Form 6314 Annual Financial Statements of Surety Companies - Schedu

Annual Financial Statements of Surety Companies - Schedule FA

Schedule F Form 2007 - Draft.xls

Annual Financial Statements of Surety Companies - Schedule F

OMB: 1510-0012

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Section I
Section II
Section III
Section IV and V
Section VI
Section VII
Section VIII
Funds Held Section
Summary Page
Section II Overflow Page
Section IV Overflow Page
Section VII Overflow Page
Section VIII Overflow Page
Funds Held Overflow Page

Sheet 1: Instructions
U.S. Treasury Schedule F
For the Year-Ended December 31, 2XXX
Spreadsheet Version


Following is a series of worksheets that have been designed to provide those companies filing U.S. Treasury
Schedule F with a spreadsheet template for completing the Schedule. Each individual section of the
U.S. Treasury Schedule F has been given a separate worksheet that can be accessed by clicking on the
appropriate TAB Button located at the bottom of this worksheet. Please note that all TABS may not be
immediately viewable within your computer screen but can be accessed using the scrolling arrows located in
the bottom left corner of the viewable screen.


Within this worksheet you will find the following U.S. Treasury Schedule F Sections:
(Please note there are 35 total printable pages - all pages will print in black and white.




1. Section I - Treasury Authorized Companies (12 printable pages)
2. Section II - Other Treasury Authorized Companies (1 printable page)
3. Section III - Treasury Authorized Pools and Associations (11 printable pages)
4. Section IV THRU V - Other Treasury Authorized Pools and Associations (1 printable page)
5. Section VI - Treasury Unauthorized Pools and Associations (3 printable pages)
6. Section VII - Other Treasury Unauthorized Pools and Associations (1 printable page)
7. Section VIII - Treasury Unauthorized Companies (3 printable pages)
8. Funds Held Section - Funds Held Securing Reinsurance Recoverables from Unauthorized Companies (2 printable pages)
9. Summary Page - Summary Total of Treasury Unauthorized Reinsurance (1 printable page)


Overflow Pages have been included as separate TAB items and may be used if additional pages of the
above-listed sections are required in order to complete your company's Treasury Schedule F.
Please reproduce these worksheets when needed by using the copy and paste features of your spreadsheet
program.


Overflow Pages included with this spreadsheet program are:


10. Section II Overflow Page - Other Treasury Authorized Companies - (Add-on to Section II above)
11. Section IV Overflow Page - Other Treasury Authorized Pools and Associations - (Add-on to Section IV above)
12. Section VII Overflow Page - Other Treasury Unauthorized Pools and Associations - (Add-on to Section VII above)
13. Section VIII Overflow Page - Treasury Unauthorized Companies - (Add-on to Section VIII above)
14. Funds Held Overflow Page - Funds Held Securing Reins. Recoverables from Unauth.Companies - (Add-on to Funds Held section)


Note:
Certain cell ranges within these worksheets have been write-protected. If you select a cell-range that has
been write-protected an error message will appear. Simply select OK or cancel and you may proceed to
an area designed for data-entry.


If you experience problems with this spreadsheet, please contact the Surety Bond Branch at (202) 874-6850 for
assistance. In lieu of completing this spreadsheet version of U.S. Treasury Schedule F, a company may still
complete the 11 x 14 inch printed version of U.S. Treasury Schedule F that will be sent along with the annual
filing requirements to be mailed in early 2XXX.

Sheet 2: Section I







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 1 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES: Do not include reinsurance applicable to alien companies in this section. All such reinsurance is unauthorized and should be listed under Section VIII.






























01-0471706 31325 Acadia Insurance Company ME











59-1362150 26379 ACCREDITED SURETY AND CASUALTY COMPANY, INC. FL











36-2704802 22950 ACSTAR INSURANCE COMPANY CT











23-2035821 33898 Aegis Security Insurance Company PA











05-0254496 10014 Affiliated FM Insurance Company RI











63-0262164 19135 Alfa Mutual Insurance Company AL











34-0935740 20222 ALL AMERICA INSURANCE COMPANY OH











25-0315340 13285 Allegheny Casualty Company PA











42-1201931 42579 ALLIED Property and Casualty Insurance Company IA











36-3586255 30511 Allstate Floridian Insurance Company IL











36-0719665 19232 ALLSTATE INSURANCE COMPANY IL











36-4181960 10852 ALLSTATE NEW JERSEY INSURANCE COMPANY IL











42-6054959 19100 AMCO Insurance Company IA











36-2661954 10103 American Agricultural Insurance Company IL











52-2048110 19720 AMERICAN ALTERNATIVE INSURANCE CORPORATION NJ











22-1608585 21849 American Automobile Insurance Company CA











59-0593886 10111 AMERICAN BANKERS INSURANCE COMPANY OF FLORIDA FL











23-0342560 20427 American Casualty Company of Reading, Pennsylvania IL











95-4290651 10216 AMERICAN CONTRACTORS INDEMNITY COMPANY CA











35-1044900 19690 American Economy Insurance Company WA











04-1027270 20613 American Employers' Insurance Company MA











59-0141790 24066 American Fire and Casualty Company OH











36-6071400 26247 American Guarantee and Liability Insurance Company IL











41-0299900 13331 American Hardware Mutual Insurance Company OH











13-5124990 19380 American Home Assurance Company NY











22-0731810 21857 American Insurance Company (The) CA











66-0319193 31674 AMERICAN INTERNATIONAL INSURANCE COMPANY OF PUERTO RICO PR











02-0226203 23795 American International Pacific Insurance Company NY











41-0735002 19615 AMERICAN RELIABLE INSURANCE COMPANY AZ



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 2 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























38-1630841 19631 AMERICAN ROAD INSURANCE COMPANY (THE) MI











58-2056755 39969 American Safety Casualty Insurance Company GA











58-6016195 10235 American Southern Insurance Company GA











35-0145400 19704 American States Insurance Company WA











35-1466792 37214 AMERICAN STATES PREFERRED INSURANCE COMPANY WA











95-3730189 31380 American Surety Company IN











38-0829210 23396 Amerisure Mutual Insurance Company MI











98-4207369 10308 Antilles Insurance Company PR











43-0990710 11150 Arch Insurance Company NY











06-1430254 10348 Arch Reinsurance Company NJ











22-1708002 21865 Associated Indemnity Corporation CA











41-1435765 41769 ATHENA ASSURANCE COMPANY MN











52-1236659 41114 Atlantic Bonding Company, Inc. MD











72-0417091 19933 AUDUBON INSURANCE COMPANY LA











38-0315280 18988 Auto-Owners Insurance Company MI











06-0848755 19062 Automobile Insurance Company of Hartford, Connecticut (The) CT











52-0795746 10367 AVEMCO INSURANCE COMPANY MD











51-0434766 20370 AXIS Reinsurance Company GA











04-2656602 37540 Beazley Insurance Company, Inc. CT











47-0574325 32603 Berkley Insurance Company CT











43-1432586 29580 Berkley Regional Insurance Company IA











25-1118791 19402 Birmingham Fire Insurance Company of Pennsylvania NY











36-0810360 20095 BITUMINOUS CASUALTY CORPORATION IL











36-6054328 20109 BITUMINOUS FIRE AND MARINE INSURANCE COMPANY IL











36-2761729 27081 BOND SAFEGUARD INSURANCE COMPANY KY











04-6017710 20761 Boston Old Colony Insurance Company IL











75-1509104 32875 BRITISH AMERICAN INSURANCE COMPANY TX











31-0708754 20788 Buckeye Union Insurance Company (The) IL











57-0810811 30589 Capital City Insurance Company, Inc. SC











39-0971527 10472 Capitol Indemnity Corporation WI



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 3 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























59-0733942 10510 Carolina Casualty Insurance Company FL











63-0701609 34568 Centennial Casualty Company AL











34-4202560 20230 CENTRAL MUTUAL INSURANCE COMPANY OH











42-1194107 42765 Centurion Casualty Company IA











31-0936702 36951 CENTURY SURETY COMPANY OH











06-0291290 25615 Charter Oak Fire Insurance Company (The) CT











38-3464294 10642 Cherokee Insurance Company MI











22-3291862 12777 CHUBB INDEMNITY INSURANCE COMPANY NJ











31-0826946 28665 Cincinnati Casualty Company (The) OH











31-0542366 10677 Cincinnati Insurance Company (The) OH











38-0421730 31534 CITIZENS INSURANCE COMPANY OF AMERICA MI











13-2781282 25070 Clearwater Insurance Company CT











52-1096670 34347 COLONIAL AMERICAN CASUALTY AND SURETY COMPANY IL











23-0485115 10758 COLONIAL SURETY COMPANY NJ











13-1938623 19410 COMMERCE AND INDUSTRY INSURANCE COMPANY NY











57-0768836 12157 COMPANION PROPERTY AND CASUALTY INSURANCE COMPANY SC











35-6018566 22640 Consolidated Insurance Company MA











36-2114545 20443 Continental Casualty Company IL











87-0363183 39551 CONTINENTAL HERITAGE INSURANCE COMPANY OH











13-5010440 35289 Continental Insurance Company (The) IL











13-1941984 20923 CONTINENTAL REINSURANCE CORPORATION IL











91-1082952 37206 CONTRACTORS BONDING AND INSURANCE COMPANY WA











66-0257478 18163 Cooperativa de Seguros Multiples de Puerto Rico PR











22-2868548 31348 Crum & Forster Indemnity Company NJ











22-2464174 42471 CRUM AND FORSTER INSURANCE COMPANY NJ











39-0972608 10847 CUMIS INSURANCE SOCIETY, INC. WI











38-1775863 10499 DaimlerChrysler Insurance Company MI











56-0997452 16624 Darwin National Assurance Company CT











13-2930697 35408 Delos Insurance Company NY











42-0429710 12718 Developers Surety and Indemnity Company CA



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 4 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























39-0264050 21458 Employers Insurance Company of Wausau WI











42-0234980 21415 Employers Mutual Casualty Company IA











48-0921045 39845 Employers Reinsurance Corporation KS











04-1288420 20648 EMPLOYERS' FIRE INSURANCE COMPANY (THE) MA











99-0360327 11551 Endurance Reinsurance Corporation of America NY











25-1232960 26263 Erie Insurance Company PA











54-1132719 39020 ESSEX INSURANCE COMPANY VA











36-2950161 35378 EVANSTON INSURANCE COMPANY IL











22-2005057 26921 Everest Reinsurance Company NJ











36-2467238 12750 Evergreen National Indemnity Company OH











15-0302550 11045 Excelsior Insurance Company MA











13-2912259 35181 Executive Risk Indemnity Inc. NJ











94-2784519 40029 Explorer Insurance Company CA











05-0316605 21482 Factory Mutual Insurance Company RI











94-0781581 25518 Fairmont Premier Insurance Company TX











74-1280541 24384 Fairmont Specialty Insurance Company TX











48-0214040 19194 Farmers Alliance Mutual Insurance Company KS











42-0245840 13897 FARMERS MUTUAL HAIL INSURANCE COMPANY OF IOWA IA











06-1067463 41483 Farmington Casualty Company CT











42-0618271 13838 Farmland Mutual Insurance Company IA











13-1963496 20281 Federal Insurance Company NJ











41-0417460 13935 FEDERATED MUTUAL INSURANCE COMPANY MN











13-5069150 35270 Fidelity and Casualty Company of New York (The) IL











13-3046577 39306 Fidelity and Deposit Company of Maryland IL











42-1091525 35386 FIDELITY AND GUARANTY INSURANCE COMPANY MN











52-0616768 25879 Fidelity and Guaranty Insurance Underwriters, Inc. MN











16-0986300 16578 Fidelity National Property and Casualty Insurance Company FL











68-0111081 31453 Financial Pacific Insurance Company CA











94-1610280 21873 Fireman's Fund Insurance Company CA



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 5 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























22-1721950 20850 Firemen's Insurance Company of Newark, New Jersey IL











36-2694846 11177 FIRST FINANCIAL INSURANCE COMPANY NC











20-1384826 12150 First Founders Assurance Company NJ











99-0218317 41742 First Insurance Company of Hawaii, Ltd. HI











04-3058503 33588 First Liberty Insurance Corporation (The) MA











91-0742144 24724 First National Insurance Company of America WA











23-2671078 28519 First Sealord Surety, Inc. PA











13-2997499 38776 FOLKSAMERICA REINSURANCE COMPANY NY











36-2667627 22969 GE Reinsurance Corporation KS











91-0231910 24732 General Insurance Company of America WA











13-2673100 22039 General Reinsurance Corporation CT











13-1958482 11967 GENERAL STAR NATIONAL INSURANCE COMPANY CT











47-6023787 11304 Global Surety & Insurance Co. NE











73-1282413 26310 GRANITE RE, INC. OK











02-0140690 23809 Granite State Insurance Company NY











72-1326720 10671 GRAY CASUALTY & SURETY COMPANY (THE) LA











72-0824217 36307 GRAY INSURANCE COMPANY (THE) LA











95-1542353 26832 Great American Alliance Insurance Company OH











31-0501234 16691 Great American Insurance Company OH











13-5539046 22136 GREAT AMERICAN INSURANCE COMPANY OF NEW YORK OH











41-0729473 20303 Great Northern Insurance Company NJ











95-1479095 22322 Greenwich Insurance Company CT











38-2907623 36650 Guarantee Company of North America USA (The) MI











13-5129825 22292 Hanover Insurance Company (The) MA











13-6108721 26433 HARCO NATIONAL INSURANCE COMPANY IL











23-0902325 14168 Harleysville Mutual Insurance Company PA











04-1989660 26182 Harleysville Worcester Insurance Company MA











06-0383030 22357 Hartford Accident and Indemnity Company CT











06-0294398 29424 Hartford Casualty Insurance Company CT



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 6 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























06-0383750 19682 Hartford Fire Insurance Company CT











06-1010609 38288 Hartford Insurance Company of Illinois CT











06-1008026 37478 Hartford Insurance Company of the Midwest CT











06-1013048 38261 Hartford Insurance Company of the Southeast CT











06-1222527 30104 Hartford Underwriters Insurance Company CT











74-2195939 42374 Houston Casualty Company TX











42-0333150 14257 IMT Insurance Company (Mutual) IA











95-2545113 25550 Indemnity Company of California CA











64-0838376 18468 Indemnity National Insurance Company TN











76-0430879 10024 Independence Casualty and Surety Company CA











35-0410010 22659 Indiana Insurance Company MA











35-0410420 14265 Indiana Lumbermens Mutual Insurance Company IN











47-6025666 23264 Inland Insurance Company NE











13-5540698 19429 Insurance Company of the State of Pennsylvania (The) NY











95-2769232 27847 Insurance Company of the West CA











74-2262949 43273 Insurors Indemnity Company TX











66-0317672 26778 INTEGRAND ASSURANCE COMPANY PR











36-6067575 24139 International Business & Mercantile REassurance Company IL











22-1010450 11592 International Fidelity Insurance Company NJ











99-6004946 22845 ISLAND INSURANCE COMPANY, LIMITED HI











48-0287450 15962 Kansas Bankers Surety Company (The) KS











25-1149494 19437 Lexington Insurance Company MA











52-1662720 37940 LEXINGTON NATIONAL INSURANCE CORPORATION MD











76-0128873 13307 Lexon Insurance Company KY











03-0316876 42404 Liberty Insurance Corporation MA











04-1924000 23035 Liberty Mutual Fire Insurance Company MA











04-1543470 23043 Liberty Mutual Insurance Company MA











23-2023242 33855 Lincoln General Insurance Company PA











04-3058504 33600 LM Insurance Corporation MA











43-1139865 35769 Lyndon Property Insurance Company MO



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 7 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























58-2258882 10702 Madison Insurance Company GA











36-3347420 23876 Mapfre Reinsurance Corporation NJ











54-1398877 28932 Markel American Insurance Company VA











36-3101262 38970 MARKEL INSURANCE COMPANY VA











04-2217600 22306 Massachusetts Bay Insurance Company MA











42-0410010 14494 Merchants Bonding Company (Mutual) IA











38-0828980 14508 Michigan Millers Mutual Insurance Company MI











95-6016640 21687 Mid-Century Insurance Company CA











73-0556513 23418 MID-CONTINENT CASUALTY COMPANY OK











31-0978280 23515 MIDWESTERN INDEMNITY COMPANY (THE) MA











41-0665921 30996 Minnesota Surety and Trust Company MN











22-3818012 20362 Mitsui Sumitomo Insurance Company of America NJ











13-3467153 22551 Mitsui Sumitomo Insurance USA Inc. NJ











31-4259550 14621 Motorists Mutual Insurance Company OH











38-0855585 22012 Motors Insurance Corporation MI











13-4924125 10227 Munich Reinsurance America, Inc. NJ











47-0247300 23663 National American Insurance Company OK











84-0982643 16217 NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY CO











47-6021331 20079 National Fire & Marine Insurance Company NE











06-0464510 20478 National Fire Insurance Company of Hartford IL











47-0355979 20087 National Indemnity Company NE











13-1988169 34835 NATIONAL REINSURANCE CORPORATION CT











36-2704643 21881 National Surety Corporation CA











25-0687550 19445 National Union Fire Insurance Company of Pittsburgh, PA NY











11-3658357 11595 NATIONS BONDING COMPANY IA











31-1399201 10070 Nationwide Indemnity Company OH











31-4177110 23779 Nationwide Mutual Fire Insurance Company OH











31-4177100 23787 Nationwide Mutual Insurance Company OH











13-3138390 42307 NAVIGATORS INSURANCE COMPANY NY











02-0342937 24171 Netherlands Insurance Company (The) MA



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 8 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























06-1053492 41629 New England Reinsurance Corporation MA











02-0172170 23841 New Hampshire Insurance Company NY











22-2187459 35432 New Jersey Re-Insurance Company NJ











02-0170490 14788 NGM Insurance Company NH











98-0032627 27073 NIPPONKOA Insurance Company, Limited (U.S. Branch) NY











02-0311919 29874 NORTH AMERICAN SPECIALTY INSURANCE COMPANY NH











38-2706529 27740 NORTH POINTE INSURANCE COMPANY MI











22-1964135 21105 North River Insurance Company (The) NJ











13-2930109 22047 North Star Reinsurance Corporation CT











04-2974375 38369 Northern Assurance Company of America (The) MA











95-2379438 20338 NORTHWESTERN PACIFIC INDEMNITY COMPANY NJ











16-1140177 42552 NOVA Casualty Company NY











47-0698507 23680 Odyssey America Reinsurance Corporation CT











31-0396250 24074 Ohio Casualty Insurance Company (The) OH











34-0438190 24104 Ohio Farmers Insurance Company OH











31-0620146 26565 Ohio Indemnity Company OH











73-0773259 23426 Oklahoma Surety Company OK











59-2070420 40231 OLD DOMINION INSURANCE COMPANY NH











25-0410420 24147 Old Republic Insurance Company PA











39-1395491 40444 Old Republic Surety Company WI











04-2475442 20621 OneBeacon America Insurance Company MA











23-1502700 21970 OneBeacon Insurance Company MA











95-1078160 20346 Pacific Indemnity Company NJ











96-0001575 18380 PACIFIC INDEMNITY INSURANCE COMPANY GU











06-1401918 10046 Pacific Insurance Company, Limited MA











13-3031176 38636 PARTNER REINSURANCE COMPANY OF THE U.S. CT











13-3531373 10006 PARTNERRE INSURANCE COMPANY OF NEW YORK CT











13-2919779 18333 Peerless Indemnity Insurance Company MA











02-0177030 24198 Peerless Insurance Company MA



























Page Subtotal





































































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 9 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























37-6028411 24228 Pekin Insurance Company IL











24-0686200 14982 Penn Millers Insurance Company PA











23-1471444 21962 Pennsylvania General Insurance Company MA











23-0961349 14990 Pennsylvania National Mutual Casualty Insurance Company PA











23-1738402 18058 PHILADELPHIA INDEMNITY INSURANCE COMPANY PA











06-0303275 25623 Phoenix Insurance Company (The) CT











84-1144827 12670 Pioneer General Insurance Company CO











52-1952955 10357 PLATINUM UNDERWRITERS REINSURANCE, INC. NY











56-0997453 18619 PLATTE RIVER INSURANCE COMPANY WI











34-6513736 24260 Progressive Casualty Insurance Company OH











34-1318335 38628 PROGRESSIVE NORTHERN INSURANCE COMPANY OH











91-1187829 42919 Progressive Northwestern Insurance Company OH











34-1287020 37834 Progressive Preferred Insurance Company OH











35-6021485 12416 Protective Insurance Company IN











13-3333610 35157 PUTNAM REINSURANCE COMPANY NY











06-1206728 29807 PXRE Reinsurance Company NJ











23-1641984 10219 QBE Reinsurance Corporation NY











41-0451140 67105 ReliaStar Life Insurance Company GA











31-4290270 12475 Republic - Franklin Insurance Company NY











76-0227154 28860 RLI Indemnity Company IL











37-0915434 13056 RLI Insurance Company IL











59-2136562 42706 Roche Surety and Casualty Company, Inc. FL











91-0742148 24740 SAFECO Insurance Company of America WA











91-1115311 39012 SAFECO Insurance Company of Illinois WA











91-0885519 24759 SAFECO National Insurance Company WA











43-0727872 15105 Safety National Casualty Corporation MO











35-1524574 40460 Sagamore Insurance Company IN











13-5379820 22535 Seaboard Surety Company CT











39-0355180 22543 SECURA INSURANCE, A Mutual Company WI











22-1272390 12572 Selective Insurance Company of America NJ



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 10 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























16-1209233 13730 Selective Insurance Company of New York NJ











56-0564874 19259 Selective Insurance Company of South Carolina NJ











56-1285899 39926 Selective Insurance Company of the Southeast NJ











22-2001995 26301 Selective Way Insurance Company NJ











13-2941133 10936 Seneca Insurance Company, Inc. NY











06-1552103 11000 SENTINEL INSURANCE COMPANY, LTD. CT











39-0333950 24988 Sentry Insurance A Mutual Company WI











36-2674180 21180 Sentry Select Insurance Company WI











59-1786118 36560 SERVICE INSURANCE COMPANY FL











22-2842279 28240 SERVICE INSURANCE COMPANY INC. (THE) NJ











41-0406690 24767 St. Paul Fire and Marine Insurance Company MN











41-0963301 24775 ST. PAUL GUARDIAN INSURANCE COMPANY MN











41-1435766 41750 St. Paul Medical Liability Insurance Company MN











41-0881659 24791 St. Paul Mercury Insurance Company MN











36-2542404 19224 ST. PAUL PROTECTIVE INSURANCE COMPANY MN











06-6033509 19070 Standard Fire Insurance Company (The) CT











38-2626205 18023 Star Insurance Company MI











57-6010814 25127 State Auto Property and Casualty Insurance Company OH











31-4316080 25135 State Automobile Mutual Insurance Company OH











37-0533080 25143 State Farm Fire and Casualty Company IL











31-4423946 10952 Stonebridge Casualty Insurance Company MD











13-3031274 39187 Suecia Insurance Company NY











76-0568746 10916 Suretec Insurance Company TX











46-0417363 24047 SURETY BONDING COMPANY OF AMERICA SD











95-2564845 12793 Surety Company of the Pacific CA











13-1675535 25364 Swiss Reinsurance America Corporation NY











75-1161565 20389 TEXAS PACIFIC INDEMNITY COMPANY NJ











20-0940754 32301 TNUS Insurance Company NY











13-2918573 42439 TOA REINSURANCE COMPANY OF AMERICA (THE) NJ











13-6108722 12904 Tokio Marine & Nichido Fire Insurance Co., Ltd. NY



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 11 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























13-5616275 19453 TRANSATLANTIC REINSURANCE COMPANY NY











36-6043106 20486 Transcontinental Insurance Company IL











36-1877247 20494 Transportation Insurance Company IL











06-6033504 19038 Travelers Casualty and Surety Company CT











06-0907370 31194 Travelers Casualty and Surety Company of America CT











06-1286266 36170 Travelers Casualty Company of Connecticut CT











06-0876835 19046 Travelers Casualty Insurance Company of America CT











06-1286268 36137 Travelers Commercial Insurance Company CT











06-0566050 25658 Travelers Indemnity Company (The) CT











58-6020487 25666 TRAVELERS INDEMNITY COMPANY OF AMERICA (THE) CT











06-0336212 25682 Travelers Indemnity Company of Connecticut (The) CT











36-3703200 38130 Travelers Personal Insurance Company CT











36-2719165 25674 Travelers Property Casualty Company of America CT











75-0620550 19887 Trinity Universal Insurance Company TX











59-2174734 41211 TRITON INSURANCE COMPANY TX











06-1184984 27120 Trumbull Insurance Company CT











06-0732738 29459 Twin City Fire Insurance Company CT











52-1504975 29599 U.S. Specialty Insurance Company TX











95-4234708 41050 Underwriter for the Professions Insurance Company CA











91-6027360 25747 Unigard Insurance Company WA











47-0547953 25844 Union Insurance Company IA











58-1847495 36226 UNITED CASUALTY AND SURETY INSURANCE COMPANY MA











42-0644327 13021 United Fire & Casualty Company IA











74-6045664 19496 UNITED FIRE & INDEMNITY COMPANY IA











52-0515280 25887 United States Fidelity and Guaranty Company MN











13-5459190 21113 United States Fire Insurance Company NJ











52-1976385 10656 United States Surety Company MD











66-0457223 44423 UNITED SURETY AND INDEMNITY COMPANY PR











66-0313825 31704 UNIVERSAL INSURANCE COMPANY PR











47-0363416 25933 Universal Surety Company NE



























Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 12 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION I














TREASURY AUTHORIZED COMPANIES (Continued):






























43-1249228 41181 UNIVERSAL UNDERWRITERS INSURANCE COMPANY KS











15-0476880 25976 Utica Mutual Insurance Company NY











23-1620527 20508 Valley Forge Insurance Company IL











46-0310317 30279 VAN TOL SURETY COMPANY, INCORPORATED SD











73-1278263 28517 VICTORE INSURANCE COMPANY OK











13-1963495 20397 Vigilant Insurance Company NJ











36-2860812 32778 Washington International Insurance Company IL











31-0624491 44393 West American Insurance Company OH











39-0698170 15350 WEST BEND MUTUAL INSURANCE COMPANY WI











13-5481330 21121 Westchester Fire Insurance Company PA











88-0312513 10008 Western Insurance Company NV











46-0204900 13188 Western Surety Company SD











34-6516838 24112 Westfield Insurance Company OH











34-1022544 24120 Westfield National Insurance Company OH











13-1941868 34207 Westport Insurance Corporation KS











13-1290712 20583 XL Reinsurance America Inc. CT











85-0277191 37885 XL Specialty Insurance Company CT











95-1651549 13269 ZENITH INSURANCE COMPANY CA











36-4233459 16535 Zurich American Insurance Company IL











































































































































































































Page Subtotal














SECTION I TOTAL (ENTER IN SECTION V)














Sheet 3: Section II







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 13 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
Section II














OTHER TREASURY AUTHORIZED COMPANIES:






























(A) Reinsurance with subsidiaries (other affiliated companies are unauthorized and should be shown in Section VIII.)














Credit may be allowed for reinsurance cessions to subsidiaries not shown under Section I. List the names of such companies, complete the














corresponding columns, and submit a completely executed financial statement for each listed company.






























































































































































































































(B) Reinsurance with other Treasury authorized companies.














































































































































































































SECTION II TOTAL (ENTER IN SECTION V)














Sheet 4: Section III







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 14 of 36

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: Show percentages as indicated, of authorized reinsurance in this section. If percentage is less than 100%, show remainder under Section VI.

































67 Alabama Commercial Automobile Procedure Johnston, RI













68 Alabama Workers’ Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













34 Alaska Workers' Compensation Assigned Risk Pool Boca Raton, FL













100 American Hull Insurance Syndicate New York, NY














American Nuclear Insurers: West Haven, CT













86 Domestic Property and Liability Syndicate














60 Foreign Property and Liability Syndicate














100 American Offshore Insurance Syndicate New York, NY













65 Arizona Commercial Automobile Insurance Procedure Johnston, RI













61 Arkansas Commercial Automobile Insurance Procedure Johnston, RI













85 Arkansas Mutual Assigned Risk Reinsurance Pool Boca Raton, FL













55 Arkansas Stock Pool For Assigned Risks Boca Raton, FL













88 Associated Aerospace Underwriters Short Hills, NJ













75 Associated Aviation Underwriters Short Hills, NJ













53 California Commercial Automobile Insurance Procedure Johnston, RI













58 Colorado Commercial Automobile Insurance Procedure Johnston, RI













52 Commonwealth Automobile Reinsurers Boston, MA













79 Connecticut Commercial Automobile Insurance Procedure Johnston, RI













70 Delaware Commercial Automobile Insurance Procedure Johnston, RI













86 District of Columbia Commercial Automobile Insurance Procedure Washington, DC













39 Excess & Casualty Reinsurance Association New York, NY













100 Excise Bond Underwriters New York, NY













59 Georgia Commercial Automobile Insurance Procedure Johnston, RI













73 Global Aerospace Pool Short Hills, NJ













51 Idaho Commercial Automobile Insurance Procedure Johnston, RI













51 Illinois Commercial Automobile Insurance Procedure Johnston, RI













62 Illinois Fair Plan Association Chicago, IL













72 Illinois Mutual Assigned Risk Reinsurance Pool Boca Raton, FL













56 Illinois Stock Pool For Assigned Risks Boca Raton, FL













62 Illinois Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL












Page Subtotal
























































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 15 of 36

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS (Continued):

































65 Indiana Commercial Automobile Insurance Procedure Johnston, RI













100 Industrial Risk Insurers Hartford, CT













55 Iowa Commercial Automobile Insurance Procedure Johnston, RI













57 Iowa Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













58 Kansas Commerical Automobile Insurance Procedure Johnston, RI













66 Kentucky Commercial Automobile Insurance Procedure Johnston, RI













68 Kentucky Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













++ Lloyds' Underwriters, London, England














54 Louisiana Commercial Automobile Insurance Procedure Johnston, RI













64 Maine Commercial Automobile Insurance Procedure Johnston, RI













58 Maine Workers' Compensation Reinsurance Pool Boca Raton, FL













70 Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmen's Compensation Insurance Boston, MA













49 Massachusetts Workers' Compenstation Assigned Risk Pool Boca Raton, FL













25 Michigan Catastrophic Claims Association Livonia, MI













43 Michigan Workers' Compensation Placement Facility Boca Raton, FL













52 Minnesota Commercial Automobile Insurance Procedure Johnston, RI













56 Minnesota Workers' Compensation Insurers Association, Inc. Minneapolis, MN













58 Mississippi Commercial Automobile Insurance Procedure Johnston, RI













64 Montana Commerical Automobile Insurance Procedure Johnston, RI













60 Mutual Reinsurance Bureau Cherry Valley, IL













52 National Workers' Compensation Reinsurance Pool Boca Raton, FL













49 Nebraska Commercial Automobile Insurance Procedure Johnston, RI













58 Nevada Commercial Automobile Insurance Procedure Johnston, RI













43 New Hampshire Reinsurance Facility Automobile Johnston, RI













67 New Hampshire Commercial Automobile Insurance Procedure Johnston, RI













63 New Jersey Commercial Automobile Insurance Procedure Johnston, RI













56 New Mexico Commercial Automobile Insurance Procedure Johnston, RI













50 New Mexico Worker's Compensation Assigned Risk Pool Boca Raton, FL












Page Subtotal
























































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 16 of 36

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS (Continued):

































60 New York Special Risk Distribution Program Johnston, RI













49 North Carolina Reinsurance Facility Johnston, RI













52 North Dakota Commercial Automobile Insurance Procedure Johnston, RI













73 Ohio Commerical Automobile Insurance Procedure Johnston, RI













69 Oklahoma Commercial Automobile Insurance Procedure Johnston, RI













49 Oregon Commercial Automobile Insurance Procedure Johnston, RI













56 Pennsylvania Pooled Commercial Assignment Procedure Johnston, RI













53 Pennsylvania Workers' Compensation Insurance Plan and Reinsurance Pool Boca Raton, FL













73 Rhode Island Commercial Automobile Insurance Procedure Johnston, RI













27 South Carolina Commercial Automobile Insurance Procedure Johnston, RI













36 South Carolina Reinsurance Facility Johnston, RI













49 South Dakota Commercial Automobile Insurance Procedure Johnston, RI













57 Tennessee Commercial Automobile Insurance Procedure Johnston, RI













61 Tennessee Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













70 United States Aircraft Insurance Group New York, NY













62 Utah Commerical Automobile Insurance Procedure Johnston, RI













71 Vermont Commercial Automobile Insurance Procedure Johnston, RI













68 Virginia Commercial Automobile Insurance Procedure Johnston, RI













62 Virginia Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













54 Washington Commercial Automobile Insurance Procedure Johnston, RI













75 West Virginia Commercial Automobile Insurance Procedure Johnston, RI













49 Wisconsin Compensation Rating Bureau Milwaukee, WI













54 Wisconsin Special Risk Distrib. Program Johnston, RI













30 Workers' Compensation Reinsurance Association St. Paul, MN













74 Workers' Compensation Reinsurance Bureau (The) Minneapolis, MN













64 Wyoming Commercial Automobile Insurance Procedure Johnston, RI














































Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 17 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1122000 Lloyds of London (Authorized)















AA 1120048 5820














AA 1126002 2














AA 1126003 5000














AA 1126004 4444














AA 1126005 4000














AA 1126006 4472














AA 1126028 28














AA 1126033 33














AA 1126034 34














AA 1126040 40














AA 1126047 47














AA 1126048 48














AA 1126051 51














AA 1126052 52














AA 1126053 53














AA 1126055 55














AA 1126062 62














AA 1126079 79














AA 1126102 102














AA 1126112 112














AA 1126122 122














AA 1126123 123














AA 1126136 136














AA 1126138 138














AA 1126159 159














AA 1126172 172














AA 1126173 173














AA 1126178 178














AA 1126179 179






























Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 18 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1126183 183














AA 1126187 187














AA 1126190 190














AA 1126204 204














AA 1126205 205














AA 1126218 218














AA 1126219 219














AA 1126227 227














AA 1126228 228














AA 1126250 250














AA 1126270 270














AA 1126271 271














AA 1126282 282














AA 1126314 314














AA 1126318 318














AA 1126322 322














AA 1126328 328














AA 1126329 329














AA 1126340 340














AA 1126360 360














AA 1126362 362














AA 1126375 375














AA 1126376 376














AA 1126382 382














AA 1126386 386














AA 1126397 397














AA 1126431 431














AA 1126435 435














AA 1126441 441














AA 1126456 456






























Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 19 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1126457 457














AA 1126473 473














AA 1126483 483














AA 1126484 484














AA 1126488 488














AA 1126490 490














AA 1126500 500














AA 1126506 506














AA 1126507 507














AA 1126510 510














AA 1126529 529














AA 1126535 535














AA 1126536 536














AA 1126538 538














AA 1126539 539














AA 1126545 545














AA 1126552 552














AA 1126557 557














AA 1126566 566














AA 1126570 570














AA 1126575 575














AA 1126582 582














AA 1126588 588














AA 1126590 590














AA 1126609 609














AA 1126623 623














AA 1126624 624














AA 1126625 625














AA 1126626 626














AA 1126658 658






























Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 20 of 36
. AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1126672 672














AA 1126683 683














AA 1126702 702














AA 1126718 718














AA 1126724 724














AA 1126727 727














AA 1126732 732














AA 1126734 734














AA 1126735 735














AA 1126741 741














AA 1126744 744














AA 1126765 765














AA 1126766 766














AA 1126780 780














AA 1126800 800














AA 1126807 807














AA 1126808 808














AA 1126822 822














AA 1126823 823














AA 1126824 824














AA 1126839 839














AA 1126858 858














AA 1126861 861














AA 1126902 902














AA 1126920 920














AA 1126923 923














AA 1126925 925














AA 1126947 947














AA 1126955 955














AA 1126957 957






























Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 21 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1126958 958














AA 1126959 959














AA 1126960 960














AA 1126963 963














AA 1126990 990














AA 1126991 991














AA 1126994 994














AA 1126998 998














AA 1127003 1003














AA 1127007 1007














AA 1127009 1009














AA 1127010 1010














AA 1127019 1019














AA 1127023 1023














AA 1127027 1027














AA 1127028 1028














AA 1127036 1036














AA 1127038 1038














AA 1127047 1047














AA 1127051 1051














AA 1127055 1055














AA 1127057 1057














AA 1127069 1069














AA1127084 1084














AA 1127087 1087














AA 1127093 1093














AA 1127095 1095














AA 1127096 1096














AA 1127101 1101














AA 1127115 1115






























Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 22 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS

































AA 1127119 1119














AA 1127121 1121














AA 1127124 1124














AA 1127141 1141














AA 1127165 1165














AA 1127173 1173














AA 1127175 1175














AA 1127176 1176














AA 1127179 1179














AA 1127183 1183














AA 1127185 1185














AA 1127200 1200














AA 1127202 1202














AA 1127203 1203














AA 1127204 1204














AA 1127205 1205














AA 1127206 1206














AA 1127207 1207














AA 1127208 1208














AA 1127209 1209














AA 1127210 1210














AA 1127211 1211














AA 1127212 1212














AA 1127213 1213














AA 1127214 1214














AA 1127215 1215














AA 1127218 1218














AA 1127221 1221














AA 1127223 1223














AA 1127224 1224






























Page Subtotal
























































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 23 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS


















































AA 1127225 1225














AA 1127227 1227














AA 1127229 1229














AA 1127232 1232














AA 1127234 1234














AA 1127236 1236














AA 1127239 1239














AA 1127241 1241














AA 1127242 1242














AA 1127243 1243














AA 1127245 1245














AA 1127251 1251














AA 1127265 1265














AA 1127301 1301














AA 1127308 1308














AA 1127323 1323














AA 1127400 1400














AA 1127411 1411














AA 1127414 1414














AA 1127415 1415














AA 1127511 1511














AA 1127607 1607














AA 1127611 1611














AA 1127688 1688














AA 1127861 1861














AA 1120054 1886














AA 1127900 1900














AA 1127999 1999














AA 1128000 2000






























Page Subtotal
























































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 24 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS


















































AA 1128001 2001














AA 1128003 2003














AA 1128010 2010














AA 1128011 2011














AA 1128020 2020














AA 1128021 2021














AA 1128027 2027














AA 1128121 2121














AA 1128147 2147














AA 1128176 2176














AA 1128183 2183














AA 1128227 2227














AA 1128241 2241














AA 1128271 2271














AA 1128322 2322














AA 1128323 2323














AA 1128341 2341














AA 1128345 2345














AA 1128376 2376














AA 1128488 2488














AA 1128490 2490














AA 1128506 2506














AA 1128591 2591














AA 1128607 2607














AA 1128623 2623














AA 1128658 2658














AA 1128659 2659














AA 1128724 2724






























Page Subtotal























































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 25 of 36

AIIN Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable





Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION III















TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: SYNDICATES FOR LLOYD'S UNDERWRITERS


















































AA 1128734 2734














AA 1128741 2741














AA 1128791 2791














AA 1128923 2923














AA 1128947 2947














AA 1128987 2987














AA 1129000 3000














AA 1129030 3030














AA 1129210 3210














AA 1120056 3786
















































































































































































































































































































































Page Subtotal















SECTION III TOTAL (ENTER IN SECTION V)
































Sheet 5: Section IV and V







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 26 of 36

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage



(A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION IV














OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:














List any pools (not shown in Section III) in which Treasury authorized companies participate. The Treasury authorized percentage may be computed by determining














the percentage of participation of Treasury authorized companies in the pool. Do not include percentages of participation of any alien reinsurer. List the pools














alphabetically, inserting the computed percentage to the left of each name and complete Columns 1 through 8. In instances where the percentage is less than 100%,














the remainder should be shown under Section VII. Submit on a separate sheet the names and percentage of participation of companies comprising the pools.














Failure to submit this information will result in Treasury nonadmitting the cessions to these pools.






























































































































































































































































SECTION IV TOTAL (ENTER IN SECTION V)














































SECTION V














TREASURY AUTHORIZED:






























Total Section I














Total Section II














Total Section III














Total Section IV














GRAND TOTAL TREASURY AUTHORIZED (ENTER IN SECTION X)














Sheet 6: Section VI







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 27 of 36

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VI















TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:

































33 Alabama Commercial Automobile Procedure Johnston, RI













32 Alabama Workers’ Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













66 Alaska Workers' Compensation Assigned Risk Pool Boca Raton, FL













0 American Hull Insurance Syndicate New York, NY














American Nuclear Insurers: West Haven, CT













14 Domestic Property and Liability Syndicate














40 Foreign Property and Liability Syndicate














0 American Offshore Insurance Syndicate New York, NY













35 Arizona Commercial Automobile Insurance Procedure Johnston, RI













39 Arkansas Commercial Automobile Insurance Procedure Johnston, RI













15 Arkansas Mutual Assigned Risk Reinsurance Pool Boca Raton, FL













45 Arkansas Stock Pool For Assigned Risks Boca Raton, FL













12 Associated Aerospace Underwriters Short Hills, NJ













25 Associated Aviation Underwriters Short Hills, NJ













47 California Commercial Automobile Insurance Procedure Johnston, RI













42 Colorado Commercial Automobile Insurance Procedure Johnston, RI













48 Commonwealth Automobile Reinsurers Boston, MA













21 Connecticut Commercial Automobile Insurance Procedure Johnston, RI













30 Delaware Commercial Automobile Insurance Procedure Johnston, RI













14 District of Columbia Commercial Automobile Insurance Procedure Washington, DC













61 Excess & Casualty Reinsurance Association New York, NY













0 Excise Bond Underwriters New York, NY













41 Georgia Commercial Automobile Insurance Procedure Johnston, RI













27 Global Aerospace Pool Short Hills, NJ













49 Idaho Commercial Automobile Insurance Procedure Johnston, RI













49 Illinois Commercial Automobile Insurance Procedure Johnston, RI













38 Illinois Fair Plan Association Chicago, IL













28 Illinois Mutual Assigned Risk Reinsurance Pool Boca Raton, FL













44 Illinois Stock Pool For Assigned Risks Boca Raton, FL












Page Subtotal 38 Illinois Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL












Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 28 of 36

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION VI















TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS (Continued):

































35 Indiana Commercial Automobile Insurance Procedure Johnston, RI













0 Industrial Risk Insurers Hartford, CT













45 Iowa Commercial Automobile Insurance Procedure Johnston, RI













43 Iowa Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













42 Kansas Commerical Automobile Insurance Procedure Johnston, RI













34 Kentucky Commercial Automobile Insurance Procedure Johnston, RI













32 Kentucky Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













++ Lloyds' Underwriters, London, England














46 Louisiana Commercial Automobile Insurance Procedure Johnston, RI













36 Maine Commercial Automobile Insurance Procedure Johnston, RI













42 Maine Workers' Compensation Reinsurance Pool Boca Raton, FL













30 Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmen's Compensation Insurance Boston, MA













51 Massachusetts Workers' Compenstation Assigned Risk Pool Boca Raton, FL













75 Michigan Catastrophic Claims Association Livonia, MI













57 Michigan Workers' Compensation Placement Facility Boca Raton, FL













48 Minnesota Commercial Automobile Insurance Procedure Johnston, RI













44 Minnesota Workers' Compensation Insurers Association, Inc. Minneapolis, MN













42 Mississippi Commercial Automobile Insurance Procedure Johnston, RI













36 Montana Commerical Automobile Insurance Procedure Johnston, RI













40 Mutual Reinsurance Bureau Cherry Valley, IL













48 National Workers' Compensation Reinsurance Pool Boca Raton, FL













51 Nebraska Commercial Automobile Insurance Procedure Johnston, RI













42 Nevada Commercial Automobile Insurance Procedure Johnston, RI













57 New Hampshire Reinsurance Facility Automobile Johnston, RI













33 New Hampshire Commercial Automobile Insurance Procedure Johnston, RI













37 New Jersey Commercial Automobile Insurance Procedure Johnston, RI













44 New Mexico Commercial Automobile Insurance Procedure Johnston, RI













50 New Mexico Worker's Compensation Assigned Risk Pool Boca Raton, FL












Page Subtotal







































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 29 of 36

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION VI















TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS (Continued):

































40 New York Special Risk Distribution Program Johnston, RI













51 North Carolina Reinsurance Facility Johnston, RI













48 North Dakota Commercial Automobile Insurance Procedure Johnston, RI













27 Ohio Commerical Automobile Insurance Procedure Johnston, RI













31 Oklahoma Commercial Automobile Insurance Procedure Johnston, RI













51 Oregon Commercial Automobile Insurance Procedure Johnston, RI













44 Pennsylvania Pooled Commercial Assignment Procedure Johnston, RI













47 Pennsylvania Workers' Compensation Insurance Plan and Reinsurance Pool Boca Raton, FL













27 Rhode Island Commercial Automobile Insurance Procedure Johnston, RI













73 South Carolina Commercial Automobile Insurance Procedure Johnston, RI













64 South Carolina Reinsurance Facility Johnston, RI













51 South Dakota Commercial Automobile Insurance Procedure Johnston, RI













43 Tennessee Commercial Automobile Insurance Procedure Johnston, RI













39 Tennessee Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













30 United States Aircraft Insurance Group New York, NY













38 Utah Commerical Automobile Insurance Procedure Johnston, RI













29 Vermont Commercial Automobile Insurance Procedure Johnston, RI













32 Virginia Commercial Automobile Insurance Procedure Johnston, RI













38 Virginia Workers' Compensation Reinsurance Pool For Coal Mine Risks Boca Raton, FL













46 Washington Commercial Automobile Insurance Procedure Johnston, RI













25 West Virginia Commercial Automobile Insurance Procedure Johnston, RI













51 Wisconsin Compensation Rating Bureau Milwaukee, WI













46 Wisconsin Special Risk Distrib. Program Johnston, RI













70 Workers' Compensation Reinsurance Association St. Paul, MN













26 Workers' Compensation Reinsurance Bureau (The) Minneapolis, MN













36 Wyoming Commercial Automobile Insurance Procedure Johnston, RI
















































































Page Subtotal















SECTION VI TOTAL (ENTER IN SECTION IX)






















































































































































Sheet 7: Section VII







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 30 of 36

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VII














OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:














List pools and associations as shown in Section IV. Show the percentage of unauthorized reinsurance as the difference between the percentage authorized in














Section IV and 100%. Also, list other pools and associations appearing on Schedule F of your annual financial statement and not listed in Sections III, IV, or VI.














































































































































































































































































































































































































































































































SECTION VII TOTAL (ENTER IN SECTION IX)














Sheet 8: Section VIII







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 31 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 32 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.






























































































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Page 33 of 36
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned Premiums (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Estimated (Cols 2D+5+6+7)
SECTION VIII














TREASURY UNAUTHORIZED COMPANIES (Continued):






























































































































































































































Page Subtotal














SECTION VIII TOTAL (ENTER IN SECTION IX)






























SECTION IX














TREASURY UNAUTHORIZED:






























Total Section VI














Total Section VII














Total Section VIII














Grand Total Treasury Unauthorized: (Enter in Section X)














(Enter the total of Column 8 on the last page of this Schedule)






























SECTION X














ALL REINSURANCE:






























Total Section V














Total Section IX














GRAND TOTAL: ALL REINSURANCE














(Should agree with Schedule F - Part 3 of the Annual Financial Statement














Sheet 9: Funds Held Section






ANNUAL STATEMENT FOR THE YEAR 2XXX OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Page 34 of 36





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Location (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
























































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2XXX OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Page 35 of 36





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Location (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal










PART 2 TOTAL (ENTER TOTAL OF COL. 3 ON LAST PAGE OF THIS SCHEDULE)










Sheet 10: Summary Page












ANNUAL STATEMENT FOR THE YEAR 2XXX OF







OMB No. 1510-0012














Write or Stamp Name





OMB Expiration Date: 06-30-2XXX






















Page 36 of 36
( 000's OMITTED )






















The following calculations represent the net unauthorized reinsurance for the above-mentioned company based on information provided in Parts 1 and 2 of the U.S. Treasury Schedule F.




















It is not necessary to make pen and ink adjustments to the figures on Page 3 of the Annual Financial Statement

































































Total Unauthorized Reinsurance for Treasury purposes




















(Section IX, Grand Total, Column 8)……………………………………………………………………………………………………………………………………………………………………………………………………………………..














$


























Less:




















Funds held or retained by the Company on account for such Treasury




















Unauthorized companies per Treasury Schedule F, Part 2, Col. 3……………………………………………………………………………………………………………………………………………………………………………………..














$


























Treasury Unauthorized Reinsurance…………………………………………………………………………………………………………………………………………………………………………………………………………..














$


























Less:




















* Liability for Unauthorized Reinsurance shown on the Company's




















financial statement…………………………………………………………………………………………………………………………………………………………………………………………………..














$


























Net Unauthorized Reinsurance for Treasury rating purposes…………………………………………………………………………………………………………………………………………………………………………….














$
















































* Include provision for overdue Authorized Reinsurance as well






















































































COMPANY CONTACT PERSON FOR THIS SHEDULE:

























(NAME)
(PHONE NO.)




















































Paperwork Reduction Act and
Privacy Act Statement - FMS Form 6314























By authority of 31 USC 9304-9308, 31 CFR 223, the information requested on this form is required to retain a benefit and to enable the Assistant Commissioner, Financial Operations,




















Financial Management Service, Department of the Treasury, to determine if your Company is maintaining compliance with the requirements of the Department of the Treasury in order for your Company




















to remain qualified and acceptable as a surety or reinsurance company for Federal bonds. Certified companies are required to file this form with the Treasury once each year. Failure to provide this




















information will result in non-compliance with Treasury regulations and may result in revocation of your Company's authority
































































The estimated average burden associated with this collection of information is 48 hours, 45 minutes per respondent for each response. Comments concerning the accuracy of this burden estimate




















and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Program Section, Room 100, 3700 East-West Highway,




















Hyattsville, MD 20782 and to the Office of Management and Budget, Paperwork Reduction Project, Washington, DC 20503, Attention: Desk Officer for Treasury Department, Financial Management Service



















Sheet 11: Section II Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section II Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
Section II - Overflow Page














OTHER TREASURY AUTHORIZED COMPANIES:






























(A) Reinsurance with subsidiaries (other affiliated companies are unauthorized and should be shown in Section VIII.)














Credit may be allowed for reinsurance cessions to subsidiaries not shown under Section I. List the names of such companies, complete the














corresponding columns, and submit a completely executed financial statement for each listed company.






























































































































































































































(B) Reinsurance with other Treasury authorized companies.














































































































































































SECTION II TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section II Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
Section II - Overflow Page














OTHER TREASURY AUTHORIZED COMPANIES:






























(A) Reinsurance with subsidiaries (other affiliated companies are unauthorized and should be shown in Section VIII.)














Credit may be allowed for reinsurance cessions to subsidiaries not shown under Section I. List the names of such companies, complete the














corresponding columns, and submit a completely executed financial statement for each listed company.






























































































































































































































(B) Reinsurance with other Treasury authorized companies.














































































































































































SECTION II TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section II Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
Section II - Overflow Page














OTHER TREASURY AUTHORIZED COMPANIES:






























(A) Reinsurance with subsidiaries (other affiliated companies are unauthorized and should be shown in Section VIII.)














Credit may be allowed for reinsurance cessions to subsidiaries not shown under Section I. List the names of such companies, complete the














corresponding columns, and submit a completely executed financial statement for each listed company.






























































































































































































































(B) Reinsurance with other Treasury authorized companies.














































































































































































SECTION II TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section II Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
Section II - Overflow Page














OTHER TREASURY AUTHORIZED COMPANIES:






























(A) Reinsurance with subsidiaries (other affiliated companies are unauthorized and should be shown in Section VIII.)














Credit may be allowed for reinsurance cessions to subsidiaries not shown under Section I. List the names of such companies, complete the














corresponding columns, and submit a completely executed financial statement for each listed company.






























































































































































































































(B) Reinsurance with other Treasury authorized companies.














































































































































































SECTION II TOTAL (ENTER IN SECTION V)






























Sheet 12: Section IV Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage



(A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION IV - Overflow Page














OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:














List any pools (not shown in Section III) in which Treasury authorized companies participate. The Treasury authorized percentage may be computed by determining














the percentage of participation of Treasury authorized companies in the pool. Do not include percentages of participation of any alien reinsurer. List the pools














alphabetically, inserting the computed percentage to the left of each name and complete Columns 1 through 8. In instances where the percentage is less than 100%,














the remainder should be shown under Section VII. Submit on a separate sheet the names and percentage of participation of companies comprising the pools.














Failure to submit this information will result in Treasury nonadmitting the cessions to these pools.






























































































































































































































































































































































































SECTION IV TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage



(A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION IV - Overflow Page














OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:














List any pools (not shown in Section III) in which Treasury authorized companies participate. The Treasury authorized percentage may be computed by determining














the percentage of participation of Treasury authorized companies in the pool. Do not include percentages of participation of any alien reinsurer. List the pools














alphabetically, inserting the computed percentage to the left of each name and complete Columns 1 through 8. In instances where the percentage is less than 100%,














the remainder should be shown under Section VII. Submit on a separate sheet the names and percentage of participation of companies comprising the pools.














Failure to submit this information will result in Treasury nonadmitting the cessions to these pools.






























































































































































































































































































































































SECTION IV TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage



(A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION IV - Overflow Page














OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:














List any pools (not shown in Section III) in which Treasury authorized companies participate. The Treasury authorized percentage may be computed by determining














the percentage of participation of Treasury authorized companies in the pool. Do not include percentages of participation of any alien reinsurer. List the pools














alphabetically, inserting the computed percentage to the left of each name and complete Columns 1 through 8. In instances where the percentage is less than 100%,














the remainder should be shown under Section VII. Submit on a separate sheet the names and percentage of participation of companies comprising the pools.














Failure to submit this information will result in Treasury nonadmitting the cessions to these pools.






























































































































































































































































































































































SECTION IV TOTAL (ENTER IN SECTION V)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage



(A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION IV - Overflow Page














OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:














List any pools (not shown in Section III) in which Treasury authorized companies participate. The Treasury authorized percentage may be computed by determining














the percentage of participation of Treasury authorized companies in the pool. Do not include percentages of participation of any alien reinsurer. List the pools














alphabetically, inserting the computed percentage to the left of each name and complete Columns 1 through 8. In instances where the percentage is less than 100%,














the remainder should be shown under Section VII. Submit on a separate sheet the names and percentage of participation of companies comprising the pools.














Failure to submit this information will result in Treasury nonadmitting the cessions to these pools.






























































































































































































































































































































































SECTION IV TOTAL (ENTER IN SECTION V)






























Sheet 13: Section VII Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VII - Overflow Page














OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:














List pools and associations as shown in Section IV. Show the percentage of unauthorized reinsurance as the difference between the percentage authorized in














Section IV and 100%. Also, list other pools and associations appearing on Schedule F of your annual financial statement and not listed in Sections III, IV, or VI.














































































































































































































































































































































































































































SECTION VII TOTAL (ENTER IN SECTION IX)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VII - Overflow Page














OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:














List pools and associations as shown in Section IV. Show the percentage of unauthorized reinsurance as the difference between the percentage authorized in














Section IV and 100%. Also, list other pools and associations appearing on Schedule F of your annual financial statement and not listed in Sections III, IV, or VI.














































































































































































































































































































































































































































SECTION VII TOTAL (ENTER IN SECTION IX)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VII - Overflow Page














OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:














List pools and associations as shown in Section IV. Show the percentage of unauthorized reinsurance as the difference between the percentage authorized in














Section IV and 100%. Also, list other pools and associations appearing on Schedule F of your annual financial statement and not listed in Sections III, IV, or VI.














































































































































































































































































































































































































































SECTION VII TOTAL (ENTER IN SECTION IX)





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable

Percentage


Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VII - Overflow Page














OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:














List pools and associations as shown in Section IV. Show the percentage of unauthorized reinsurance as the difference between the percentage authorized in














Section IV and 100%. Also, list other pools and associations appearing on Schedule F of your annual financial statement and not listed in Sections III, IV, or VI.














































































































































































































































































































































































































































SECTION VII TOTAL (ENTER IN SECTION IX)






























Sheet 14: Section VIII Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2XXX OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in













Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal





































ANNUAL STATEMENT FOR THE YEAR 2006 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 06-30-2XXX
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VIII Overflow Page
Federal ID NAIC Company Name of Reinsurer Location + (1) Reinsurance Premiums (2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue (3) Total Overdue (4) Percentage Overdue (5) (Known Case) Reinsurance Recoverable on Unpaid Losses (6) Incurred But Not Reported Losses and (7) Unearned (8) Total Recoverable
Number Code

Ceded (A) Current and 1 - 90 (B) 91 - 120 (C) Over 120 (D) Total (Col 2B + 2C) (Col 3/Col 2D) and Unpaid Loss Adjustment Expense Loss Adjustment Expense Premiums (Cols 2D+5+6+7)
SECTION VIII - Overflow Page














TREASURY UNAUTHORIZED COMPANIES:














List alphabetically the names of all companies appearing in Schedule F, Part 3 of your company's annual financial statement which are not listed in














Sections I and II, including unauthorized parents and affiliates, and complete Columns 1 through 8.














































































































































































































































































































































































































































Page Subtotal






























Sheet 15: Funds Held Overflow Page






ANNUAL STATEMENT FOR THE YEAR 2XXX OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal




























ANNUAL STATEMENT FOR THE YEAR 2006 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 06-30-2XXX
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page





(2)

Federal ID Number NAIC Company Code Name of Reinsurer Domiciliary Jurisdiction (1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8 (A) Funds Held By Company Under Reinsurance Treaties (B) Letters of Credit (C) Trust Agreements (D) Other Allowed Offset Items (E) Total Funds Held (Cols 2A Through 2D) (3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E) (4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3












































































































































































































































































































































































































Page Subtotal






















File Typeapplication/vnd.ms-excel
AuthorGary Kosciolek
Last Modified Byrnoel
File Modified2007-06-08
File Created2000-04-07
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