Form FMS 6314 FMS 6314 Annual Financial Statement of Surety Companies - Schedul

Annual Financial Statements of Surety Companies - Schedule F

FMS 6312_Schedule-F.xls

Annual Financial Statements of Surety Companies - Schedule F

OMB: 1530-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Section I
Section II
Section III
Section IV THRU V
Section VI
Section VII
Section VIII thru X
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 Instructions

For the Year-Ended December 31, 2009 For the year ended December 31, 2012

Spreadsheet Version 1.0



Please Enter Your Company Name in the Box →→→



Following is a series of worksheets that have been designed to provide those companies filing U.S. Treasury

Schedule F with a spreadsheet based program 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 your worksheet. The TABS have been color coded for easy identification.




Within this worksheet you will find the following U.S. Treasury Schedule F Sections:

(Please note there are 36 total printable pages (excluding over-flow pages)- all pages will print in black and white (without color, shading,

or any other formats that have been included in this spreadsheet for presentation purposes only.)




1. Section I - Treasury Authorized Companies (11 printable pages)

2. Section II - Other Treasury Authorized Companies (1 printable page)

3. Section III - Treasury Authorized Pools and Associations & Lloyds Syndicates(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.

If you enter data in the overflow pages it will be automatically carried to the appropriate Treasury Schedule F summary page sections.

If you require more overflow pages than those provided, you will need to reproduce the related worksheet and manually enter any totals from

your reproduced worksheet(s) on the appropriate summary page. Rows and columns have been established on the summary pages to allow for these types of entries.




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 to provide for easier data entry. Normally such protected cells contain formulas or information

that should not change. If you need to edit a protected cell (normally shaded green), you may unlock the cell by accessing the following menu options

"tools" "protection" unprotect" and entering the password " f ".




If you need to reproduce any of the overflow pages you will first need to unprotect the worksheet and then reproduce the worksheet via normal copy/past keystrokes.

For any reproduced worksheets, you'll need to enter your company totals manually in the appropriate summary page in the spaces provided.




Printing - All pages in this worksheet are designed to print on legal size paper. When printing your Schedule F for filing with the Treasury, you should print

all pages in sections I through the Summary Page.

In printing the overflow pages you may wish to specify the page(s) to print, otherwise blank overflow pages from a respective worksheet will print.




If you experience problems with this spreadsheet, please contact the Surety Bond Branch at (202) 874-6850 for assistance.

Sheet 2: Section I







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
















Federal ID NAIC Company Name of Reinsurer Domiciliary + (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
Jurisdiction
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.






























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




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36-2704802 22950 ACSTAR INSURANCE COMPANY Illinois




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23-2035821 33898 Aegis Security Insurance Company Pennsylvania




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05-0254496 10014 Affiliated FM Insurance Company Rhode Island




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34-0935740 20222 ALL AMERICA INSURANCE COMPANY Ohio




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25-0315340 13285 Allegheny Casualty Company Pennsylvania




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25-1548154 34541 ALLEGHENY SURETY COMPANY Pennsylvania




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42-1201931 42579 ALLIED Property and Casualty Insurance Company Iowa




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06-1182357 22730 Allied World Reinsurance Company New Hampshire




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06-1481194 10829 Alterra Reinsurance USA Inc. Connecticut




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42-6054959 19100 AMCO Insurance Company Iowa




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36-2661954 10103 American Agricultural Insurance Company Indiana




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52-2048110 19720 AMERICAN ALTERNATIVE INSURANCE CORPORATION Delaware




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22-1608585 21849 American Automobile Insurance Company Missouri




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59-0593886 10111 AMERICAN BANKERS INSURANCE COMPANY OF FLORIDA Florida




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




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95-4290651 10216 AMERICAN CONTRACTORS INDEMNITY COMPANY California




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35-1044900 19690 American Economy Insurance Company Indiana




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59-0141790 24066 American Fire and Casualty Company Ohio




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36-6071400 26247 American Guarantee and Liability Insurance Company New York




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13-5124990 19380 American Home Assurance Company New York




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22-0731810 21857 American Insurance Company (The) Ohio




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




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58-2056755 39969 American Safety Casualty Insurance Company Oklahoma




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36-3223936 42897 AMERICAN SERVICE INSURANCE COMPANY, INC. Illinois




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58-6016195 10235 American Southern Insurance Company Kansas




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35-0145400 19704 American States Insurance Company Indiana




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95-3730189 31380 American Surety Company Indiana




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38-0829210 23396 Amerisure Mutual Insurance Company Michigan




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98-4207369 10308 Antilles Insurance Company Puerto Rico




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43-0990710 11150 Arch Insurance Company Missouri




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06-1430254 10348 Arch Reinsurance Company Nebraska




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94-1390273 19801 Argonaut Insurance Company Illinois




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75-2344200 43460 ASPEN AMERICAN INSURANCE COMPANY Texas




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22-1708002 21865 Associated Indemnity Corporation California




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41-1435765 41769 ATHENA ASSURANCE COMPANY Connecticut




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38-0315280 18988 Auto-Owners Insurance Company Michigan




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




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52-0795746 10367 AVEMCO INSURANCE COMPANY Maryland




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39-1338397 37273 AXIS Insurance Company Illinois




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51-0434766 20370 AXIS Reinsurance Company New York




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59-1673015 33162 Bankers Insurance Company Florida




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04-2656602 37540 Beazley Insurance Company, Inc. Connecticut




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47-0574325 32603 Berkley Insurance Company Delaware




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43-1432586 29580 Berkley Regional Insurance Company Delaware




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36-0810360 20095 BITUMINOUS CASUALTY CORPORATION Illinois




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36-6054328 20109 BITUMINOUS FIRE AND MARINE INSURANCE COMPANY Illinois




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36-2761729 27081 BOND SAFEGUARD INSURANCE COMPANY Illinois




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46-0310317 30279 Boston Indemnity Company, Inc. South Dakota




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64-0911627 10993 Brierfield Insurance Company Mississippi




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75-1509104 32875 BRITISH AMERICAN INSURANCE COMPANY Texas




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39-0971527 10472 Capitol Indemnity Corporation Wisconsin




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59-3499140 10908 Capitol Preferred Insurance Company, Inc. Florida




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59-0733942 10510 Carolina Casualty Insurance Company Iowa




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63-0701609 34568 Centennial Casualty Company Alabama




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34-4202560 20230 CENTRAL MUTUAL INSURANCE COMPANY Ohio




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42-1194107 42765 Centurion Casualty Company Iowa




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31-0936702 36951 CENTURY SURETY COMPANY Ohio




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




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25-1118791 19402 Chartis Property Casualty Company Pennsylvania




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38-3464294 10642 Cherokee Insurance Company Michigan




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22-3291862 12777 CHUBB INDEMNITY INSURANCE COMPANY New York




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31-0826946 28665 Cincinnati Casualty Company (The) Ohio




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31-0542366 10677 Cincinnati Insurance Company (The) Ohio




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38-0421730 31534 CITIZENS INSURANCE COMPANY OF AMERICA Michigan




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52-1096670 34347 COLONIAL AMERICAN CASUALTY AND SURETY COMPANY Maryland




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23-0485115 10758 COLONIAL SURETY COMPANY Pennsylvania




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47-0530077 27812 Columbia Insurance Company Nebraska




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13-1938623 19410 COMMERCE AND INDUSTRY INSURANCE COMPANY New York




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57-0768836 12157 COMPANION PROPERTY AND CASUALTY INSURANCE COMPANY South Carolina




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36-2114545 20443 Continental Casualty Company Illinois




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87-0363183 39551 CONTINENTAL HERITAGE INSURANCE COMPANY Florida




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13-5010440 35289 Continental Insurance Company (The) Pennsylvania




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91-1082952 37206 CONTRACTORS BONDING AND INSURANCE COMPANY Washington




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




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38-1775863 10499 CorePointe Insurance Company Michigan




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22-2868548 31348 Crum & Forster Indemnity Company Delaware




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22-2464174 42471 CRUM AND FORSTER INSURANCE COMPANY New Jersey




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39-0972608 10847 CUMIS INSURANCE SOCIETY, INC. Iowa




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56-0997452 16624 Darwin National Assurance Company Delaware




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42-0429710 12718 Developers Surety and Indemnity Company Iowa




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39-0264050 21458 Employers Insurance Company of Wausau Wisconsin




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42-0234980 21415 Employers Mutual Casualty Company Iowa




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




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03-0350908 10641 Endurance American Insurance Company Delaware




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35-2293075 11551 Endurance Reinsurance Corporation of America Delaware




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25-1232960 26263 Erie Insurance Company Pennsylvania




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54-1132719 39020 ESSEX INSURANCE COMPANY Delaware




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36-2950161 35378 EVANSTON INSURANCE COMPANY Illinois




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22-2005057 26921 Everest Reinsurance Company Delaware




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36-2467238 12750 Evergreen National Indemnity Company Ohio




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13-2912259 35181 Executive Risk Indemnity Inc. Delaware




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94-2784519 40029 Explorer Insurance Company California




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05-0316605 21482 Factory Mutual Insurance Company Rhode Island




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13-3333610 35157 Fair American Insurance and Reinsurance Company New York




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48-0214040 19194 Farmers Alliance Mutual Insurance Company Kansas




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




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06-1067463 41483 Farmington Casualty Company Connecticut




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42-0618271 13838 Farmland Mutual Insurance Company Iowa




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59-1365094 10178 FCCI Insurance Company Florida




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13-1963496 20281 Federal Insurance Company Indiana




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41-0417460 13935 FEDERATED MUTUAL INSURANCE COMPANY Minnesota




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13-3046577 39306 Fidelity and Deposit Company of Maryland Maryland




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42-1091525 35386 FIDELITY AND GUARANTY INSURANCE COMPANY Iowa




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




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68-0266416 25180 Fidelity National Insurance Company California




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16-0986300 16578 Fidelity National Property and Casualty Insurance Company New York




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75-2304982 35009 Financial Casualty & Surety, Inc. Texas




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68-0111081 31453 Financial Pacific Insurance Company California




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06-1325038 39136 Finial Reinsurance Company Connecticut




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94-1610280 21873 Fireman's Fund Insurance Company California




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36-2694846 11177 FIRST FINANCIAL INSURANCE COMPANY Illinois




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20-1384826 12150 First Founders Assurance Company New Jersey




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




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




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91-0742144 24724 First National Insurance Company of America New Hampshire




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66-0561082 10972 First Net Insurance Company Guam




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22-3129711 29930 First Trenton Indemnity Company Connecticut




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39-0301590 24414 General Casualty Company Of Wisconsin Wisconsin




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91-0231910 24732 General Insurance Company of America New Hampshire




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13-2673100 22039 General Reinsurance Corporation Delaware




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13-1958482 11967 GENERAL STAR NATIONAL INSURANCE COMPANY Ohio




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33-0763205 10836 GOLDEN EAGLE INSURANCE CORPORATION New Hampshire




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31-1769414 11136 GRANGE INSURANCE COMPANY OF MICHIGAN Ohio




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31-4192970 14060 GRANGE MUTUAL CASUALTY COMPANY Ohio




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73-1282413 26310 GRANITE RE, INC. Oklahoma




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02-0140690 23809 Granite State Insurance Company Pennsylvania




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




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72-0824217 36307 GRAY INSURANCE COMPANY (THE) Louisiana




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95-1542353 26832 Great American Alliance Insurance Company Ohio




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31-0501234 16691 Great American Insurance Company Ohio




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13-5539046 22136 GREAT AMERICAN INSURANCE COMPANY OF NEW YORK New York




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41-0729473 20303 Great Northern Insurance Company Indiana




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95-1479095 22322 Greenwich Insurance Company Delaware




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




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13-5129825 22292 Hanover Insurance Company (The) New Hampshire




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13-6108721 26433 HARCO NATIONAL INSURANCE COMPANY Illinois




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04-1989660 26182 Harleysville Worcester Insurance Company Pennsylvania




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06-0383030 22357 Hartford Accident and Indemnity Company Connecticut




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06-0294398 29424 Hartford Casualty Insurance Company Indiana




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06-0383750 19682 Hartford Fire Insurance Company Connecticut




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06-1010609 38288 Hartford Insurance Company of Illinois Illinois




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06-1008026 37478 Hartford Insurance Company of the Midwest Indiana




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06-1013048 38261 Hartford Insurance Company of the Southeast Connecticut




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06-0384680 11452 Hartford Steam Boiler Inspection and Insurance Company (The) Connecticut




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06-1222527 30104 Hartford Underwriters Insurance Company Connecticut




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74-2195939 42374 Houston Casualty Company Texas




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13-5150451 25054 Hudson Insurance Company Delaware




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13-2930697 35408 IMPERIUM INSURANCE COMPANY Delaware




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42-0333150 14257 IMT Insurance Company Iowa




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95-2545113 25550 Indemnity Company of California California




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64-0838376 18468 Indemnity National Insurance Company Mississippi




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76-0430879 10024 Independence Casualty and Surety Company Texas




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35-0410420 14265 Indiana Lumbermens Mutual Insurance Company Indiana




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47-6025666 23264 Inland Insurance Company Nebraska




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




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95-2769232 27847 Insurance Company of the West California




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74-2262949 43273 Insurors Indemnity Company Texas




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66-0317672 26778 INTEGRAND ASSURANCE COMPANY Puerto Rico




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39-0367560 14303 Integrity Mutual Insurance Company Wisconsin




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22-1010450 11592 International Fidelity Insurance Company New Jersey




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99-6004946 22845 ISLAND INSURANCE COMPANY, LIMITED Hawaii




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




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25-1149494 19437 Lexington Insurance Company Delaware




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52-1662720 37940 LEXINGTON NATIONAL INSURANCE CORPORATION Maryland




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76-0128873 13307 Lexon Insurance Company Texas




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03-0316876 42404 Liberty Insurance Corporation Illinois




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04-1924000 23035 Liberty Mutual Fire Insurance Company Wisconsin




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04-1543470 23043 Liberty Mutual Insurance Company Massachusetts




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04-3058504 33600 LM Insurance Corporation Illinois




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43-1139865 35769 Lyndon Property Insurance Company Missouri




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23-2086596 36897 Manufacturers Alliance Insurance Company Pennsylvania




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54-1398877 28932 Markel American Insurance Company Virginia




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36-3101262 38970 MARKEL INSURANCE COMPANY Illinois




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04-2217600 22306 Massachusetts Bay Insurance Company New Hampshire




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42-0410010 14494 Merchants Bonding Company (Mutual) Iowa




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11-3658357 11595 Merchants National Bonding, Inc. Iowa




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38-0828980 14508 Michigan Millers Mutual Insurance Company Michigan




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95-6016640 21687 Mid-Century Insurance Company California




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73-0556513 23418 MID-CONTINENT CASUALTY COMPANY Ohio




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22-3818012 20362 Mitsui Sumitomo Insurance Company of America New York




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13-3467153 22551 Mitsui Sumitomo Insurance USA Inc. New York




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41-0299900 13331 Motorists Commercial Mutual Insurance Company Ohio




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31-4259550 14621 Motorists Mutual Insurance Company Ohio




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38-0855585 22012 Motors Insurance Corporation Michigan




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13-4924125 10227 Munich Reinsurance America, Inc. Delaware




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47-0247300 23663 National American Insurance Company Oklahoma




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38-0865250 11991 National Casualty Company Wisconsin




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




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47-6021331 20079 National Fire & Marine Insurance Company Nebraska




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06-0464510 20478 National Fire Insurance Company of Hartford Illinois




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47-0355979 20087 National Indemnity Company Nebraska




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36-2704643 21881 National Surety Corporation Illinois




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62-0729866 20141 NATIONAL TRUST INSURANCE COMPANY Indiana




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




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31-1399201 10070 Nationwide Indemnity Company Ohio




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31-4177110 23779 Nationwide Mutual Fire Insurance Company Ohio




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31-4177100 23787 Nationwide Mutual Insurance Company Ohio




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13-3138390 42307 NAVIGATORS INSURANCE COMPANY New York




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06-1053492 41629 New England Reinsurance Corporation Connecticut




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02-0172170 23841 New Hampshire Insurance Company Pennsylvania




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22-2187459 35432 New Jersey Re-Insurance Company New Jersey




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02-0170490 14788 NGM Insurance Company Florida




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




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02-0311919 29874 NORTH AMERICAN SPECIALTY INSURANCE COMPANY New Hampshire




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22-1964135 21105 North River Insurance Company (The) New Jersey




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




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95-2379438 20338 NORTHWESTERN PACIFIC INDEMNITY COMPANY Oregon




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16-1140177 42552 NOVA Casualty Company New York




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47-0698507 23680 Odyssey Reinsurance Company Connecticut




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




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34-0438190 24104 Ohio Farmers Insurance Company Ohio




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31-0620146 26565 Ohio Indemnity Company Ohio




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73-0773259 23426 Oklahoma Surety Company Ohio




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59-2070420 40231 OLD DOMINION INSURANCE COMPANY Florida




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36-6067575 24139 Old Republic General Insurance Corporation Illinois




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25-0410420 24147 Old Republic Insurance Company Pennsylvania




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39-1395491 40444 Old Republic Surety Company Wisconsin




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04-2475442 20621 OneBeacon America Insurance Company Massachusetts




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23-1502700 21970 OneBeacon Insurance Company Pennsylvania




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95-1077060 22748 Pacific Employers Insurance Company Pennsylvania




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95-1078160 20346 Pacific Indemnity Company Wisconsin




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96-0001575 18380 PACIFIC INDEMNITY INSURANCE COMPANY Guam




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06-1401918 10046 Pacific Insurance Company, Limited Connecticut




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04-1590940 11835 PARIS RE America Insurance Company Delaware




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




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13-3531373 10006 PARTNERRE INSURANCE COMPANY OF NEW YORK New York




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02-0177030 24198 Peerless Insurance Company New Hampshire




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37-6028411 24228 Pekin Insurance Company Illinois




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23-1471444 21962 Pennsylvania General Insurance Company Pennsylvania




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23-2217934 41424 Pennsylvania Manufacturers Indemnity Company Pennsylvania




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23-1642962 12262 Pennsylvania Manufacturers' Association Insurance Company Pennsylvania




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23-0961349 14990 Pennsylvania National Mutual Casualty Insurance Company Pennsylvania




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23-1738402 18058 PHILADELPHIA INDEMNITY INSURANCE COMPANY Pennsylvania




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06-0303275 25623 Phoenix Insurance Company (The) Connecticut




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52-1952955 10357 PLATINUM UNDERWRITERS REINSURANCE, INC. Maryland




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56-0997453 18619 PLATTE RIVER INSURANCE COMPANY Nebraska




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58-1140651 30945 Plaza Insurance Company Missouri




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94-6078027 21903 ProCentury Insurance Company Texas




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34-6513736 24260 Progressive Casualty Insurance Company Ohio




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34-1318335 38628 PROGRESSIVE NORTHERN INSURANCE COMPANY Wisconsin




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91-1187829 42919 Progressive Northwestern Insurance Company Ohio




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35-6021485 12416 Protective Insurance Company Indiana




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06-1206728 29807 PXRE Reinsurance Company Connecticut




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23-1641984 10219 QBE Reinsurance Corporation Pennsylvania




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39-6062860 24449 Regent Insurance Company Wisconsin




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41-0451140 67105 ReliaStar Life Insurance Company Minnesota




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31-4290270 12475 Republic - Franklin Insurance Company Ohio




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76-0227154 28860 RLI Indemnity Company Illinois




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37-0915434 13056 RLI Insurance Company Illinois




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




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25-1620138 35505 Rockwood Casualty Insurance Company Pennsylvania




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91-0742148 24740 SAFECO Insurance Company of America New Hampshire




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91-1115311 39012 SAFECO Insurance Company of Illinois Illinois




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91-0885519 24759 Safeco National Insurance Company New Hampshire




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43-0727872 15105 Safety National Casualty Corporation Missouri




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35-1524574 40460 Sagamore Insurance Company Indiana




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75-1444207 30058 SCOR REINSURANCE COMPANY New York




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39-0355180 22543 SECURA INSURANCE, A Mutual Company Wisconsin




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22-1272390 12572 Selective Insurance Company of America New Jersey




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16-1209233 13730 Selective Insurance Company of New York New York




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56-0564874 19259 Selective Insurance Company of South Carolina Indiana




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56-1285899 39926 Selective Insurance Company of the Southeast Indiana




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22-2001995 26301 Selective Way Insurance Company New Jersey




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13-2941133 10936 Seneca Insurance Company, Inc. New York




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06-1552103 11000 SENTINEL INSURANCE COMPANY, LTD. Connecticut




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39-0333950 24988 Sentry Insurance A Mutual Company Wisconsin




- - -


-
36-2674180 21180 Sentry Select Insurance Company Wisconsin




- - -


-
59-1786118 36560 SERVICE INSURANCE COMPANY Florida




- - -


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




- - -


-
13-2997499 38776 SIRIUS AMERICA INSURANCE COMPANY New York




- - -


-
20-3248706 12294 SOUTHWEST MARINE AND GENERAL INSURANCE COMPANY Arizona




- - -


-
04-1027270 20613 SPARTA Insurance Company Connecticut




- - -


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




- - -


-
41-0963301 24775 ST. PAUL GUARDIAN INSURANCE COMPANY Connecticut




- - -


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




- - -


-
41-0881659 24791 St. Paul Mercury Insurance Company Connecticut




- - -


-
36-2542404 19224 ST. PAUL PROTECTIVE INSURANCE COMPANY Illinois




- - -


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




- - -


-
38-2626205 18023 Star Insurance Company Michigan




- - -


-
22-3590451 40045 StarNet Insurance Company Delaware




- - -


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




- - -


-
31-4316080 25135 State Automobile Mutual Insurance Company Ohio




- - -


-
37-0533080 25143 State Farm Fire and Casualty Company Illinois




- - -


-
13-3031274 39187 Suecia Insurance Company New York




- - -


-
76-0568746 10916 SureTec Insurance Company Texas




- - -


-
46-0417363 24047 SURETY BONDING COMPANY OF AMERICA South Dakota




- - -


-
13-1675535 25364 Swiss Reinsurance America Corporation New York




- - -


-
75-1161565 20389 TEXAS PACIFIC INDEMNITY COMPANY Texas




- - -


-
20-0940754 32301 TNUS Insurance Company New York




- - -


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




- - -


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




- - -


-
13-5616275 19453 TRANSATLANTIC REINSURANCE COMPANY New York




- - -


-
06-6033504 19038 Travelers Casualty and Surety Company Connecticut




- - -


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




- - -


-
06-1286266 36170 Travelers Casualty Company of Connecticut Connecticut




- - -


-
06-0876835 19046 Travelers Casualty Insurance Company of America Connecticut




- - -


-
06-1286268 36137 Travelers Commercial Insurance Company Connecticut




- - -


-
06-0566050 25658 Travelers Indemnity Company (The) Connecticut




- - -


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




- - -


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




- - -


-
36-3703200 38130 Travelers Personal Insurance Company Connecticut




- - -


-
36-2719165 25674 Travelers Property Casualty Company of America Connecticut




- - -


-
59-2174734 41211 TRITON INSURANCE COMPANY Texas




- - -


-
06-1184984 27120 Trumbull Insurance Company Connecticut




- - -


-
06-0732738 29459 Twin City Fire Insurance Company Indiana




- - -


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




- - -


-
91-6027360 25747 Unigard Insurance Company Wisconsin




- - -


-
58-1847495 36226 UNITED CASUALTY AND SURETY INSURANCE COMPANY Massachusetts




- - -


-
42-0644327 13021 United Fire & Casualty Company Iowa




- - -


-
74-6045664 19496 UNITED FIRE & INDEMNITY COMPANY Texas




- - -


-
52-0515280 25887 United States Fidelity and Guaranty Company Connecticut




- - -


-
13-5459190 21113 United States Fire Insurance Company Delaware




- - -


-
52-1976385 10656 United States Surety Company Maryland




- - -


-
66-0457223 44423 UNITED SURETY AND INDEMNITY COMPANY Puerto Rico




- - -


-
47-0363416 25933 Universal Surety Company Nebraska




- - -


-
43-1249228 41181 UNIVERSAL UNDERWRITERS INSURANCE COMPANY Kansas




- - -


-
15-0476880 25976 Utica Mutual Insurance Company New York




- - -


-
13-1963495 20397 Vigilant Insurance Company New York




- - -


-
36-2860812 32778 Washington International Insurance Company New Hampshire




- - -


-
31-0624491 44393 West American Insurance Company Indiana




- - -


-
39-0698170 15350 WEST BEND MUTUAL INSURANCE COMPANY Wisconsin




- - -


-
92-0040526 10030 Westchester Fire Insurance Company Pennsylvania




- - -


-
41-0430825 15377 Western National Mutual Insurance Company Minnesota




- - -


-
46-0204900 13188 Western Surety Company South Dakota




- - -


-
34-6516838 24112 Westfield Insurance Company Ohio




- - -


-
34-1022544 24120 Westfield National Insurance Company Ohio




- - -


-
48-0921045 39845 Westport Insurance Corporation Missouri




- - -


-
13-1290712 20583 XL Reinsurance America Inc. New York




- - -


-
85-0277191 37885 XL Specialty Insurance Company Delaware




- - -


-
95-1651549 13269 ZENITH INSURANCE COMPANY California




- - -


-
36-4233459 16535 Zurich American Insurance Company New York




- - -


-
SECTION I TOTALS WILL BE ENTERED IN SECTION V



- - - - - - - - - - -

Sheet 3: Section II







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
















Federal ID NAIC Company Name of Reinsurer Domiciliary + (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
Jurisdiction
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. If you require additional worksheets goto the overflow page for Section II (orange tab)























- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-
(B) Reinsurance with other Treasury authorized companies.







- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-
SECTION II TOTALS WILL BE ENTERED IN SECTION V



- - - - - - - - - - -

Sheet 4: Section III







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)


















Authorized Name of Reinsurer
+ (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.

































64 Alabama Commercial Automobile Procedure (AIPSO) Johnston, RI

- - -


-

67 Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

36 Alaska Workers' Compensation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

85 American Hull Insurance Syndicate New York, NY




- - -


-

84 American Nuclear Insurers - Domestic Liability Syndicate West Hartford, CT




- - -


-

96 American Nuclear Insurers - Domestic Property Syndicate West Hartford, CT




- - -


-

78 American Nuclear Insurers - Foreign Property and Liability Syndicate West Hartford, CT




- - -


-

100 American Offshore Insurance Syndicate New York, NY




- - -


-

69 Arizona Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

63 Arkansas Commercial Automobile Insurance Procedure Johnston, RI




- - -


-

86 Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

55 Arkansas Stock Pool for Assigned Risks (NCCI) Boca Raton, FL




- - -


-

88 Associated Aerospace Underwriters Short Hills, NJ




- - -


-

75 Associated Aviation Underwriters Short Hills, NJ




- - -


-

67 California Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

62 Colorado Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

24 Commonwealth Automobile Reinsurers Boston, MA




- - -


-

85 Connecticut Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

62 Delaware Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

85 District of Columbia Commercial Automobile Insurance Procedure Washington, DC




- - -


-

100 Excise Bond Underwriters New York, NY




- - -


-

69 Georgia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

90 Global Aerospace Underwriters Short Hills, NJ




- - -


-

57 Idaho Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

63 Illinois Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

67 Illinois Fair Plan Association Chicago, IL




- - -


-

72 Illinois Mutual Assigned Risk Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

55 Illinois Stock Pool For Assigned Risks (NCCI) Boca Raton, FL




- - -


-

62 Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

78 Indiana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

62 Iowa Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

57 Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

68 Kansas Commerical Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

79 Kentucky Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

69 Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

100 Lloyd's Underwriters London, DC




- - -


-

64 Louisiana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

59 Maine Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

58 Maine Workers Compensation Reinsurance Pool Boca Raton, FL




- - -


-

70 Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance Boston, MA




- - -


-

44 Massachusetts Workers Compenstation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

16 Michigan Catastrophic Claims Association (MCCA) Livonia, MI




- - -


-

43 Michigan Workers Compensation Placement Facility (NCCI) Boca Raton, FL




- - -


-

63 Minnesota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

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




- - -


-

57 Mississippi Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

49 Missouri Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

72 Montana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

50 Mutual Reinsurance Bureau Cherry Valley, IL




- - -


-

44 National Workers' Compensation Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

59 Nebraska Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

70 Nevada Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

60 New Hampshire Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

41 New Hampshire Reinsurance Facility Automobile (AIPSO) Johnston, RI




- - -


-

61 New Jersey Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

66 New Mexico Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

46 New Mexico Workers' Compensation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

65 New York Special Risk Distribution Program (AIPSO) Johnston, RI




- - -


-

43 North Carolina Reinsurance Facility (AIPSO) Johnston, RI




- - -


-

56 North Dakota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

78 Ohio Commerical Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

74 Oklahoma Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

49 Oregon Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

66 Pennsylvania Pooled Commercial Assignment Procedure (AIPSO) Johnston, RI




- - -


-

67 Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

77 Rhode Island Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

69 South Carolina Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

45 South Carolina Reinsurance Facility (AIPSO) Johnston, RI




- - -


-

52 South Dakota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

63 Tennessee Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

62 Tennessee Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

67 United States Aircraft Insurance Group New York, NY




- - -


-

71 Utah Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

65 Vermont Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

73 Virginia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

60 Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

59 Washington Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

84 West Virginia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

72 Wisconsin Compensation Rating Bureau Milwaukee, WI




- - -


-

65 Wisconsin Special Risk Distrib. Program (AIPSO) Johnston, RI




- - -


-

42 Workers Compensation Reinsurance Association St. Paul, MN




- - -


-

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




- - -


-

66 Wyoming Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-









- - -


-



















Syndicates for Lloyds' Underwriters














AIIN















AA 1122000 Lloyds of London (Authorized)
London




- - -


-

AA1126002  2 London




- - -


-

AA1126028  28 London




- - -


-

AA1126033  33 London




- - -


-

AA1126034  34 London




- - -


-

AA1126040  40 London




- - -


-

AA1126047  47 London




- - -


-

AA1126048  48 London




- - -


-

AA1126051  51 London




- - -


-

AA1126052  52 London




- - -


-

AA1126053  53 London




- - -


-

AA1126055  55 London




- - -


-

AA1126062  62 London




- - -


-

AA1126079  79 London




- - -


-

AA1126102  102 London




- - -


-

AA1126112  112 London




- - -


-

AA1126122  122 London




- - -


-

AA1126123  123 London




- - -


-

AA1126136  136 London




- - -


-

AA1126138  138 London




- - -


-

AA1126159  159 London




- - -


-

AA1126172  172 London




- - -


-

AA1126173  173 London




- - -


-

AA1126178  178 London




- - -


-

AA1126179  179 London




- - -


-

AA1126183  183 London




- - -


-

AA1126187  187 London




- - -


-

AA1126190  190 London




- - -


-

AA1126204  204 London




- - -


-

AA1126205  205 London




- - -


-

AA1126218  218 London




- - -


-

AA1126219  219 London




- - -


-

AA1126227  227 London




- - -


-

AA1126228  228 London




- - -


-

AA1126250  250 London




- - -


-

AA1126270  270 London




- - -


-

AA1126271  271 London




- - -


-

AA1126282  282 London




- - -


-

AA1126314  314 London




- - -


-

AA1126318  318 London




- - -


-

AA1126322  322 London




- - -


-

AA1126328  328 London




- - -


-

AA1126329  329 London




- - -


-

AA1126340  340 London




- - -


-

AA1126360  360 London




- - -


-

AA1126362  362 London




- - -


-

AA1126375  375 London




- - -


-

AA1126376  376 London




- - -


-

AA1126382  382 London




- - -


-

AA1126386  386 London




- - -


-

AA1126397  397 London




- - -


-

AA1126431  431 London




- - -


-

AA1126435  435 London




- - -


-

AA1126441  441 London




- - -


-

AA1126456  456 London




- - -


-

AA1126457  457 London




- - -


-

AA1126473  473 London




- - -


-

AA1126483  483 London




- - -


-

AA1126484  484 London




- - -


-

AA1126488  488 London




- - -


-

AA1126490  490 London




- - -


-

AA1126500  500 London




- - -


-

AA1126506  506 London




- - -


-

AA1126507  507 London




- - -


-

AA1126510  510 London




- - -


-

AA1126529  529 London




- - -


-

AA1126535  535 London




- - -


-

AA1126536  536 London




- - -


-

AA1126538  538 London




- - -


-

AA1126539  539 London




- - -


-

AA1126545  545 London




- - -


-

AA1126552  552 London




- - -


-

AA1126557  557 London




- - -


-

AA1126566  566 London




- - -


-

AA1126570  570 London




- - -


-

AA1126575  575 London




- - -


-

AA1126582  582 London




- - -


-

AA1126588  588 London




- - -


-

AA1126590  590 London




- - -


-

AA1126609  609 London




- - -


-

AA1126623  623 London




- - -


-

AA1126624  624 London




- - -


-

AA1126625  625 London




- - -


-

AA1126626  626 London




- - -


-

AA1126658  658 London




- - -


-

AA1126672  672 London




- - -


-

AA1126683  683 London




- - -


-

AA1126702  702 London




- - -


-

AA1126718  718 London




- - -


-

AA1126724  724 London




- - -


-

AA1126727  727 London




- - -


-

AA1126732  732 London




- - -


-

AA1126734  734 London




- - -


-

AA1126735  735 London




- - -


-

AA1126741  741 London




- - -


-

AA1126744  744 London




- - -


-

AA1126765  765 London




- - -


-

AA1126766  766 London




- - -


-

AA1126780  780 London




- - -


-

AA1126800  800 London




- - -


-

AA1126807  807 London




- - -


-

AA1126808  808 London




- - -


-

AA1126822  822 London




- - -


-

AA1126823  823 London




- - -


-

AA1126824  824 London




- - -


-

AA1126839  839 London




- - -


-

AA1126858  858 London




- - -


-

AA1126861  861 London




- - -


-

AA1126902  902 London




- - -


-

AA1126920  920 London




- - -


-

AA1126923  923 London




- - -


-

AA1126925  925 London




- - -


-

AA1126947  947 London




- - -


-

AA1126955  955 London




- - -


-

AA1126957  957 London




- - -


-

AA1126958  958 London




- - -


-

AA1126959  959 London




- - -


-

AA1126960  960 London




- - -


-

AA1126963  963 London




- - -


-

AA1126990  990 London




- - -


-

AA1126991  991 London




- - -


-

AA1126994  994 London




- - -


-

AA1126998  998 London




- - -


-

AA1127003  1003 London




- - -


-

AA1127007  1007 London




- - -


-

AA1127009  1009 London




- - -


-

AA1127010  1010 London




- - -


-

AA1127019  1019 London




- - -


-

AA1127023  1023 London




- - -


-

AA1127027  1027 London




- - -


-

AA1127028  1028 London




- - -


-

AA1127036  1036 London




- - -


-

AA1127038  1038 London




- - -


-

AA1127047  1047 London




- - -


-

AA1127051  1051 London




- - -


-

AA1127055  1055 London




- - -


-

AA1127057  1057 London




- - -


-

AA1127069  1069 London




- - -


-

AA1127084  1084 London




- - -


-

AA1127087  1087 London




- - -


-

AA1127093  1093 London




- - -


-

AA1127095  1095 London




- - -


-

AA1127096  1096 London




- - -


-

AA1127101  1101 London




- - -


-

AA1120105  1110 London




- - -


-

AA1127115  1115 London




- - -


-

AA1127119  1119 London




- - -


-

AA1127121  1121 London




- - -


-

AA1127124  1124 London




- - -


-

AA1127141  1141 London




- - -


-

AA1127165  1165 London




- - -


-

AA1127173  1173 London




- - -


-

AA1127175  1175 London




- - -


-

AA1127176  1176 London




- - -


-

AA1127179  1179 London




- - -


-

AA1127183  1183 London




- - -


-

AA1127185  1185 London




- - -


-

AA1127200  1200 London




- - -


-

AA1127202  1202 London




- - -


-

AA1127203  1203 London




- - -


-

AA1127204  1204 London




- - -


-

AA1127205  1205 London




- - -


-

AA1127206  1206 London




- - -


-

AA1127207  1207 London




- - -


-

AA1127208  1208 London




- - -


-

AA1127209  1209 London




- - -


-

AA1127210  1210 London




- - -


-

AA1127211  1211 London




- - -


-

AA1127212  1212 London




- - -


-

AA1127213  1213 London




- - -


-

AA1127214  1214 London




- - -


-

AA1127215  1215 London




- - -


-

AA1127218  1218 London




- - -


-

AA1127221  1221 London




- - -


-

AA1127223  1223 London




- - -


-

AA1127224  1224 London




- - -


-

AA1127225  1225 London




- - -


-

AA1127227  1227 London




- - -


-

AA1127229  1229 London




- - -


-

AA1127232  1232 London




- - -


-

AA1127234  1234 London




- - -


-

AA1127236  1236 London




- - -


-

AA1127239  1239 London




- - -


-

AA1127241  1241 London




- - -


-

AA1127242  1242 London




- - -


-

AA1127243  1243 London




- - -


-

AA1127245  1245 London




- - -


-

AA1127251  1251 London




- - -


-

AA1127265  1265 London




- - -


-

AA1120085  1274 London




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AA1127301  1301 London




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AA1127308  1308 London




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AA1120095  1318 London




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AA1127323  1323 London




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AA1127400  1400 London




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AA1127411  1411 London




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AA1127414  1414 London




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AA1127415  1415 London




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AA1120102  1458 London




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AA1127511  1511 London




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AA1127607  1607 London




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AA1127611  1611 London




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AA1127688  1688 London




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AA1127861  1861 London




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AA1120096  1880 London




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AA1120109  1882 London




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AA1120054  1886 London




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AA1120131  1897 London




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AA1127900  1900 London




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AA1120083  1910 London




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AA1120064  1919 London




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AA1120124  1945 London




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AA1120084  1955 London




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AA1120103  1967 London




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AA1120106  1969 London




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AA1127999  1999 London




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AA1128000  2000 London




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AA1128001  2001 London




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AA1128003  2003 London




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AA1120071  2007 London




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AA1128010  2010 London




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AA1128011  2011 London




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AA1120104  2012 London




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AA1120114  2015 London




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AA1128020  2020 London




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AA1128021  2021 London




- - -


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AA1128027  2027 London




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AA1120072  2112 London




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AA1128121  2121 London




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AA1128147  2147 London




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AA1128176  2176 London




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AA1128183  2183 London




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AA1128227  2227 London




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AA1120112  2232 London




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AA1128241  2241 London




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AA1120081  2243 London




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AA1128271  2271 London




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AA1128322  2322 London




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AA1128323  2323 London




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AA1128341  2341 London




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AA1128345  2345 London




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AA1128376  2376 London




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AA1120097  2468 London




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AA1128488  2488 London




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AA1128490  2490 London




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AA1128506  2506 London




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AA1128591  2591 London




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AA1128607  2607 London




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AA1128623  2623 London




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AA1128658  2658 London




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AA1128659  2659 London




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AA1128724  2724 London




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AA1128734  2734 London




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AA1128741  2741 London




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AA1128791  2791 London




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AA1128923  2923 London




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AA1128947  2947 London




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AA1128987  2987 London




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AA1129000  3000 London




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AA1120082  3010 London




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AA1129030  3030 London




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AA1129210  3210 London




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AA1120113  3334 London




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AA1120055  3623 London




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AA1120098  3624 London




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AA1120056  3786 London




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AA1120068  3820 London




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AA1120116  3902 London




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AA1126005  4000 London




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AA1120075  4020 London




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AA1120069  4040 London




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AA1120086  4141 London




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AA1120067  4242 London




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AA1126004  4444 London




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AA1126006  4472 London




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AA1120090  4711 London




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AA1126003  5000 London




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AA1120080  5151 London




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AA1120065  5555 London




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AA1120048  5820 London




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SECTION III TOTALS WILL BE ENTERED IN SECTION V



- - - - - - - - - - -

Sheet 5: Section IV THRU V







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)

















Authorized Name of Reinsurer
+ (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.














If you require additional worksheets to complete this section, goto Section IV of the overflow pages (orange tabs).























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SECTION IV TOTALS WILL BE ENTERED IN SECTION V



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SECTION V














TREASURY AUTHORIZED:






























Total Section I (totals automatically copied from section I)



- - - - - - - - - - -
Total Section II



- - - - - - - - - - -
Total Section II Overflow Page (s) if applicable



- - - - - - - - - - -
Total Section III



- - - - - - - - - - -
Total Section IV



- - - - - - - - - - -
Total Section IV Overflow Page (s) if applicable



- - - - - - - - - - -
Authorized Reinsurance from company produced worksheets not included in totals above







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GRAND TOTAL TREASURY AUTHORIZED WILL BE ENTERED IN SECTION X



- - - - - - - - - - -

Sheet 6: Section VI







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)


















Unauthorized Name of Reinsurer
+ (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:

































36 Alabama Commercial Automobile Procedure (AIPSO) Johnston, RI




- - -


-

33 Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

64 Alaska Workers' Compensation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

15 American Hull Insurance Syndicate New York, NY




- - -


-

16 American Nuclear Insurers - Domestic Liability Syndicate West Hartford, CT




- - -


-

4 American Nuclear Insurers - Domestic Property Syndicate West Hartford, CT




- - -


-

22 American Nuclear Insurers - Foreign Property and Liability Syndicate West Hartford, CT




- - -


-

0 American Offshore Insurance Syndicate New York, NY




- - -


-

31 Arizona Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

37 Arkansas Commercial Automobile Insurance Procedure Johnston, RI




- - -


-

14 Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

45 Arkansas Stock Pool for Assigned Risks (NCCI) Boca Raton, FL




- - -


-

12 Associated Aerospace Underwriters Short Hills, NJ




- - -


-

25 Associated Aviation Underwriters Short Hills, NJ




- - -


-

33 California Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

38 Colorado Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

76 Commonwealth Automobile Reinsurers Boston, MA




- - -


-

15 Connecticut Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

38 Delaware Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

15 District of Columbia Commercial Automobile Insurance Procedure Washington, DC




- - -


-

0 Excise Bond Underwriters New York, NY




- - -


-

31 Georgia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

10 Global Aerospace Underwriters Short Hills, NJ




- - -


-

43 Idaho Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

37 Illinois Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

33 Illinois Fair Plan Association Chicago, IL




- - -


-

28 Illinois Mutual Assigned Risk Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

45 Illinois Stock Pool For Assigned Risks (NCCI) Boca Raton, FL




- - -


-

38 Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

22 Indiana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

38 Iowa Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

43 Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

32 Kansas Commerical Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

21 Kentucky Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

31 Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

0 Lloyd's Underwriters London, DC




- - -


-

36 Louisiana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

41 Maine Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

42 Maine Workers Compensation Reinsurance Pool Boca Raton, FL




- - -


-

30 Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance Boston, MA




- - -


-

56 Massachusetts Workers Compenstation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

84 Michigan Catastrophic Claims Association (MCCA) Livonia, MI




- - -


-

57 Michigan Workers Compensation Placement Facility (NCCI) Boca Raton, FL




- - -


-

37 Minnesota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

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




- - -


-

43 Mississippi Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

51 Missouri Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

28 Montana Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

50 Mutual Reinsurance Bureau Cherry Valley, IL




- - -


-

56 National Workers' Compensation Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

41 Nebraska Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

30 Nevada Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

40 New Hampshire Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

59 New Hampshire Reinsurance Facility Automobile (AIPSO) Johnston, RI




- - -


-

39 New Jersey Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

34 New Mexico Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

54 New Mexico Workers' Compensation Assigned Risk Pool (NCCI) Boca Raton, FL




- - -


-

35 New York Special Risk Distribution Program (AIPSO) Johnston, RI




- - -


-

57 North Carolina Reinsurance Facility (AIPSO) Johnston, RI




- - -


-

44 North Dakota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

22 Ohio Commerical Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

26 Oklahoma Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

51 Oregon Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

34 Pennsylvania Pooled Commercial Assignment Procedure (AIPSO) Johnston, RI




- - -


-

33 Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI) Boca Raton, FL




- - -


-

23 Rhode Island Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

31 South Carolina Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

55 South Carolina Reinsurance Facility (AIPSO) Johnston, RI




- - -


-

48 South Dakota Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

37 Tennessee Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

38 Tennessee Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

33 United States Aircraft Insurance Group New York, NY




- - -


-

29 Utah Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

35 Vermont Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

27 Virginia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

40 Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) Boca Raton, FL




- - -


-

41 Washington Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

16 West Virginia Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-

28 Wisconsin Compensation Rating Bureau Milwaukee, WI




- - -


-

35 Wisconsin Special Risk Distrib. Program (AIPSO) Johnston, RI




- - -


-

58 Workers Compensation Reinsurance Association St. Paul, MN




- - -


-

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




- - -


-

34 Wyoming Commercial Automobile Insurance Procedure (AIPSO) Johnston, RI




- - -


-









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-
SECTION VI TOTALS WILL BE ENTERED IN SECTION IX



- - - - - - - - - - -

Sheet 7: Section VII







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)

















Unauthorized Name of Reinsurer
+ (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.














If you require additional worksheets to complete this section, goto the overflow page for Section VII (orange tab).













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SECTION VII TOTALS WILL BE ENTERED IN SECTION IX



- - - - - - - - - - -

Sheet 8: Section VIII thru X







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
















Federal ID NAIC Company Name of Reinsurer Domiciliary + (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
Jurisdiction
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.














If you require additional worksheets to complete this section, goto the overflow pages for section VIII (orange tabs).























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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX



- - - - - - - - - - -
















SECTION IX














TREASURY UNAUTHORIZED:






























Total Section VI



- - - - - - - - - - -
Total Section VII



- - - - - - - - - - -
Total Section VII Overflow Page (s) if applicable



- - - - - - - - - - -
Total Section VIII



- - - - - - - - - - -
Total Section VIII Overflow Page (s) if applicable



- - - - - - - - - - -
Unauthorized Reinsurance from company produced worksheets not included in totals above







- - -


-
















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 2012 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)

















(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
Companies may take credit for acceptable offsets to unauthorized reinsurance recoverables. Offsets can include funds held, letters of credit (issued by a bank on the NAIC approved bank list),







- -
and trust funds. Reinsurance payables are acceptable so long as a legal right of offset exists in the contract language. Evidence should be submitted in support of such offsets for large or







- -
material amounts. Materiality for Treasury purposes normally falls within a range of 5-10% of the reporting company's policyholders' surplus.







- -
If you require additional worksheets to complete this section, please goto the funds held overflow page (orange tabs).







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TOTAL(COL. 3) WILL BE ENTERED ON THE SUMMARY PAGE OF THIS SCHEDULE)


- - - - - - - -

Sheet 10: Summary Page












ANNUAL STATEMENT FOR THE YEAR 2012 OF







OMB No. 1510-0012














Write or Stamp Name





OMB Expiration Date: 9-30-2013




































Page 34 of 34




















(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……………………………………………………………………………………………………………………………………………………………………………………..














$ -

























Additional Funds held from company reproduced overflow page worksheets - total must be entered manually………………………………………………………………………………………………………………………………………………………………….














$


























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














$ -

























Less:




















* Liability for Unauthorized Reinsurance shown on the Company's




















annual year-end financial statement…………………………………………………………………………………………………………………………………………………………………………………………………..














$


























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














$ -

























* Include provision for overdue Authorized Reinsurance as well






















































































COMPANY CONTACT PERSON FOR THIS SCHEDULE:

























(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, Management,




















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 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.























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(B) Reinsurance with other Treasury authorized companies







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SECTION II TOTALS WILL BE ENTERED IN SECTION V



- - - - - - - - - - -







































ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.























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(B) Reinsurance with other Treasury authorized companies







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SECTION II TOTALS WILL BE ENTERED IN SECTION V



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Sheet 12: Section IV Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer
+ (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.























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SECTION IV TOTALS WILL BE ENTERED IN SECTION V



- - - - - - - - - - -







































ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section IV Overflow Page

Authorized Name of Reinsurer
+ (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.























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SECTION IV TOTALS WILL BE ENTERED IN SECTION V



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Sheet 13: Section VII Overflow Page







ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer
+ (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.







































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SECTION VII TOTALS WILL BE ENTERED IN SECTION IX



- - - - - - - - - - -







































ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)
Section VII Overflow Page

Unauthorized Name of Reinsurer
+ (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.







































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SECTION VII TOTALS WILL BE ENTERED IN SECTION IX



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Sheet 14: Section VIII Overflow Page














OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.







































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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX



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ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.







































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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX



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ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.







































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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX



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ANNUAL STATEMENT FOR THE YEAR 2012 OF






OMB No. 1510-0012









Write or Stamp Name




OMB Expiration Date: 9-30-2013
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 Domiciliary + (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
Jurisdiction
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.







































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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX



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Sheet 15: Funds Held Overflow Page






ANNUAL STATEMENT FOR THE YEAR 2012 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 9-30-2013
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
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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE


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ANNUAL STATEMENT FOR THE YEAR 2012 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 9-30-2013
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









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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE


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ANNUAL STATEMENT FOR THE YEAR 2012 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 9-30-2013
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









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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE


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ANNUAL STATEMENT FOR THE YEAR 2012 OF



OMB No. 1510-0012








Write or Stamp Name

OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
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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









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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE


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File Typeapplication/vnd.ms-excel
AuthorGary Kosciolek
Last Modified ByWolfgang, Dawn
File Modified2013-09-30
File Created2000-04-07
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