ANNUAL STATEMENT
OF THE
UNION AMERICAN INSURANCE
COMPANY
IN RECEIVERSHIP
OF
Tallahassee
IN THE STATE OF
Florida
TO THE
INSURANCE DEPARTMENT
OF THE
STATE OF Florida
FOR THE YEAR ENDED
DECEMBER 31, 2009
PROPERTY AND CASUALTY
2009
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
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 (less
$
encumbrances)
4.2 Properties held for the production of income
(less $
encumbrances)
4.3 Properties held for sale (less
$
encumbrances)
5. Cash ($
, Schedule E, Part 1), cash equivalents
($
, Schedule E, Part 2) and short-term
investments ($
, Schedule DA)
6. Contract loans, (including $
premium notes)
7. Other invested assets (Schedule BA)
8. Receivables for securities
9. Aggregate write-ins for invested assets
10. Subtotals, cash and invested assets (Lines 1 to 9)
11. Title plants less $
charged off (for Title insurers
only)
12. Investment income due and accrued
13. Premiums and considerations:
13.1 Uncollected premiums and agents’ balances in the course of
collection
13.2 Deferred premiums, agents’ balances and installments booked but
deferred and not yet due (including $
earned
but unbilled premium)
13.3 Accrued retrospective premium
14. Reinsurance:
14.1 Amounts recoverable from reinsurers
14.2 Funds held by or deposited with reinsured companies
14.3 Other amounts receivable under reinsurance contracts
15. Amounts receivable relating to uninsured plans
16.1 Current federal and foreign income tax recoverable and interest thereon
16.2 Net deferred tax asset
17. Guaranty funds receivable or on deposit
18. Electronic data processing equipment and software
19. Furniture and equipment, including health care delivery assets
($
)
20. Net adjustment in assets and liabilities due to foreign exchange rates
21. Receivables from parent, subsidiaries and affiliates
22. Health care ($
) and other amounts receivable
23. Aggregate write-ins for other than invested assets
24. Total assets excluding Separate Accounts, Segregated Accounts and
Protected Cell Accounts (Lines 10 to 23)
25. From Separate Accounts, Segregated Accounts and Protected
Cell Accounts
26. Total (Lines 24 and 25)
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)
2301.
2302.
2303.
2398. Summary of remaining write-ins for Line 23 from overflow page
2399. Totals (Lines 2301 through 2303 plus 2398)(Line 23 above)
2
1
Current Year
2
3
Prior Year
4
Assets
Nonadmitted Assets
Net Admitted Assets
(Cols. 1 - 2)
Net Admitted
Assets
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
LIABILITIES, SURPLUS AND OTHER FUNDS
1
Current Year
2
Prior Year
1. Losses (Part 2A, Line 35, Column 8)
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)
4. Commissions payable, contingent commissions and other similar charges
5. Other expenses (excluding taxes, licenses and fees)
6. Taxes, licenses and fees (excluding federal and foreign income taxes)
7.1Current federal and foreign income taxes (including $
on realized capital gains (losses))
7.2 Net deferred tax liability
8. Borrowed money $
and interest thereon $
9. Unearned premiums (Part 1A, Line 38, Column 5)
(after deducting unearned premiums for ceded reinsurance of $
reserves of $
)
and including warranty
10. Advance premium
11. Dividends declared and unpaid:
11.1 Stockholders
11.2 Policyholders
12. Ceded reinsurance premiums payable (net of ceding commissions)
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 (Schedule F, Part 7)
17. Net adjustments in assets and liabilities due to foreign exchange rates
18. Drafts outstanding
19. Payable to parent, subsidiaries and affiliates
20. Payable for securities
21. Liability for amounts held under uninsured plans
22. Capital notes $
and interest thereon $
23. Aggregate write-ins for liabilities
24. Total liabilities excluding protected cell liabilities (Lines 1 through 23)
25. Protected cell liabilities
26. Total liabilities (Lines 24 and 25)
27. Aggregate write-ins for special surplus funds
28. Common capital stock
29. Preferred capital stock
30. Aggregate write-ins for other than special surplus funds
31. Surplus notes
32. Gross paid in and contributed surplus
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33. Unassigned funds (surplus)
34. Less treasury stock, at cost:
34.1
shares common (value included in Line 28 $
)
34.2
shares preferred (value included in Line 29 $
)
35. Surplus as regards policyholders (Lines 27 to 33, less 34) (Page 4, Line 39)
36. Totals (Page 2, Line 26, Col. 3)
DETAILS OF WRITE-INS
2301. " #
$ %&'( )
%
2302. *
2303.
2398. Summary of remaining write-ins for Line 23 from overflow page
2399. Totals (Lines 2301 through 2303 plus 2398) (Line 23 above)
2701.
2702.
2703.
2798. Summary of remaining write-ins for Line 27 from overflow page
2799. Totals (Lines 2701 through 2703 plus 2798) (Line 27 above)
3001.
3002.
3003.
3098. Summary of remaining write-ins for Line 30 from overflow page
3099. Totals (Lines 3001 through 3003 plus 3098) (Line 30 above)
3
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ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
STATEMENT OF INCOME
1
Current Year
2
Prior Year
UNDERWRITING INCOME
1. Premiums earned (Part 1, Line 35, Column 4)
DEDUCTIONS:
2.
3.
4.
5.
6.
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Losses incurred (Part 2, Line 35, Column 7)
Loss adjustment expenses incurred (Part 3, Line 25, Column 1)
Other underwriting expenses incurred (Part 3, Line 25, Column 2)
Aggregate write-ins for underwriting deductions
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Total underwriting deductions (Lines 2 through 5)
7. Net income of protected cells
8. Net underwriting gain (loss) (Line 1 minus Line 6 plus Line 7)
!
INVESTMENT INCOME
9. Net investment income earned (Exhibit of Net Investment Income, Line 17)
10. Net realized capital gains (losses) less capital gains tax of $
11. Net investment gain (loss) (Lines 9 + 10)
(Exhibit of Capital Gains (Losses))
OTHER INCOME
12. Net gain (loss) from agents'or premium balances charged off (amount recovered $
charged off $
)
13. Finance and service charges not included in premiums
14. Aggregate write-ins for miscellaneous income
15. Total other income (Lines 12 through 14)
amount
16. Net 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
18. Net income, after dividends to policyholders, after capital gains tax and before all other federal and foreign income taxes
(Line 16 minus Line 17)
19. Federal and foreign income taxes incurred
20. Net income (Line 18 minus Line 19) (to Line 22)
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CAPITAL AND SURPLUS ACCOUNT
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
Surplus as regards policyholders, December 31 prior year (Page 4, Line 39, Column 2)
Net income (from Line 20)
Net transfers (to) from Protected Cell accounts
Change in net unrealized capital gains or (losses) less capital gains tax of $
Change in net unrealized foreign exchange capital gain (loss)
Change in net deferred income tax
Change in nonadmitted assets (Exhibit of Nonadmitted Assets, Line 26, Col. 3)
Change in provision for reinsurance (Page 3, Line 16, Column 2 minus Column 1)
Change in surplus notes
Surplus (contributed to) withdrawn from protected cells
Cumulative effect of changes in accounting principles
Capital changes:
32.1. Paid in
32.2. Transferred from surplus (Stock Dividend)
32.3. Transferred to surplus
Surplus adjustments:
33.1. Paid in
33.2. Transferred to capital (Stock Dividend)
33.3. Transferred from capital
Net remittances from or (to) Home Office
Dividends to stockholders
Change in treasury stock (Page 3, Lines 34.1 and 34.2, Column 2 minus Column 1)
Aggregate write-ins for gains and losses in surplus
34.
35.
36.
37.
38. Change in surplus as regards policyholders for the year (Lines 22 through 37)
39. Surplus as regards policyholders, December 31 current year (Line 21 plus Line 38) (Page 3, Line 35)
DETAILS OF WRITE-INS
0501.
0502.
0503.
0598. Summary of remaining write-ins for Line 5 from overflow page
0599. Totals (Lines 0501 through 0503 plus 0598) (Line 5 above)
1401.
+ #
,-$
. $ $,
/
+
1402. 0
- , 1- 2
1403.
- , 3 . $ ##
1498. Summary of remaining write-ins for Line 14 from overflow page
1499. Totals (Lines 1401 through 1403 plus 1498) (Line 14 above)
3701.
3702.
3703.
3798. Summary of remaining write-ins for Line 37 from overflow page
3799. Totals (Lines 3701 through 3703 plus 3798) (Line 37 above)
4
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ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
CASH FLOW
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Cash from Operations
Premiums collected net of reinsurance
Net investment income
Miscellaneous income
Total (Lines 1 through 3)
Benefit and loss related payments
Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts
Commissions, expenses paid and aggregate write-ins for deductions
Dividends paid to policyholders
Federal and foreign income taxes paid (recovered) net of $
tax on capital gains (losses)
Total (Lines 5 through 9)
Net cash from operations (Line 4 minus Line 10)
Cash from Investments
Proceeds from investments sold, matured or repaid:
12.1 Bonds
12.2 Stocks
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)
Cost of investments acquired (long-term only):
13.1 Bonds
13.2 Stocks
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)
Net increase (decrease) in contract loans and premium notes
Net cash from investments (Line 12.8 minus Line 13.7 minus Line 14)
Cash from Financing and Miscellaneous Sources
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)
Net cash from financing and miscellaneous sources (Lines 16.1 to 16.4 minus Line 16.5 plus Line 16.6)
RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS
Net change in cash, cash equivalents and short-term investments (Line 11, plus Lines 15 and 17)
Cash, cash equivalents and short-term investments:
19.1 Beginning of year
19.2 End of year (Line 18 plus Line 19.1)
5
1
Current Year
2
Prior Year
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ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Part 1
NONE
Part 1A
NONE
Part 1B
NONE
6, 7, 8
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
UNDERWRITING AND INVESTMENT EXHIBIT
PART 2 - LOSSES PAID AND INCURRED
Losses Paid Less Salvage
2
3
1
9
Line of Business
1.
Fire
2.
Allied lines
3.
Farmowners multiple peril
4.
Homeowners multiple peril
5.
Commercial multiple peril
6.
Mortgage guaranty
8.
Ocean marine
9.
Inland marine
10.
Financial guaranty
11.1
Medical professional liability - occurrence
11.2
Medical professional liability - claims-made
12.
Earthquake
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 lines of business
35.
TOTALS
DETAILS OF WRITE-INS
3401.
3402.
3403.
3498.
Summary of remaining write-ins for Line 34 from overflow page
3499.
Totals (Lines 3401 through 3403 + 3498) (Line 34 above)
Reinsurance
Assumed
Direct Business
Reinsurance
Recovered
4
Net Payments
(Cols. 1 + 2 - 3)
5
6
7
Net Losses
Unpaid
Current Year
(Part 2A, Col. 8)
Net Losses
Unpaid
Prior Year
Losses Incurred
Current Year
(Cols. 4 + 5 - 6)
8
Percentage of Losses
Incurred
(Col. 7, Part 2)
to Premiums Earned
(Col. 4, Part 1)
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XXX
XXX
XXX
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4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
UNDERWRITING AND INVESTMENT EXHIBIT
PART 2A - UNPAID LOSSES AND LOSS ADJUSTMENT EXPENSES
Reported Losses
1
10
Line of Business
1.
Fire
2.
Allied lines
3.
Farmowners multiple peril
4.
Homeowners multiple peril
5.
Commercial multiple peril
6.
Mortgage guaranty
8.
Ocean marine
9.
Inland marine
10.
Financial guaranty
11.1
Medical professional liability - occurrence
11.2
Medical professional liability - claims-made
12.
Earthquake
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 lines of business
35.
TOTALS
DETAILS OF WRITE-INS
3401.
3402.
3403.
3498.
Summary 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 life indemnity claims.
Direct
2
Reinsurance
Assumed
3
Deduct Reinsurance
Recoverable from
Authorized and
Unauthorized
Companies
4
Net Losses Excl.
Incurred But
Not Reported
(Cols. 1 + 2 - 3)
5
Incurred But Not Reported
6
7
Direct
Reinsurance
Assumed
Reinsurance
Ceded
8
9
Net Losses
Unpaid
(Cols. 4 + 5 + 6 - 7)
Net Unpaid Loss
Adjustment
Expenses
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XXX
XXX
XXX
XXX
XXX
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ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
UNDERWRITING AND INVESTMENT EXHIBIT
PART 3 - EXPENSES
1
Loss Adjustment
Expenses
2
Other Underwriting
Expenses
3
Investment
Expenses
4
Total
1. Claim adjustment services:
1.1 Direct
1.2 Reinsurance assumed
1.3 Reinsurance ceded
1.4 Net claim adjustment services (1.1 + 1.2 - 1.3)
2. Commission and brokerage:
2.1 Direct, excluding contingent
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
2.8 Net commission and brokerage (2.1 + 2.2 - 2.3 + 2.4 + 2.5 - 2.6 + 2.7)
3. Allowances to manager and agents
4. Advertising
5. Boards, bureaus and associations
6. Surveys and underwriting reports
7. Audit of assureds'records
8. Salary and related items:
8.1 Salaries
8.2 Payroll taxes
9. Employee relations and welfare
10. Insurance
11. Directors'fees
12. Travel and travel items
13. Rent and rent items
14. Equipment
15. Cost or depreciation of EDP equipment and software
16. Printing and stationery
17. Postage, telephone and telegraph, exchange and express
18. Legal and auditing
19. Totals (Lines 3 to 18)
20. Taxes, licenses and fees:
20.1 State and local insurance taxes deducting guaranty association
credits of $
20.2 Insurance department licenses and fees
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)
21. Real estate expenses
22. Real estate taxes
23. Reimbursements by uninsured plans
24. Aggregate write-ins for miscellaneous expenses
25.
Total expenses incurred
(a)
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)
DETAILS OF WRITE-INS
2401. "%)
*5/ -
2402. %(&'( 6(* *5/ 2403. 0
!
- ,
2498. Summary of remaining write-ins for Line 24 from overflow page
2499. Totals (Lines 2401 through 2403 plus 2498) (Line 24 above)
(a) Includes management fees of $
to affiliates and $
to non-affiliates.
11
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ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
EXHIBIT OF NET INVESTMENT INCOME
1
Collected
During Year
1.
1.1
1.2
1.3
2.1
2.11
2.2
2.21
3.
4.
5.
6.
7.
8.
9.
10.
U.S. Government bonds
Bonds exempt from U.S. tax
Other bonds (unaffiliated)
Bonds of affiliates
Preferred stocks (unaffiliated)
Preferred stocks of affiliates
Common stocks (unaffiliated)
Common stocks of affiliates
Mortgage loans
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
11.
12.
13.
14.
15.
16.
17.
Investment expenses
Investment taxes, licenses and fees, excluding federal income taxes
Interest expense
Depreciation on real estate and other invested assets
Aggregate write-ins for deductions from investment income
Total deductions (Lines 11 through 15)
Net investment income (Line 10 minus Line 16)
2
Earned
During Year
(a)
(a)
(a)
(a)
(b)
(b)
(c)
(d)
(e)
(f)
(g)
(g)
(h)
(i)
DETAILS OF WRITE-INS
0901.
0902.
0903.
0998.
0999.
Summary of remaining write-ins for Line 9 from overflow page
Totals (Lines 0901 through 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)
(a) Includes $
paid for accrued interest on purchases.
accrual of discount less $
amortization of premium and less $
(b) Includes $
paid for accrued dividends on purchases.
accrual of discount less $
amortization of premium and less $
(c) Includes $
accrual of discount less $
amortization of premium and less $
paid for accrued interest on purchases.
(d) Includes $
for company’s occupancy of its own buildings; and excludes $
interest on encumbrances.
(e) Includes $
accrual of discount less $
amortization of premium and less $
paid for accrued interest on purchases.
(f) Includes $
accrual of discount less $
amortization of premium.
(g) Includes $
investment expenses and $
investment taxes, licenses and fees, excluding federal income taxes, attributable to
segregated and Separate Accounts.
(h) Includes $
interest on surplus notes and $
interest on capital notes.
(i) Includes $
depreciation on real estate and $
depreciation on other invested assets.
EXHIBIT OF CAPITAL GAINS (LOSSES)
1
Realized
Gain (Loss)
On Sales or
Maturity
1.
1.1
1.2
1.3
2.1
2.11
2.2
2.21
3.
4.
5.
6.
7.
8.
9.
10.
0901.
0902.
0903.
0998.
0999.
2
Other
Realized
Adjustments
U.S. Government bonds
Bonds exempt from U.S. tax
Other bonds (unaffiliated)
Bonds of affiliates
Preferred stocks (unaffiliated)
Preferred stocks of affiliates
Common stocks (unaffiliated)
Common stocks of affiliates
Mortgage loans
Real estate
Contract loans
Cash, cash equivalents and short-term investments
Derivative instruments
Other invested assets
Aggregate write-ins for capital gains (losses)
Total capital gains (losses)
DETAILS OF WRITE-INS
Summary of remaining write-ins for Line 9 from
overflow page
Totals (Lines 0901 through 0903) plus 0998 (Line 9,
above)
12
3
4
5.
Total Realized Capital
Change in Unrealized
Change in Unrealized Foreign Exchange
Gain (Loss)
Capital Gain (Loss)
(Columns 1 + 2)
Capital Gain (Loss)
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
EXHIBIT OF NONADMITTED ASSETS
1
2
Current Year Total
Nonadmitted Assets
Prior Year
Nonadmitted Assets
3
Change in Total
Nonadmitted Assets
(Col. 2 - Col. 1)
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. Other invested assets (Schedule BA)
8. Receivables for securities
9. Aggregate write-ins for invested assets
10. Subtotals, cash and invested assets (Lines 1 to 9)
11. Title plants (for Title insurers only)
12. Investment income due and accrued
13. Premiums and considerations:
13.1 Uncollected premiums and agents’ balances in the course of
collection
13.2 Deferred premiums, agents’ balances and installments booked but deferred
!
and not yet due
13.3 Accrued retrospective premiums
14. Reinsurance:
14.1 Amounts recoverable from reinsurers
14.2 Funds held by or deposited with reinsured companies
14.3 Other amounts receivable under reinsurance contracts
15. Amounts receivable relating to uninsured plans
16.1 Current federal and foreign income tax recoverable and interest thereon
16.2 Net deferred tax asset
17. Guaranty funds receivable or on deposit
18. Electronic data processing equipment and software
19. Furniture and equipment, including health care delivery assets
20. Net adjustment in assets and liabilities due to foreign exchange rates
21. Receivables from parent, subsidiaries and affiliates
22. Health care and other amounts receivable
23. Aggregate write-ins for other than invested assets
24. Total assets excluding Separate Accounts, Segregated Accounts and
Protected Cell Accounts (Lines 10 to 23)
25. From Separate Accounts, Segregated Accounts and Protected Cell Accounts
26. Total (Lines 24 and 25)
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)
2301.
2302.
2303.
- - $2
$
2398. Summary of remaining write-ins for Line 23 from overflow page
2399. Totals (Lines 2301 through 2303 plus 2398)(Line 23 above)
13
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
Note 1 – Summary of Significant Accounting Principles
A.
Accounting Practices
The accompanying financial statements of Union American insurance Company (“the Company”) have been prepared
on the basis of accounting practices prescribed or permitted by the Florida Office of Insurance Regulation (“FOOIR”).
The FOOIR requires insurance companies domiciled in the state of Florida to prepare their statutory financial
statements in accordance with the National Association of Insurance Commissioners’ Accounting Practices and
Procedures Manual (“NAIC SAP”), subject to any deviations prescribed or permitted by the FOOIR.
B.
Use of Estimates
The preparation of statutory financial statements requires management to make estimates and assumptions that affect
the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the
statutory financial statements and the reported amounts of revenues and expenses during the reporting period. Actual
results could differ from those estimates.
C. Accounting Policy
Earned premiums are recorded using the daily pro rata method over the policy period and are subject to revisions after
the end of the policy period. Unearned premiums represent the portion of premium related to the unexpired policy term.
An estimate has been accrued for expected revisions to premium from the final premium audit process on policies
subject to final audit. Related expenses, including commissions and premium-related taxes/assessments, are
recognized on the basis of written premium. The Company is subject to premium-based assessments from certain state
agencies to fund administrative expenses, second injury fund benefits and the guarantee fund. Assessments are
accrued based on current year premiums written. Expenses incurred are reduced for ceding allowances received or
receivable.
In addition, the Company uses the following accounting policies:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Cash and short-term investments are stated at cost, which approximates fair value.
Bonds not backed by other loans are stated at amortized value using the interest method.
Common stocks, other than investments in stocks of subsidiaries and affiliates, are stated at market.
The Company has no preferred stocks.
The Company has no mortgage loans.
The Company has no loan-backed securities.
The Company has no investments in subsidiaries or affiliates.
The Company has no interests in joint ventures, partnerships or limited liability companies.
The Company has no derivatives.
The Company does not utilize anticipated investment income as a factor in the premium deficiency calculation.
The liability for loss and loss adjustment expense reflects the estimated cost of claims occurring prior to the end of
the accounting period, whether or not reported to the Company. Liabilities for losses and loss adjustment expenses
(including liabilities for losses incurred but not reported) are estimated by management based upon independent
actuarial reviews of current year and historical loss experience, premium data, and industry development factors.
Management continually reviews the adequacy of these loss liabilities and adjusts these liabilities as additional loss
experience data becomes available; such adjustments are included in current operations. Ultimate losses may differ
from loss liabilities currently recorded due to uncertainties inherent in the loss estimation process. The Company
does not discount its WC reserves. Liabilities are reduced for estimated amounts of salvage, subrogation,
deductibles recoverable from policyholders and amounts recoverable through reinsurance contracts. Although
considerable variability is inherent in such estimates, management believes that the liabilities for losses and loss
adjustment expenses are adequate.
D.
On February 9, 2005, Judge P. Kevin Davey of the Second Judicial Circuit Court in Leon County, Florida signed
a Consent Order placing the Company in receivership for purposes of rehabilitation. The Florida Department of
Financial Services (“Department”) is the court appointed Receiver. The Company consented to be placed into
rehabilitation in order to better assist the Company in meeting its obligations. Company voluntarily agreed with the
FOOIR to place the Company into a protective order of rehabilitation following a 30 day consent order that required the
Company to obtain a loss portfolio transfer (“LPT”) on the large deductible workers’ compensation policy with Certified
HR Services. The Company has attracted markets for the LPT and will continue to seek a solution acceptable to the
FOIR.
Note 2 – Accounting Changes and Corrections of Errors
A.
Material Changes and Corrections of Errors - Not applicable
B. Initial Implementation of Codification
The Company prepares its statutory financial statements in conformity with accounting practices prescribed or permitted
by the State of Florida. Effective January 1, 2001, the State of Florida required that insurance companies domiciled in
the State of Florida prepare their statutory basis financial statements in accordance with the NAIC SAP, subject to any
deviations prescribed or permitted by the State of Florida.
14
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
Accounting changes adopted to conform to the provisions of the NAIC SAP are reported as changes in accounting
principles. The cumulative effect of changes in accounting principles is reported as an adjustment to unassigned funds
(surplus) in the period of the change in accounting principle. The cumulative effect is the difference between the
amount of capital and surplus at the beginning of the year and the amount of capital and surplus that would have been
reported at that date if the new accounting principles had been applied retroactively for all prior periods. The Company
recognized no change in surplus, as a result of the implementation of NAIC SAP.
Note 3 – Business Combinations and Goodwill
A.
Statutory Purchase Method – Not applicable
B.
Statutory Merger – Not applicable
C.
Impairment Loss – Not applicable
Note 4 – Discontinued Operations
None
Note 5 – Investments
A.
Mortgage Loans – Not applicable.
B.
Debt Restructuring – Not applicable
C.
Reverse Mortgages – Not applicable
D.
Loan Backed Securities – Not applicable
E.
Repurchase Agreements – Not applicable
F.
Real Estate – Not applicable
Note 6 – Joint Ventures, Partnerships and Limited Liability Companies
A.
Investments Exceeding 10% of Admitted Assets – Not Applicable
B.
Impaired Investments – Not Applicable
Note 7 – Investment Income
A.
Accrued Investment Income
The Company non-admits investment income due and accrued if amounts are over 90 days past due.
B.
Amounts Non-Admitted – Not applicable
Note 8 – Derivative Instruments
A.
Market Risk, Credit Risk and Cash Requirements – Not applicable
B.
Objectives – Not applicable
F. Description of Accounting Policies – Not applicable
G. Net gain or loss – Not applicable
Note 9 – Income Taxes
A.
The components of the net deferred tax asset (“DTA”) and deferred tax liability (“DTL”) at December 31 are as
follows:
Description
Gross deferred tax assets
Gross deferred tax liabilities
Net deferred tax asset
Non admitted deferred tax assets
Admitted deferred tax asset
Increase (decrease) in non admitted
2009
$ 41,972
41,972
41,972
$
$ (5,723)
14.1
2008
$ 47,695
47,695
47,695
$
$ (75,057)
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
Deferred tax assets
B.
Unrecognized Deferred Tax Liabilities – Not Applicable
C.
Current Tax and Change in Deferred Tax
Description
Current income tax expense
Prior year adjustments
Income taxes incurred
$
2009
-
$
-
-
$
2008
10,130
$
10,130
-
The main components of the deferred tax amounts were as follows:
Deferred Tax Assets
Loss and lae reserves
Unearned
premium
reserves
Other
Gross DTAs
Non admitted DTAs
2009
$ 41,972
-
2008
$ 47,695
-
Change
$ (5,723)
-
$ 41,972
$ 41,972
$ 47,695
$ 47,695
$ (5,723)
$ (5,723)
Deferred Tax
Liabilities
Salvage
and
subrogation
Unrealized gains
Other
Gross DTLs
2009
2008
Change
-
-
-
-
-
-
D.
Reconciliation of Federal Income Tax Rate to Actual Effective Rate
The significant book-to-tax adjustments were as follows:
Description
Income before taxes
Change in discounted unpaid losses
Change in unearned premium reserve
Net operating loss carryforward
Taxable income
Federal income taxes incurred
Total statutory income taxes
Amount
(130,086)
-
Tax Effect @ 35%
-
H. Operating Loss and Tax Credit Carryforwards
F.
Consolidated Federal Income Tax Return
The Company’s federal income tax return is consolidated with the following entities:
AIB Financial Group, Inc.
J.P.C. Insurance Underwriters, Inc.
Associated Insurance Brokers, Inc.
AIB International Insurance Co.
AIB Associate Advertisers, Inc.
AIB Life and Health Underwriters, Inc.
First Security Insurance Underwriters, Inc.
Associated Membership Club of America
AIB Insurance Underwriters of Texas, Inc.
AIB Insurance Group, Inc.
The Cigar Connection, Inc.
AIB Travel and Tours, Inc.
Loopo, Inc.
Union Assurance Finance
AIB Syndicate, Inc.
Auto Premium Finance Corp.
AIB Claims Management, Inc.
Under an inter-company tax sharing agreement, the companies compute their tax liabilities (or receivable) on a separate
return basis without benefit for the surtax exemptions. Those companies suffering a loss may report a tax benefit and a
concurrent receivable only to the extent that other members of the group have reported sufficient taxable income to
realize the benefit of the individual company’s tax loss. Inter-company tax balances are settled annually in the first
quarter.
Note 10 – Information Concerning Parent, Subsidiaries and Affiliates
A.
Nature of Relationships
14.2
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
The Company is a wholly owned subsidiary of AIB Insurance Group, which is wholly owned by AIB Financial Group, Inc.
B.
Details of Transactions Greater than ½ of 1% of Admitted Assets
In 2003, the Company issued Surplus Notes to AIB Insurance Group with a face value amount of $4,500,000. The
Surplus Notes are recorded as statutory surplus and bear an interest rate of 5% per annum. Any payments of principal
and interest are subject to approval by the FOOIR.
C. Change in Terms of Inter-company Arrangements – Not applicable
D. Amounts Due to or from Related Parties – Not applicable
E.
Guarantees or Contingencies for Related Parties – Not applicable
F.
Management, Service Contracts, Cost Sharing Agreements – Not applicable
G.
Nature of Relationship that Could Affect Operations – Not applicable
H.
Amount Deducted for Investment in Upstream Company – Not Applicable
I.
Detail of Investments in Affiliates Greater than 10% of Admitted Assets – Not Applicable
J.
Write-down of Impairments of Investments in Subsidiary, Controlled or Affiliated Companies
Not Applicable
Note 11 – Debt
None
Note 12 – Retirement Plans, Deferred Compensation, Post-employment Benefits and Compensated Absences
and Other Postretirement Benefit Plans
A.
Defined Benefit Plans – Not applicable
B.
Defined Contribution Plans
None
C.
Multi-employer Plans – Not applicable
D.
Consolidated Company Plans
None
E.
Post-employment Benefits and Compensated Absences – Not applicable
Note 13 – Capital and Surplus Shareholders’ Dividend Restrictions and Quasi-Reorganizations
A.
Outstanding Shares
The Company has 50,000 shares of $100 par value common stock authorized, issued and outstanding. The Company
has no preferred stock authorized, issued or outstanding.
B.
Dividend Rate of Preferred Stock – Not applicable
C.
Dividend Restrictions
Dividends on common stock must be declared by the Board of Directors of the Company. Florida Statutes restrict
dividends to stockholders to that part of its available and accumulated surplus funds which is derived from realized net
operating profits on its business and net realized capital gains. In addition, without the prior approval of the FOOIR,
dividends may not exceed the larger of: 10% of the Company’s surplus as to policyholders derived from realized net
operating profits on its business and net realized capital gains; or the Company’s net operating profits and realized net
capital gains derived during the immediately preceding calendar year.
D.
Available Surplus
The Company does not have sufficient surplus to pay dividends to surplus.
E.
Surplus Restrictions
14.3
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
See Note 13 C.
F.
G.
Mutual Surplus Advances – Not applicable
Company Stock Held for Special Purposes – Not applicable
H.
I.
Changes in Special Surplus Funds – Not applicable
Changes in Unassigned Funds attributable to unrealized gains / losses - none
J.
Surplus Notes
On 6/17/03 and 6/30/03, the Company issued Surplus Notes, in the amounts of $1,500,000 and $3,000,000,
respectively, to AIB Insurance Group, Inc. in exchange for $4,500,000 in cash. Interest accrues at 5% per annum.
There is no maturity date or repayment schedule. Payments of principal and interest are subject to approval by the
FOOIR.
K., L.
Quasi Reorganizations – Not applicable
Note 14 – Contingencies
A.
Contingent Commitments – Not applicable
B.
Guaranty Fund and Other Assessments
The Company is subject to guaranty fund and other assessments in the state of Florida. Guaranty fund assessments
should be accrued at the time of insolvencies if the amount of loss can be reasonably estimated. Other assessments
should be accrued either at the time of assessments or in the case of premium based assessments, at the time the
premiums were written. At December 31, 2009, the Company owed $235,620.
C.
Gain Contingencies – Not applicable
D.
All Other Contingencies
The Company is party to litigation and workers’ compensation administrative proceedings involving claims arising in the
normal course of business, none of which, in the opinion of management, will have a materially adverse effect on the
financial position or results of operations of the Company. The Company has committed no reserves to cover any
contingent liabilities.
Note 15 – Leases
A.
Lessee Operating Lease – Not applicable
B.
Lessor Leases – Not applicable
Note 16 – Information about Financial Instruments with Off-Balance Sheet Risk and Financial Instruments with
Concentrations of Credit Risk
A.
Financial Instruments – Not applicable
Note 17 – Sale, Transfer and Servicing of Financial Assets and Extinguishments of Liabilities
A.
Transfers of Receivables Reported as Sales – Not applicable
B.
Transfer and Servicing of Financial Assets – Not applicable
C.
Wash Sales – Not applicable
Note 18 – Gain or Loss to the Reporting Entity from Uninsured A&H Plans and the Uninsured Portion of
Partially Insured Plans
A.
Administrative Services Only (ASO) Plans – Not applicable
B.
Administrative Services Contract (ASC) Plans – Not applicable
C.
Medicare or Other Similarly Structured Cost Based Reimbursement Contracts – Not applicable
Note 19 – Direct Premium Written/Produced by Managing General Agents/Third Party Administrators
None
Note 20 – September 11 Events
Not applicable
14.4
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
Note 21 – Other Items
A.
Extraordinary Items – Not applicable
B.
Troubled Debt Restructuring for Debtors – Not applicable
C.
Other Disclosures
Required Disclosure for Florida Special Disability Trust Fund (“SDTF”)
Item
Credit taken in loss reserves
for anticipated recoveries
Payments received
Assessments
D.
2009
$
$
$
0
2008
-
$
$
$
0
Uncollectible Premiums Receivable
Florida Disclosure for Agents’ Balances Certification:
Agents’ Balances
Premiums collected by “controlled” or
“controlling” person
Amount of applicable collateral:
Trust Fund
Letter of Credit
Financial Guaranty Bond
Total Collateral
$
$
$
$
0
$
0
$
-
Note 22 – Events Subsequent
None
Note 23 – Reinsurance
A.
Unsecured Reinsurance Recoverable
At December 31, 2009, the Company had unsecured aggregate recoverable for losses, paid and unpaid, including IBNR
and LAE with in excess of 3% of policyholders’ surplus with the following reinsures:
Scor Reinsurance Company (NAIC 30058, FEIN 75-1444207)
Lloyds Atrium Syndicate (FEIN AA-1126570)
$ 81,000
$ 859,000
B. Reinsurance Recoverable in Dispute - none
C.
Reinsurance Assumed and Ceded
The Company has no assumed reinsurance. The following table summarizes ceded unearned premiums and the
related commission equity at December 31, 2009:
Unearned Premium
Affiliate
$
All Other
Total
$
Direct Unearned Premium Reserve - $0
D.
Commission Equity
$
$
-
Uncollectible Reinsurance – Not applicable
I.
Commutation of Ceded Reinsurance – Not applicable
J.
Retroactive Reinsurance – Not applicable
K. Reinsurance Accounted for as a Deposit – Not applicable
Note 24 – Retrospectively Rated Contracts and Contracts Subject to Re-determination
14.5
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
A.
Method Used to Estimate – Not applicable
B. Premium Recognition – Not applicable
C. Net Premiums Written – Not applicable
D.
Calculation of Nonadmitted Accrued Retrospective Premiums – Not applicable
Note 25 – Changes in Incurred Losses and Loss Adjustment Expenses
The estimated cost of loss and loss adjustment expenses attributable to insured events of prior years provided a
savings of $15,00 during 2009, as shown in the chart below:
See Note 31 for an explanation for the development for prior years.
Line of Business
Homeowners
Commercial Multiple
Peril
Workers’
Compensation
Other Liability
Private Passenger
Auto Liability
Commercial Auto
Liability
Auto Physical
Damage
Total
$
Incurred In Current Calendar Year ($000’s)
Current
Prior
Accident Year
Accident Years
Total
$
$
-
$
-
6
-
(103)
13
(103)
13
-
41
41
-
34
34
-
4
(15)
$
6
$
4
(15)
There were no adjustments to premiums as the result of the adverse development in claims.
Note 26 – Inter-company Pooling Arrangements
A.
Participating Companies – Not applicable
B.
Lines of Business – Not applicable
C.
Cessions to Non-affiliated Reinsurers – Not applicable
D.
Parties with Reinsurance Agreements with Non-affiliates – Not applicable
E.
Explanation of Discrepancies – Not applicable
F.
Inter-company Sharing Agreement – Not applicable
Note 27 – Structured Settlements
A.
Reserves Released due to Purchase of Annuities – Not applicable
B.
Annuity Insurers – Not applicable
Note 28 – Health Care Receivables
A. Pharmaceutical Rebate Receivables – Not applicable
B. Risk Sharing Receivables – Not applicable
Note 29 - Participating Policies
A. Percentage of Participating Insurance – Not applicable
B. Method of Accounting for Policyholder Dividends – Not applicable
C. Amount of Dividends – Not applicable
D. Income allocated to Participating Policyholders – Not applicable
Note 30 – Premium Deficiency Reserves
14.6
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NOTES TO FINANCIAL STATEMENTS
As of December 31, 2009, the Company had no liabilities related to premium deficiency reserves. The Company did not
consider anticipated investment income when calculating its premium deficiency reserves.
Note 31 – High Deductibles
On December 1, 2004 the Company terminated its large deductible workers’ compensation policy with Certified HR
Services, formerly the Cura Group, Inc., for non-payment of premiums. The policy was originally issued on June 30,
2003 with a $1 million deductible limit. The policy is accounted for in accordance with SSAP 65. During 2005, the
insured filed a claim for bankruptcy and has not been paying for the claims under the $1 million deductible. Since the
insured is insolvent, the total liabilities under the workers compensation policy are being recorded on the Company’s
books. As of December 31, 2009, the amount of gross and net loss and LAE reserves recorded by the Company for
workers compensation amounted to $594,975 and $101,979, respectively. The Florida Department of Financial
Services has filed a claim trying to recover approximately $5.5 million in order to cover the future losses under the high
deductible policy.
Note 32 – Discounting of Liabilities for Unpaid Losses and Unpaid Loss Adjustment Expenses
A.
Tabular Discounts – Not applicable
B.
Non-Tabular Discounts – Not applicable
C.
Changes in Discount Assumptions – Not applicable
Note 33 – Asbestos/Environmental Reserves
A.
Liability for Asbestos Losses – Not applicable
B.
IBNR for Asbestos Losses – Not applicable
C.
Loss Adjustment Reserves for Asbestos Losses – Not applicable
D.
Liability for Environmental Losses – Not applicable
E.
IBNR for Environmental Losses – Not applicable
F.
Loss Adjustment Reserves for Environmental Losses – Not applicable
Note 34 – Subscriber Savings Accounts
Not applicable
Note 35 – Multiple Peril Crop Insurance
Not applicable
14.7
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
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?
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
standards and disclosure requirements substantially similar to those required by such Act and regulations?
1.3
State Regulating?
2.1
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?
(
2.2
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.
7 7
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.
7 7
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
date).
7 7
3.4
By what department or departments? Florida Office of Insurance Regulatoin
3.5
Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial
statement filed with departments?
(
3.6
Have all of the recommendations within the latest financial examination report been complied with?
(
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?
4.2
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?
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.
4.12 renewals?
4.22 renewals?
1
Name of Entity
6.1
2
NAIC Company Code
3
State of Domicile
Has the reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or
revoked by any governmental entity during the reporting period?
6.2
If yes, give full information
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,
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
attorney - in - fact).
1
Nationality
2
Type of Entity
15
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
8.1
8.2
Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board?
If response to 8.1 is yes, please identify the name of the bank holding company.
8.3
8.4
Is the company affiliated with one or more banks, thrifts or securities firms?
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 Office of
Thrift Supervision (OTS), the Federal Deposit Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify
the affiliate’s primary federal regulator.
1
Affiliate Name
2
Location
(City, State)
3
4
5
6
7
FRB
OCC
OTS
FDIC
SEC
9.
What is the name and address of the independent certified public accountant or accounting firm retained to conduct the annual audit?
Hevia Beagles & Company, 9400 4th St N., Ste 120, St Petersburg, FL 33702
10. What is the name, address and affiliation (officer/employee of the reporting entity or actuary/consultant associated with an actuarial consulting
firm) of the individual providing the statement of actuarial opinion/certification?
Jerome Vogel of Vogel Consulting, Inc., 3836 Killearn Ct, Tallahassee, FL 32309
11.1 Does the reporting entity own any securities of a real estate holding company or otherwise hold real estate indirectly?
11.11 Name of real estate holding company
11.12 Number of parcels involved
11.13 Total book/adjusted carrying value
$
11.2 If yes, provide explanation
12. FOR UNITED STATES BRANCHES OF ALIEN REPORTING ENTITIES ONLY:
12.1 What changes have been made during the year in the United States manager or the United States trustees of the reporting entity?
12.2
12.3
12.4
13.1
Does this statement contain all business transacted for the reporting entity through its United States Branch on risks wherever located?
Have there been any changes made to any of the trust indentures during the year?
If answer to (12.3) is yes, has the domiciliary or entry state approved the changes?
Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons
performing similar functions) of the reporting entity subject to a code of ethics, which includes the following standards?
Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and
a. professional relationships;
b. Full, fair, accurate, timely and understandable disclosure in the periodic reports required to be filed by the reporting entity;
c. Compliance with applicable governmental laws, rules and regulations;
d. The prompt internal reporting of violations to an appropriate person or persons identified in the code; and
e. Accountability for adherence to the code.
13.11 If the response to 13.1 is No, please explain:
13.2 Has the code of ethics for senior managers been amended?
13.21 If the response to 13.2 is Yes, provide information related to amendment(s).
13.3 Have any provisions of the code of ethics been waived for any of the specified officers?
13.31 If the response to 13.3 is Yes, provide the nature of any waiver(s).
BOARD OF DIRECTORS
14.
15.
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?
Does the reporting entity keep a complete permanent record of the proceedings of its board of directors and all subordinate committees
thereof?
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?
15.1
(
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
FINANCIAL
17.
Has this statement been prepared using a basis of accounting other than Statutory Accounting Principles (e.g., Generally Accepted Accounting
Principles)?
18.1 Total amount loaned during the year (inclusive of Separate Accounts, exclusive of policy loans):
18.11 To directors or other officers
$
18.12 To stockholders not officers
$
18.13 Trustees, supreme or grand
(Fraternal only)
$
18.2 Total amount of loans outstanding at end of year (inclusive of Separate Accounts, exclusive of policy
loans):
18.21 To directors or other officers
$
18.22 To stockholders not officers
$
18.23 Trustees, supreme or grand
(Fraternal only)
$
19.1 Were any assets reported in the statement subject to a contractual obligation to transfer to another party without the liability for such obligation
being reported in the statement?
19.2 If yes, state the amount thereof at December 31 of the current year:
19.21 Rented from others
$
19.22 Borrowed from others
$
19.23 Leased from others
$
19.24 Other
$
20.1 Does this statement include payments for assessments as described in the Annual Statement Instructions other than guaranty fund or
guaranty association assessments?
20.2 If answer is yes:
20.21 Amount paid as losses or risk adjustment
$
20.22 Amount paid as expenses
$
20.23 Other amounts paid
$
21.1 Does the reporting entity report any amounts due from the parent, subsidiaries or affiliates on Page 2 of this statement?
21.2 If yes, indicate any amounts receivable from parent included in the Page 2 amount:
$
INVESTMENT
22.1 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 22.3)
22.2 If no, give full and complete information relating thereto:
22.3 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 16 where this information is also provide)
22.4 Does the company’s security lending program meet the requirements for a conforming program as outlined in the Risk-Based Capital
Instructions?
(
22.5 If answer to 22.4 is YES, report amount of collateral
$
22.6 If answer to 22.4 is NO, report amount of collateral
$
23.1 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
control of the reporting entity or has the reporting entity sold or transferred any assets subject to a put option contract that is currently in
force? (Exclude securities subject to Interrogatory 19.1 and 22.3)
23.2 If yes, state the amount thereof at December 31 of the current year:
23.21
Subject to repurchase agreements
$
23.22
Subject to reverse repurchase agreements
$
23.23
Subject to dollar repurchase agreements
$
23.24
Subject to reverse dollar repurchase agreements
$
23.25
Pledged as collateral
$
23.26
Placed under option agreements
$
23.27
Letter stock or securities restricted as to sale
$
23.28
On deposit with state or other regulatory body
$
23.29
Other
$
23.3 For category (23.27) provide the following:
1
Nature of Restriction
2
Description
3
Amount
24.1 Does the reporting entity have any hedging transactions reported on Schedule DB?
(
24.2 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.
25.1 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?
25.2 If yes, state the amount thereof at December 31 of the current year.
$
15.2
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
26.
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 3, III Conducting Examinations, F - Custodial or
Safekeeping agreements of the NAIC Financial Condition Examiners Handbook?
26.01 For agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook, complete the following:
1
Name of Custodian(s)
2
Custodian’s Address
26.02 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:
1
Name(s)
2
Location(s)
3
Complete Explanation(s)
26.03 Have there been any changes, including name changes, in the custodian(s) identified in 26.01 during the current year?
26.04 If yes, give full and complete information relating thereto:
1
2
Old Custodian
New Custodian
3
Date of
Change
4
Reason
26.05 Identify all investment advisors, brokers/dealers or individuals acting on behalf of broker/dealers that have access to the investment
accounts, handle securities and have authority to make investments on behalf of the reporting entity:
1
Central Registration Depository Number(s)
2
Name
3
Address
27.1 Does the reporting entity have any diversified mutual funds reported in Schedule D, Part 2 (diversified according to the Securities and
Exchange Commission (SEC) in the Investment Company Act of 1940 [Section 5 (b) (1)])?
27.2 If yes, complete the following schedule:
1
CUSIP #
2
Name of Mutual Fund
3
Book/Adjusted Carrying Value
27.2999 TOTAL
27.3 For each mutual fund listed in the table above, complete the following schedule:
1
2
Name of Mutual Fund
(from above table)
Name of Significant Holding
Of the Mutual Fund
3
Amount of Mutual Fund’s
Book/Adjusted Carrying Value
Attributable to the Holding
15.3
4
Date of Valuation
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
28.
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.
28.1
Bonds
28.2
Preferred stocks
28.3
Totals
1
2
Statement (Admitted)
Value
Fair Value
3
Excess of Statement
over Fair Value (-)
or Fair Value
over Statement (+)
28.4 Describe the sources or methods utilized in determining the fair values:
29.1 Was the rate used to calculate fair value determined by a broker or custodian for any of the securities in Schedule D?
29.2 If 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?
29.3 If no, describe the reporting entity’s process for determining a reliable pricing source for purposes of disclosure of fair value for Schedule D:
30.1 Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Securities Valuation Office been followed?
30.2 If no, list exceptions:
OTHER
31.1 Amount of payments to trade associations, service organizations and statistical or rating bureaus, if any?
$
31.2 List the name of the organization and the amount paid if any such payment represented 25% or more of the total payments to trade
associations, service organizations and statistical or rating bureaus during the period covered by this statement.
1
Name
2
Amount Paid
32.1 Amount of payments for legal expenses, if any?
$
32.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payments for legal expenses during
the period covered by this statement.
1
Name
6+$ 8
6
2
Amount Paid
9
33.1 Amount of payments for expenditures in connection with matters before legislative bodies, officers or departments of government, if any?
33.2 List the name of the firm and the amount paid if any such payment represented 25% or more of the total payment expenditures in connection
with matters before legislative bodies, officers or departments of government during the period covered by this statement.
1
Name
2
Amount Paid
15.4
$
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
(continued)
PART 2 - PROPERTY & CASUALTY INTERROGATORIES
1.1
Does the reporting entity have any direct Medicare Supplement Insurance in force?
1.2
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 and/or Other Alien not included in Item (1.2) above.
$
1.5
Indicate total incurred claims on all Medicare Supplement insurance.
$
1.6
Individual policies:
Most current three years:
1.61 Total premium earned
$
1.62 Total incurred claims
$
1.63 Number of covered lives
All years prior to most current three years:
1.64 Total premium earned
$
1.65 Total incurred claims
$
1.66 Number of covered lives
1.7
Group policies:
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
2.
Health Test:
1
Current Year
3.1
3.2
2.1
Premium Numerator
$
2.2
Premium Denominator
$
2.3
Premium Ratio (2.1/2.2)
2.4
Reserve Numerator
$
2.5
Reserve Denominator
$
2.6
Reserve Ratio (2.4/2.5)
2
Prior Year
$
$
4
4
$
$
4
4
Does the reporting entity issue both participating and non-participating policies?
If yes, state the amount of calendar year premiums written on:
3.21 Participating policies
3.22 Non-participating policies
$
$
4.
4.1
4.2
4.3
4.4
For Mutual reporting entities and Reciprocal Exchanges only:
Does the reporting entity issue assessable policies?
Does the reporting entity issue non-assessable policies?
If assessable policies are issued, what is the extent of the contingent liability of the policyholders?
Total amount of assessments paid or ordered to be paid during the year on deposit notes or contingent premiums.
$
5.
5.1
5.2
For Reciprocal Exchanges Only:
Does the exchange appoint local agents?
If yes, is the commission paid:
5.3
5.21 Out of Attorney'
s-in-fact compensation
5.22 As a direct expense of the exchange
What expenses of the Exchange are not paid out of the compensation of the Attorney-in-fact?
5.4
5.5
Has any Attorney-in-fact compensation, contingent on fulfillment of certain conditions, been deferred?
If yes, give full information
16
%
(
(
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
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:
: 8
, 6.2
6.5
7.2
7.3
8.1
8.2
9.1
9.2
9.3
9.4
9.5
9.6
10.
- , -
/
$ -. #
2
- 5
# ; 2
- -$ ,/
; 2
- - -
2/ -+ / 2
, +
2
+ ,-$ =
, 2
$
4
# $
= 8
2/ -
- - %
$
-$ ,
>
# -
2/ -+ $
-
/,
-+
/
- , -
$,
2
$ /
/ + 5/ ,
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?
If no, describe any arrangements or mechanisms employed by the reporting entity to supplement its catastrophe reinsurance program or to
hedge its exposure to unreinsured catastrophic loss.
)
7.1
#
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?
<
6.4
- 5
4
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:
<
6.3
2/ -
/ -
4
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, a 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 reflect 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 the risk, or portion thereof, reinsured?
If yes, give full information
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.
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 agreements 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
policyholders 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.
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.
Except for transactions meeting the requirements of paragraph 32 of SSAP No. 62, 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?
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.
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.
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
7(
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
GENERAL INTERROGATORIES
PART 2 - PROPERTY & CASUALTY INTERROGATORIES
11.1 Has the reporting entity guaranteed policies issued by any other entity and now in force:
11.2 If yes, give full information
12.1 If the reporting entity recorded accrued retrospective premiums on insurance contracts on Line 13.3 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)
$
12.2 Of the amount on Line 13.3, Page 2, state the amount that is secured by letters of credit, collateral and other funds?
$
12.3 If the reporting entity underwrites commercial insurance risks, such as workers’ compensation, are premium notes or promissory notes
accepted from its insureds covering unpaid premiums and/or unpaid losses?
12.4 If yes, provide the range of interest rates charged under such notes during the period covered by this statement:
12.41 From
12.42 To
12.5 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 the 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?
12.6 If yes, state the amount thereof at December 31 of the current year:
$
12.61 Letters of Credit
12.62 Collateral and other funds
$
13.1 Largest net aggregate amount insured in any one 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 company 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 answer to 14.4 is no, please explain:
15.1 Has the reporting entity guaranteed any financed premium accounts?
15.2 If yes, give full information
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:
5
Direct Premium
Earned
4
Direct Premium
Unearned
3
Direct Written
Premium
2
Direct Losses
Unpaid
1
Direct Losses
Incurred
16.11 Home
$
$
$
$
$
16.12 Products
$
$
$
$
$
16.13 Automobile
$
$
$
$
$
16.14 Other*
$
$
$
$
$
* Disclose type of coverage:
16.2
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
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 not 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
Gross amount of unauthorized reinsurance in Schedule F – Part 3
excluded from Schedule F – Part 5
$
17.12
Unfunded portion of Interrogatory 17.11
$
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 17.11
$
17.16
Unearned premium portion of Interrogatory 17.11
$
17.17
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.
17.18
Gross amount of unauthorized reinsurance in Schedule F – Part 3
excluded from Schedule F – Part 5
$
17.19
Unfunded portion of Interrogatory 17.18
$
17.20
Paid losses and loss adjustment expenses portion of Interrogatory 17.18
$
17.21
Case reserves portion of Interrogatory 17.18
$
17.22
Incurred but not reported portion of Interrogatory 17.18
$
17.23
Unearned premium portion of Interrogatory 17.18
$
17.24
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.
16.3
$
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
FIVE-YEAR HISTORICAL DATA
Show amounts in whole dollars only, no cents; show percentages to one decimal place, i.e. 17.6.
1
2
3
4
2009
2008
2007
2006
5
2005
Gross Premiums Written
(Page 8, Part 1B, 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)
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 &
33)
6. Total (Line 35)
Net Premiums Written (Page 8, Part 1B, 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)
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)
12. Total (Line 35)
Statement of Income (Page 4)
13.
14.
15.
16.
17.
Net underwriting gain (loss) (Line 8)
Net investment gain (loss) (Line 11)
Total other income (Line 15)
Dividends to policyholders (Line 17)
Federal and foreign income taxes incurred
(Line 19)
18. Net income (Line 20)
Balance Sheet Lines (Pages 2 and 3)
19. Total admitted assets excluding protected cell
business (Page 2, Line 24, Col. 3)
20. Premiums and considerations (Page 2, Col. 3)
20.1 In course of collection (Line 13.1)
20.2 Deferred and not yet due (Line 13.2)
20.3 Accrued retrospective premiums (Line 13.3)
21. Total liabilities excluding protected cell
business (Page 3, Line 24)
22. Losses (Page 3, Line 1)
23. Loss adjustment expenses (Page 3, Line 3)
24. Unearned premiums (Page 3, Line 9)
25. Capital paid up (Page 3, Lines 28 & 29)
26. Surplus as regards policyholders (Page 3, Line 35)
Cash Flow (Page 5)
27. Net cash from operations (Line 11)
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)(Item divided by Page 2, Line 10,
Col. 3) x 100.0
30. Bonds (Line 1)
31. Stocks (Lines 2.1 & 2.2)
32. Mortgage loans on real estate (Lines 3.1 and 3.2)
33. Real estate (Lines 4.1, 4.2 & 4.3)
34. Cash, cash equivalents and short-term investments
(Line 5)
35. Contract loans (Line 6)
36. Other invested assets (Line 7)
37. Receivables for securities (Line 8)
38. Aggregate write-ins for invested assets (Line 9)
39. Cash, cash equivalents and invested assets (Line
10)
Investments in Parent, Subsidiaries and Affiliates
40. Affiliated bonds, (Sch. D, Summary, Line 12, Col. 1)
41. Affiliated preferred stocks
(Sch. D, Summary, Line 18, Col. 1)
42. Affiliated common stocks
(Sch. D, Summary, Line 24, Col. 1)
43. Affiliated short-term investments (subtotals included
in Schedule DA Verification, Col. 5, Line 10)
44. Affiliated mortgage loans on real estate
45. All other affiliated
46. Total of above Lines 40 to 45
47. Percentage of investments in parent, subsidiaries
and affiliates to surplus as regards policyholders
(Line 46 above divided by Page 3, Col. 1, Line 35 x
100.0)
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
100.0
100.0
4
100.0
4
17
100.0
4
100.0
4
4
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
FIVE-YEAR HISTORICAL DATA
(Continued)
2
2008
1
2009
3
2007
4
2006
5
2005
Capital and Surplus Accounts (Page 4)
48. Net unrealized capital gains (losses) (Line 24)
49. Dividends to stockholders (Line 35)
50. Change in surplus as regards policyholders for the
year (Line 38)
!
!
!
!
!
!
!
!
!
Gross Losses Paid (Page 9, Part 2, Cols. 1 & 2)
51. 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)
52. Property lines (Lines 1, 2, 9, 12, 21 & 26)
53. Property and liability combined lines
(Lines 3, 4, 5, 8, 22 & 27)
54. All other lines
(Lines 6, 10, 13, 14, 15, 23, 24, 28, 29, 30 & 34)
55. Nonproportional reinsurance lines
(Lines 31, 32 & 33)
56. Total (Line 35)
Net Losses Paid (Page 9, Part 2, Col. 4)
57. 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)
58. Property lines (Lines 1, 2, 9, 12, 21 & 26)
59. Property and liability combined lines
(Lines 3, 4, 5, 8, 22 & 27)
60. All other lines
(Lines 6, 10, 13, 14, 15, 23, 24, 28, 29, 30 & 34)
61. Nonproportional reinsurance lines
(Lines 31, 32 & 33)
62. Total (Line 35)
Operating Percentages (Page 4)
(Item divided by Page 4, Line 1) x 100.0
63. Premiums earned (Line 1)
100.0
100.0
100.0
100.0
100.0
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4 !
68. Other underwriting expenses to net premiums written
(Page 4, Lines 4 + 5 - 15 divided by
Page 8, Part 1B, Col. 6, Line 35 x 100.0)
4
4
4
4
4
69. Losses and loss expenses incurred to premiums
earned (Page 4, Lines 2 + 3 divided by
Page 4, Line 1 x 100.0)
4
4
4
4
4
70. Net premiums written to policyholders'surplus
(Page 8, Part 1B, Col. 6, Line 35 divided by Page
3, Line 35, Col. 1 x 100.0)
4
4
4
4
4 !
64. Losses incurred (Line 2)
65. Loss expenses incurred (Line 3)
66. Other underwriting expenses incurred (Line 4)
67. Net underwriting gain (loss) (Line 8)
Other Percentages
One Year Loss Development (000 omitted)
71. Development in estimated losses and loss
expenses incurred prior to current year
(Schedule P, Part 2 - Summary, Line 12, Col. 11)
72. Percent of development of losses and loss expenses
incurred to policyholders'surplus of prior year end
(Line 71 above divided by Page 4,
Line 21, Col. 1 x 100.0)
!
!
4 !
4
!
4 !
4
4
4
4
Two Year Loss Development (000 omitted)
73. 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)
74. Percent of development of losses and loss expenses
incurred to reported policyholders'surplus of
second prior year end (Line 73 above divided by
Page 4, Line 21, Col. 2 x 100.0)
!
!
4
4
!
4
NOTE: If a party to a merger, have the two most recent years of this exhibit been restated due to a merger in compliance with the
disclosure requirements of SSAP No. 3, Accounting Changes and Correction of Errors?
If no, please explain:
18
Yes [ ] No [
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NAIC Group Code
0000
EXHIBIT OF PREMIUMS AND LOSSES (Statutory Page 14)
BUSINESS IN THE STATE OF Florida
3
Gross Premiums, Including Policy and
Membership Fees Less Return Premiums
and Premiums on Policies not Taken
19.FL
1.
2.1
2.2
2.3
3.
4.
5.1
5.2
6.
8.
9.
10.
11.
12.
13.
14.
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
16.
17.1
17.2
17.3
18.
19.1
19.2
19.3
19.4
21.1
21.2
22.
23.
24.
26.
27.
28.
30.
34.
35.
Line of Business
Fire
Allied lines
Multiple peril crop
Federal flood
Farmowners multiple peril
Homeowners multiple peril
Commercial multiple peril (non-liability portion)
Commercial multiple peril (liability portion)
Mortgage guaranty
Ocean marine
Inland marine
Financial guaranty
Medical malpractice
Earthquake
Group accident and health (b)
Credit A & H (group and individual)
Collectively renewable A & H (b)
Non-cancelable A & H (b)
Guaranteed renewable A & H (b)
Non-renewable for stated reasons only (b)
Other accident only
Medicare Title XVIII exempt from state taxes or fees
All other A & H (b)
Federal employees health benefits program premium (b)
Workers'compensation
Other liability - occurrence
Other liability - claims-made
Excess workers'compensation
Products liability
Private passenger auto no-fault (personal injury protection)
Other private passenger auto liability
Commercial auto no-fault (personal injury protection)
Other commercial auto liability
Private passenger auto physical damage
Commercial auto physical damage
Aircraft (all perils)
Fidelity
Surety
Burglary and theft
Boiler and machinery
Credit
Warranty
Aggregate write-ins for other lines of business
TOTALS (a)
DETAILS OF WRITE-INS
1
Direct Premiums
Written
2
Direct Premiums
Earned
Dividends Paid
or Credited to
Policyholders on
Direct Business
4
5
Direct
Unearned
Premium
Reserves
Direct Losses
Paid
(deducting
salvage)
DURING THE YEAR 2009
7
8
Direct Defense
and Cost
Containment
Expense
Direct Losses
Direct Losses
Paid
Incurred
Unpaid
6
!
!
!
!
!
!
3401.
3402.
3403.
3498. Summary of remaining write-ins for Line 34 from overflow page
3499. Totals (Lines 3401 through 3403 plus 3498) (Line 34 above)
(a) Finance and service charges not included in Lines 1 to 35 $
.
(b) For health business on indicated lines report: Number of persons insured under PPO managed care products
NAIC Company Code 15075
10
11
12
Direct Defense
and Cost
Containment
Commissions
Taxes,
Expense
and Brokerage
Licenses and
Unpaid
Expenses
Fees
9
Direct Defense
and Cost
Containment
Expense
Incurred
and number of persons insured under indemnity only products
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
NAIC Group Code
0000
EXHIBIT OF PREMIUMS AND LOSSES (Statutory Page 14)
BUSINESS IN THE STATE OF Consolidated
3
Gross Premiums, Including Policy and
Membership Fees Less Return Premiums
and Premiums on Policies not Taken
19.GT
1.
2.1
2.2
2.3
3.
4.
5.1
5.2
6.
8.
9.
10.
11.
12.
13.
14.
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
16.
17.1
17.2
17.3
18.
19.1
19.2
19.3
19.4
21.1
21.2
22.
23.
24.
26.
27.
28.
30.
34.
35.
Line of Business
Fire
Allied lines
Multiple peril crop
Federal flood
Farmowners multiple peril
Homeowners multiple peril
Commercial multiple peril (non-liability portion)
Commercial multiple peril (liability portion)
Mortgage guaranty
Ocean marine
Inland marine
Financial guaranty
Medical malpractice
Earthquake
Group accident and health (b)
Credit A & H (group and individual)
Collectively renewable A & H (b)
Non-cancelable A & H (b)
Guaranteed renewable A & H (b)
Non-renewable for stated reasons only (b)
Other accident only
Medicare Title XVIII exempt from state taxes or fees
All other A & H (b)
Federal employees health benefits program premium (b)
Workers'compensation
Other liability - occurrence
Other liability - claims-made
Excess workers'compensation
Products liability
Private passenger auto no-fault (personal injury protection)
Other private passenger auto liability
Commercial auto no-fault (personal injury protection)
Other commercial auto liability
Private passenger auto physical damage
Commercial auto physical damage
Aircraft (all perils)
Fidelity
Surety
Burglary and theft
Boiler and machinery
Credit
Warranty
Aggregate write-ins for other lines of business
TOTALS (a)
DETAILS OF WRITE-INS
1
Direct Premiums
Written
2
Direct Premiums
Earned
Dividends Paid
or Credited to
Policyholders on
Direct Business
4
5
Direct
Unearned
Premium
Reserves
Direct Losses
Paid
(deducting
salvage)
DURING THE YEAR 2009
7
8
Direct Defense
and Cost
Containment
Expense
Direct Losses
Direct Losses
Paid
Incurred
Unpaid
6
!
!
!
!
!
!
3401.
3402.
3403.
3498. Summary of remaining write-ins for Line 34 from overflow page
3499. Totals (Lines 3401 through 3403 plus 3498) (Line 34 above)
(a) Finance and service charges not included in Lines 1 to 35 $
.
(b) For health business on indicated lines report: Number of persons insured under PPO managed care products
NAIC Company Code 15075
10
11
12
Direct Defense
and Cost
Containment
Commissions
Taxes,
Expense
and Brokerage
Licenses and
Unpaid
Expenses
Fees
9
Direct Defense
and Cost
Containment
Expense
Incurred
and number of persons insured under indemnity only products
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule F - Part 1
NONE
Schedule F - Part 2
NONE
20, 21
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 3
1
2
Federal
ID
Number
?
?
?
?
?
((?
?
?
?
?
?
?
?
?
?
?
?
3
4
NAIC
Company
Code
<
? (,
(,
'4)4
> $
(,
(,
<
<
> $
> $
? (,
? '-
'- ,
>
'- ,
>
'- ,
>
<
? '<
? (,
<
? A
Name of Reinsurer
> $ ? (##
)
- , - 3 2/ -+
6 - - @ 1- 3
'- ## 1- ,
'-$ ;
!
?
'4)4 '- ##
$ 1- ,
6 +$ ( ,2 )+-$
?
-?'4)4 1- ,
'-$ ;
!
?
-?'4)4 1- ,
> $
,
> $ ? (##
'$
- 1- 3
$ ?
'4)4 '- ##
$ 1- ,
'-$ ;
$ ?
'4)4 '- ##
$ 1- ,
$ ?
-?'4)4 1- ,
'-$ ;
!
,
> $
> $ -$ '- ,
> $
$ 3
Domiciliary
Jurisdiction
Ceded Reinsurance as of December 31, Current Year (000 Omitted)
Reinsurance Recoverable On
6
7
8
9
10
11
12
5
Reinsurance
Contracts
Ceding 75%
or More of
Direct
Reinsurance
Premiums
Premiums
Written
Ceded
Paid
Losses
Paid
LAE
Known Case Known Case
Loss
LAE
IBNR Loss
Reserves
Reserves
Reserves
A(
@9
A(
!
22
9999999 Totals
NOTE:
A.
1.
2.
3.
4.
54
B.
1.
2.
3.
4.
54
Report the five largest provisional commission rates included in the cedant’s reinsurance treaties. The commission rate to be reported is by
contract with ceded premium in excess of $50,000:
1
2
3
Name of Reinsurer
Commission Rate
Ceded Premium
Report the five largest reinsurance recoverables reported in Column 15, due from any one 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.
2
3
4
1
Total Recoverables
Ceded Premiums
Affiliated
Name of Reinsurer
IBNR LAE
Reserves
13
14
15
Unearned
Premiums
Contingent
Commissions
Cols.
7 thru 14
Totals
Reinsurance Payable
16
17
Ceded
Balances
Payable
18
19
Net Amount
Recoverable Funds Held
From
By Company
Other
Reinsurers
Under
Amounts
Cols. 15 - Reinsurance
Due to
[16 + 17]
Treaties
Reinsurers
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 4
1
2
3
4
Aging of Ceded Reinsurance as of December 31, Current Year (000 Omitted)
Reinsurance Recoverable on Paid Losses and Paid Loss Adjustment Expenses
Overdue
5
6
23
Federal
ID
Number
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
(,
(,
(,
<
(,
(,
(,
(,
<
'''<
''''<
<
<
NAIC
Company
Code
Name of Reinsurer
> $ ? (##
? '4)4 12/ -+ A
-.
> $ ? (##
? '4)4 -?A
> $ ? (##
?
-?'4)4!
? (,
> $ ? (##
)
- , - 3 2/ -+
6 - - @ 1- 3
> $ ?
'4)4 '- ##
$ 1- ,
> $ ? A
? 0 -$
+ A
> $ ? A
? B ,- + A
> $ ?
-?'4)4 1- ,
? (,
> $
,
> $ ? (##
? '4)4 12/ -+ A
-.
,
> $ ? (##
? '4)4 -?A
,
> $ ? (##
?
-?'4)4!
? '- ,
> $ ? (##
,
> $ ?
'4)4 '- ##
$ 1- ,
,
> $ ? A
? 0 -$
+ A
,
> $ ? A
? B ,- + A
,
> $ ?
-?'4)4 1- ,
? '- ,
> $
? (,
> $ -$ '- ,
> $
? A
$ 3
9999999 Totals
Domiciliary
Jurisdiction
A(
Current
1 to 29 Days
7
30 - 90 Days
8
91 - 120 Days
9
Over 120 Days
12
13
11
10
Total Overdue
Cols. 6 + 7 + 8 + 9
Total Due
Cols. 5 + 10
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Percentage more
Than 120 Days
Overdue Col. 9 /
Col. 11
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Percentage
Overdue
Col. 10/Col. 11
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 5
1
2
3
Federal
NAIC
ID
Company
Name of Reinsurer
Number
Code
?
'- $
- 1- 3
?
'4)4 '- ##
$ 1- ,
? <
? (##
-$
? <
? A
$ 3
4
Domiciliary
Jurisdiction
A(
24
9999999 Totals
1. Amounts in dispute totaling $
2. Amounts in dispute totaling $
are included in Column 5.
are excluded from Column 13.
5
Provision for Unauthorized Reinsurance as of December 31, Current Year (000 Omitted)
6
7
8
9
10
11
Reinsurance
Recoverable
all Items
Schedule F
Part 3,
Col. 15
Funds Held
By Company
Under
Reinsurance
Treaties
Letters of
Credit
Ceded
Balances
Payable
Miscellaneous
Balances
Other
Allowed
Offset Items
Sum of Cols.
6 thru 10 but
not in excess
of Col. 5
12
13
14
15
Subtotal
Col. 5 minus
Col. 11
Recoverable
Paid Losses
& LAE
Expenses
Over 90 Days
Past Due not
in Dispute
20% of
Amount in
Col. 13
Smaller of
Col. 11 or
Col. 14
16
17
Total Provision
for
Smaller of Col. Unauthorized
11 or 20% of Reinsurance
Smaller of
Amount in
Col.5 or
Dispute
Cols.
Included in
12 +15 + 16
Col. 5
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 6
1
2
Federal
ID
Number
?
NAIC
Company
Code
3
Name of Reinsurer
)
- , -
1- 3
Provision for Overdue Authorized Reinsurance as of December 31, Current Year
4
5
6
7
Reinsurance
Recoverable on Paid
Total Reinsurance
Losses and LAE More
Recoverable on Paid
Than 90 Days Overdue Losses and Paid LAE
Amounts Received
Col. 4 divided by
(a)
(b)
Prior 90 Days
(Cols. 5 + 6)
4
25
9999999 Totals
(a) From Schedule F - Part 4 Columns 8 + 9, total authorized, less $
(b) From Schedule F - Part 3 Columns 7 + 8, total authorized, less $
in dispute.
in dispute.
8
9
10
11
Amounts in Col. 4 for
Companies Reporting
less than
20% in Col. 7
Amounts in Dispute
Excluded from Col. 4 for
Companies Reporting
less than 20% in Col. 7
20% of Amount
in Col. 9
Amount Reported in
Col. 8 x 20% + Col. 10
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 7
1
Federal
ID
Number
?
2
NAIC
Company
Code
3
)
- , -
Name of Reinsurer
3 2/ -+
4
Reinsurance
Recoverable
All Items
Provision for Overdue Reinsurance as of December 31, Current Year
5
6
7
8
Funds Held By
Company Under
Ceded Balances
Other Miscellaneous
Reinsurance Treaties
Letters of Credit
Payable
Balances
9
Other Allowed
Offset Items
10
Sum of Cols. 5 thru 9
but not in excess of
Col. 4
11
Col. 4 minus Col. 10
26
9999999 Totals
1.
2.
3.
4.
5.
6.
Total
Line 1 x .2
Schedule F - Part 6 Col. 11
Provision for Overdue Authorized Reinsurance (Lines 2 + 3)
Provision for Unauthorized Reinsurance (Schedule F - Part 5 Col. 17 x 1000)
Provision for Reinsurance (sum Lines 4 + 5) [Enter this amount on Page 3, Line 16]
12
Greater of Col. 11 or
Schedule F - Part 4
Cols. 8 + 9
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE F - PART 8
Restatement of Balance Sheet to Identify Net Credit for Reinsurance
1
As Reported
(Net of Ceded)
2
Restatement
Adjustments
3
Restated
(Gross of Ceded)
ASSETS (Page 2, Col. 3)
1. Cash and invested assets (Line 10)
2. Premiums and considerations (Line 13)
!
3. Reinsurance recoverable on loss and loss adjustment expense payments (Line 14.1)
4
Funds held by or deposited with reinsured companies (Line 14.2)
5. Other assets
6. Net amount recoverable from reinsurers
7. Protected cell assets (Line 25)
8. Totals (Line 26)
LIABILITIES (Page 3)
9. Losses and loss adjustment expenses (Lines 1 through 3)
10. Taxes, expenses, and other obligations (Lines 4 through 8)
11. Unearned premiums (Line 9)
12. Advance Premiums (Line 10)
13. Dividends declared and unpaid (Line 11.1 and 11.2)
14. Ceded reinsurance premiums payable (net of ceded commissions) (Line 12)
!
15. Funds held by company under reinsurance treaties (Line 13)
16. Amounts withheld or retained by company for account of others (Line 14)
!
17. Provision for reinsurance (Line 16)
18. Other liabilities
19. Total liabilities excluding protected cell business (Line 24)
20. Protected cell liabilities (Line 25)
21. Surplus as regards policyholders (Line 35)
XXX
22. Totals (Line 36)
NOTE: Is the restatement of this exhibit the result of grossing up balances ceded to affiliates under 100 percent reinsurance or pooling arrangements?
If yes, give full explanation:
27
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule H - Part 1
NONE
Schedule H - Part 2
NONE
Schedule H - Part 3
NONE
Schedule H - Part 4
NONE
Schedule H - Part 5
NONE
28, 29, 30
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - ANALYSIS OF LOSSES AND LOSS EXPENSES
SCHEDULE P - PART 1 - SUMMARY
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1. Prior
1
Premiums Earned
2
3
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Loss Payments
4
5
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
XXX
XXX
XXX
Direct and
Assumed
Ceded
Direct and
Assumed
Direct and
Assumed
Ceded
Ceded
10
12
11
Salvage
Total Net
and
Paid (Cols.
Subrogation 4 - 5 + 6 Received
7 + 8 - 9)
Number of
Claims
Reported Direct and
Assumed
XXX
2. 2000
XXX
!
3. 2001
XXX
4. 2002
XXX
5. 2003
XXX
6. 2004
XXX
7. 2005
XXX
8. 2006
XXX
9. 2007
XXX
10. 2008
XXX
11. 2009
12. Totals
XXX
XXX
XXX
XXX
XXX
Losses Unpaid
Case Basis
Bulk + IBNR
13
14
15
16
Direct and
Assumed
Ceded
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Ceded
Direct and
Assumed
Direct and
Assumed
Ceded
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
25
Total
Number of
Salvage
Net
Claims
and
Losses
OutstandSubrogand
ing ation
Expenses Direct and
Anticipated Unpaid
Assumed
1.
XXX
2.
XXX
3.
XXX
4.
XXX
5.
XXX
6.
XXX
7.
XXX
8.
XXX
9.
XXX
10.
XXX
11.
XXX
12. Totals
XXX
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
Net
XXX
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Loss
XXX
2.
4
4
4
3.
4
4 !
4
4.
4
4
4
5.
4
4
4
6.
4
4
4
7.
4
4
4
8.
4
4
4
9.
4
4
4
10.
4
4
4
4
11.
12. Totals
XXX
XXX
XXX
XXX
4
Loss
Expense
Net Balance Sheet Reserves
34
After Discount
InterCompany
35
36
Pooling
Loss
Participation
Losses
Expenses
Percentage
Unpaid
Unpaid
4
XXX
XXX
XXX
Note: Parts 2 and 4 are gross of all discounting, including tabular discounting. Part 1 is gross of only nontabular discounting, which is reported in Columns 32 and 33 of Part 1.
The tabular discount, if any, is reported in the Notes to Financial Statements which will reconcile Part 1 with Parts 2 and 4.
31
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 2 - SUMMARY
Years in Which
Losses Were
Incurred
1
INCURRED NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END
($000 OMITTED)
2
3
4
5
6
7
8
9
2000
2001
2002
2003
2004
2005
2006
2007
2008
DEVELOPMENT
11
12
10
2009
One Year
Two Year
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
!
XXX
XXX
XXX
SCHEDULE P - PART 3 - SUMMARY
CUMULATIVE PAID NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000
OMITTED)
1
2
3
4
5
6
7
8
9
10
1. Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
12
Number of
Number of
Claims
Claims
Closed
Closed With
Without
Loss
Loss
Payment
Payment
2. 2000
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
Years in Which
Losses Were
Incurred
!
11
000
3. 2001
XXX
!
12. Totals
Years in Which
Losses Were
Incurred
!
XXX
SCHEDULE P - PART 4 - SUMMARY
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
BULK AND IBNR RESERVES ON NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
!
1. Prior
!
!
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
32
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1A - HOMEOWNERS/FARMOWNERS
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2000
!
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
XXX
12. Totals
XXX
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Salvage
Net Losses
and
and
Subrogation Expenses
Anticipated
Unpaid
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Net
Loss
XXX
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
33
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1B - PRIVATE PASSENGER AUTO
LIABILITY/MEDICAL
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Totals
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Net Losses
Salvage
and
and
Subrogation Expenses
Unpaid
Anticipated
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
Net
XXX
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Loss
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
34
4
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1C - COMMERCIAL AUTO/TRUCK
LIABILITY/MEDICAL
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Premiums Earned
2
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
1
3
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
!
XXX
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Totals
XXX
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Net Losses
Salvage
and
and
Subrogation Expenses
Unpaid
Anticipated
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
Net
XXX
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Loss
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
35
4
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1D - WORKERS'COMPENSATION
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Totals
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Salvage
Net Losses
and
and
Subrogation Expenses
Anticipated
Unpaid
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Net
Loss
XXX
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
36
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1E - COMMERCIAL MULTIPLE PERIL
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Premiums Earned
2
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
1
3
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
XXX
2. 2000
!
3. 2001
!
4. 2002
!
5. 2003
!
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
XXX
12. Totals
XXX
XXX
XXX
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Salvage
Net Losses
and
and
Subrogation Expenses
Anticipated
Unpaid
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Net
Loss
XXX
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4
4
4
4
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
4.
!
5.
!
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
37
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 1F - Prof. Liab. Occur
NONE
Schedule P - Part 1F - Prof. Liab. Claim
NONE
Schedule P - Part 1G - Special Liability
NONE
38, 39, 40
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1H - SECTION 1 - OTHER LIABILITY - OCCURRENCE
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Totals
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Salvage
Net Losses
and
and
Subrogation Expenses
Anticipated
Unpaid
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Net
Loss
XXX
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
41
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1H - SECTION 2 - OTHER LIABILITY - CLAIMS-MADE
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Totals
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Salvage
Net Losses
and
and
Subrogation Expenses
Anticipated
Unpaid
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Net
Loss
XXX
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
4
4
4
4
5.
4
4
4
4
6.
4
4
4
4
7.
4
4
4
4
8.
4
4
4
4
9.
4
4
4
4
10.
4
4
4
4
11.
4
4
4
4
12.
XXX
XXX
XXX
XXX
XXX
XXX
42
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1I - SPECIAL PROPERTY (FIRE, ALLIED LINES,
INLAND MARINE, EARTHQUAKE, BURGLARY AND THEFT)
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Premiums Earned
2
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
1
3
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
NONE
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Ceded
Direct and
Assumed
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
XXX
2. 2008
XXX
3. 2009
XXX
XXX
4. Totals
XXX
XXX
XXX
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
NONE
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Net Losses
Salvage
and
and
Subrogation Expenses
Unpaid
Anticipated
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
NONE
Ceded
Net
XXX
XXX
Loss
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
XXX
XXX
XXX
XXX
XXX
XXX
43
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1J - AUTO PHYSICAL DAMAGE
Premiums Earned
2
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
3
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
2. 2008
3. 2009
4. Totals
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Net Losses
Salvage
and
and
Subrogation Expenses
Unpaid
Anticipated
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
Net
XXX
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Loss
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
XXX
XXX
XXX
XXX
XXX
XXX
44
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Losses
Expenses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 1K - FIDELITY/SURETY
Years in
Which
Premiums
Were
Earned
and Losses
Were
Incurred
Premiums Earned
2
Direct and
Assumed
Ceded
Net
(Cols. 1 - 2)
1. Prior
XXX
XXX
XXX
1
3
($000 Omitted)
Loss and Loss Expense Payments
Defense and Cost
Adjusting and Other
Containment Payments
Payments
6
7
8
9
Loss Payments
4
5
Direct and
Assumed
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Ceded
10
11
Salvage
and
Subrogation
Received
Total
Net Paid
(Cols. 4 - 5
+6-7
+ 8 - 9)
12
Number of
Claims
Reported Direct and
Assumed
XXX
2. 2008
XXX
3. 2009
XXX
XXX
4. Totals
XXX
XXX
XXX
Losses Unpaid
Case Basis
13
14
Direct and
Assumed
Defense and Cost Containment Unpaid
Case Basis
Bulk + IBNR
17
18
19
20
Bulk + IBNR
15
16
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Direct and
Assumed
Ceded
Adjusting and Other
Unpaid
21
22
Direct and
Assumed
Ceded
23
24
Total
Net Losses
Salvage
and
and
Subrogation Expenses
Unpaid
Anticipated
25
Number of
Claims
Outstanding - Direct
and
Assumed
1.
2.
3.
4.
Total
Losses and Loss Expenses Incurred
26
27
28
1.
Loss and Loss Expense Percentage
(Incurred/Premiums Earned)
29
30
31
Direct and
Assumed
Ceded
Net
Direct and
Assumed
Ceded
Net
XXX
XXX
XXX
XXX
XXX
XXX
Nontabular Discount
32
33
Loss
Loss
Expense
34
InterCompany
Pooling
Participation
Percentage
XXX
2.
4
4
4
4
3.
4
4
4
4
4.
XXX
XXX
XXX
XXX
XXX
XXX
45
XXX
Net Balance Sheet
Reserves After Discount
35
36
Loss
Expenses
Losses
Unpaid
Unpaid
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 1L - Other
NONE
Schedule P - Part 1M - International
NONE
Schedule P - Part 1N - Reinsurance A
NONE
Schedule P - Part 1O - Reinsurance B
NONE
Schedule P - Part 1P - Reinsurance C
NONE
Schedule P - Part 1R - Prod Liab Occur
NONE
Schedule P - Part 1R - Prod Liab Claims
NONE
Schedule P - Part 1S-Fin./Mtg. Guaranty
NONE
Schedule P - Part 1T - Warranty
NONE
46, 47, 48, 49, 50, 51, 52, 53, 54
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 2A - HOMEOWNERS/FARMOWNERS
INCURRED NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
Years in Which
1
2
3
4
5
6
7
8
9
10
Losses Were
Incurred
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
DEVELOPMENT
11
12
One Year
Two Year
XXX
XXX
XXX
SCHEDULE P - PART 2B - PRIVATE PASSENGER AUTO LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
SCHEDULE P - PART 2C - COMMERCIAL AUTO/TRUCK LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
!
!
!
XXX
XXX
XXX
!
12. Totals
SCHEDULE P - PART 2D- WORKERS’ COMPENSATION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
!
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
12. Totals
!
SCHEDULE P - PART 2E- COMMERCIAL MULTIPLE PERIL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
55
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 2F - SECTION 1 - MEDICAL PROFESSIONAL LIABILITY OCCURRENCE
Years in Which
Losses Were
Incurred
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
INCURRED NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
NONE
2000
2001
2002
2003
2004
2005
2006
2007
2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2009
DEVELOPMENT
11
12
One Year
Two Year
XXX
XXX
XXX
12. Totals
SCHEDULE P - PART 2F - SECTION 2 - MEDICAL PROFESSIONAL LIABILITY CLAIMS-MADE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
SCHEDULE P - PART 2G - SPECIAL LIABILITY
(OCEAN MARINE, AIRCRAFT (ALL PERILS), BOILER AND MACHINERY)
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
SCHEDULE P - PART 2H - SECTION 1 - OTHER LIABILITY - OCCURRENCE
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
SCHEDULE P - PART 2H - SECTION 2 - OTHER LIABILITY - CLAIMS-MADE
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
56
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 2I - SPECIAL PROPERTY (FIRE, ALLIED LINES, INLAND
MARINE, EARTHQUAKE, BURGLARY, AND THEFT)
Years in Which
Losses Were
Incurred
INCURRED NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
2002
2003
2004
2005
2006
2007
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2008
2009
DEVELOPMENT
11
12
One Year
Two Year
XXX
XXX
XXX
XXX
4. Totals
SCHEDULE P - PART 2J - AUTO PHYSICAL DAMAGE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
4. Totals
SCHEDULE P - PART 2K - FIDELITY, SURETY
NONE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
4. Totals
SCHEDULE P - PART 2L - OTHER
(INCLUDING CREDIT, ACCIDENT AND HEALTH)
NONE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
4. Totals
SCHEDULE P - PART 2M - INTERNATIONAL
1. Prior
2. 2000
NONE
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
12. Totals
57
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 2N
NONE
Schedule P - Part 2O
NONE
Schedule P - Part 2P
NONE
Schedule P - Part 2R - Prod Liab Occur
NONE
Schedule P - Part 2R - Prod Liab Claims
NONE
Schedule P - Part 2S
NONE
Schedule P - Part 2T
NONE
58, 59
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 3A - HOMEOWNERS/FARMOWNERS
CUMULATIVE PAID NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END
($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
Years in Which
Losses Were
Incurred
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2000
2001
2002
2003
2004
2005
2006
2007
2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2009
11
12
Number of
Number of
Claims
Claims
Closed
Closed With Without
Loss
Loss
Payment
Payment
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3B - PRIVATE PASSENGER AUTO LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
!
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3C - COMMERCIAL AUTO/TRUCK LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3D - WORKERS’ COMPENSATION
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3E - COMMERCIAL MULTIPLE PERIL
!
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
60
XXX
XXX
XXX
XXX
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 3F - SECTION 1 - MEDICAL PROFESSIONAL LIABILITY OCCURRENCE
CUMULATIVE PAID NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END
($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
Years in Which
Losses Were
Incurred
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
2001
2002
2003
2004
2005
2006
2007
2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
2009
11
12
Number of
Number of
Claims
Claims
Closed
Closed With Without
Loss
Loss
Payment
Payment
SCHEDULE P - PART 3F - SECTION 2 - MEDICAL PROFESSIONAL LIABILITY CLAIMS-MADE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3G - SPECIAL LIABILITY
(OCEAN MARINE, AIRCRAFT (ALL PERILS), BOILER AND MACHINERY)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3H - SECTION 1 - OTHER LIABILITY - OCCURRENCE
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3H - SECTION 2 - OTHER LIABILITY - CLAIMS-MADE
000
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
61
XXX
XXX
XXX
XXX
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 3I - SPECIAL PROPERTY
(FIRE, ALLIED LINES, INLAND MARINE, EARTHQUAKE, BURGLARY, AND THEFT)
CUMULATIVE PAID NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END
($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
Years in Which
Losses Were
Incurred
2008
2009
11
12
Number of
Number of
Claims
Claims
Closed
Closed With Without
Loss
Loss
Payment
Payment
2000
2001
2002
2003
2004
2005
2006
2007
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3J - AUTO PHYSICAL DAMAGE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3K - FIDELITY/SURETY
NONE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3L - OTHER (INCLUDING CREDIT, ACCIDENT AND HEALTH)
NONE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
000
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 3M - INTERNATIONAL
1. Prior
000
2. 2000
NONE
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
62
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 3N
NONE
Schedule P - Part 3O
NONE
Schedule P - Part 3P
NONE
Schedule P - Part 3R - Prod Liab Occur
NONE
Schedule P - Part 3R - Prod Liab Claims
NONE
Schedule P - Part 3S
NONE
Schedule P - Part 3T
NONE
63, 64
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 4A - HOMEOWNERS/FARMOWNERS
Years in Which
Losses Were
Incurred
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
BULK AND IBNR RESERVES ON NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2002
2003
2004
2005
2006
2007
2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2009
!
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4B - PRIVATE PASSENGER AUTO LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4C - COMMERCIAL AUTO/TRUCK LIABILITY/MEDICAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
!
!
!
!
!
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4D - WORKERS’ COMPENSATION
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4E - COMMERCIAL MULTIPLE PERIL
!
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
65
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 4F - SECTION 1 - MEDICAL PROFESSIONAL LIABILITY OCCURRENCE
Years in Which
Losses Were
Incurred
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
BULK AND IBNR RESERVES ON NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
2002
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
2003
2004
2005
2006
2007
2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2009
SCHEDULE P - PART 4F - SECTION 2 - MEDICAL PROFESSIONAL LIABILITY CLAIMS-MADE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4G - SPECIAL LIABILITY
(OCEAN MARINE, AIRCRAFT (ALL PERILS), BOILER AND MACHINERY)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4H - SECTION 1 - OTHER LIABILITY - OCCURRENCE
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4H - SECTION 2 - OTHER LIABILITY - CLAIMS-MADE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
66
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 4I - SPECIAL PROPERTY
(FIRE, ALLIED LINES, INLAND MARINE, EARTHQUAKE, BURGLARY AND THEFT)
Years in Which
Losses Were
Incurred
BULK AND IBNR RESERVES ON NET LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
1
2
3
4
5
5
7
8
9
10
2000
2001
2002
2003
2004
2005
2006
2007
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2008
2009
XXX
SCHEDULE P - PART 4J - AUTO PHYSICAL DAMAGE
1. Prior
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4K - FIDELITY/SURETY
1. Prior
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4L - OTHER (INCLUDING CREDIT, ACCIDENT AND HEALTH)
1. Prior
XXX
XXX
XXX
2. 2008
XXX
XXX
XXX
3. 2009
XXX
XXX
XXX
NONE
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SCHEDULE P - PART 4M - INTERNATIONAL
1. Prior
2. 2000
NONE
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
67
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 4N
NONE
Schedule P - Part 4O
NONE
Schedule P - Part 4P
NONE
Schedule P - Part 4R - Prod Liab Occur
NONE
Schedule P - Part 4R - Prod Liab Claims
NONE
Schedule P - Part 4S
NONE
Schedule P - Part 4T
NONE
68, 69
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5A - HOMEOWNERS/FARMOWNERS
SECTION 1
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
2008
10
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
!
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
70
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5B - PRIVATE PASSENGER AUTO
LIABILITY/MEDICAL
SECTION 1
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
2008
10
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
!
1. Prior
2007
9
10
2008
2009
!
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
71
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5C - COMMERCIAL AUTO/TRUCK
LIABILITY/MEDICAL
SECTION 1
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
!
1. Prior
2007
!
9
10
2008
2009
!
!
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
72
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5D - WORKERS'COMPENSATION
SECTION 1
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
2008
10
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
73
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5E - COMMERCIAL MULTIPLE PERIL
SECTION 1
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
!
1. Prior
2007
9
10
2008
2009
!
!
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
74
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 5F- SN1A
NONE
Schedule P - Part 5F- SN2A
NONE
Schedule P - Part 5F- SN3A
NONE
Schedule P - Part 5F- SN1B
NONE
Schedule P - Part 5F- SN2B
NONE
Schedule P - Part 5F- SN3B
NONE
75, 76
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 5H - OTHER LIABILITY - OCCURRENCE
SECTION 1A
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2000
CUMULATIVE NUMBER OF CLAIMS CLOSED WITH LOSS PAYMENT DIRECT AND ASSUMED AT YEAR END
2
3
4
5
6
7
8
9
2001
2002
2003
2004
2005
2006
2007
2008
10
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2A
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
NUMBER OF CLAIMS OUTSTANDING DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 3A
Years in
Which
Premiums
Were Earned
and Losses
Were Incurred
1
2
2000
2001
CUMULATIVE NUMBER OF CLAIMS REPORTED DIRECT AND ASSUMED AT YEAR END
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
!
1. Prior
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
77
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 5H- SN1B
NONE
Schedule P - Part 5H- SN2B
NONE
Schedule P - Part 5H- SN3B
NONE
Schedule P - Part 5R- SN1A
NONE
Schedule P - Part 5R- SN2A
NONE
Schedule P - Part 5R- SN3A
NONE
Schedule P - Part 5R- SN1B
NONE
Schedule P - Part 5R- SN2B
NONE
Schedule P - Part 5R- SN3B
NONE
Schedule P - Part 5T- SN1
NONE
Schedule P - Part 5T- SN2
NONE
78, 79, 80, 81
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 5T- SN3
NONE
81
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 6C - COMMERCIAL AUTO/TRUCK LIABILITY/MEDICAL
SECTION 1
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
1
CUMULATIVE PREMIUMS EARNED DIRECT AND ASSUMED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
10
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
XXX
SECTION 2
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
CUMULATIVE PREMIUMS EARNED CEDED AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
1
2
2000
2001
2002
2003
2004
2005
2006
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
9
10
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
XXX
SCHEDULE P - PART 6D - WORKERS'COMPENSATION
SECTION 1
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
1
CUMULATIVE PREMIUMS EARNED DIRECT AND ASSUMED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
10
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
XXX
SECTION 2
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
CUMULATIVE PREMIUMS EARNED CEDED AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
1
2
2000
2001
2002
2003
2004
2005
2006
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
9
10
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
XXX
82
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 6E - COMMERCIAL MULTIPLE PERIL
SECTION 1
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
CUMULATIVE PREMIUMS EARNED DIRECT AND ASSUMED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
1
2000
2001
2002
2003
2004
2005
2006
2007
11
Current
Year
Premiums
Earned
10
2008
2009
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
!
XXX
XXX
!
XXX
!
XXX
SECTION 2
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
1
2
2000
2001
CUMULATIVE PREMIUMS EARNED CEDED AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
2002
2003
2004
2005
2006
2007
9
10
2008
2009
11
Current
Year
Premiums
Earned
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
XXX
!
XXX
XXX
XXX
!
XXX
XXX
!
XXX
!
XXX
SCHEDULE P - PART 6H - OTHER LIABILITY - OCCURRENCE
SECTION 1A
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
1
2000
CUMULATIVE PREMIUMS EARNED DIRECT AND ASSUMED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
2001
2002
10
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 2A
Years in Which
Premiums Were
Earned and Losses
Were Incurred
1. Prior
2. 2000
3. 2001
4. 2002
5. 2003
6. 2004
7. 2005
8. 2006
9. 2007
10. 2008
11. 2009
12. Total
13. Earned
Premiums
(Sch P, Part 1)
1
2
2000
2001
CUMULATIVE PREMIUMS EARNED CEDED AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
2002
9
10
2003
2004
2005
2006
2007
2008
2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11
Current
Year
Premiums
Earned
!
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
83
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 6H - SN1B
NONE
Schedule P - Part 6H - SN2B
NONE
Schedule P - Part 6M - SN1
NONE
Schedule P - Part 6M - SN2
NONE
Schedule P - Part 6N - SN1
NONE
Schedule P - Part 6N - SN2
NONE
Schedule P - Part 6O - SN1
NONE
Schedule P - Part 6O - SN2
NONE
Schedule P - Part 6R - SN1A
NONE
Schedule P - Part 6R - SN2A
NONE
Schedule P - Part 6R - SN1B
NONE
84, 85, 86
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule P - Part 6R - SN2B
NONE
86
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 7A - PRIMARY LOSS SENSITIVE CONTRACTS
($000 OMITTED)
SECTION 1
1
Total Net Losses
and Expenses
Unpaid
Schedule P - Part 1
2
Net Losses and
Expenses Unpaid
on Loss Sensitive
Contracts
3
4
5
6
Loss Sensitive
as Percentage of
Total
Total Net
Premiums
Written
Net Premiums
Written on Loss
Sensitive Contacts
Loss Sensitive
as Percentage of
Total
1. Homeowners/Farmowners
2. Private Passenger Auto Liability/Medical
3. Commercial Auto/Truck Liability/Medical
4. Workers’ Compensation
5. Commercial Multiple Peril
6. Medical Professional Liability - Occurrence
7. Medical Professional Liability - ClaimsMade
8. Special Liability
9. Other Liability - Occurrence
10. Other Liability - Claims-Made
11. Special Property
12. Auto Physical Damage
13. Fidelity/Surety
14. Other
15. International
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
16. Reinsurance - Nonproportional Assumed
Property
XXX
XXX
XXX
XXX
XXX
XXX
17. Reinsurance - Nonproportional Assumed
Liability
XXX
XXX
XXX
XXX
XXX
XXX
18. Reinsurance - Nonproportional Assumed
Financial Lines
XXX
XXX
XXX
XXX
XXX
XXX
22. Warranty
4
4
4
4
4
4
4
4
23. Totals
4
4
19. Products Liability - Occurrence
20. Products Liability - Claims-Made
21. Financial Guaranty/Mortgage Guaranty
SECTION 2
Years in
Which
Policies
Were Issued
1
2000
INCURRED LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
2001
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2008
10
2009
XXX
SECTION 3
Years in
Which
Policies
Were Issued
BULK AND INCURRED BUT NOT REPORTED RESERVES FOR LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES AT YEAR END ($000
OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
87
2008
XXX
2009
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 7A - PRIMARY LOSS SENSITIVE CONTRACTS
(Continued)
SECTION 4
Years in
Which Policies
Were Issued
1
2
3
2000
2001
2002
1. Prior
NET EARNED PREMIUMS REPORTED AT YEAR END ($000 OMITTED)
4
5
6
7
2003
2004
2005
2006
8
9
10
2007
2008
2009
NONE
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
SECTION 5
Years in
Which Policies
Were Issued
1
2000
NET RESERVE FOR PREMIUM ADJUSTMENTS AND ACCRUED RETROSPECTIVE PREMIUMS AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
2001
2002
1. Prior
2003
2004
2005
2006
2007
2008
NONE
2. 2000
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
88
XXX
10
2009
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 7B - REINSURANCE LOSS SENSITIVE CONTRACTS
($000 OMITTED)
SECTION 1
1
Total Net Losses
and Expenses
Unpaid
Schedule P - Part 1
2
Net Losses and
Expenses Unpaid
on Loss Sensitive
Contracts
3
4
5
6
Loss Sensitive
as Percentage of
Total
Total Net
Premiums
Written
Net Premiums
Written on Loss
Sensitive Contacts
Loss Sensitive
as Percentage of
Total
4
4
4
4
4
4
4
4
4
4
4
4
15. International
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
16. Reinsurance - Nonproportional Assumed
Property
4
4
17. Reinsurance - Nonproportional Assumed
Liability
4
4
22. Warranty
4
4
4
4
4
4
4
4
4
4
23. Totals
4
4
1. Homeowners/Farmowners
2. Private Passenger Auto Liability/Medical
3. Commercial Auto/Truck Liability/Medical
4. Workers’ Compensation
5. Commercial Multiple Peril
6. Medical Professional Liability - Occurrence
7. MedicalProfessional Liability - ClaimsMade
8. Special Liability
9. Other Liability - Occurrence
10. Other Liability - Claims-Made
11. Special Property
12. Auto Physical Damage
13. Fidelity/Surety
14. Other
18. Reinsurance - Nonproportional Assumed
Financial Lines
19. Products Liability - Occurrence
20. Products Liability - Claims-Made
21. Financial Guaranty/Mortgage Guaranty
SECTION 2
Years in
Which Policies
Were Issued
1
2000
INCURRED LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES REPORTED AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
2001
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2008
10
2009
XXX
SECTION 3
Years in
Which Policies
Were Issued
BULK AND INCURRED BUT NOT REPORTED RESERVES FOR LOSSES AND DEFENSE AND COST CONTAINMENT EXPENSES AT YEAR END ($000
OMITTED)
1
2
3
4
5
6
7
8
9
10
2000
2001
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
89
2008
XXX
2009
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE P - PART 7B - REINSURANCE LOSS SENSITIVE CONTRACTS
(continued)
SECTION 4
Years in
Which Policies
Were Issued
1
2
3
2000
2001
2002
1. Prior
2. 2000
NET EARNED PREMIUMS REPORTED AT YEAR END ($000 OMITTED)
4
5
6
7
8
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
9
10
2008
2009
XXX
SECTION 5
Years in
Which Policies
Were Issued
1
2000
NET RESERVE FOR PREMIUM ADJUSTMENTS AND ACCRUED RETROSPECTIVE PREMIUMS AT YEAR END ($000 OMITTED)
2
3
4
5
6
7
8
9
2001
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2008
10
2009
XXX
SECTION 6
Years in
Which Policies
Were Issued
1
2
2000
2001
INCURRED ADJUSTABLE COMMISSIONS REPORTED AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
9
10
2008
2009
XXX
SECTION 7
Years in
Which Policies
Were Issued
1
2
2000
2001
RESERVES FOR COMMISSION ADJUSTMENTS AT YEAR END ($000 OMITTED)
3
4
5
6
7
8
2002
1. Prior
2. 2000
NONE
2003
2004
2005
2006
2007
3. 2001
XXX
4. 2002
XXX
XXX
5. 2003
XXX
XXX
XXX
6. 2004
XXX
XXX
XXX
XXX
7. 2005
XXX
XXX
XXX
XXX
XXX
8. 2006
XXX
XXX
XXX
XXX
XXX
XXX
9. 2007
XXX
XXX
XXX
XXX
XXX
XXX
XXX
10. 2008
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
11. 2009
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
90
9
10
2008
2009
XXX
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
1.
SCHEDULE P INTERROGATORIES
The following questions relate to yet-to-be-issued Extended Reporting Endorsements (EREs) arising from Death, Disability, or Retirement (DDR) provisions in Medical
Professional Liability Claims Made insurance policies. EREs provided for reasons other than DDR are not to be included.
1.1 Does the company issue Medical Professional Liability Claims Made insurance policies that provide tail (also known as an extended
reporting endorsement, or "ERE") benefits in the event of Death, Disability, or Retirement (DDR) at a reduced charge or at no additional
cost?
If the answer to question 1.1 is "no", leave the following questions blank. If the answer to question 1.1 is "yes", please answer the following
questions:
1.2 What is the total amount of the reserve for that provision (DDR Reserve), as reported, explicitly or not, elsewhere in this statement (in
dollars)?
1.3 Does the company report any DDR reserve as Unearned Premium Reserve per SSAP #65?
1.4 Does the company report any DDR reserve as loss or loss adjustment expense reserve?
1.5 If the company reports DDR reserve as Unearned Premium Reserve, does that amount match the figure on the Underwriting and
Investment Exhibit, Part 1A – Recapitulation of all Premiums (Page 7) Column 2, Lines 11.1 plus 11.2?
7(
1.6 If the company reports DDR reserve as loss or loss adjustment expense reserve, please complete the following table corresponding to
where these reserves are reported in Schedule P:
Years in Which Premiums Were Earned and
Losses Were Incurred
1.601
1.602
1.603
1.604
1.605
1.606
1.607
1.608
1.609
1.610
1.611
1.612
DDR Reserve Included in
Schedule P, Part 1F, Medical Professional Liability
Column 24: Total Net Losses and Expenses Unpaid
1
2
Section 1: Occurrence
Section 2: Claims-Made
Prior
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Totals
2.
The definition of allocated loss adjustment expenses (ALAE) and, therefore, unallocated loss adjustment expenses (ULAE) was changed
effective January 1, 1998. This change in definition applies to both paid and unpaid expenses. Are these expenses (now reported as
"Defense and Cost Containment" and "Adjusting and Other") reported in compliance with these definitions in this statement?
3.
The Adjusting and Other expense payments and reserves should be allocated to the years in which the losses were incurred based on the
number of claims reported, closed and outstanding in those years. When allocating Adjusting and Other expense between companies in
a group or a pool, the Adjusting and Other expense should be allocated in the same percentage used for the loss amounts and the claim
counts. For reinsurers, Adjusting and Other expense assumed should be reported according to the reinsurance contract. For Adjusting
and Other expense incurred by reinsurers, or in those situations where suitable claim count information is not available, Adjusting and
Other expense should be allocated by a reasonable method determined by the company and described in Interrogatory 7, below. Are they
so reported in this Statement? Answer:
4.
Do any lines in Schedule P include reserves that are reported gross of any discount to present value of future payments, and that are
reported net of such discounts on Page 10?
If Yes, proper disclosure must be made in the Notes to Financial Statements, as specified in the Instructions. Also, the discounts must be
reported in Schedule P - Part 1, Columns 32 and 33.
Schedule P must be completed gross of non-tabular discounting. Work papers relating to discount calculations must be available for
examination upon request.
Discounting is allowed only if expressly permitted by the state insurance department to which this Annual Statement is being filed.
5.
What were the net premiums in force at the end of the year for:
(in thousands of dollars)
5.1Fidelity
5.2Surety
6.
Claim count information is reported per claim or per claimant (Indicate which)
If not the same in all years, explain in Interrogatory 7.
7.1
The information provided in Schedule P will be used by many persons to estimate the adequacy of the current loss and expense reserves,
among other things. Are there any especially significant events, coverage, retention or accounting changes that have occurred that must
be considered when making such analyses?
7.2
An extended statement may be attached.
91
36(10( <
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE T - EXHIBIT OF PREMIUMS WRITTEN
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
States, etc.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Guam
Puerto Rico
U.S. Virgin Islands
Northern Mariana
Islands
Canada
Aggregate other alien
Totals
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
GU
PR
VI
Active
Status
N
N
N
N
N
N
N
N
N
L
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
MP
CN
OT
N
N
XXX
DETAILS OF WRITE-INS
5801.
5802.
5803.
5898. Summary of remaining
write-ins for Line 58 from
overflow page
5899. Totals (Lines 5801 through
5803 + 5898) (Line 58 above)
!
Allocated by States and Territories
Gross Premiums, Including
4
5
Policy and Membership Fees
Less Return Premiums and
Premiums on Policies Not
Dividends
Taken
Paid
2
3
or Credited to Direct Losses
Direct
Direct
Policyholders
Paid
Premiums
Premiums
on Direct
(Deducting
Written
Earned
Business
Salvage)
6
Direct Losses
Incurred
XXX
XXX
XXX
XXX
XXX
Explanation of basis of allocation of premiums by states, etc.
(a) Insert the number of L responses except for Canada and Other Alien.
92
7
8
Direct Losses
Unpaid
Finance and
Service
Charges Not
Included in
Premiums
9
Direct
Premium
Written for
Federal
Purchasing
Groups
(Included in
Col. 2)
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE T – PART 2
INTERSTATE COMPACT – EXHIBIT OF PREMIUMS WRITTEN
Allocated by States and Territories
States, Etc.
1. Alabama
2. Alaska
3. Arizona
4. Arkansas
5. California
6. Colorado
7. Connecticut
8. Delaware
9. District of Columbia
10. Florida
11. Georgia
12. Hawaii
13. Idaho
14. Illinois
15. Indiana
16. Iowa
17. Kansas
18. Kentucky
19. Louisiana
20. Maine
21. Maryland
22. Massachusetts
23. Michigan
24. Minnesota
25. Mississippi
26. Missouri
27. Montana
28. Nebraska
29. Nevada
30. New Hampshire
31. New Jersey
32. New Mexico
33. New York
34. North Carolina
35. North Dakota
36. Ohio
37. Oklahoma
38. Oregon
39. Pennsylvania
40. Rhode Island
41. South Carolina
42. South Dakota
43. Tennessee
44. Texas
45. Utah
46. Vermont
47. Virginia
48. Washington
49. West Virginia
50. Wisconsin
51. Wyoming
52. American Samoa
53. Guam
54. Puerto Rico
55. U.S. Virgin Islands
56. Northern Mariana Islands
57. Canada
58. Aggregate Other Alien
59. Totals
1
2
Life
(Group and
Individual)
Annuities (Group
and Individual)
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
GU
PR
VI
MP
CN
OT
93
Direct Business Only
3
4
Disability
Long-Term Care
Income
(Group and
(Group and
Individual)
Individual)
5
6
Deposit-Type
Contracts
Totals
94
AIB General Insurance
Agency, Inc.
Auto Premium
Finance Corp.
AIB International
Insurance Company
AIB Insurance Underwriters
of Texas, Inc.
AIB Claims
Management, Inc.
First Security Insurance
Underwriters, Inc.
AIB Life & Health
Underwriters, Inc.
Union American
Insurance Company
Associated Insurance
Brokers, Inc.
AIB Insurance Group
AIB Financial Group, Inc.
Loopo, Inc.
AIB Syndicate, Inc.
JPC Insurance
Underwriters, Inc.
PART 1 - ORGANIZATIONAL CHART
SCHEDULE Y - INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
95
3 -
<
Federal ID
Number
NAIC
Company
Code
?
?
?
2
1
(19 3 2 0 - . 2 (19 1- 4
'- - (2
- 1- , -
3
Names of Insurers and Parent, Subsidiaries or Affiliates
3
Shareholder
Dividends
4
Capital
Contributions
5
7
8
Income/
Purchases, Sales or (Disbursements)
Incurred in
Exchanges of
Connection with
Loans, Securities,
Guarantees or
Real
Estate, Mortgage Undertakings for the
Management
Benefit of any
Loans or Other
Agreements and
Affiliate(s)
Investments
Service Contracts
6
10
*
9
Income/
(Disbursements)
Incurred Under
Reinsurance
Agreements
11
Any Other Material
Activity Not in the
Ordinary Course of
the Insurer’s
Business
SCHEDULE Y
PART 2 - SUMMARY OF INSURER’S TRANSACTIONS WITH ANY AFFILIATES
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Totals
12
Reinsurance
Recoverable/
(Payable) on Losses
and/or Reserve
Credit
Taken/(Liability)
13
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
The following supplemental reports are required to be filed as part of your statement filing unless specifically waived by the domiciliary state.
However, in the event that your domiciliary state waives the filing requirement, your response of WAIVED to the specific interrogatory will be
accepted in lieu of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being
filed for whatever reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions.
RESPONSES
MARCH FILING
1.
Will an actuarial opinion be filed by March 1?
*)
2.
Will the Supplemental Compensation Exhibit be filed with the state of domicile by March 1?
*)
3.
Will the confidential Risk-based Capital Report be filed with the NAIC by March 1?
*)
4.
Will the confidential Risk-based Capital Report be filed with the state of domicile, if required, by March 1?
*)
5.
Will the Insurance Expense Exhibit be filed with the state of domicile and the NAIC by April 1?
*)
6.
Will Management’s Discussion and Analysis be filed by April 1?
*)
7.
Will the Supplemental Investment Risk Interrogatories be filed by April 1?
*)
8.
Will this company be included in a combined annual statement which is filed with the NAIC by May 1?
9.
Will an audited financial report be filed by June 1?
*)
10.
Will Accountants Letter of Qualifications be filed with the state of domicile and electronically with the NAIC by June 1?
*)
APRIL FILING
MAY FILING
)** * A6( (<1
JUNE FILING
The following supplemental reports are required to be filed as part of your statement filing. However, in the event that your company does not
transact the type of business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu
of filing a "NONE" report and a bar code will be printed below. If the supplement is required of your company but is not being filed for whatever
reason enter SEE EXPLANATION and provide an explanation following the interrogatory questions.
MARCH FILING
11.
Will Schedule SIS (Stockholder Information Supplement) be filed with the state of domicile by March 1?
12.
Will the Financial Guaranty Insurance Exhibit be filed March 1?
13.
Will the Medicare Supplement Insurance Experience Exhibit be filed with the state of domicile and the NAIC by March 1?
14.
Will Supplement A to Schedule T (Medical Professional Liability Supplement) be filed by March 1?
15.
Will the Trusteed Surplus Statement be filed with the state of domicile and the NAIC by March 1?
16.
Will the Premiums Attributed to Protected Cells Exhibit be filed by March 1?
17.
Will the Reinsurance Summary Supplemental Filing for General Interrogatory 9 be filed with the state of domicile and the NAIC by March 1?
18.
Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC by March 1?
19.
Will the confidential Actuarial Opinion Summary be filed with the state of domicile, if required by March 15 (or the date otherwise specified)?
20.
Will the Reinsurance Attestation Supplement be filed with the state of domicile and the NAIC by March 1?
21.
Will the Exceptions to the Reinsurance Attestation Supplement be filed with the state of domicile by March 1?
22.
Will the Bail Bond Supplement be filed with the state of domicile and the NAIC by March 1?
23.
Will the Credit Insurance Experience Exhibit be filed with the state of domicile and the NAIC by April 1?
24.
Will the Long-term Care Experience Reporting Forms be filed with the state of domicile and the NAIC by April 1?
25.
Will the Accident and Health Policy Experience Exhibit be filed by April 1?
APRIL FILING
Explanation:
4 7(
4
96
*)
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
4
4
4
4
4
4
4
4
4
4
4
4
4
Bar Code:
11.
12.
13.
14.
15.
16.
17.
18.
19.
21.
22.
23.
24.
25.
96.1
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
96.2
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
OVERFLOW PAGE FOR WRITE-INS
97
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SUMMARY INVESTMENT SCHEDULE
Gross
Investment Holdings
1
Amount
Investment Categories
2
Percentage
Admitted Assets as Reported
in the
Annual Statement
3
4
Amount
Percentage
1. Bonds:
4
4
1.21 Issued by U.S. government agencies
4
4
1.22 Issued by U.S. government sponsored agencies
4
4
4
4
1.41 States, territories and possessions general obligations
4
4
1.42 Political subdivisions of states, territories and possessions and
political subdivisions general obligations
4
4
1.43 Revenue and assessment obligations
4
4
1.44 Industrial development and similar obligations
4
4
1.511 Issued or guaranteed by GNMA
4
4
1.512 Issued or guaranteed by FNMA and FHLMC
4
4
1.513 All other
4
4
1.521 Issued or guaranteed by GNMA, FNMA, FHLMC or VA
4
4
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
4
4
1.523 All other
4
4
2.1 Unaffiliated domestic securities (includes credit tenant loans and hybrid
securities)
4
4
2.2 Unaffiliated non-U.S. securities (including Canada)
4
4
2.3 Affiliated securities
4
4
4
4
3.21 Affiliated
4
4
3.22 Unaffiliated
4
4
3.31 Affiliated
4
4
3.32 Unaffiliated
4
4
3.41 Affiliated
4
4
3.42 Unaffiliated
4
4
3.51 Affiliated
4
4
3.52 Unaffiliated
4
4
4.1 Construction and land development
4
4
4.2 Agricultural
4
4
4.3 Single family residential properties
4
4
4.4 Multifamily residential properties
4
4
4.5 Commercial loans
4
4
4.6 Mezzanine real estate loans
4
4
4
4
4
4
1.1 U.S. treasury securities
1.2 U.S. government agency obligations (excluding mortgage-backed
securities):
1.3 Non-U.S. government (including Canada, excluding mortgaged-backed
securities)
1.4 Securities issued by states, territories, and possessions and political
subdivisions in the U.S.:
1.5 Mortgage-backed securities (includes residential and commercial
MBS):
1.51 Pass-through securities:
1.52 CMOs and REMICs:
2. Other debt and other fixed income securities (excluding short-term):
3. Equity interests:
3.1 Investments in mutual funds
3.2 Preferred stocks:
3.3 Publicly traded equity securities (excluding preferred stocks):
3.4 Other equity securities:
3.5 Other equity interests including tangible personal property under lease:
4. Mortgage loans:
5. Real estate investments:
5.1 Property occupied by the company
5.2 Property held for the production of income (including
$
of property acquired in satisfaction of debt)
5.3 Property held for sale (including $
property
4
4
6. Contract loans
4
4
7. Receivables for securities
4
4
8. Cash, cash equivalents and short-term investments
4
4
acquired in satisfaction of debt)
9. Other invested assets
4
4
10. Total invested assets
4
4
SI01
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE A - VERIFICATION BETWEEN YEARS
Real Estate
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 6)
NONE
2.2 Additional investment made after acquisition (Part 2, Column 9)
3. Current year change in encumbrances:
3.1 Totals, Part 1, Column 13
3.2 Totals, Part 3, Column 11
4. Total gain (loss) on disposals, 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
8. Deduct current year’s depreciation:
8.1 Totals, Part 1, Column 11
8.2 Totals, Part 3, Column 9
9. Book/adjusted carrying value at the end of current period (Lines 1+2+3+4-5+6-7-8)
10. Deduct total nonadmitted amounts
11. Statement value at end of current period (Line 9 minus Line 10)
SCHEDULE B - VERIFICATION BETWEEN YEARS
Mortgage Loans
1. Book value/recorded 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
NONE
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 value/recorded 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)
SI02
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
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):
NONE
5.1 Totals, Part 1, Column 13
5.2 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. Deduct amortization of premium and depreciation
9. 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 carrying 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
2. Cost of bonds and stocks acquired, Part 3, Column 7
3. Accrual of discount
4. Unrealized valuation increase (decrease):
4.1 Part 1, Column 12
4.2 Part 2, Section 1, Column 15
4.3 Part 2, Section 2, Column 13
4.4 Part 4, Column 11
5. Total gain (loss) on disposals, Part 4, Column 19
6. Deduction consideration for bonds and stocks disposed of, Part 4, Column 7
7. Deduct amortization of premium
8. Total foreign exchange change in book/adjusted carrying value:
8.1 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)
11. Deduct total nonadmitted amounts
12. Statement value at end of current period (Line 10 minus Line 11)
SI03
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule D - Summary By Country
NONE
Schedule D - Part 1A - Section 1
NONE
Schedule D - Part 1A - Section 2
NONE
SI04, SI05, 1, 2, SI08, 1, 2
SI11
(a) Indicate the category of such assets, for example, joint ventures, transportation equipment:
12. Statement value at end of current period (Line 10 minus Line 11)
11. Deduct total nonadmitted amounts
10. Book adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9)
9. Deduct current year’s other than temporary impairment recognized
8. Total foreign exchange change in book/adjusted carrying value
7. Deduct amortization of premium
6. Deduct consideration received on disposals
5. Total gain (loss) on disposals
4. Unrealized valuation increase (decrease)
3. Accrual of discount
2. Cost of short-term investments acquired
1. Book/adjusted carrying value, December 31 of prior year
<
, + %,-$
Short-Term Investments
2
Bonds
1
Total
SCHEDULE DA - VERIFICATION BETWEEN YEARS
3
Mortgage Loans
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
5
Investments in Parent,
Subsidiaries and Affiliates
4
Other Short-term
Investment Assets(a)
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule DB - Part A - VBY
NONE
Schedule DB - Part B - VBY
NONE
Schedule DB - Part C - VBY
NONE
Schedule DB - Part D - VBY
NONE
Schedule DB - Part E - VBY
NONE
Schedule DB - Part F - Section 1
NONE
Schedule DB - Part F - Section 2
NONE
Schedule E - Verification
NONE
Schedule A - Part 1
NONE
Schedule A - Part 2
NONE
Schedule A - Part 3
NONE
SI12, SI13, SI14, SI15, SI16, E01, E02, E03
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule B - Part 1
NONE
Schedule B - Part 2
NONE
Schedule B - Part 3
NONE
Schedule BA - Part 1
NONE
Schedule BA - Part 2
NONE
Schedule BA - Part 3
NONE
Schedule D - Part 1
NONE
Schedule D - Part 2 - Section 1
NONE
Schedule D - Part 2 - Section 2
NONE
Schedule D - Part 3
NONE
E04, E05, E06, E07, E08, E09, E10, E11, E12, E13
E14
?
?
?
?
?
9999999 Totals
*? ?
9 -$ ? A
<
? 9 -$
A #
$ ) 8 ? A
<
? A #
$ ) 8
3 - C $ -.
3 22 - ) 8 ? 1-$,
-$ 0
3 22 - ) 8 ? A
3 22 - ) 8 ? A
<
? 3 22 - ) 8
<
? A #
$ -$ 3 22 - ) 8
Description
CUSIP
Identification
?
?
?
?
2
1
7 7
'- ##
Disposal
Date
F
o
r
e
i
g
n
- ,
4
3
:
$!
) ,
Name of Purchaser
5
4
Number of
Shares of
Stock
6
Consideration
7
Par Value
8
Actual Cost
9
Prior Year
Book/Adjusted
Carrying
Value
10
Unrealized
Valuation
Increase/
(Decrease)
11
13
14
15
Current Year’s
Other Than
Total Foreign
Current Year
Temporary
Total Change in
Exchange
(Amortization)/
Impairment
B/A. C.V.
Change in
Accretion
Recognized
(11 + 12 - 13)
B/A. C.V.
12
Change in Book/Adjusted Carrying Value
Showing all Long-Term Bonds and Stocks SOLD, REDEEMED or Otherwise DISPOSED OF During Current Year
SCHEDULE D - PART 4
16
17
18
Book/
Adjusted
Foreign
Carrying Value Exchange Gain Realized Gain
at
(Loss) on
(Loss) on
Disposal Date
Disposal
Disposal
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Total Gain
(Loss) on
Disposal
19
Bond
Interest/Stock
Dividends
Received
During Year
20
Maturity
Date
21
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule D - Part 5
NONE
Schedule D - Part 6 - Section 1
NONE
Schedule D - Part 6 - Section 2
NONE
E15, E16
E17
9199999 Totals
? <
Description
?
? 9 -$
CUSIP
Identification
? <
)A1(
2
1
Codes
4
Code Foreign
3
7 7
Date
Acquired
5
%
$ <
, +
Name of Vendor
6
7 7
Maturity
Date
7
Book/
Adjusted
Carrying
Value
8
Current
Year’s
(Amortization)
/
Accretion
Current
Year’s
Other Than
Temporary
Impairment
Recognized
Total
Foreign
Exchange
Change in
B./A.C.V.
Change In Book/Adjusted Carrying Value
10
11
12
Unrealized
Valuation
Increase/
(Decrease)
9
Par Value
13
Showing all SHORT-TERM INVESTMENTS Owned December 31 of Current Year
SCHEDULE DA - PART 1
Actual Cost
14
Amount Due
And Accrued
Dec. 31 of
Current Year
On Bond Not
In Default
15
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Non-Admitted
Due and
Accrued
16
4
Rate of
Interest
17
4
Effective
Rate of
18
0
When
Paid
19
Amount Received
During Year
20
Paid for
Accrued
Interest
21
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule DB - Part A - Section 1
NONE
Schedule DB - Part A - Section 2
NONE
Schedule DB - Part A - Section 3
NONE
Schedule DB - Part B - Section 1
NONE
Schedule DB - Part B - Section 2
NONE
Schedule DB - Part B - Section 3
NONE
Schedule DB - Part C - Section 1
NONE
Schedule DB - Part C - Section 2
NONE
Schedule DB - Part C - Section 3
NONE
Schedule DB - Part D - Section 1
NONE
Schedule DB - Part D - Section 2
NONE
E18, E19, E20, E21, E22, E23
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
Schedule DB - Part D - Section 3
NONE
Schedule DB - Part E - Section 1
NONE
E23, E24
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE E - PART 1 - CASH
1
2
Depository
9
9
9
%
0
- ?
0
- ?
0
- ?
$ " /
"
<
/
-.
" , 2
= 8
# % - /
=
? / -
2/
Code
0
0
0
<
$
)
2
- -+ - $ /
" /
+ )
2
2
2
/
1-
%6
%6
%6
,
3
Rate of
Interest
4
5
Amount of Interest Amount of Interest
Received
Accrued
During
December 31 of
Year
Current Year
%6
=
$ 5
- ! ? / - $ /
$
TOTALS OF DEPOSITORY BALANCES ON THE LAST DAY OF EACH MONTH DURING THE CURRENT YEAR
4. April
5. May
6. June
7
Balance
*
!
<
3
- " /
3
- 3 2/ -+D ##
0599999 Total Cash
1. January
2. February
3. March
6
7. July
8. August
9. September
E25
10. October
11. November
12. December
E26
8699999 Totals
2
Code
1
Description
3
Date
Acquired
NONE
Show Investments Owned End of Current Quarter
4
5
Rate of
Maturity
Interest
Date
6
Book/Adjusted
Carrying Value
SCHEDULE E - PART 2 - CASH EQUIVALENTS
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
7
Amount of Interest Due
& Accrued
8
Amount Received
During Year
ANNUAL STATEMENT FOR THE YEAR 2009 OF THE UNION AMERICAN INSURANCE COMPANY
IN RECEIVERSHIP
SCHEDULE E PART 3 - SPECIAL DEPOSITS
States, Etc.
1. Alabama
2. Alaska
3. Arizona
4. Arkansas
5. California
6. Colorado
7. Connecticut
8. Delaware
9. District of Columbia
10. Florida
11. Georgia
12. Hawaii
13. Idaho
14. Illinois
15. Indiana
16. Iowa
17. Kansas
18. Kentucky
19. Louisiana
20. Maine
21. Maryland
22. Massachusetts
23. Michigan
24. Minnesota
25. Mississippi
26. Missouri
27. Montana
28. Nebraska
29. Nevada
30. New Hampshire
31. New Jersey
32. New Mexico
33. New York
34. North Carolina
35. North Dakota
36. Ohio
37. Oklahoma
38. Oregon
39. Pennsylvania
40. Rhode Island
41. South Carolina
42. South Dakota
43. Tennessee
44. Texas
45. Utah
46. Vermont
47. Virginia
48. Washington
49. West Virginia
50. Wisconsin
51. Wyoming
52. American Samoa
53. Guam
54. Puerto Rico
55. US Virgin Islands
56. Northern Mariana Islands
57. Canada
58. Aggregate Other Alien
59. Total
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
GU
PR
VI
MP
CN
OT
1
2
Type of
Deposits
Purpose of
Deposits
)<
E,
Deposits For
The Benefit of All Policyholders
3
4
Book/Adjusted
Fair
Carrying Value
Value
$
DETAILS OF WRITE-INS
5801.
5802.
5803.
5898.
5899.
Summary of remaining write-ins for
Line 58 from overflow page
Totals (Lines 5801 - 5803 +
5898)(Line 58 above)
E27
All Other Special Deposits
5
6
Book/Adjusted
Fair
Carrying Value
Value
ALPHABETICAL INDEX
ANNUAL STATEMENT BLANK
Assets
Cash Flow
Exhibit of Capital Gains (Losses)
Exhibit of Net Investment Income
Exhibit of Nonadmitted Assets
Exhibit of Premiums and Losses (State Page)
Five-Year Historical Data
General Interrogatories
Jurat Page
Liabilities, Surplus and Other Funds
Notes To Financial Statements
Overflow Page For Write-ins
Schedule A – Part 1
Schedule A – Part 2
Schedule A – Part 3
Schedule A – Verification Between Years
Schedule B – Part 1
Schedule B – Part 2
Schedule B – Part 3
Schedule B – Verification Between Years
Schedule BA – Part 1
Schedule BA – Part 2
Schedule BA – Part 3
Schedule BA – Verification Between Years
Schedule D – Part 1
Schedule D – Part 1A – Section 1
Schedule D – Part 1A – Section 2
Schedule D – Part 2 – Section 1
Schedule D – Part 2 – Section 2
Schedule D – Part 3
Schedule D – Part 4
Schedule D – Part 5
Schedule D – Part 6 – Section 1
Schedule D – Part 6 – Section 2
Schedule D – Summary By Country
Schedule D – Verification Between Years
Schedule DA – Part 1
INDEX1
2
5
12
12
13
19
17
15
1
3
14
97
E01
E02
E03
SI02
E04
E05
E06
SI02
E07
E08
E09
SI03
E10
SI05
SI08
E11
E12
E13
E14
E15
E16
E16
SI04
SI03
E17
ALPHABETICAL INDEX
ANNUAL STATEMENT BLANK (Continued)
Schedule DA – Verification Between Years
Schedule DB – Part A – Section 1
Schedule DB – Part A – Section 2
Schedule DB – Part A – Section 3
Schedule DB – Part A – Verification Between Years
Schedule DB – Part B – Section 1
Schedule DB – Part B – Section 2
Schedule DB – Part B – Section 3
Schedule DB – Part B – Verification Between Years
Schedule DB – Part C – Section 1
Schedule DB – Part C – Section 2
Schedule DB – Part C – Section 3
Schedule DB – Part C – Verification Between Years
Schedule DB – Part D – Section 1
Schedule DB – Part D – Section 2
Schedule DB – Part D – Section 3
Schedule DB – Part D – Verification Between Years
Schedule DB – Part E – Section 1
Schedule DB – Part E – Verification
Schedule DB – Part F – Section 1
Schedule DB – Part F – Section 2
Schedule E – Part 1 – Cash
Schedule E – Part 2 – Cash Equivalents
Schedule E – Part 3 – Special Deposits
Schedule E – Verification Between Years
Schedule F – Part 1
Schedule F – Part 2
Schedule F – Part 3
Schedule F – Part 4
Schedule F – Part 5
Schedule F – Part 6
Schedule F – Part 7
Schedule F – Part 8
Schedule H – Accident and Health Exhibit – Part 1
Schedule H – Parts – 2, 3, and 4
Schedule H – Part 5 – Health Claims
Schedule P – Part 1 – Analysis of Losses and Loss Expenses
Schedule P – Part 1A – Homeowners/Farmowners
Schedule P – Part 1B – Private Passenger Auto Liability/Medical
Schedule P – Part 1C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 1D – Workers’ Compensation
INDEX2
SI11
E18
E18
E19
SI12
E19
E20
E20
SI12
E21
E21
E22
SI13
E22
E23
E23
SI13
E24
SI13
SI14
SI15
E25
E26
E27
SI16
20
21
22
23
24
25
26
27
28
29
30
31
33
34
35
36
ALPHABETICAL INDEX
ANNUAL STATEMENT BLANK (Continued)
Schedule P – Part 1E – Commercial Multiple Peril
Schedule P – Part 1F – Section 1 – Medical Professional Liability – Occurrence
Schedule P – Part 1F – Section 2 – Medical Professional Liability – Claims-Made
Schedule P – Part 1G - Special Liability (Ocean, Marine, Aircraft (All Perils), Boiler and
Machinery)
Schedule P – Part 1H – Section 1 – Other Liability–Occurrence
Schedule P – Part 1H – Section 2 – Other Liability – Claims-Made
Schedule P – Part 1I – Special Property (Fire, Allied Lines, Inland Marine, Earthquake, Burglary &
Theft)
Schedule P – Part 1J – Auto Physical Damage
Schedule P – Part 1K – Fidelity/Surety
Schedule P – Part 1L – Other (Including Credit, Accident and Health)
Schedule P – Part 1M – International
Schedule P – Part 1N – Reinsurance
Schedule P – Part 1O – Reinsurance
Schedule P – Part 1P – Reinsurance
Schedule P – Part 1R – Section 1 – Products Liability – Occurrence
Schedule P – Part 1R – Section 2 – Products Liability – Claims – Made
Schedule P – Part 1S – Financial Guaranty/Mortgage Guaranty
Schedule P – Part 1T – Warranty
Schedule P – Part 2, Part 3 and Part 4 - Summary
Schedule P – Part 2A – Homeowners/Farmowners
Schedule P – Part 2B – Private Passenger Auto Liability/Medical
Schedule P – Part 2C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 2D – Workers’ Compensation
Schedule P – Part 2E – Commercial Multiple Peril
Schedule P – Part 2F – Section 1 – Medical Professional Liability – Occurrence
Schedule P – Part 2F – Section 2 – Medical Professional Liability – Claims – Made
Schedule P – Part 2G – Special Liability (Ocean Marine, Aircraft (All Perils), Boiler and
Machinery)
Schedule P – Part 2H – Section 1 – Other Liability – Occurrence
Schedule P – Part 2H – Section 2 – Other Liability – Claims – Made
Schedule P – Part 2I – Special Property (Fire, Allied Lines, Inland Marine, Earthquake, Burglary,
and Theft)
Schedule P – Part 2J – Auto Physical Damage
Schedule P – Part 2K – Fidelity, Surety
Schedule P – Part 2L – Other (Including Credit, Accident and Health)
Schedule P – Part 2M – International
Schedule P – Part 2N – Reinsurance
Schedule P – Part 2O – Reinsurance
Schedule P – Part 2P – Reinsurance
Schedule P – Part 2R – Section 1 – Products Liability – Occurrence
Schedule P – Part 2R – Section 2 – Products Liability – Claims-Made
Schedule P – Part 2S – Financial Guaranty/Mortgage Guaranty
Schedule P – Part 2T – Warranty
Schedule P – Part 3A – Homeowners/Farmowners
INDEX3
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
32
55
55
55
55
55
56
56
56
56
56
57
57
57
57
57
58
58
58
59
59
59
59
60
ALPHABETICAL INDEX
ANNUAL STATEMENT BLANK (Continued)
Schedule P – Part 3B – Private Passenger Auto Liability/Medical
Schedule P – Part 3C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 3D – Workers’ Compensation
Schedule P – Part 3E – Commercial Multiple Peril
Schedule P – Part 3F – Section 1 – Medical Professional Liability – Occurrence
Schedule P – Part 3F – Section 2 – Medical Professional Liability – Claims-Made
Schedule P – Part 3G – Special Liability (Ocean Marine, Aircraft (All Perils), Boiler and
Machinery)
Schedule P – Part 3H – Section 1 – Other Liability – Occurrence
Schedule P – Part 3H – Section 2 – Other Liability – Claims-Made
Schedule P – Part 3I – Special Property (Fire, Allied Lines, Inland Marine, Earthquake, Burglary,
and Theft)
Schedule P – Part 3J – Auto Physical Damage
Schedule P – Part 3K – Fidelity/Surety
Schedule P – Part 3L – Other (Including Credit, Accident and Health)
Schedule P – Part 3M – International
Schedule P – Part 3N – Reinsurance
Schedule P – Part 3O – Reinsurance
Schedule P – Part 3P – Reinsurance
Schedule P – Part 3R – Section 1 – Products Liability – Occurrence
Schedule P – Part 3R – Section 2 – Products Liability – Claims-Made
Schedule P – Part 3S – Financial Guaranty/Mortgage Guaranty
Schedule P – Part 3T – Warranty
Schedule P – Part 4A – Homeowners/Farmowners
Schedule P – Part 4B – Private Passenger Auto Liability/Medical
Schedule P – Part 4C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 4D – Workers’ Compensation
Schedule P – Part 4E – Commercial Multiple Peril
Schedule P – Part 4F – Section 1 – Medical Professional Liability – Occurrence
Schedule P – Part 4F – Section 2 – Medical Professional Liability – Claims-Made
Schedule P – Part 4G – Special Liability (Ocean Marine, Aircraft (All Perils), Boiler and
Machinery)
Schedule P – Part 4H – Section 1 – Other Liability – Occurrence
Schedule P – Part 4H – Section 2 – Other Liability – Claims-Made
Schedule P – Part 4I – Special Property (Fire, Allied Lines, Inland Marine, Earthquake, Burglary
and Theft)
Schedule P – Part 4J – Auto Physical Damage
Schedule P – Part 4K – Fidelity/Surety
Schedule P – Part 4L – Other (Including Credit, Accident and Health)
Schedule P – Part 4M – International
Schedule P – Part 4N – Reinsurance
Schedule P – Part 4O – Reinsurance
Schedule P – Part 4P – Reinsurance
Schedule P – Part 4R – Section 1 – Products Liability – Occurrence
Schedule P – Part 4R – Section 2 – Products Liability – Claims-Made
INDEX4
60
60
60
60
61
61
61
61
61
62
62
62
62
62
63
63
63
64
64
64
64
65
65
65
65
65
66
66
66
66
66
67
67
67
67
67
68
68
68
69
69
ALPHABETICAL INDEX
ANNUAL STATEMENT BLANK (Continued)
Schedule P – Part 4S – Financial Guaranty/Mortgage Guaranty
Schedule P – Part 4T – Warranty
Schedule P – Part 5A – Homeowners/Farmowners
Schedule P – Part 5B – Private Passenger Auto Liability/Medical
Schedule P – Part 5C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 5D – Workers’ Compensation
Schedule P – Part 5E – Commercial Multiple Peril
Schedule P – Part 5F – Medical Professional Liability – Claims-Made
Schedule P – Part 5F – Medical Professional Liability – Occurrence
Schedule P – Part 5H – Other Liability – Claims-Made
Schedule P – Part 5H – Other Liability – Occurrence
Schedule P – Part 5R – Products Liability – Claims-Made
Schedule P – Part 5R – Products Liability – Occurrence
Schedule P – Part 5T – Warranty
Schedule P – Part 6C – Commercial Auto/Truck Liability/Medical
Schedule P – Part 6D – Workers’ Compensation
Schedule P – Part 6E – Commercial Multiple Peril
Schedule P – Part 6H – Other Liability – Claims-Made
Schedule P – Part 6H – Other Liability – Occurrence
Schedule P – Part 6M – International
Schedule P – Part 6N – Reinsurance
Schedule P – Part 6O – Reinsurance
Schedule P – Part 6R – Products Liability – Claims-Made
Schedule P – Part 6R – Products Liability – Occurrence
Schedule P – Part 7A – Primary Loss Sensitive Contracts
Schedule P – Part 7B – Reinsurance Loss Sensitive Contracts
Schedule P Interrogatories
Schedule T – Exhibit of Premiums Written
Schedule T – Part 2 – Interstate Compact
Schedule Y – Information Concerning Activities of Insurer Members of a Holding Company Group
Schedule Y – Part 2 – Summary of Insurer’s Transactions With Any Affiliates
Statement of Income
Summary Investment Schedule
Supplemental Exhibits and Schedules Interrogatories
Underwriting and Investment Exhibit Part 1
Underwriting and Investment Exhibit Part 1A
Underwriting and Investment Exhibit Part 1B
Underwriting and Investment Exhibit Part 2
Underwriting and Investment Exhibit Part 2A
Underwriting and Investment Exhibit Part 3
INDEX5
69
69
70
71
72
73
74
76
75
78
77
80
79
81
82
82
83
84
83
84
85
85
86
86
87
89
91
92
93
94
95
4
SI01
96
6
7
8
9
10
11
INDEX6