999999, Column 15, the amount of ceded premium, and indicate whether the recoverables are due from an affiliated insurer. 1 234

Name of Reinsurer Total Recoverables Ceded Premiums Affiliated I. Wisconsin Reinsurance Corprat iOlt ........................................................................................................................... ~3,894 ................. 400,863 Ves -[-I-No [ X I 2. ....................................................................... ................................................. ......................... ................................ Ves [ I No [ I 3. .................................................................................... ............................. ........................... .. ............................................... Ves [ I No [ I 4. ......................................... ........................... ................................................ ............................. Ves [ I No [ I 5. ................................................................. . ........................................................ __ ....................... Ves [ I No [ I


2 3

NAIC

U .. '.'?L __ Company ~u",u~r Code Name of Reinsurer lOrized - fil,ates - .S. PoolinQ 'Oflled - III,ates - .S. Noo-"OO - iptlve hQrized - Affiliates - .S. N01-POO - her hOflled - Affll,ates - Other :Non-U.S) - Gaptive IOfiled - All ,I,ates - Uther :Non-U.S) - utner

J!MiJlJ!J - tal - Uther U.S, unallil 'ated Insurers Aul hor izel - ools landatory POQIs Aul 'OrlZ" - ols - 'oluntarv PoolS AUI ,oriz .. - loU Insurers

1399999 - - TI ta, Aulhor ized Unau lOr iz .. - tes - U.S. Pool InQ lJrlau lOriz .. - tes - u.s. 1-"00 - Gaptive Unau lOriz .. _- ,tes - U.S. N l-PO - Othe, ~nau lOriz .. - 'ates - Other ~on- .S. - Gapt ive ~nau lOriz .. - ,ales - Utner ~on- '.S. - Uther Unau 10riz .. -_ "" U.S. Unallill ted Insurers ~nau lOriz .. - ools - Mandatorv 'ools ~nau lOr izo< - 001S - vOluntarv 'OOIS

,or zel - ther Non-U.S. Ins~ ii' - AIfiliales - I.S. 'oollno ii '-Alliliates- .S.Non-POO -Gap,ve i i Afti I iates - U.S. Non-Po - Other i i,ed - AIf i I iates - Other on-I .S) - ;apllve i ied - All i I iates - Uther (Non-' .S.) - Uthe,

~ i ied - Other U.S. unalll Insurers :er i ied - Pools - Mandatorv 'ools ;er i ied - PoolS - VOluntarv '001S :er ilied - Ulner Non-u.s. In$Jrers

4099999 - Total Author ized. 9999999 Totals

I and Ger; iI ied



4

I 1

SCHEDULE F - PART 4 Aging of Ceded

5

6

Current 1 to 29 Daj>"

.

14 I

141

14 141

as of" . 31, Current Year (000

7

30 - 90 Days

I

I

I 1

, on Paid Losses and Paid Loss Overdue

8 9

91 -120 Days Over 120 Davs

1

1 I

.

I I 1 I 1

10

Total Overdue Cols, 6 + 7 + 8 +9

I

I

L

11

Total Due Cols. 5 + 10

141

14 I

14 I 14

12

Percentage Overdue

Col. 10lCoi. 11

1

1

13

Percentage More Than 120 Days Overdue Col. 9 I

Col. 11

---.. ~---. _ .. _ ... _----------------------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

Schedule F - Part 5

NONE Schedule F - Part 6 - Section 1

NONE Schedule F - Part 6 - Section 2



NONE

24,25,26,27,28

_____ .. ~ __ ~~....,.,.-. ,,,,,.,_,_'.'"'"M_........_. __________ ... , __ ..... ' ___________________________________ _


SSETS (Page 2, Col. 3)

SCHEDULE F - PART 9 Restatement of Balance Sheet to Identify Net Credit for Reinsurance

1 As Reported

(Net of Ceded)

2 Restatement Adiustments

3 Restated

(Gross of Ceded)

1. Cash and invested assets (Line 12) ........... . .......... 12,817 ,054 ......................................................... 12,817,054

2. Premiums and considerations (Line 15) ............................................................ . . ..................................... .8 ,407 ................................................................. .8 ,407

3. Reinsurance recoverable on loss and loss adjustment expense payments (Line 16.1) ............................................... 13,694 ................................................ 13,694

4 Funds held by or deposited with reinsured companies (Line 16.2).

5. Other assets .. . ......................................................................... 31, 342 ................................................................. 31,342

6. Net amount recoverable from reinsurers .................................................... __ ..... __ ......................... ,_ . ......................... 13,694 ......................... 24,458 ........... 38,152

7. Protected cell assets (Line 27) ............................................................................................................... .

8. Totals (Line 28) ................................................................................................................................................. 12,884,191 ......................... 24,458 . ......... 12,908,649

LIABILITIES (Page 3)

9. Losses and loss adjustment expenses (Lines 1 through 3) .................... . ............................................................. .462, 381 ......................... 20,000 .................. .482,381

10. Taxes, expenses, and other obligations (Lines 4 through 8) ........................................................................................... .44 ,764 ................................................................ .44,764

11. Uneamed premiums (Line 9) ...................................................... . ........ 1,071,735 . .......................................... 1,071,735

12. Advance premiums (Line 10) ....

13. Dividends declared and unpaid (Line 11.1 and 11.2) ..................................................... .

14. Ceded reinsurance premiums payable (net of ceding commissions) (Line 12) ........................ (4,458) ........................... .4,458 ..... .

15. Funds held by company under reinsurance treaties (Une 13) ..... ___ ........................... _________ . __ . ________________ .................. .

16. Amounts withheld or retained by company for account of others (Line 14) ................................................................................................................................................ .

17. Provision for reinsurance (Line 16) ................................ ~ ................................................................... .

18. Other liabilities ............................................................................................................................................... t-___ ---'4"-3"',2"'38'+ ______ -t-_____ 4:.::3.c:,2"'3"-j8

19. Total liabilities excluding protected cell business (Line 26) ..................................................................... 1-__ ---'1-",6:..:1:.-7"',6"'60'+ ____ -'2"-4'-',4:.::58'+ ___ -'1"-,6"-4:.::2'-, 1:..:1"-j8

20. Prote.cted cell liabilities (Line 27) ...................................................................................... ~ ................... 1------+------+--------l

21. Surplus as regards policyholders (Line 37) 11,266,532 xxx 11,266,532

22. Totals (Line 38) 12,884,191 24,458 12,908,649

NOTE: Is the restatement of this exhibit the result of grossing up balances ceded to affiliates under 100 percent reinsurance or pooling arrangements? Ves J No [ X J

If yes, give full explanation:

See Independent Accoun1ant's Compi lat ion Report.

29

.~--.~-.-------.------------------------


OVERFLOW PAGE FOR WRITE-INS

P004 Additional Aggregate Lines for Page 4 Line 14. 'STMTINCOME - Statement of Income

1404. Over.r i Ie Fee ...................................................................................................................................................... . 1497. Summary of remaining write-ins for Line 14 from page 4

100

2 Current Year Prior Year

............... 13,345 ..................... 11,222 13,345 11,222


SUMMARY INVESTMENT SCHEDULE

Investment CateQories

1. Bonds:

Gross Investment Holdin s

2

Amount PercentaQe

1,1 U.S. treasury securities ................................................................................................................... .

1.2 U.S. government agency obligations (excluding mortgage-backed securities):

1.21 Issued by U.S. govemment agencies ............................... .

3

Amount

1.22 Issued by U.S. government sponsored agencies ...................................................................................... ___ ..

1.3 Non-U.S. government (including (:anada, excluding mortgage-backed securities).. ............................................ ..................... ...... .. .................................................. ..

1.4 Securities issued by states, territories, and possessions and political subdivisions in the U.S.:

1.41 States, territories and possessions general obligations ........................................................... .

1.42 Political subdivisions of states, territories and possessions and political subdivisions general obligations .............................. ..

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 FNMA and FHLMC ...

....... 446 ,234 ......... .3.482 ..... 3,643,575 ....... 28.428

.. 446,234 ......... 3,643,575

Admitted Assets as Reported in the Annual Statement

4 5

Securities Lending

Reinvested Collateral Amount

Total (Col. 3+4) Amount

6

Percentace

...... .446 ,234 .......... 3.482 ...3,643,575 ........ 28.428

1.513Allother ................................................................................................................................................................. ..

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 collateralized by mortgage-backed securities issued or guaranteed by agencies shown in Line 1.521

1.523 All other .................................................... ..

2. Other debt and other fixed income securities (excluding short term):

2.1 Unaffiiiated domestic securities (includes credit tenant loans and hybrid securities).. . ................ 423,452 ......... .3.304 .............. .423,452 ............................................... .423,452 .......... 3.304

2.2 Unaffiliated non-U.S. securities (including Canada) ..

2.3 Affiliated securities .............................................................................................................................. .

3. Equity interests:

3.1 Investments in mutual funds ... ............. 1,147,442 ......... B.952 ............. 1,147,442 ............................................ 1,147,442 .... 8.952 3.2 Preferred stocks:

3.21 Affiliated ................................................................................................................................................................................................. .

3.22 Unaffiliated ...................................................................................................................... .

3.3 Publicly traded equity securities (excluding preferred stocks):

3.31 Affiliated ..................... ........................... ............... . .. .............. 319,439 ......... 2.492 .............. 319,439 3.32 Unaffiliated... .. .......... .4,348,531 ....... .33.928 ............ .4,348,531

3.4 Other equity securities:

3.41 Affiliated

3.42 Unaffiliated ..

3.5 Other equity interests including tangible personal property under. lease:

3.51 Affiliated.

3.52 Unaffiliated ..

4. Mortgage loans:

4.1 Construction and land development ................................................................................................... .

4.2 Agricultural .............. _

4.3 Single family residential properties ................................ .

4.4 Multifamily residential properties ..

4.5 Commercial loans ................. .

4.6 Mezzanine real estate loans ..

5. Real estate investments:

5.1 Property occupied by company ... ............................................................. 190,323 ........ ..1.485 ................. 190,323 5.2 Property held for production of income (including

$ ....................................... of property acquired in satisfaction

of debt) ...

5.3 Property held for sale (including $ ...

property acquired in satisfaction of debt) ........................................ ................................ .... .

6. Contract loans

7. Derivatives _ .......................... .. ................. .

8. Receivables for securities ......................................................... .

................................... 319,439 ....... 2.492 .............. .4,348,531 ........ 33.928

.... _ .......................................... 190,323 .......... 1.485

9. Securities Lending (Line 10, Asset Page reinvested collateral) ......... . .. ................................................ XXIl ........................ XXL .................. XXL 10. Cash, cash equivalents and short-term investments .. ...2,298,058 ........ 17.930 ......... 2,298,058 ........... 2,298,058 ........ 17.930 11. Other invested assets ................. .

12. Total invested assets 12,817,054 100.000 12 817,054 12 817 054 100.000 See Independent Accountanl 's CompllallOn Report.

8101

----------.... ...,."."" .. ,~~"'-.,~ .. -~----... -------... -, ... ---------------------------------------ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

SCHEDULE A - VERIFICATION BETWEEN YEARS Real Estate

1. Book/adjusted carrying value, December 31 of prior year ... .. ................................ 199, 114 2. Cost of acquired:

2.1 Actual cost at time of acquisition (Part 2, Column 6) ... 2.2 Additional investment made after acquisition (Part 2, Column 9) .................... .

3. Current year change in enc;umbrances: 3.1 Totals, Part 1, Column 13 ............. .. 3.2 Totals, Part 3, Column 11.. ........... .

4. Total gain (loss) on disposals, Part 3, Column 18 ...... 5. Deduct amounts received on disposals, Part 3, Column 15 ................................. . 6. Total foreign exchange change in book/adjusted carrying value:

6.1 Totals, Part 1, Column 15...................... ......................... .. ................ .. 6.2 Totals, Part 3, Column 13. .. ........................................ ..

7. Deduct current year's other-than-temporary impairment recognized: 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. .......................................... ............ ................... ...................................... .. ... 8,791 8.2 Totals, Part 3, Column 9..... ...................................... ................................................... .................. .. ........................ 8,791

9. Book/adjusted carrying value at the end of current period (Lines 1+2+3+4-5+6-7-8)... ......................................................................................... ...................... ..190,323 10. Deduct total nonadmitted amounts.. .. ................................ .. 11. Statement value at end of current period (Line 9 minus Line 10). ......................................... ....................................... .. ....... 190 ,323

See Independenl Accountant's Campi lat ion Report.

SCHEDULE B - VERIFICATION BETWEEN YEARS Mortgage Loans

1. Book valuelrecorded investment excluding accrued interest, December 31 of prior year .................................................................... " ...... .. 2. Cost of acquired:

2.1 Actual cost at time of acquisition (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):

5.1 Totals, Part 1, Column 9 .................................................. ~..... ...Q......... .. .. ~.... "1"' ...... " .. .. 5.2 Totals, Part 3, Column 8 .................................................. .. ... ... ............ ..... ...... ....... .................................. ..

6. Total gain (loss) on disposals, Part 3, Column 18................ ..... .... .......... ... ..... ... .. ....................................................... . 7. Deduct amounts received 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 valuelrecorded investment excluding accrued interest:

9.1 Totals, Part 1, Column 13 ........................ .. 9.2 Totals, Part 3, Column 13 .. ..

10. Deduct current year's other·than-temporary impairment recognized: 10.1 Totals, Part 1, Column 11........................................ .. ...................................... .. 10.2 Totals, Part 3, Column 10 ..................................................................................... ..

11. Book value/recorded investment excluding accrued interest at end of current period (Lines 1+2+3+4+5+6-7-8+9-10) ....................................... _ ......................... . 12. Total valuation allowance.......... ............................ .......................................... .. .............. ".. .. ..................... .. 13. Subtotal (Line 11 plus Line 12). ............................... ............. .......... ................................. .. ....................................... . 14. Deduct total nonadmitted amounts.. ......................... ............. ...... ....................................... ....................... .. .............................................. .. 15. Statement value of mortgages owned at end of current period (Line 13 minus Line 14) ................... .. .............................. .

8102


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 cost at time of acquisition (Part 2, Column 8) ....... .. .............. .. 2.2 Additional investment made after acquisition (Part 2, Column 9) ..

3. Capitalized deferred interest and other: 3.1 Totals, Part 1, Column 16. 3.2 Totals, Part 3, Column 12 .....

4. Accrual of discount..

5. Unrealized valuation increase (decrease): ~ e ~ E 5.1 Totals. Part 1. Column 13 ... .. ..... ..... ....... . 52 Totals. Part 3. Column 9.. . . .... . ... .... .. ... ... . ........................ .

6. Total gain (loss) on disposals. Part 3, Column 19. . ....... ...... ... .. .... ...... .... ... . 7. Deduct amounts received on disposals. Part 3. Column 16. .. ............... . 8. 9.

Deduct amortization of premium and depreciation Total foreign eXChange change in book/adjusted carrying value: 9.1 Totals, Part 1. Column 17 ................................................. . 9.2 Totals, Part 3. Column 14........... .. ...................................... .

10. Deduct current year's other-than-temporary impairment recognized: 10.1 Totals. Part 1. Column 15........... .............................. .......................................................................... .. .................................................... . 10.2 Totals. Part 3. Column 11 ............................ ............ .............. .. ....................................................................................................................................... ..

11. Book/adjusted canrying value at end of current period (Lines 1 +2+3+4+5+6·7·8+9·10)... .............................................................. .. .......................... .. 12. Deduct total nonadmitted amounts......................... ........................................... ........................ .................... .......................... .. ................ .. 13. Statement value at end of current period (Line 11 minus Line 12)... .. ........................................... ..

SCHEDULE D - VERIFICATION BETWEEN YEARS Bonds and Stocks

1. Book/adjusted carrying value. December 31 of prior year ... .............................................................................. ........................ .. ........... 9.411.638 2. Cost of bonds and stocks acquired. Part 3. Column 7 ... .. ....................................... 2.784.395 3. Accrual of discount ..................................................... 18,540 4, Unrealized valuation increase (decrease):

4.1. Part 1. Column 12 ............ .. .... 2,480 4.2 Part 2. Section 1. Column 15 .. . 4.3 Part 2. Section 2. Column 13 .. . .............................. .. .................. 553.255 4.4 Part 4. Column 11... .................................. . . ............................. (208 ,405) .... .347.329

5. Total gain (loss) on disposals, Part 4. Column 19 ......................................... .. .. .......................... 113.570 6. Deduction consideration for bonds and stocks disposed of. Part 4. Column 7 ... .. .............. .2.307.241 7. Deduct amortization of premium ......................... .. .................. . .. ................................. 39,558 8. Total foreign exchange change in book/adjusted carrying value:

8.1 Part 1. Column 15 ....................................... .. 8.2 Part 2, Section 1. Column 19 ......................................................................... .. 8.3 Part 2. Section 2, Column 16 .. . 8.4 Part 4, Column 15 ............ .

9. Deduct current year's other-than-temporary impairment recognized: 9.1 Part 1. Column 14..... .......................... ........................................... .. ...................................... . 9.2 Part 2, Section 1. Column 17... ................ ............ .. ................. . 9:3 Part 2. Section 2, Column 14... . ............................................................... . 9.4 Part 4. Column 13. .................. ........................................................... ............................................ .. ................... ..

10. Book/adjusted carrying value at end of current period (Lines 1 +2+3+4+5·6·7+8·9) ................................................................ .10.328,673 11. Deduct total nonadmitted amounts .................................... ............................................... .. ......................... .. 12. Statement value at end of current period (Line 10 minus Line 11 )... ............................................ .................... ........ .. ................................... ..10,328.673

See independent Accountant's Compi iat ion Report.

8103

, _____ ~" __ _7"""' __ ._,~,_.,~,~""...,,,, _________ , ........ !iZ __ ".U .. I ... ' __________________________________ _


SCHEDULE D - SUMMARY BY COUNTRY Lon~-Term Bonds and Stocks OWNED December 31 of Current Year

1 2 3 4 Book/Adjusted

Description Carrvina Value Fair Value Actual Cost Par Value of Bonds

BONDS 1. United States . ............... ......................... _- ....... .. __ ._ .. _-- . ...................... ..... _- ._ .. -_. __ ..

Governments 2. Canada . .............. ....... - ....... _----_. __ .. __ ._- .. _--- -_ .............................. . __ .... _------ --_._--_ .. _------.. ... ........ -...... ......... ........... (Inclvding all obligations guaranteed 3. Other Countries by governments) 4. Totals

U.S, States, Territories and Possessions Direct and guaranteed) 5, Totals U,S, Political Subdivisions of States, Territories

and Possessions (Direct and guaranteed) 6. Totals 446,234 452,590 379,694 450,000 U,S. Special revenue and special assessment

pbligations and all non-guaranteed jobligations of agencies and authorities of k:lovernments and their Dolitical subdivisions 7. Totals 3,643,575 3,629,944 3,701,152 3,525,000

8. United States .................... ....... ...... ........ .423 ,452 .. ..................... .436,307 ............ 432 ,607 .. ....... ............. .423,000 Industrial and Miscellaneous, SVO Identified 9. Canada .............................. .......... ............................ ....................................... .. ................ ..... .............. ....... .. ............................

Funds and Hybrid Securities (unaffiliated) 10. Other Countries

11. Totals 423,452 436,307 432,607 423,000 Parent, Subsidiaries and Affiliates 12. Totals

13, Total Bonds 4,513,262 4,518,841 4,513,453 4,398,000 PREFERRED STOCKS 14. United States .. .. ............................... ...... ..... ........ ........ .. ....

Industrial and Miscellaneous (unaffiliated) 15. Canada ....... .. .................. ............................... .................................. .. ................. . .................... 16. Other Countries

17. Totals

Parent, Subsidiaries and Affiliates 18. Totals

19, Total Preferred Stocks

COMMON STOCKS 20. United States ..................... .............. 5,495,972 .. ...... ........... 5,495,972 ....... .4, 170,237 Industrial and Miscellaneous (unaffiliated) 21. Canada ............. ... .............. .............................. ..... ................. .............. .. ............ .. ....................

22. Other Countries

23. Totals 5,495,972 5,495,972 4,170 237 Parent, Subsidiaries and Affiliates 24. Totals 319,439 319,439 246,602

25. Total Common Stocks 5,815,411 5,815,411 4,416,839 26. Total Stocks 5,815,411 5,815,411 4,416,839 27. Total Bonds and Stocks 10,328,673 10,334,252 8,930,293

See Independent Accounlant 's Campi lat ion Report.

8104

(J)

o 01


SCHEDULE D - PART 1A - SECTION 1 Quality and Maturity Distribution of All Bonds Owned December 31. at Book/Adjusted Carrying Values by Major Types of Issues and NAIC Designations

234 Over 1 Year Through Over 5 Years Over 10 Years

NAIC Desionation 1 Year or Less 5 Years Throuoh 10 Years Throuoh 20 Years 1. U.S. Governments

5

Over 20 Years

6 No Maturity

Date

7 Total

Current Year

8 Col. 7asa

% of line 10.7

9 Total from Col. 6

Prior Year

1.1 NAIC1 ............................................. . ................................... ................................. . .............. J(XX ............. . 1.2 NAIC 2 1.3 1.4 1.5

NAIC3 NAIC4 NAIC5 .................... .

1.6 NAIC 6 .......... . 1.7 Totals

2. All Other Governments 2.1 NAIC 1 ..... . 2.2 NAIC 2 2.3 NAIC 3 .. 2.4 NAIC4 ............................. . 2.5 NAIC 5 .. 2.6 NAIC 6 2.7 Totals

3. U.S. States, Territories and Possessions, etc., Guaranteed

3.1 NAIC 1 ....... ....................... . .................. . 3.2 NAIC 2...................... ..... .... ............. . ............................ .

.......... ............. J(XX .... . ............................... . ... J(XX

. ... .. ..... J(XX ... J(XX.

XXX xxx

... .. J(XX ........................... . .................... . . ..... ... J(XX ........... ................. . .................. .

.......... XXx....... . .......................... . . .. J(Xx. ....................................................... .

. .... J(XX.... . .................................. . XXX

XXX

.. .. ...................................................................... XXX.... ...... ............................ . .............................. . . ........ J(XX............... . .................................. ... . ...................... .

3.3 NAIC 3 ..... . .................. .......... .. ........ ............................................................... J(XX............... .. ................... . .......... . 3.4 NAIC4 .................... . 3.5 NAIC 5 3.6 NAIC 6 .. 3.7 Totals

4. U.S. Political Subdivisions of States, Territories and Possessions. Guaranteed 4.1 NAIC 1.. . .............................. 97.980 ................... 239,770 ....... . ..108.484 4.2 NAIC 2........ . ........... ...... . .................................... . 4.3 NAIC 3 ................... . 4.4 NAIC4 ....................................... . 4.5 NAIC 5 ..... . 4.6 NAIC 6 ...... . 4.7 Totals 97.980 239,770 108.484

5. U.S. Special Revenue & Special Assessment Obligations. etc., Non-Guaranteed 5.1 NAIC 1... ............. .310.438 ......... .1.920.282 .................. 1.169.264 5.2 NAIC2.. . .... 143.811 .................... 99.780 ................................... . 5.3 NAIC 3 ... . 5.4 NAIC4 .... . 5.5 NAIC 5 ..... . 5.6 NAIC 6 ..... . 5.7 Totals 454.249 2.020.062 1.169.264

............... J(Xx....... ...... ..................................... ... . ......................................... . ................................ . .............. J(XX...... . .......................................................................... .

XXX

xxx

.XXX ... ......... 446.234 ............................ 9.7 ..................... .560.347 . ... XXX .. .... XXX .. ..

. ....... J(XX ................... . . ............ J(XX.. ............... .

XXX XXX 446.234 9.7 560.347

............................................................................ J(XX...... . ...... .3.399.985 ............ .74.1 .................. 3.081.118 .................................................. J(XX ................................. 243.591 ... .. 5.3 .................... .242.781

. .............. J(XX.............. . ................................... .

. .............. J(XX ...................................................... .

. .............. J(XX ............. . XXX XXX 3.643.575 79.4 3.323.899

10 11 % From Col. 7

Prior Year Total Publicly

Traded

..... 12.5 ............. 446.234

12.5 446.234

.. 68.9 .. 3.399.985 ........ 5.4 ..................... 243.591

74.3 3.643.575

12 Total Privately

Placed Cal

(f)

a 0)


SCHEDULE D - PART 1A - SECTION 1 (Continued) Quality and Maturity Distribution of All Bonds Owned December 31, at Book/Adjusted Carrying Values by Major Types of Issues and NAIC Designations

234 S 6 7 8 9 Over 1 Year Through Over 5 Years Over 10 Years No Maturity

Date Total Col. 7 asa Total from Col. 6

NAIC Designation 1 Year or Less S Years Throuoh 10 Years Throuoh 20 Years Over 20 Vears Current Year % of Line 10.7 Prior Year 6. Industrial and Miscellaneous (unaffiliated)

6.1 NAIC 1 .................................... .. .. . ..106,949 .................... .207 ,348 ..................... .186,046 ........XXx. ......... .500 ,344 .10.9 ..................... .586,839 6.2 NAIC2. .................. .. ................. . . ....... XXx.. 6.3 NAIC 3 . ................... .. ...................................................... . .. ........................................................... XXL .. . 6.4 NAIC4 ...... XXL 6.S NAICS ................................................................ . .. XXL .................................................... . 6.6 NAIC 6 ......... XXX 6.7 Totals 106,949 207,348 186,046 xxx 500,344 10.9 586,839

7. Hybrid Securities 7.1 NAIC 1 .... . ............................... . XXX ......................... ............................. .. 7.2 NAIC 2 .. .. .......... XXx... . ............................................ .. 7.3 NAIC 3 .................... . .. ....... XXx. .. .... ....... . 7.4 NAIC4 ............................................................... .. ........................ XXx. ................ .. 7.S NAIC S ........... . .................. .................. ................ .................... ............ ........... .XXL .. .

10 % From Col.7

Prior Year

........ ..13.1

13.1

11 Total Publicly

Traded

........ .500,344

500,344

12 Total Privately

Placed (a)

7.6 NAIC 6 ..................... t------t---____ t--_____ t--_____ f-_____ +-_---'X!!!X!!..X --+------+------+------+-----+-----+------4 7.7 Totals XXX

8. Parent, Subsidiaries and Affiliates 8.1 NAIC1 .................................. . . ...................................... XXL...... ..... ................... .. ............................................. . 8.2 8.3

NAIC2 NAIC3 .....

............... XXX...... ........ ............. ................. ... .................... . ................................ . ............... XXL ....................................................................................................... ..

8.4 NAIC4 .............................................................................................. . .................................................. XXL............ ........... .................. ............................ .. .......................................................................................................................... . 8.S NAICS ..

NAIC6 ... Totals

....... XXL............ . ............................................................................................................................. . 8.6 XXX 8.7 xxx

9. SVO-Designated Securities 9.1 NAIC 1 ..................... ...XXL ............... XXx.................. .. .... XXx... . .................. XXL........... . ... XXL ................................................. .. . .......... XXL ........................... XXL. ....................................... .. 9.2 NAIC 2 .................................... XXL .......................... XXL............ .. .... ... XXx. ............... XXL .......................... XXL ..................... . .................... .................................... ... .. ........ XXL............ . .............. XXX............... .......... ......... .. . 9.3 NAIC 3 .................................... XXL ............ ............... XXX.............. .. ...... XXx. ......................... XXL....... .XXL .... .. . ......... ........... .......................................................... XXL............ .. ....... XXL.... .. ......................................... . 9.4 NAIC 4 ................................... XXL ............ ............... XXX.. ..XXL .......................... XXL........... .. ....... XXL. ...... .. . .................................................. XXL .......................... XXx. ......................... . 9.S NAIC S .................................. XXL..... .. ............. XXX ... .. ... XXx. ..... XXL........... ..XXx.. .. .................................................................................. XXL........... ...XXL ............................. . 9.6 NAIC 6.. . XXX XXX XXX XXX XXX XXX XXX 9.7 Totals XXX XXX XXX XXX XXX XXX XXX

C/)

a -..I

NAIC Desianation 1 Year or less 10. Total Bonds Current Year


SCHEDULE D - PART 1A - SECTION 1 (Continued) Quality and Maturity Distribution of All Bonds Owned December 31, at BooklAd'usted Carrying Values bv Maior Tvpes of Issues and NAIC Designations 2 3 4 5 6 7 8 9

Over 1 Year Through Over 5 Years Over 10 Years No Maturity . Total Col. 7 as a Total from Col. 6 5 Years Through 10 Years Throuah 20 Years Over 20 Years Date Current Year % of Line 10.7 Prior Year

10 % From Col. 7

Prior Year

10.1 NAIC 1.................... d) ........... 408,418 ........ 2,267,002 .............. 1 ,485,097 .................. . ...... .186,046 .... .4,346,563 .......................... 94.7 ............... XXx..... . ... XXx. .. . 10.2 NAIC2 ...................... d) .................. 143,811 ................ 99,780 .................. ......... .... . ..... 243,591 ..... 5.3 ............. XXx..... . ..... XXx. .. . 10.3 NAIC 3... . ........... d) ........................... ......... •.•.....•... .. ................. .................. . •......... XXx.... . ........... XXx. .. 10.4 NAIC 4 ......................... d) ..................... ....................... .. .....•................. ................... .. •............................... . ..... XXx...... . .............. XXx. .. . 10.5 NAIC 5.. . ...... d) ....................... ....................... ,) . .. ..... ......... ..............•.... .. ..... XXx..... . .............. .xXx. ............. .

11 Total Publicly

Traded

.. ..4,346,563 .. ........ 243,591

12 Total Privately

Placed!a)

10.6 NAIC 6 .......... 1-d.:..,) ---."","";;;-I---""'==;-+----,-.."""..,=+-------I----=,.-;;-:",-+-------t.;',...) __ .-=c-:;-;o;;-f ____ --,-,""";-+-__ -.;;:XX"'Xc-_--f __ ---;X"'X",X __ + ___ ,..-,,""=+-_____ -1 10.7 Totals... . ........ 552,229 ........... 2,366,782 ......... .1,485,097 ................... .186,046 .................................. b) ............ .4,590,153 .. 100.0 .......... XXx. ........................... .xXX. . .... ..4,590,153 10.8 Line 10.7 asa % of Col. 7 12.0 51.6 32.4 4.1 100.0 XXX XXX XXX 100.0

11. Total Bonds Prior Year 11.1 NAIC1 ......... 11.2 NAIC2. 11.3 NAIC 3 ...... .. 11.4 NAIC4 ...................... . 11.5 NAIC5 .............. .. 11.6 NAIC6 .... ..

... .536,630

11.7 Totals .............................................. .536,630 11.8 Lioel1.7asa%ofCol.9 12.0

12. Total Publicly Traded Bonds 12.1 NAIC1 ...................... .. 12.2 NAIC 2 .. .. 12.3 NAIC 3 ........................ . 12.4 NAIC4. 12.5 NAIC 5 ................ .. 12.6 NAIC 6. 12.7 Totals .. 12.8 Line 12.7asa % of Col. 7. 12.9 Line 12.7 as a % of Une

10.7, Col. 7, Section 10

13. Total Privately Placed Bonds

13.1 NAIC 1 .................. . 13.2 NAIC 2 .. . 13.3 NAIC 3 ...... .

.408,418 .. 143,811

... .552,229 ............. 12.0

12.0

13.4 NAIC 4 ................................................ .. 13.5 NAlC 5 .............. .. 13.6 NAIC 6 .............. .. 13.7 Totals 13.8 Line 13.7 as a % Col. 7 13.9 line 13.7 as a % of Line

10.7, Col. 7, Section 10

......... 2,146,510 .................. 1,435,787 .. .......... 242,781

... 2,389,291 53.4

..... 2,267,002 ............ 99,780

........ 2,366,782 ......................... 51.6

51.6

........... 1,435,787 32.1

......... 1,485,097

.... .1 ,485,097 ................. 32.4

32.4

.(a) Includes $ ........................................ freely tradable under SEC Rule 144 or qualified for resale under SEC Rule 144A.

......... 109,377

.................. 109,377 2.4

...... .186 ,046

.. .186,046 .............. 4.1

4.1

........... XXx..... . . ...XXx. .......................... .xXX . .............. XXx.. .. ..... XXx.... .. ....... XXx..

.. ......... XXX.. .. .......... XXx. .......... XXx. . ............. XXX...... .. ... .xXx.. .. ............ XXx.

...... XXx.... . ... .xXx. ............... XXx. XXX XXX XXX XXx. ........................... XXx. .... .. XXx... XXX XXX XXX

............ .4 ,228 ,304 ............. 242,781

,)

,)

b) ............. .4,471 ,085 100.0

..... 94.6 ............. .4,228,304 .. ........... 5.4 ........ 242,781

......................... 100.0 XXX

........... 4,471 ,085 100.0

...... .4,346,563 ........ .243,591

.......................... 94.7 ....... .4,228,304 ............... 94.6 ........... 5.4

........ .4,346,563 ....... 243,591

.. ...... xxx. . ............... XXx.. .......XXL

..XXx.

..... 5.3 ..................... 242,781

................. .4,590,153 .......................... 100.0

. ..... .... ............ 100.0 ............... XXL

100.0 XXX

..... _---_. __ ... __ ..

......... ...... ............... XXx.

XXX

.......... .4,471,085 .......................... 100.0 ............ XXx... ........................... XXx... .. .

XXX XXX

.... 4,590,153 ........ 100.0

100.0

. ... XXx. XXX

............. XXx. .............. XXx. .

XXX

............... XXx............... .. ......... .. .. ................................................. XXx........ .. ................. .. ........................... .. .... XXL .. . .. ................................................. .xXX ....... .

. ........ XXx... .... .. XXX

.................................. . .............................................. .xXx... ............................. .. .. ............ .xXx... ........................... XXx............... .. ... XXx... .. .

XXX XXX XXX

(b) Includes $ ________ . ___________ ..... ________ .. __ ... current year, $ ___________________ ._._. ________________ prior year of bonds with Z designations and $ ________________________________________ current year, $ _______ _ _ ____ prior year of bonds with Z* designations_ The letter "Z" means the NAte deSignation was not assigned By the Securities Valuation Office (SVO) at the date of the statement .. z"" means the SVO could not evaluate the obligation because valuation procedures for the security class is under regulatory review_

(c) Includes $ ____________ __ _ ___________________ current year, $ _______________________ _ _______ prior year of bonds With 5* designations and $ ________________________________________ current year, $ ________________________________________ prior year of bonds with 6* designations. "5*" means the NAle designation was assigned by the SVO in reliance on the insurer's certification that the issuer is current in all principal and interest payments_ "6"" means the NAle designation was assigned by the SVO due to inadequate certification of principal and interest payments_

(d) Includes the following amount of short·term and cash equivalent bonds by NAIC designation: NAIC 1$.... .. ..... .76,891; NAIC 2 $ ...................................... ; NAIC 3 $ . .. ....... ; NAIC 4 $ ................ .; NAIC 5 $ ...................................... ; NAIC 6 $ .................. ..


(J)

a 00


SCHEDULE D - PART 1A - SECTION 2 Maturity Distribution of All Bonds Owned December 31, At Book/Adjusted Cam ing Values by Major Type and Subtype of Issues

Distribution by Type 2 3 4 5 6 7 8

1 Year or less 1. U.S. Governments

1.1 Issuer Obligations ............. ____ . ______ ................ _ ....... . 1.2 Residential Mortgage-Backed Securities 1.3 Commercial Mortgage~Backed Securities 1.4 Other Loan-Backed and Structured Securities .. 1.5 Totals

2. All Other Governments 2.1 Issuer Obligations . __ . . .................... _ .. ___________ ._~ .. . 2.2 Residential Mortgage-Backed Securities ... . 2.3 Commercial Mortgage-Backed Securities . ............... _ .. . 2.4 Other Loan-Backed and Structured Securities .. . 2.5 Totals

3. U.S. States, Territories and Possessions, Guaranteed 3.1 Issuer Obligations .. 3.2 Residential Mortgage-Backed Securities. 3.3 Commercial Mortgage-Backed Securities . ............................................ . 3.4 Other Loan-Backed and Structured Securities .. . 3.5 Totals

4. U.S. Political Subdivisions of States, Territories and Possessions, Guaranteed

Over 1 Year Through 5 Years

Over 5 Years Over 10 Years Through 10 Years Through 20 Years Over 20 Years

No Maturity Date

________________ _____________ XXL _______________________________________ XXll ___ _

____________________________ XXll __ _ XXX xxx

_._ .. ____ ... ________________________ XXll_._ __ .. ___ .. ___ ._ ... _______ ______________ XXX_._

__ ________________________ ______________ XXx. __ XXX XXX

____________________________________ XXL ______________ __________________ XXll

__________ XXL XXX XXX

_______ . __ .108,484 4.1 Issuer Obligations nnmnmnnnmnnn 91.980 noon 00 nnnnmnnnnn B __ m_ mnXXLBmn 4.2 Residential Mortgage-Backed Securities___ _______________________________ __________________ ___________________ _ _____ XXll __ _ 4_3- Commercial Mortgage-Backed Securities _ __________ __________________________________ ____________________________ __________________ __________________ _ __ XXll __ _

Total Current Year

___ .446 ,234

Col. 7asa % of Line 10.6

________ 9_7

9 Total from Col. 6

Prior Year

________________ 560,347

10 % From Col. 7

Prior Year

_______ ._ ..... 12.5

11 Total Publicly

Traded

_ _ ___ ..446,234

12 Total Privately

Placed (a)

4.4 Other Loan-Backed and Structured Securities_ ----f--=--=---=---=--=---=---=---o;;---"'--o;;---""--·rr---"'''''roc+---=,---",,-f--------+------+---iX::.;XX;;---f-----;c;;;-;;o:c+----;;-.,,-I-----,,""""',-t------,<oce-t------,-,;;;--."'+-------1 4.5 Totals 97,980 239,770 108,484 XXX 446,234 9.7 560,347 12.5 446,234

5. U.S. Special Revenue & Special Assessment Obligations, etc., Non-Guaranteed

Issuer Obligations ______________________________________________ 45-1..249 ___________ .2,020,062 ____________ 1 , 169,264 ________________________ _ ___________________________________________ XXll ____________ _ Residential Mortgage-Backed Securities_ _______________________________ ___________________ _ _________________________________ XXll ___ .. _ Commercial Mortgage-Backed Securities _______________ ._. ____ .... _._. ___ .. __ .. __ __ __________________ ____________ ________ ______________________ _ _________________ XXll __ _

___________ .3,643,575 ____________ .19.4 __________ 3 ,323,899 _______ . ___ .14.3 ___ .3,643,575 5.1 5.2 5.3 5.4 5.5

Other Loan-Backed and Structured Securities -----,,--=--=---=---=---=--=---"'---"'---';'--,,---7,---;+---;;-=;n;=+--.-=""''''f-------+------+---::XiiiXX;;.---f--,--,,--,=-;=;,-+---''''-rl-----.,--,;-''''''''''.t------.;-;;-,.-+---;;--,,-,"""""'+-------1 Totals 454,249 2,020,062 1,169,264 XXX 3,643,575 79,4 3,323,899 74.3 3,643,575

6. Industrial and Miscellaneous 6.1 Issuer Obligations _______________________________________________ _____ ____106,949.207,348 ___________ .186 ,046 ___ XXL ______________ 500,344 _______ .10 _ 9 ____________ 586 ,839 __________ . .13.1 __ . ___________ 500,344 6.2 Residential Mortgage-Backed Securities __ _______________________________ ____________________ _______________________________ _ _________________________________________ XXL_ 6.3 Commercial Mortgage-Backed Securities___ __________________________________ ______________________________ ___________________ _ ________________________________ XXL_

6.4 Other Loan-Backed and Structured Securities ___ --,,--=--=---=---=--=---=---=---=---=--=---=---'-+ ___ ----,-,""=+ ___ ="'=-'f-_____ -+ ___ ----,-,"'=+ __ -::XiiiXX;;.-__ f-__ ---.==.-+ ___ ""-,ri ___ -."=-=.t-__ ---,,,,-.-+---~"'=+-------1 6.5 Totals 106,949 207,348 186,046 XXX 500,344 10.9 586,839 13.1 500,344

7. Hybrid Securities 7.1 Issuer Obligations ________ . ___ . ___ . ___ .. ____ .___ _____________________ _ ___________________________ XXll __ _ 7.2 Residential Mortgage-Backed Securities____ _________________________ _ _____ XXll __ _ 7.3 Commercial Mortgage-Backed Securities ________________________ ._._. __ .... _ .... _____ _______________________________ _ __________ ._______ _______________________ ____________ ______________ _ ____________ XXll

7.4 Other Loan-Backed and Structured Securities_ ----f--=--=---=---=---=--=---=---=---=--=---=----+------+-------1f--------+------+---iX::.;XX;;---f--------+-----t------+-----+------+-------1 7.5 Totals XXX

8. Parent, Subsidiaries and Affiliates 8.1 Issuer Obligations ...... ______________________________________________ _________ _______________________________ _ __ . _______ .__________ _ ________________________ ______________ XXx. ____________ _ 8.2 Residential Mortgage-Backed Securities_ _ ____ .. ________________________ _ __________________________ , ____________ XXL_. __ 8.3 Commercial Mortgage-Backed Securities__ __________________________________ _ ________ XXll 8.4 Other Loan-Backed and Structured SeCUrities ______ f __ = __ = ___ = ___ = ___ = __ = ___ = ___ = ___ = __ = ___ =----+------+-------1f--------+------+---iX::.;XX;;---f--------+-----t------+-----+------+-------1 8.5 Totals XXX

(f)

a (0

Distribution by Type

9. SVO Identified Funds

9.1 Exchange Traded Funds Identified by the SVO ... 9.2 Bond Mutual Funds Identified by the SVO ....... . 9.3 Totals

10. Total Bonds Current Year 10.1 Issuer Obligations ___________ . __ .. __ _

10.2 Residential Mortgage-Backed Securities __ 10.3 Commercial Mortgage-Backed Securities 10.4 Other Loan-Backed and Structured Securities ___ _ 10.S SVO Identified Funds .............. . 10.6 Totals ............................ . 10.7 lines 10.6 as a % Col. 7

11. Total Bonds Prior Year

1 Year or Less

........... XXL XXX XXX

.... ........ ... 552,229

XXX ........ .552,229

12.0


SCHEDULE D - PART 1A - SECTION 2 (Continued) Maturity Distribution of All Bonds Owned December 31 at Book/Adjusted Carr ing Values by Major Tvee and Subtype of Issues

2 3 4 S 6 7 8 9 10 11

Over 1 Year OVer 5 Years Over 10 Years Through S Years Through 10 Years Through 20 Years

... XXX .. XXX XXX

....... XXIt XXX XXX

. ................ XXL XXX XXX

... .2,366,782 .............. .1 ,485,097

Over 20 Years

.. XXIt . XXX XXX

No Maturity Date

.. 186,046 .............. XXX. ............. ........XXX

............ XXX ... .............. .... .................. .. ........... XXX

XXX XXX XXX XXX

Total Col. 7 as a Total from Col. 6 % From Col. 7 Total Publicly Current Year % of Line 10.6 Prior Year Prior Vear Traded

........................................... Xxx.. ...................... XXX ......... .......... ............... . XXX XXX XXX XXX

A,590,153 ...... .100.0 .............. XXL.. . ..... XXX ........ .......... A,590, 153 ......... ... ... . . ..... XXX... .. .. ....... XXL

........................ XXIt .................. XXX .. . .... XXL..XXX ..

XXX XXX ... .2,366,782 .......... .1 ,485,097 ................... 186,046

4.1 .... ......................... .. A,590,153 .............. .100.0 . .. XXx.. ....... XXIt .. .... . ........... A. 590,153

51.6 32.4 100.0 XXX XXX XXX 100.0

11.1 Issuer Obligations. .. ... 536,630 ... .2,389,291 ....... .1 ,435,787 ................... ..... ...... 109 ,377 ........... XXIt...... . ............. XXL ..................... XXx. .............. A ,471,085 ............... 100.0.... ..4,471,085 11.2 Residential Mortgage-Backed Securities ..... ......... .................. ..... ........... .................. . ........ _ .................................................................................... .xXX. . ............. XXIt ........................ XXIt ...................... . 11.3 Commercial Mortgage-Backed Securities ........ ....................... ................ ................ ........................... . ......................... .xXL ......................... XXIt .......... XXIt .. 11.4 Other Loan-Backed and Structured Securities ._._ ....................... ___________ ._ .... ___ .. _______ __________________________________ _ _____________ XXx. ______________ XXx.. _____________ __________ XXI __ 11.S SVO Identified Funds ............................... XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 11.6 Totals .... ........... 536,630.2 ,389 ,291 .............. .1 ,435,787 ......... .109,377 .............. XXx....XXL... ... .. XXIt ........ ............. A ,471 ,085 ..... .100.0 .............. A, 471,085 11.7 Line 11.6 as a % of CoL 9 12.0 53.4 32.1 2.4 XXX XXX XXX 100.0 XXX 100.0

12. Total Publicly Traded Bonds

12 Total Privately

Placed (a)

XXX

12.1 Issuer Obligations .. . ... 552,229 2,386,782 .... .1 ,485,097 ....... .. .......... .186,046 .............. XXIt .A, 590,153 ....... .100.0 ..... A ,471 ,085 ...... .100.0 ............. A, 590,153 .... XXL 12.2 Residential Mortgage-Backed Securities ............................. ................ ...... ....... ......................... .. .......... ........................ . ............. XXIt ........................ ...................... .......................... ............................... . ....... XXIt 12.3 Commercial Mortgage-Backed Securities.. ................................ ..................... .................................. . ............. XXL. ...................... ......... ....... ................... . ... XXL. 12.4 Other Loan-Backed and Structured Securities ...... .................................. . . ... ................ . ............................... .......... . .................................. XXX... ......................... . .................. ........... .......................... ................................... . ....... XXL .... . 12.S SVO Identified Funds ...... . ..................... I-_---"'XX""X=-=+-__ ::OXX""X==+-__ -"'XX"'X==+ __ -"'XX""X'--_-I-__ -"XX"'X'-:-=--:-:-::-I-_____ -+ __ ---,--=--=::-t __ ---:-=::-:-+-__ Xe;X::;X==-+_--'X"'XX";-;:;;c-::-+-__ c--:::c::-:-:::-+-_-;;X;;;XX:-_...., 12.6 Totals........... . ..................................................... 552,229 .2,366,782 .............. .1 ,485,097 .............. .186,046 .A ,590,153 ............. .100 .O ....... A ,471,085 ....... .100.0 .. A, 590,153 ....... .xXL .. 12.7 Une 11.6 asa % of Col. 7 .... ..................... .12.0 ......... 51.6 ...................... .32.4 .......................... .4.1 ............................................ 100.0 .......... XXL...... . ...... XXL. . . .... XXIt ................... .100.0 ........ XXL ... . 12.8 Une 11.6 as a % of Une 10.6, Col. 7, Section 10 12.0 51.6 32.4 4.1 100.0 XXX XXX XXX 100.0 XXX

13. Total Privately Placed Bonds 13.1 Issuer Obligations ___________ _ __________________ _ ......................... ....... .............. XXX .. . ........ XXL ......... . 13_2 Residential Mortgage-Backed Securities _______________ _ ........ .............. XXX .. . ............... .xxx. ............. . 13.3 Commercial Mortgage-Backed Securities ............ . ..... .. .... XXX ................................. .xXL .... . 13.4 Other Loan-Backed and Structured Securities _____ _ .............. .............. XXX .. . .................... . .......... XXIt ...... . 13.S SVO Identified Funds ........... . XXX XXX XXX xxx XXX XXX XXX XXX 13.6 Totals ..................................... . . ...... XXIt ...... . 13.7 Une 13.6 as a % of Col. 7 ........... . ...... ........ ...... .xXL .................. XXL. XXL ........... .xXIt .. 13.8 Une 13.6 as a % of Une 10.6, Col. 7, Section 10 XXX XXX XXX XXX

See Independent Accountant's Campllat IOn Reporl.


SCHEDULE DA - VERIFICATION BETWEEN YEARS Short-Term Investments

2 3 4

Other Short-tenn Investments in Parent, Total Bonds Mortgage Loans Investment Assets{a} Subsidiaries and Affiliates

1. Book/adjusted carrying value, December 31 of prior year .. ........................... .159,601 .................................................. .159 ,601

2. Cost of short-term investments acquired __ ..................... _ ........................... 361 ,062 . ....... 361 ,062

3. Accrual of discount

4. Unrealized valuation increase (decrease)

5. Total gain (loss) on disposals ................................................................................................................................................................... .

6. Deduct consideration received on disposals .. .. A43 ,772 . .... A43,772

7. Deduct amortization of premium _,_

8. Total foreign exchange change in book/adjusted carrying value _____ .. ___________ _

9. Deduct current year's other-than-temporary impairment recognized ................. __ ...... __

10. Book adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9) .. ....................................................................................................................... .76,891 ............................... 76 ,891

11. Oeduct total nonadmitted amounts

12. Statement value at end of current period (Line 10 minus Line 11) 76,891 76,891

(a) Indicate the category of such assets, for example, joint ventures, transportation equipment: Money Ma r ke t Fund ........................... .


, ________ n:\~ ____________________ _


Schedule DB - Part A - Verification

NONE Schedule DB - Part B - Verification

NONE Schedule DB - Part C - Section 1

NONE Schedule DB - Part C - Section 2

NONE Schedule DB - Verification

NONE

8111,8112,8113,8114

m o ~

1 2 Loc<; lion

3

Cede City _Properlies occupied by Ihe reporting enlily - Health Care Delivery

Prop riles occupied bv Ihe reporlinQ enlilv . Adminislralive

I J!!..l.m ~~'r:rlies ~c~pied by Ihe repo"I'ing'~~I~\~ri_ Admi~i;lraliv~ - Tol I Properties OCCUPied bv lhe repor InQ enlilv

prop les ne Id tor tne prOduct ion ot income Propel ieshe .Id for sale

I ...... · ...... 1 ...... _ ......

: ...... -...... ... ....... _ ......

.... ....... _ ......

... ...... _ ......

0699999 T etals See Accounlanl 's C"""i lal ion Report.


SCHEDULE A - PART 1 Showing All Rei'L Estate OWNE '310f Current Year

5 6 7 8 9 10 ChanQ ,in I

4 11 12

Current Year's Book/Adjusted Other-Than-

Date of Carrying Value Fair Value Temporary Date Last Actual Amount of Less Less Current Year's Impairment

State Acquired ~, 0;< I Cost !" !" !" i i

.00/10/' ,J<J ,f~1

I 342,839 I I 190,323 I I 8,791 I I 342,839 190,323 I 8,791 I I

342,839 190,323 8,791

I CarryinQ Val Je Less 16 17

13 14 15

Gross Income Total Foreign Earned Less Taxes.

Current Year's IT etal Change in Exchange Interest Repairs and Change in

(13-11-'12) Change in i I=!ncurred on ~~~~~r:~S B.!A.C.V.

1~,f~1 .11,~M

I (8,791)1 I I 1~ I 18,791)1 I I 11 ,~&I

(8,791) 11,984


Schedule A - Part 2

NONE Schedule A - Part 3

NONE Schedule B - Part 1



NONE Schedule BA - Part 1



NONE

E02, E03, E04, E05, E06, EO?, E08, E09

m -->.

a


SCHEDULE 0 - PART 1 Showing All Long-Term BONDS Owned December 31 of Current Year

2 Codes 6 7 Fair Value 10 11 Change in Book 1 Adjusted Carrying Value Interest 18

Dates 3 4

F o r e

5

CUSIP g Bond NAIC Identification Description Code n CHAR DesiQnation Bonds - U.S. Governments - Issuer Obi igal ions Bonds - U.S. Governments - Resident ial Morlaaoe-Backed Securities Bonds - U.S. Governments - Coumercial MortQaqe-Backed Securities Bonds - U.S. Governments - Other loan-Backed and Structured Securities Bonds - All Other Goverrvnents - Issuer Obi laat ions Bonds - All Other Goverrvnents - Resident ial MortqaQe-Backed Securit ies Bonds - All Other Governments - Conmercial Mortgage-Backed Securities Bonds - All Other Governments - Other loan-Backed and Structured Securities

Actual Cost

8

Rate Used to Obtain

Fair Value

Bonds - U.S. States, Territories and Possessions Direct and Guaranteed - Issuer ObI iqat ions

9

Fair Value

Bonds - U.S. States, Territories and Possessioos Direct and Guaranteed - Residential Mort a e-Backed Securities Bonds - U.S. States, Territories and Possessions Direct and Guaranteed) - CCIm'lIercial Mortgage-Backed Securities Bonds - U.S. States, Territories and Possessions Direct and Guaranteed - Other loan-Backed and Structured Securities Bonds - U.S. Political Subdivisions of States, Territories and Possessions Direct and Guaranteed - Issuer Obligations

Par Value

Book! Adjusted Carrying

Value

181144-PO-3 .. Clark Cty WA School Disl #lJ37 ..... ~ ..... _ .......... _ .. _ .. __ ........ 1FE ................ 99,501 ....... B7.3200 .......... .145,980 .. __ ....... 150,000 ........... 139,496 25483V-AO-7 .. District Columbia Rev ................. _ .... .1 ........... 100,675 .... 101.9600 ........... 101,960 .... _ ...... 100,000 ........... 100,275

Intermountain Pwr Agy Utah 458840-6A-8 .. Pwr Sup ............................... _ ........ ~_ ... _ ..... _ .... ___ ........... _ .. 1 ............ 68,878 _ ...... .99.4000 ..... 99,460

.... _ .. 105, 190 ... ..100,000 ............ B7,980

970701-Wl-9 .. Wi II iston ND ..... _ ........... _ ............•. _.... • ..•...... 1 ................. 110,640 ...... 105.1900 ........ .100,000 ........... 108,484 1899999 - Bonds - U.S. Political Subdivisions of Stales, Territories and

Possessions (Direct and Guaranteedi - Issuer Obi iaat ions Bonds - U.S. Political Subdivisions of Slates, Territories and Possessions Bonds - U.S. Political Subdivisions of States, Territories and Possessions Bonds - U.S. Poll tical Subdivisions of States, Terr i tor ies and Possessions

2499999 - Bonds - U.S. Political Subdivisions of States, Territories and Possessions (Direct and Guaranteed) - Subtotals - U.S. Political Subdivisions of States, Territories and Possessions

379,694 XXX 452,590 450,000 Direct and Guaranteed - Residential Nortoaoe-Backed Securities Direct and Guaranteed - Coornercial Mortgage-Backed Securities

446,234

Direct and Guaranteed) - Other loan-Backed and Structured Securities

12 13 14 15 16 17 19 20 21 22

Unrealized Valuation Increase~,

(DecreaseL

Current Year's (Amortization)1

Accretion

...... 5, 185 ... . ............ (68) .. .

..... .3 ,919

.... (1 ,220

7,816

Current Year's Olller Than

Temporary Impainnent Recognized

Total Foreign

Exchange Change

In B.fA.C-Y.

Rate of

Effective Rate

of When Paid

Admitted Amount Due &

Accrued

Amount Rec.

During Year Acquired

Stated Contractual

Maturity Date

........ _._ ..... __ ............... _ .... ___ .. _. __ ._._ ......... _._ ...... 3.824 _ .. MAT .......... _................ .... . .. _01/25/2008 ...... ..1210112018 ... . .... _3.500 ........... 3.420 _ .. _AO ... ....... _ ....... _B75 ........... 3,500 ... 08/1112010 ..... ..10/01/2020 .

.... _. ___ . ___ .4.124 _ .. MAL ................... 686 ... 05/08/2008 ..... _07/01/2017. .. ............................. ___ ._. 4.000 ... _ .. __ ._2.541 .... MN. ... ... ii67 .......... .4,000 ... 03/16/2015 ...... 05/0112023 .. .

xxx xxx xxx 1,542 8,186 xxx xxx

(Direct and Guaranteed) 379,694 XXX 452,590 450,000 446,234 7,816 XXX XXX XXX 1,542 8,186 XXX XXX Bonds - U.S. Special Revenue and Special Assessment Obligations and all Non-Guaranteed Obli atioos of A ncies and Authorities of Governments and Their Political Subdivisions· Issuer Obli ations 01179R-SG-9 .. AK Mun Bd 8Ic .............. _ ................ _ .......... 1..._ ............ ..114,300 ...... 109.7600 ........... 109,760 ... ..100,000 ........... 112,940 .. _ ... _ ................. _ ... __ ..... (1 ,360)

Clear Creek-Amana IA Crnnty 184503-EC-0. Sch Dist... ......................... . 216129-CZ-7 .. Cool< Cnty Il Cmnty College .. _ 218075-X4-6 .. Coralvi lie IA Rfdg Ser "-

Coralvi lie IA Rfdg Urban-

. ... _ .... _._._2. ............ .1 ............... ..111,822 ..... _102.4100 _ ... _ .. 107,531 ....... _.105,000 ........... 108,384 ____ (1 ,362) ...... __ .... . ....... 2. . ......... 1... .... ..116, 143 ..... .103.5600 ...... 103,560 ......... _.100,000 ........... 104,694 ................. (3,983) .

.......... 1... ............ ..136,781 ....... B9.5500 ........ _ . .129,415 ......... ..130,000 ........... 130,000

218075-2U-2.. Renewal. ....................................... _ .... _ .... _ .. _2. .. . .... .3 . ........... 96,069 ..... _.B8.8900 .... _ .. _ .... 93,946 .. _ .. 95,000 ............ B3,946 ..................... 288 ..... _ ........ (193) . Coralvi lie IA Rfdg Urban

218075-2T -5_. Renewal.. .......................... _ .... __ ....... _ .. . 218075-3T -4. Coralvi lie IA Urban Rene.al. ....... _

......... J. __ ............ _ .. 51 ,430 ....... B9.73oo _ .. ___ .... _.49,865 .. _ ......... 50,000 .... _ .. _ .... .49,865 ...... _2. ....... _ ....... .3._ .............. ..110 ,052 ....... .99 .7800 ... _._ .... _.99,780 ......... _.100 ,000 ....... B9, 780

_ ............ 322 . __ .......... _ ............ (257) .... _ ....... 1 ,870 ... -.. -.--..... (1 ,220)

238388-MS-8. Davenport IA RFDG Corp Ser .......... _. . ..... _._ ................. 1... ............. ..110,029 ... ___ 103.5300 ... _._ .... .103,530 ......... _.100,000 ........ 103,983 .. ... _ ..... __ . __ ._ ................ (1 ,612) . Du Page Cnty Il Sch Dist No

262813-1IJ-5_ 016 ............ _ ... _ ... _._ ..... _ .. _ ..... __ ...... _~ .. . ... _._. __ ........ _._ ... _1..._._ ............. 49,722 ... __ .. B4.8600 ... __ .. ___ ._52,173 ..... _ .. __ .55,000 ..... ...... E2,355 . _ ......... 903 Dubuque I A Sa I es Tax

264037 -AK-8_ Increment Rev ..... __ . ____ ._._._ ... _____ .. . .. ______ .... _ ..... _ .... 1..._._ .......... ..125 ,000 ._ ... .101.9800 ..... __ .. _.127 ,475 ... _. __ . __ .125,000 ..... 125,000 Ealon Cnty MI Eaton Cnty Bldg

278065-VY -7_ Aulh. .................. __ ... _ ...... _ ..... _ .. _ .. _. _____ 2. ................ 1..._._ .... _ ........ 67 ,305 ... _ .. 102.4500 ... _._ .... _.66 ,593 ........ ____ ~5 ,000 ....... _.£5,180 .. _ ...... __ .......... _._. ____ . ___ ... _ ..... ____ ........ (266) 28473T-AG-0_. Eldridge IA Mun Wtr Uti 1. .... _ .. _

Georgia St Higher Ed Facs ..... 1..._ .............. 118,494 ._ .. _.100.7000 ...... __ ._.115,805 .. _ .... ___ .115,000 ... 115,258 _ ..... _ ... _ .............. ______ .. _ ....... _ ........... j612)

.. _ .. _ ..................... ... E .000 ... _. _ .. _0.947 .... AO ......... _ ....... .1 ,250 .. 1,556 ... 08/23/2016 ....... 0410112020 ... .

..... _______ ........ 3.000 ........ _ . .1.634 .... JD... . ........ ___ 263 ......... 3,150 ... 05/30/2014 ...... 0610112021.... ._._ ..... _._ ......... ........ E .000 __ ... ____ .. 0.944 .... JD ................. _.-.417 ...... _.5,000 ... 02/04/2014 ..... ..1210112018 .. __ ._ .. _ ... _. ___ ...... _ .... 3.000 ... ___ . .1.278 .... JD ........ _ .... _._._ .. J25 .... 3,900 ... 04/20/2012. ...... 06/01/2017 .. .

................. _ ................ _ .......... 3.000 ........ _.2.790 .... JD._ .. _. ______ . ______ ._238 . .2,850 ... 07/08/2011... ._.06/0112018 ...

.. __ ... _ .. ___ ... __ ._ ............ 3.000 ...... 2.471 ._ .. JD ..... __ ..... ____ . ___ .125 .......... .1 ,500 .. _07/08/201t .. __ .06/01/2017 ... . .... ___ .. __ ._._ .. __ ...... _ ........... _ .. 4.000 __ .... _ .. 2.639 .... JO ...... _._._. __ . _____ J33 _ ........ ..4,000 .. _0211712012. ... __ .06/01/2021....

. __ ._ .. _. ___ . __ . ___ ._ .......... 3.000 ... 1.320 .... JD ... _ .. _ .. _ .. __ ._. __ .250 .... __ ..... 3,000 ... 02/22/2013 ... __ .06/0112019 .. .

........ _ .. _ ........ 1.747 ... MAL __ ._ .... _. __ . __ .... __ .. ... 01/08/2014 .... __ .. 11/0112019 ...

.... ... ____ .3.250 ........... 3.250 .... JO . _ ... J39 ......... ..4,063 ... 05/27/2015 ... ___ 0610112025 ... .

. __ .. _ ... _ ............. _ .... _._.4.750 __ ._ ...... .4.315 .... MS ...... ___ .. ___ ._ .. 1,029 .......... 3,088 ... 06/18/2007... _ .. 09/0112021... . .. __ .. __ .. 3.400 ___ ....... .2.850 ._ .. JD ...... _ .... __ ._ ...... J26 .......... 3,910 ... 05/06/2011 .. __ .06/0112017 ... .

373511-BH-6_ Auth Rev .. __ ._ ........ _ .............. _ ........ _ ..... __ ..... _._2. ................ 1..._._ ............ 144,603 .. ___ .107.5400 _ .. _._._ ... 139,802 __ ...... ___ 130,000 ..... _ ..... 134,528 .. _. __ ._. ____ ... _ .. _. __________ ..... _ .... ___ ..... _(1 ,737) __ ........ _ ........... _._. __ ._._ .. _._... . .. ____ ._ .. E.ooO ........... 3.506 __ .. JD ........ _ ........... 289 ........... 6,500 ... 08/18/2010 .... _ .. 0611512022. .. . 414183-0J-9 __ Harris Cnty TX Impt Dist #18... .._._._2.. .... _ ... _._ .... t ......... 80,310 . __ .113.4500 ... ___ .. _.}9,415 ........ ____ 70,000 ...... BO,274 .......... _ .......... _. ____ . ____ .... ___ ................ (35). .._ ........ _. ________ ._._ ... _ ........... _ _ . __ ._._E.ooo .......... .2.588 .... MS ........... _ ..... ..1,167 ............. _ .... . __ .12/19/2016 .... __ .09/0112024 .. .

Hills IA Hllh Facs Rev Mercy 431669-AJ-9.. Hsp ... _ ................... _ ............... _._ .. ..... __ ... _._._. __ ... _._ ..... _ .... L . ......... 100,000 . ____ .101.8100 ... __ .. _._.101,810 ........ _._100,000 ........... 100,000

Hills IA Hlth Facs Rev Mercy 431669-AN-0 __ Hsp .. __ ................ _ ................. _ ......... _ .. . . .. ___ .2. ........ _ ....... t _ .............. 100,000 ._ .. _.103.8800 ........... 103,880 ......... _.100,000 ......... 100,000 442436-H3-8 .. Houston Tex Wtr & Swr Sys Rev ..... ~ 462466-EC-3 .. IA Fin Auth Health FAGS Rev ... .

.......... 1..._ .............. .29,888 .... __ . .90.2600 ..... _._._ . .40,617 ._ .. 45,000 ......... 37,731

. ......... t ........... 109,675 ...... 108.3100 ...... 108,310 ........... 100,000 ........... 106,326

...... __ .. _ ........... ___ . ____ .. _ .............. _ ............ ___ .. _. __ ........... _ .. _. __ ... _ ... ___ .............. __ . ___ .3.250 ...... .3.249 ... .FA. ............... _..1 ,228 ........... 3,250 ... .11/10/2011... ___ 08115/2018 ... .

... _ .. __ ,_; ,328

...... _!1,275

................. _ ......... _ .... __ ..... ____ ........ _._ .... .4.000 . __ . .3.999 ... .FA. ................. .1 ,500 ......... ..4,000 ... .11/10/2011 ..... _08115/2022. .. . ...... _ ............ __ ........ _ ........ _ ........... _ .. __ .3.616 ... MAL ... . .. 06/30/2010 . .. .. ..1210112021...

. _ ......... _ ............................... __ ..... . . .4.000 ...... ___ .2.540 ... .FA.... . ... __ .1 ,511 .......... .4,000 . . 04/22/2014 ..... _08/15/2021...

m ....>.

a


SCHEDULE 0 - PART 1 Showing All Long-Term BONDS Owned December 31 of CUrrent Year

2 Codes 6 7 Fair Value 10 11 Change in Book 1 Adjusted Carrying Value Interest 18

Dates

CUSIP Identification Oescriotion

IA Fin Auth Rev 8t Revolving 462461< ·l9· L Fd .............................. . 462560·GW·0. IA SI Bd Regents Hosp Rev .. . 462461<·H2·L IA St Fin Auth Revenue ..... .

IA St Hosp Rev Rfdg Univ IA

3 4 5 F o

e

9 Code n

Bond CHAR

NAIC Desianation

Actual Cost

8 9

Rate Used to Obtain

Fair Value

Fair Value

Par Value


Value

.... .... 1... . ..49,354 ...... 104.5500 ........ 47,048 ............ 45,000 ............. 47,577 .. .............. 1 ................ 233,225 .. 103.3600 .......... 217,056 .. 210.000 .......... .232,021

. ............................... 1 ........... 141,412 ..... 111.4300 ... 133,716 .. ..120.000 ........... 138,031

462560·EV ·4 .. Hosps . . .. .................. . ... _ ...... 1.. .............. ..111,447 ..... 108.4300 .......... 108,430 ........ ..100.000 ........... 107,384 IA St Hosp Rev Vof I Hosps

462560·FN·1.. CI inic ... ....... 2 ........... 1 ................ .196,793 ...... 107.3700 .. .187.898 ....... ..175,000 ........... 190,480 IA SI Univ of Science &

462582·X7·7 .. Technology... . .......... _ .. 109,710 ........... 100.000 ........... 108,187 Kane & Oekalb Cnlys Il Cmnty

483764·GO·3 .. Un i I. ............................................. @. ............................. .1 .. .103,964 ....... .86.4100 .......... .146,897 .......... .170,000 ........... 134,786 N Scott IA Cmnty Sch Oist

662279·AF·5 .. Infra Sa I. ....................... . .......... 1. ............... 102,827 ...... 100.9400 .......... .100,940 .......... .100,000 ........... 101,181 N Scott IA C1Mty Sch Oist

662279·AG·3. Infra Sal.. .. 1... ................ 76,219 ...... 100.4700 ....... .75,353 NW Harris Cnty TX Muni Ut i I

667488·NS·5. oist 5 ....................... . ......... 1 ................ .108,050 ...... 103.7100 ..... __ ... .103,710 677521·Z4·1. Ohio State ............ . ................ 1... ................ 60,405 ...... 113.7000 ....... 56,850

Southeast Polk IA Cmnty Sch B41484·KX·5. oisl... .................. . .. 118,306 ...... 109.3900 ........... 109,390

Springfield NO Spl Oblig Rfdg 851039·FR·3 .. Ser A. ...................................... . ....... 2... .. .... 1.. ............. .109,625 ...... 102.2200 __ ....... ..102,220 888149·CG·4 .. Tipton IA Cmnty Sch oist ............... . ....... 2 ............... 1 ................. .71 ,303 ...... .1)9.4200 ............ 69,594

Traverse Ci ty MJ Area Pub 894282·0Y· I. Schs ...................................... _

Trenton NI Pub Schs oist Bldg 895028·GA·0 .. & SiL................................... . ... .2 ....... 1... ............... 55,177 ..... .103.3900 951564·AO·6 .. West Branch IA Cmnty Sch oisL ........... 2. .. .... 1... . .. ... 50.000 ..... .104.4100 951564·AP·8 .. West Branch IA Cmnty Sch oisL ........... 2.. .. ... 1. ................. 50,000 ..... .104.3400 951564·AN·3 .. West Branch IA Cmntv Sch oist. .... _ ................ 2 ................ 1....... .. ........ 50,000 ..... .104.2700

2599999· Bonds • U.S. Special Revenue and Special Assessment Obligations and all Non-Guaranteed Obi igat ions of Agencies and Author ities of Governments and Thei r Pol i tical Subdivisions -

............ 51 ,695

............ 52,205

............ 52,170 ......... 52,135

...100,000 ........... 107,090 ... 50,000 ............ 58,802

.. ..100,000 ........... 112,111

....... 100,000 ......... .108,866 ........ ..70,000 ........... .70,826

....... 125,000 ........ 128,698

.

12 13 14 15 16 17 19 20 21 22

Unrealized Valuation Increase! (Decreas~_

Current Year's (Amortization)!

Accretion

.. ....................... .(697) .

Current Year's Other Than

Temporary Impairment Recoanized

Total Foreign

Exchange . Change

In B./A.C.v.

Rate of

Effective Rate

of When Paid

Admitted Amount Due&

Accrued

Amount Ree .

During Year ACQuired

Stated Contractual

Maturity Date

............................. 3.000 ........... 1.357 ... .FA. ................... .563 ........... 1 ,350 ... D5/30/2014 ..... 0810112020 .. . ................................................ (1.204) ...... 3.000 .......... 1.350 .... MS. .. ...... 3,675 ... 08/1812016 ... ... 09/0112023 .. . ............................ .. ......... (3.010) . ..... 5.000 .......... 2.131 ... .FA. .... 2,500 ... 6,000 .. .1111012015 ... ... 08/0112022 .. .

.......................................... (1 ,482) ........................................ .. .. JOOO ....... 2.321 .... MS. .. ... .1 ,333 ........ .4,000 ... 03/1112014 ..... 0910112022 ....

..(2,528) . ........................... 4.000 .......... .2.324 .... MS ................. 2,333 ......... ..7,000 ... 0611112014 ... ... 09/0112024 .. .

.............. (1 ,589) .......................................................... 4.000 ........ 2.204 .... MN. .................. .867 ........... 4,000 .. ..1210212013 ... ..1110112021...

.............. 6,215 ..................................... 4.777 ... MAL ... ... 06128/2011 ..... ..12101/2021 .. .

........ .(477) ." ............... ....... ............... . ...... 2.000 ........... 1. 500 .... JO ... . .. ....... 167 .......... 2 ,000 ... 06/10/2013 ...... 06101/2019 .. .

.................. __ ................... __ ........ (174) ... .. ............................. 2.000 ........... 1.750 .... Jo ................... .125 ........... 1 ,500 ... 06/10/2013 ...... 0610112020 .. .

.................. __ ................... ____ .(873) ____ . . .............. __ ...... . ................. 3.500 .......... .2.438 .... I'll .................... .563 .... 3,500 .. ..11120/2015 ...... 0510112024 .. . ...................... .................... __ ... .(917) ................. .. .. ..... 5.000 ....... 2.661 .... JO .................... 111 .......... .2,500 ... 03/20/2015 ...... 06115/2025 .. ..

. ........................................ __ ....... (3,535) __ ............... . ...... 5,000 ... 03/24/2015 ...... 0510112020.

.................. .. .. 3.000 .. ____ ..... 1.525 .. __ MN. .. ____ ..... __ .500 .... .1 ,250 ... 06/0112016 ...... 05/0112024 .. . . ............................. 1.550 ....... __ .. 1.054 .... JO .. .. .. ........ ____ 90 ..... 1 ,085 ... 07123/2015 ...... 0610112020 .. .

................. .(147) ............................ 2.000 .... __ ..... 1.619 .. MN. ........ __ ......... .417 ........... 1 ,076 ... 0811812016 ... ... 05/01/2025 .. ..

..................... (1,236) ....... ........................................... 3.750 .................................. 4.200

................................... .4.150 .......... .4.100

..... __ ... 1.215

.. __ ...... .4.188

.......... .4.138 ....... 4.088

... 0211212014 ....... 05/01/2019...

... 0511412010 ... ... 07/01/2025 .. .

... 0511412010 ...... 07/01/2024 .. .

... 0511412010 ...... 07/01/2023.

Issuer Obliaat ions 3,701,152 XXX 3,629,944 3,525,000 3,643,575 2,480 (24,428 XXX xxx xxx 27,910 102,127 xxx xxx Bonds - U.S. S ecial Revenue and Special Assessment Obligations and all Non-Guaranteed Obli ations of Agencies and Authorities of Governments and The r Political SUbdivisions - Residential Mort aqe-Backed Securities Bonds - U.S. Soecial Revenue andSpt;!cial Assessment Obligations and all Non-Guaranteed Obligations of Agencies and Authorities of Governments and The r Political SUbdivisions - Commercial Mortgage-Backed Securities Bonds - U.S. Special Revenue and Special Assessment Oblioations and all Non-Guaranteed Obli at ions of A ncies and Authorities of Governments and The r Political SUbdivisions - Other loan-Backed and Structured Securities

3199999 • Bonds· U.S. Special Revenue and Special Assessment Obligat ions and al I Non-Guaranteed Obi Iga! ions of Agencies and Authorities of Governments and Their Political Subdivisions· Subtotals - U.S. Special Revenue and Special Assessment Obligat ions and all Non·Guaranteed Oblig.t ions 01 AgenCies 01 Governments and Their Political Subdivisions

Bonds - Industrial and Miscellaneous Unaffiliated) - Issuer Obligations 3,701,152 xxx 3,629,944 3,525,000 3,643,575

176553·FX·8 .. Citizens PPTY Ins Corp FlA. ........ _ ................. 1... ............. ..115,419 ...... 107.6700 ......... ..107,670 .......... 100,000 ........... 106,949 369604·80·5. General Electric Co. .. ..... 2 ................ 1... ............... 108,988 .. __ . .103.7700 .. __ 127,637 .... __ ... ..123,000 .......... 109,155

2,480 (24,428

.. __ .................. .. ... (2,778) .. __ .................. ..

949746·RG·8 .. Wells Farao & Co. .. ____ .. 3. .. ........ 1... .............. 208,200 .... __ 100.5000 .......... 201 ,000 .. 200,000 .......... 207,348 ........ ____ ..... . ::::::::i;~ .. :::::::::::::::: ::: ... 3299999 • Bonds· Industrial and Miscellaneous (Un.lfiliated) • Issuer

Obligat ions 432,607 XXX 436,307 423,000 423,452 (3,397 Bonds· Industrial and Miscellaneous Unalfiliated • Residential Mortgage·Backed Securities Bonds - Industrial and Miscellaneous Unaffiliated - Corrrnercial Martoaae-Backed Securities Bonds - Industrial and Miscellaneous Unaffiliated - Other loan-Backed and Structured Securities

3899999 • Bonds· Industrial and Miscella"",?~s (Un.flil ~?ted) • Subtotals • Industrial and Miscellaneous IUnalfiliated} 432,607 XXX 436,307 423,000 423,452 (3,397)1

Bonds - Hvbrid Securities - ·Issuer Obligations

xxx XXX XXX 27,910 102,127 XXX XXX

.. ...... 5.000 .......... 2.038 .... JO ..................... 417 ..... 5,000 ... .11/15/2013 ... ... 06/Q1/2019 .. .

.... __ ... 4.000 .......... .4.672 .... JO. .. ..... 273 .......... 5,552 ... 01/22/2016 ...... ..1212912049 .. .. ........ 5.900 ........... 5.297 .... JO .............. __ .... 524 ......... 11 ,800 .. ..11117/2015 ...... ..1213112099 .. .

XXX XXX XXX 1,214 22,352 XXX XXX

XXX XXX XXX 1,214 22,352 XXX XXX

m -" o N


2 Codes 3 4 5

F a

e i

6 7

CUSIP 9 Bond NAIC Actual Identification Description Code n CHAR Designation Cost Bonds - Hvbrid Securities - Residential MortQaQe-Backed Securities Bonds - Hybrid Securities - COOUlIercial Mortgage-Backed Securities Bonds - Hybrid Securities - Other loan-Backed and Structured Securities Bonds· Parent, Subsidiaries. and Affiliates - Issuer Db/jQations Bonds - Parent, Subsidiaries and Aff i I iates - Resident ial Mortgage-Backed Secur i ties

Bonds - Parent, Subsidiaries and Affiliates - Other loan-Backed and Structured Securities Bonds: SVO Identified Funds - Exchange Traded Funds as ldenlified bV the SVO Bonds - SVO Idenlified Funds - Bond Mulual Funds - as Idenlified by the SVO

7799999 - Bonds - Tolal Bonds - Sublolals - Issuer Obi iDa! ions 4,513,453

8399999 Subtotals - Total Bonds 4,513,453

See Independent Accountant's Corq:lllatJOIl Report.

Fair Value 8 9

Rate Used to Obtain

Fair Fair Value Value

xxx 4,518,841

xxx 4,518,841

SCHEDULE D - PART 1 Showing All Long-Tenn BONDS Owned December 31 of Current Year

10 11 Change in Book I Adjusted Carrying Value

Par Value

4,398,000

4,398,000


Value

4,513,262

4,513,262

12 13 14

Unrealized Valuation Increase!

(Decrease)

2,480

2,480


Accretion

(20,009

(20,009

Current Year's Other Than

Temporary Impairment Recoonized

15

Total Foreign

Exchange Change

In B'/A.C.v.

16

Rate of

xxx

xxx

17

Effective Rate

of

xxx

xxx

Interest 18 19

Admitted Amount

When Due & Paid Accrued

xxx 30,666

xxx 30,666

20

Amount Rec.

During Year

132,665

132,665

Dates 21 22

Stated Contractual

Maturity Acquired Date

xxx xxx

xxx xxx

m ...... ......

CUSIP Identification

2

Description

999999 Total Preferred Stocks

Codes 3 4

Code Foreign

5

Number Of

Shares


6

Par Value Per

Share

7

Rate Per

Share

8


Value

SCHEDULE D - PART 2 - SECTION 1 Showing All PREFERRED STOCKS Owned December 31 of Current Year Fair Value

9 10 Rate Per

Share Used to Obtain

Fair Value

xxx

Fair Value

11

Actual Cost

12

Dedared but

Unpaid

Dividends 13

Amount Received

During Year

14

Nonadmitted Declared

Bul Unpaid

.. ~~ ...• ~ ••••... ~ ••..................

15


~ (Decrease)

Change in Book/Adjusted Canvin Value 16 17 18

Current Year's

(Amortization) Accretion

Current Year's Other-ThanTemporary Impairment Recoanized

Total Change

In B.lA.C.V.

(15+16-171

19 Total

Foreign Exchange Change

In B.lA.CV.

20

NAIC Designation

xxx

21

Date Acquired

xxx

m ..... N


1 2 >des 3 4

CUSIP n, Code Fa,.ign

5

'i' ~!~!2!l · . '; 'i: ,425.000 · . . .070.000 · . . . .152.000

: ::1'<0.000 · . . . ,769.000

~;I :::::::tm5 ............ .1 .• ~.:

;.~~ ::::::::1:~~

ini ,"

1

1

(a) For all common stocks bearing the NAIC market indicator ~U· provide: the number of such issues

See Independent Accountant's Conpi lat roo Report.

6 .

17 731

,!A,

.115 l~l

319.4391

,,. ,., 665

5.815.4: I 1 5.815.41'

SCHEDULE D - PART 2 - SECTION 2 Showing all COMMON STOCKS Owned December 31 of Current Year Fair V"lue 9 Dividends

7 Rate per

Share Used To Obtain

XXX

XXX XXX

8 10 11

1 319.439 246.6021

1 5.815.'" '."6.839 1 1 5,m,'"

Declared but Unoaid

:tili .

1

Amount Received

Durina Year

12.335

.166

2.189 1 t22.231 '.23t

., .. _. __ ._ .. _ ... _____________ . ___ . the total $ value (included in Column 8) of an such issues $

12

Nonadmitted Dedared

But Unoaid

13


1.548

.1.",;

m1 ::~

1.~J

23.998

553.255 553.255

;hange in ,. Current Year's Other-ThanTemporary Impairment

1 1

Carrying Valu, 15

Total Change in BJA.C.v. 113-14)

(15

.086

:m , .100

:~~: .ri6s

.585

.004

470

, ... 23,998

553.255 1 553.255 1

16

Total Foreign Exchange Change in B.lA.C.V.

17

NAIC Market Ind~~tor

18

Date, ACQui<ea

m~~i~l: .12102120t6

'-lli~;Jgl: .12/29/2016

XXX X)

XXX X) XXX 1 XX)


SCHEDULE D - PART 3 Showing All L Bonds and Stocks "''''II'lOo=n During Current Year

1 2 3 4 5

CUSIP I I i Foreion Date Acouired Name of Vendor

iOn( -=-u:s: m - AI Other ""' -:u: = and (Direct and ooe - U. '01 i I ic, . of States, Tefl itories and (Direcl and <mr - U. l.r le~Soecial and all Oblioations of Anencies and Authorties at . and lhei pOlilical

' ....... ,"41~-~J.!'--..... i "i .,.�"O ............................................ + ____ -+ ...... "!~'e"" .. lltl".9:' nt", Financial Services Inc. 1·-.... ~~:~:~:~ liAKi:rr;~r~I~~ Bd~~ TX~tt!i;~~'g~ n~:;il~~'} CO" ," .. "'" 'u ........ ~ ~inanciall>ervices Inc. ,::' ""V,,, ....... , ..................................... +--------+ ..... ,n,RO"I1I.1ROli??09:".' . l'li" Financial Services Inc .

. . • ''''''R';:''Y:,. I ~~~~~~e61t~M~P!re~I~~bR~~~sSer A ~~'~il~1~. i:~ ~:~~~~:~: ~;~:~~ :~~ '31ljijQljlf--~ r:s.sDeCTaT Revenue and Special Assessment and all Non Ubi loat IOns of Anencies and luthori ties of ts and Ihel . Pol I tical

Bonds - Indus ial an I Miscellaneous (Unaffiliatedl .. l604-Bi I Elec I 99999 - Ionds - Ildustri.1 and Miscellaneous (Unaffilialedl

Bon, - !vbr ie ,cur 'es Bon. - I., ~lh' ~,ancr Aff iI iales

~ i i Funds

-=- ""' -=- >filfiiTS - Bonds - Par I 3 : - 001 - I.-rv iI", from Par 5 for Bonds I - ~nc - lublolals - Bonds fSfOcl(S - ~MlScellaneous IUnat iI ialed) I Siocks - Parent Subsidiaries, and AI iI iales

ciitiiiOO ~iscellaneous (Unaffilialed(

........ 1 :~~- ,,~!:~~I"MY7rs ~~b!r;'~'i . .. (),lIn,,,,,,," IIR~ ~inancia: Services inc . ~; ~;~~f;e~~c~:~~e'Do ruz,; P','o." E,'q 11"u fu'o j"i ,I' Ii';i"o ,'" '''n·''·"' .. ·· .... · .. · .. · .... · ........ · + .... -.-....... -.. -........ II-----"'~~~'J,:.II?7~J1IL«?f){JU, :"Oo .............. lr~;;;.lmR;;;' ~i;rl~;;, . . ..'

I..~~;~:iii-. !F~;~t Trusl Ut i I i,I~~A~ipPh~aDi:~~i;'VFd::·.:::::·.::·.::::::.·.·.:·.·.:· jt:====:t:::'~'n~,1,m~,fo lo. ____ . __ .~h""'lR< Financial Services Ino .

-IO-V ________ First Trusl Induslrial'cnw,"", .. ;~~::. - IV-"-______ . Fi rst Trust NASDAQ lW-lecnnology ,,~c'-

Income Fund of America Natixis Trusl /I Oakmark - CI C .

7':;'-iv_21:~" P;:~~:p.: ~:~: ~:~;;;:::~:~~~ , 9299999 .. COIlInon S :ks.. 'unds

[COiiiiiOiiSfocl ,=--Moi = Funds r9799997 -:orm.on :ks .. - COOilIOn Stocks - Part 3

•

9799998 .. :orm.on :ks - i",. If V item f 'om Part 5 for C<mon Slacks ~ ~ iilhl )Ials - CooJnon Siocks I - COIlInon locks .. iubl )tals - Preferred and COIlInon Slacks

See Independent Accounlant 's Compilation Report.

,invesled ~ivi "'pinvesled Diviripnri "'pinvesled Diviripnri IRp,invested Divirfp,nrf kRC: Financial Services ~nG hlRC:; Financial Services Inr.

.

I I

6 7 8 9

Par Value

J~~ ~ 7n::~ ......................... "",::,~~ . '" 00' ~ .................................. ~.-'~u:~ t ,2~~

~ ~ "<(0) m J!§!l ~. 605 ,000 4 ,064

.988 ,000 108,988 I 123,000

4,064

I I

775,292 I 108,098 I 883,390 I

728,00( 105,OOC 833,000 I 4,064

1:~::?:~~t: •• ::::::::::.::::::~X:X~: •••••• :: ••• · •••••• t:::.: ••• :~.:: •• ::.::: •• :: •••••• : •••• : •• ::::: x~nOO~----.------.--------------.--.. ~009:~5~----.. ------._----XX"XX~ ... ---- .. -- .. ----~ __ . ______ . ______ . ______ . __ • __ . ____ . __ .1

, "",' ivin 00 ,973 ~------------------.XX"xx,~:--.------.---- +--------------------------.--.----.------.1 __ l,~~,~.jl~:~~~--.. -- ... --.. I:":~: .................. +------ ________ . ______________ .1

1,17:;,947 XXX

'" .,< 3,~~~ m

--77,673 ,aAL~L" UI;YI ',,, '.;. ~._.------.------------------.--.1,,2 ,335 ",

n~~~ :::~~~::' <~~~ A~

--;; 881.373

'~~~.~~ . 1 ,;, XX 592 188

1.901 1,901 2.784,395

XXX XXX XXX XXX XXX 4,064


2 5 6

CUSIP Number of

~:~,Ii- Name S~~=Of

I"m,.,,-, I;~:I~I;:"~~/~~'~:sf~~f::~ 1 .. "'fl4/Z\J".I,al,I,~ . . I 645913-AV-0. INo. J",ev Ecen Oe, Aulh SI p, .. 0811212016 IUBS Financial Se"ices . .. .

~:.~. : ~;"':';~;n::s:~~~i;"gof::ical SUbdiv:si~n~bI,ga ions 01 I '1

. . ... ,(Unaffi'ialedl

; - Hyb, I Sec", 'I ies IBonds - 'a,~ . Sub, 'dia,ies, and A'filiales ~ denlifi j Funds ~ - lal: - Bonds - Pa

II i il

SCHEDULE D - PART 4 Showino a II Bonds and S ""ks SOLD.

7 8 9 10

P., Value Adual Cost

.,'iM· :':111"', ~~"""'-""'i"oj::'i:OOuut .

119.921 125,000 114.557 I Thei, ,

322435 350,000 324282

123:450 I 109,360

II

Prior Year

121.928

324 fiM

109.377T

) or

11

Unrealized Valuation Increasel

Chanae i, 12

Current Year

767

" ,606'

10

) OF During Current Year Cm"';na Value

13 Current Year's Other-Than-

14

Temporary ITotal Change ir

Impainnent 6i.;~~~:i)

767

(1,606]

10

I

16 17 16

15 Book!

Total Foreign Adjusted Foreign Exchange Carrying Value I Ex"hange Gain Realized Gain

~~!n~eJn I DiSPO:~1 Dale ~~~~~ ~~s:.;s~~

42.695

122,695

':J~:: .. 157 ,252

323,074 1639'

Pom I 663,074 I (12,375)1

19

(2,774

.. "'" (6391

(9~ (12,37511

20

Bond Interest/Stock

Dividends

D~=i~';,"a,

21

Stated Contractual

15.145 XXX

1 .044 XX

I~~:;H I~:;"i /I;, . icals~. . . .1211212016.11~tcnancial ""'ces , =31!~ l2;;:i; t::~~~~~~~~:~~~:·l~~ •• ~.71. 1?1t:'1~i~~ t::~:.:::i;iii~'::2! "":02217_t~::::·:: .. ( l'i6;1:" '~'8! "!'5"n::.~~.: •• ~~ ~~:::F:::::::::~: r::.: ••. : l"i6;6:}m::llf.~:~~ ••• ::~r:::.·:: .~J;1'::~~~ t ~~ •••• :d::~::::::~;~"' .• :;;:~!iil:::::: ••••• ·• ;;:~:",:""if:::::::~::E4~::7:&1'lj;;;L;1 113j~02~B6~F,·.4&;!5_·!D..jII~F1l ~:;::::: ~~~:::l~:a~?;:O:::;;e: . ".;;g;;;;,.I~:;~f F'acti",al Shares ii:4~: ,7;; L'i4,O;; F'4;766 ':::: ::~! E

1336920.,v-, IFirsl T, US IPO Inde, F, .111151201615:::::::: ::::::: ROn nnn '" dQ, '" ?nn ~"".",,_,,''''';' "",'It" .. "1 ................ \ ..................... + ................ 44',,669"5 f ....................... t ........... ,5'"O}.,,200,~ 1 ...................... + .......... 13IJ' .. ,7"OO""I\ ............... I1I'·" "I<' "'QII~ ................. "'u'" '"

Ill~l1t~} IF",; 1;::: li:s:;:so::~:::;,·I;~; i- I iB;;;;;;; I : .. c Ban .. ·k· .... · ... · ",' ................... ~ ...... J1',~634;;i·I~JO~0 'i:ili t:::::::::::::::: ::t::1 "~':~ "'l~ ~:::~l:;;; tf .. : .... :: .... :,i"'rz': ':"l't:::: ::: ::::::::t: ::::::::::t::::::·: "irz': ,286:1: '6:l~t::::::::::::t:::.. : ;'"::l::~r.l ... : . ·~:r.l OR? m

133734X.14.3 .. IFirsl Tous' Heallh Care Alphode, F'j ... ! .. 03f1812016. iFinanCial Services ',119.000 ~ .......... 113,731~"""""'''''''''''1'''''''''.J """,'''''''''' '" no, '" "0' .155,638). 72,4561 ............... + ............. 411,275~ ............ A.,,',. 'm" ~ ........................ J. ....... "'XXL .1

l17n"'_'~:: I Mills " n7ln"'""I~:::::::: :::::: "on ~ ~ .......... .47,'03~ ...................... 1 ............ 2 "4",""" " .""\ ....... 'I'''J',( .'''78)'\ ........................ + .............. \ ............. (""3,07,,8)11 ....................... + ............. ".,978 ",125 n,125 1 ................ 5,,,,, m

14(::::~~",~~i.;1 ... ,;:0-0 1~ICo'p ..~: '{It line.. .;,:: I 'i~ "~;r ..................... ;36i,:;06O 1. 1 ,·'·:in::: . "1::,,*: ",,,,~,, n17 . 1,~ m I~~;:';~ Ili~:'&n1 !lIOB.or· r~i: f... ,:: .c"?~ l' ',<; '157 : m 1746761>-i2-': ~ tn".. ~ Uia' "T~ •.... ~

•

al lIebal MuI,Ii-SI,a,eav Fd

I . ~pa, 5 I" C"""" Stocks , . Subtotals -

I~ 2,

See Independent Accountant's Campi lation Report.

;~;:~~t ••• J'''~:::~~t •••••••••••••• • •• :.l·.·· •• ··•• .••••• I~ •••• · •• · ••••• ~'.,;:l:~~itl .•.•••.•••••.•••.•••••. lt: ..... ::,'"~::~l:::mm t:::.::.::.: ••••••••• t •• ;f:fol::~~l!,r ••• •• •••• il1.,~o:!"!~'f :.:::;~::~~;!tl .. : ...• :~:~t:::! 96725 ' ~ 5,390 102,116 .. 11,437' 11 .,,' m

(208,405)

1209,4131

365,822 49,979 1,846 XXX

~31JLI26

2,193,671 113,57

125,

113. 13, 36.

2 3 4

~ ~ i

CUSIP ~ Date n Acquired

land

land, - U., . Stales, Temlories and Direct and Bonds U.S. Political: " of Siales, Temlories and I

147069 .. 0l .. 9 .. Casa Grande !l Se, A 1..06115/2016. 24"9999 Bonds· i; of Stales.

Bon ,- 11.5. Special Revenue and Special I and al Bone . Industrial and i I It

Bone s - Parent, ii, and Affiliates I Bonds va Identified Funds

83999! I - Bonds - Subtotals - Bonds I Preferre, tacks· Industrial and i II IPrere~( iiI

80mmon :ks - Industrial and I


SCHEDULE D - PART 5 Showino ,II Lana-Term Eonds and Siceks.

5 6 7

Name of Vendor Diria:al

Name of Purchaser

; (Direct,

!'" "nan"" "rvlCes. .I ""'''f11' k,,,,, i i , of Aaencies and Authorities of,

8 9

Par Value (Bonds) or Number of

(;~~:) Actual Cosl

,0< nnn ''''' /lQ' I 105,000 I 108,098 I , and Their Political

I 105,000 I 108,098 I

10

i

""'" 98,9()0

98,900

Durina Year an

I

11


6:'~~~~

. .107,919 107,919

107,919

12


I I

I

I OF Durina Currenl Year dn Carrying Value

13 14 15

Current Year's


Accretion

,17,,1 (17911

179)1

Other Than Temporary Impairment

I I

I

Total Change In

(1~:A;~'~4)

/17,,1 (179)1

(17911

16

Total Foreign Exchange

~~~~~~~

17

Foreign Exchange

Ga~i!~~~~ on

I

I

18

Realized Gain

~~:;s~~

TO n1O,1 (9,01911

(9,01911

19

Total

G~~i!~~~~ on I

TO nl" (9,019)

(9,01911

20

Interest and Dividends Received

Duri~g Year

1 n44 I. 1,0441

1,0441

21

Paid for Accrued Interest

Divf~:nds

m~1~::::::::::::~ :.::::::::.t ::::::l:: •• ::: •• ::.:.t::· ••••••••• t.: ••••••••••••••••• t:: :.~"~·~'(~~:n'::::.:: .. ~(8'1;~~ii~ ••••••••••••••• ~·t:1 1\'I'l Fi'",cial Services "'''''016 \'I'llnc'. Fin"cial ""rvices

I :O~i:~:i Concerl p~,~" ra~cetJ:~IIi;dcacla~ II s~ ;'; "'~vaiuel: I·0038/;022S/;,2{)2:J'~66··j;l: nc~ ~ .. ; ;esiOi·iiivi'iend. • ••• tM;~;jO~6:.f~! i!d:; ;.. ••••• t.. ":4;~M" Ilf1I1~Ufl~',:.1.l 1....... 12 '~',215 ~r~f;~~: ~~(~ard.looking 11Il~ ............. ,~~~ ~... 4,834

I "'''' .. ID .. l O' , . '"'''''''' It., '~k. .... ",n",,,,' I' Financial Services. '" Mn " '" " '00 "m 1543487-33 .. 4: [;;;;:" T,;m'Gov'(& 10ividend.. ..13.630 '157 ,,;S7f ............ .l4 .. ,',5~7'

, Stocks - Industrial and ,I' 40 ,789 32,514 40,789 8ommon Stocks - Parent. . and Affiliates ~f!,-m<!n SI ~ks - Mutual Funds

'" 18,2751

'" 18,2751 504

'l4W1' .. "' .. ' Il.'ani~ I SI ra::t:eg~l,:iiiC;" I :n~ca'c;.t-I .. vn,"""'";r'N''''''''' .. i' ... ;'n''SI''' DvDinivTlii'dde.ndnd .............. t.JJ9 00/1'''2>TI:''"'"''·,''' ... j\'''''1C'' .... F .. ,in .. a .. n .. ''' ... · ..... 'I .. Se ... ' .. r"' ... vi ... ·C .. es "'''11,6',1,713.220 9O.'17f ............ = 993.,289 90,917 f .................... -f ..................... t ....................... + ...................... I ...................... + .......... · ......... t ................ ,8""372,f ..................... R .. 37,,,' , ................. 4OruOo , ................. 1

1638720 .. 61 .. 6 I:~;; I","",.".,., . )2129/2016 IR,i,,",'''' DoDl;"''''ilrl',,'","o ......... +.''',,,'''''''I,,'"u16 '"haoo' """ I ............ ,',,", ."'f .................. ',,,,, f ............................ lf .................... · .. +· ....... · ...... · ...... · .. + ........................ + .. · ...... · ...... · ...... If .... ·· ............ ··+ .. · .. · ...... · .... ·"," f ..... · ........ · ....... ·"'" f ...................... + ........... 1

~ .. 6· ~1 i,'is Oakmark Inlernat ional ""Of'"" ,I, In;" '"1f1I''''' " "" '''' "" '''' '" '" :ommon Stocks .. Mulual Funr:[s_ 9, ,081 100,506 92,081 8,425 8,425

,St, :ks - Monev tarleet Mutual Funds ~ 132,870 133,021 132,870 150 150

9899999- :ommon Stoc's - Subtotals - PrEfened and Common Stocks 132,870 133,021 132,870 150 150

I 240,968 231,920 240,789 18,869) (8,8691

See Independent Accountant s Comp,'atlon Report.

400

904 904

1,949

......


2

Description Name of Subsidiary,

3

SCHEDULE D • PART 6 • SECTION 1 Valuation of Shares of Subsidiar , Controlled or Affiliated Companies 4 5 6 7 8 9

NAIC

NAIC Do Valuation Method

(See Purposes

Insurer's Assets Include

10 Stock of Such Company Owned by

Insurer on Statement Date 11 12

CUSIP Controlled or Affiliated Company - Identification Company Foreign Code ID Number

And Procedures Manual or the NA/C

Investment Analysis Office)

Intangible Assets

Connected with

Holding of Such

Company's Stock?

Total Amount of Such

Intangible Assets

Book I Adjusted Carrying

Value Nonadmitted

Amount

Number of

Shares %of

Outstanding Preferred Siocks . Parenl

• Preferred Siocks . U.S. Pro erlv & Casual IV Insurer Preferred Siocks • U.S. life Insurer Preferred Siocks • U.S. Heallh Enlilv Preferred Siocks . AI ien Insurer Preferred Stocks· Non-Insurer Which Controls Insurer Preferred Siocks • Inveslmenl Subsidiary Preferred Siocks • Olher Aft i I iales COOII1IOn Sfocks . Parenl COIIIJIOn Siocks • U.S. Prooerlv & Casual Iv Insurer Common Siocks • U.S. life Insurer COIMIOn Siocks· U.S. Heallh tnlily COIIIJIOn Siocks • AI ien Insurer Common Stocks' Non·lnsurer Which Controls Insurer Common Siocks . Inveslmenl Subsidiary 000000·00 ·0 .. .1 Sor inQdal e Aoonev ................ J. .......... J ..................... 1 ..

1699999 • COIIIJIOn Siocks • Inveslmenl Subsidiary COIlIlIOn Siocks • Olher Aft i I iales

1899999 • COIIIJIOn Siocks • Sublolals . C_on Siocks

............... .2ciBL ... L ..... No ... . ..... 319,4391 ...................................... 1,000.000 ........... .100.0 I 319,439 I XXX XXX

319,439 XXX xxx

1999999 Totals - Preferred and Common Stocks 319,439 XXX XXX 1. Amount of Insure~s capital and surplus from the prior period's stalutory statement reduced by any admitted EDP, goodwill and net deferred tax

assets included therein: ..... __ .. __ .. ____________ .............................. ______ . __ .. __ ........ _____ ............. . .............. __________________________________ .... __________ $ ____________________________ _ 2. Total amount of intangible assets nonadmitted... . ................................. ".. .............................. . ............................................................... $ ................. .

See Independenl Accounlanl 's Compi lal ion Report.

SCHEDULE D . PART 6 SECTION 2

CUSIP Identification

2

Name of Lower-Tier Company

3 4 Total Amount of Intangible Assets

Included in Amount Name of Company Listed in Section 1 Which Shown in Column 8,

Controls Lower-Tier Company Section 1

Stock in Lower·Tier Company Owned Indirectly by Insurer on

Statement Date 5 6

%at Number of Shares Outstanding

..................... ................ ...... .........................===.- ..• \I,@-N~ ••••••••••••••••••••••••• ~~~.:=-; •...............

0399999 Totals - Preferred and Common XXX XXX

E16

• ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

2 Code 5

3 14

CUSIP

~:~t n ~.' I Bonds - , Is ""' Obligal iOlls ~§ -ral j Secur i I ies

~~ ~" her ,Bonds - ~r ; -

les ,Bonds -

lories lOirec lories and PosseS! ions (Oirec

les, re" lories and ,Bonds - i , I lor and

~:~ 'Bondt-'-"iQtJ""sSpec=·"'i I""an=j '='iisce' lanews

I

".

i - I - _,;ial

6

ioaf ions

, - Ti' ~. '1 jSecur'ties L Bonds - I rrQtJili!.a I "j i - lIher I

Miscellaneous (Unaffiliated) - Sublotals - IndtJslrial and

lifi.db,

Ii ~ rloa,. •

ied 'unds - Bon~ I I

, i • and Afti liales - "" Shorl-Term Invested Assets rlgage~

~ ~ 9199999 Total~

See Independent Accountant s ~llat Jon Report.

SCHEDULE DA - PART 1 Showino all SHOI -_. ; Owned r 31 of Cunent Year

7

j Securilies

lies i

; iOi

8

.Wi:'~Of

7.89t

76.B9t ,

9

Unrealized

lanae In 10

Current Year's

13

11 12

Valuation I (Amo,-tlZOltiorl)1

Current Year's

Other-ThanTemporary Impairment

Total Foreign

~~~~~~~e B./A.E~~

Increase!

i il ies

>curil ies

Par Value

i'_'i . i ,- "il ies . . ,-:- "i lies

,an lheirpOTTI~ i ,-:- riiCfiffed I

t'

7. ""

t'

, , xXx ,

14

Actual Cost

76,B91

76,B91

15

Amount Due And Accrued

Dec. 31 of Current Year

O~~~u~tOl

19'

19

19

tg

16

Non-Admitted Due and Accrued

In .rest .

17 18

Raleof

, XXX ,

XXX

, XXX , , XXX ,

, xxx ,

xxx

xxx

xxx XXX

xxx

, .

,

, ,

,

19

xxx

xx: XXX

XXX

,

, ,

,

20

356

356 356

356

21

------,.,---,------------'----ANNUAL STATEMENT FOR THE YEAR 2016 OF THE American Mutual Insurance Association

Schedule DB - Part A - Section 1

NONE Schedule DB - Part A - Section 2

NONE •

Schedule DB - Part B - Section 1

'NONE Schedule DB - Part B - Section 2

NONE Schedule DB - Part 0 - Section 1

NONE Schedule DB - Part 0 - Section 2

NONE

E18, E19, E20, E21, E22, E23


SCHEDULE E - PART 1 -CASH 2 3 4 5 6 7

Amount of Interest Amount of Interest Received Accrued

Rate of During December 31 of Code Interest Year" Current Year Balance

West liberty State Bank............... ..... 1 ......... 11., 2 .. 10' • Du Trac C"""unity Credit Union ..... I: ........ ;U 1 ...................... <2,!1,230

~ ~!f~iU;~n::~~:;o~Sm.~~~u~in~n~~i; II/:~:~il UniOn .:::::: !n~~I::: ::::::: ::::;3: .. ;~;!~~~ II:":":':" ::::·:::.::·::.:::"3·::~,~~ ... I ................. · ... :l.~~~~,

..

UnlverSily :Hf I~~k: ~ Iy oredll Union...... . ... ..1.5901 .. · .. · .. ·· .......... · .. ;: .. ::~,·~, I .. · .... · ...... · ...... · ...... · .... · .. · 1 ....................... 10I.r XXX Matured and lut.............. . .................................................................. 1 ..................... 1 ................ + ..................... <,.,44~1;7, I...................................... . ...... XXX Fi rst I ng Ancccwo,uun"t ......................................................................................................... 1 ..................... 1 ................. 1 ................................... +.................................. 939,251 XXX Ivib;ani ..... 70.000 XXX

0199998 DepOSits in .. .. ; that do not exceed the I I limit in anyone , .. ODen Xxx XXX

0199999 Totals .. Open XX) XX) 12,889 2,071 2.221,066

x;; XXX XXX XXX XXX

1 .................. \ .................................. + ................................. 1 .. · .... · .................... · .. · .. \ XXX XXX

.. · ...... 1 .......... · ...... ·1· ............ · ........ · ........ ·-1-...... · .......... · ................ I ...... · ............ · .... · ...... · .. · XXX XXX XXX XXX

.. · ...... · ................ · .... · .. · ............ ···1 ...... · .... ..

\ •• :.1:::::::::.::::: •.•• : •••• : .... :.:1:::.:::.: .•••••••••••• : •• :: •.• \.::::. ::.:.:\ xxx

xxx xxx

1 ................................ 1 xxx 1 .................. 1 ................................. + .................................. I .. · .............................. · XXX

XXX XXX XXX

1 ................... + ................................ 1................................. 1 ...................... · .. · .. · .. · .. 1 XXX 1 ................................. 1 XXX

1 ................ + ................................ 1 ................................. 1 .. · ............ · ...... ·· .. · .. ·· .. 1 XXX 1 ................................... 1 XXX

...... · ...... · .. · .... · .. ·· .... · .................. · .. ·· .... ·· .... ·· .. ·1 ............ · ........ 1· .. · .............. 1 .... · .... · .. · .... · .... · ........ · .. + ...... · .. · .............. · ........ · 1 .. · ........ ··· .... · .......... · .. · .. 1 XXX 1 ................ + ................................ 1 .................................. 1 .............. · .. · ................ 1 XXX

XXX 1 ................ + ................................ 1.................................. 1· ........................ · .... · .. 1 XXX

I .. • ...... · .. · ............ • .. · .... · ...... · ............ ·· ...... · ........ · .... ·· .... · .... · .......... ·· ............ · .. · .... · ............ · ...... ··· .. · ........ · .. ·· .. ··1 ............ · 1 ................. + ................................ 1 .................................. 1 .. · .......... · ...... · ........ · ...... ·1 XXX 1 ................. + ................................ 1 .................................. 1 .. · ............ ·· ...... · ...... ·· .... ··1 XXX

I ................................................................................................. · .. · .. · .. · .. · ........ ·· ................ · .. · ............ · .. ··1 .................... 1· .... · .. · .. · ...... ·· ............ · .. 1 XXX 1 ................. + ................................ 1 .................................. 1 .. · ............ · ...... · .. · .. · .... ·1 XXX 1 ................. + ................................ 1 .................................. 1 .. · ...... · .... ··· ............ · .... ·1 XXX

1 ................................. 1 XXX I ............................................................................................... ·· ........................ ··· .... · .. · .. · .... · .............. · .. ·1 .... · .. ···· .. · ........ I .... ··· .. ··· ...... ~ .... · ...... · .... ·· .... ·· ...... · .. +· ...... ·· .............. · .. ·· ...... · 1""""""""",,,,,,,,,,,,,,,,1 xxx I .... · ...... · .. · ........ ·· .................. ·· .. · .. · ...... · .... ··· ........ · .. · ...... ···· ........................ · .. · .... ···· ............ ·· ................ ·1 .... · .. ···· .... ·· ...... 1 .. · .. · .. · .. · ...... 1 .... · .... · .. · .................. · .. ·1·· .. · ........ ·· .. · .. · ............ · 1 ................................... 1 xxx

:

:: •• : •• : ••• : •••••••••• :.:: •• ::.:.:::::: ••• :: •••• :.:::.::.:.:::]:: ••••••.•••• ::.::.:1 ............... -1-................................. 1· ................................ · 1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1 xxx 1 ................. -1-................................. 1 .................................. 1",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1 xxx

1.: •••• • •••••••••• ::.\: \: ••••••••• :........................................................... ... I •••••••••• ~ f~~~~~F~~.~~= ~~~ I

:.. ::.:...................... II ;;; ....... t~~~:~~~~\w ...................... ·· .. · ...... · ................ ·· .... · ...... 1 .... · .... ·· .... · .... ·1 .................. 1· ............ · .... · ............ · .. 1 ...... ·· .... ··· .. · .. ·· .. · .. ·· .... · .. 1'''''''''''''''''''''''''''''''''''''1 xxx

I· .... · .... ··· .... · .... ··· ........ · .. · .. · .. ··· ................ ··· ........................ 1 .... ·· ............ 1 .... · .... · .. · ........ · .. · ...... · .. ·1 .............. ·· .. · .. · .. · .. · ...... · 1""""""'''''''''''''''''''''''1 XXX ........ · .. ····· .......... ·· .... ·· .. ·· .......... · .. ···· .... · ...... · .. 1· ...... ··· .... ·· ...... 1 .... ·· ............ 1 .... · .... · .. ·· .... · ............ · .. +· ............ ·· ........ · .. · ....... 1"""''''''''''''''''''''''' ..... 1 XXX ................................................................. 1 ................. 1· ............ · .. ·~ .............. · .. · ............ · .. I· ................................ 1 ..................................... 1 XXX

1 .... · .... · .. ·· .... ·1 .... · ...... · ........ · .. · ...... · .. +· ...... · ...... ·· .. · .. ·· ...... · .... 1 .. · ........ · .. · ...... · ...... · ...... 1 XXX 1 .................. 1 ................................. + ................................ I· ...... · ............ · ...... · .... I XXX

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=+~~~~=-~~~~~=-~~~~F=~~~~~XXX 0399999 Total Cash on DeDosit XXX XXX 12,889 2,071 2,221,066 XXX

I· ...... ·· ...... · ............ · .... · ........ · .. · ............ · .... ·

0499999 Cash In ,'s Office XXX XXX XXX XX) 100 XXX 05~_9 Total Casl!. XXX XXX 12,889 2,071. 2,121,166 XXX

TOTALS OF DEPOSITORY BALANCES ON THE LAST DAY OF EACH MONTH DURING THE CURRENT YEAR 1. January ...... .................... 2,429,958 4. April.. .. ............ 2,546,739 7. July ......................................... 2,531 ,460 10. October ................................ 2, 192, 181 2. February .. .. ......... 2,423,012 5. May ........................................ 2,519,945 8. AugusL............. .. .... 2,603,246 11. November ....................... 2,244.934 3. March 2.529,472 6. June 2,450.138 9. September 2.513.891 12. December 2,221,066

See Independent Accountanl 's Campi lalion Report .

E26


Schedule E - Part 2

NONE Schedule E - Part 3

NONE

•

E27,E28

american mutual insurance association - iowaamerican mutual insurance association john t. fiderlein...

Documents