U.S. Treasury Schedule F Instructions | ||
For the Year-Ended December 31, 2009 | For the year ended December 31, 2021 | |
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) | ||
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 Surety.Bonds@fiscal.treasury.gov for assistance. | ||
Updated: 2/9/2022 |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | - | - | - | |||||||||
95-2371728 | 22667 | ACE American Insurance Company | Pennsylvania | - | - | - | |||||||||
06-0237820 | 20699 | ACE Property and Casualty Insurance Company | Pennsylvania | - | - | - | |||||||||
36-2704802 | 22950 | ACSTAR INSURANCE COMPANY | Illinois | - | - | - | |||||||||
39-0491540 | 14184 | ACUITY, A Mutual Insurance Company | Wisconsin | - | - | - | |||||||||
23-2035821 | 33898 | Aegis Security Insurance Company | Pennsylvania | - | - | - | |||||||||
05-0254496 | 10014 | Affiliated FM Insurance Company | Rhode Island | - | - | - | |||||||||
25-1118791 | 19402 | AIG Property Casualty Company | Illinois | - | - | - | |||||||||
34-0935740 | 20222 | ALL AMERICA INSURANCE COMPANY | Ohio | - | - | - | |||||||||
25-0315340 | 13285 | Allegheny Casualty Company | New Jersey | - | - | - | |||||||||
94-6078058 | 21911 | Allianz Reinsurance America, Inc. | California | - | - | - | |||||||||
42-1201931 | 42579 | ALLIED Property and Casualty Insurance Company | Iowa | - | - | - | |||||||||
95-4387273 | 19489 | Allied World Assurance Company (U.S.) Inc. | Delaware | - | - | - | |||||||||
06-1182357 | 22730 | Allied World Insurance Company | New Hampshire | - | - | - | |||||||||
02-0493244 | 10690 | Allied World National Assurance Company | New Hampshire | - | - | - | |||||||||
56-0997452 | 16624 | Allied World Specialty Insurance Company | Delaware | - | - | - | |||||||||
51-0331163 | 24319 | Allied World Surplus Lines Insurance Company | Arkansas | - | - | - | |||||||||
42-6054959 | 19100 | AMCO Insurance Company | Iowa | - | - | - | |||||||||
36-2661954 | 10103 | American Agricultural Insurance Company | Indiana | - | - | - | |||||||||
52-2048110 | 19720 | AMERICAN ALTERNATIVE INSURANCE CORPORATION | Delaware | - | - | - | |||||||||
23-0342560 | 20427 | American Casualty Company of Reading, Pennsylvania | Pennsylvania | - | - | - | |||||||||
95-4290651 | 10216 | AMERICAN CONTRACTORS INDEMNITY COMPANY | California | - | - | - | |||||||||
59-0141790 | 24066 | American Fire and Casualty Company | New Hampshire | - | - | - | |||||||||
36-6071400 | 26247 | American Guarantee and Liability Insurance Company | New York | - | - | - | |||||||||
13-5124990 | 19380 | American Home Assurance Company | New York | - | - | - | |||||||||
38-1630841 | 19631 | AMERICAN ROAD INSURANCE COMPANY (THE) | Michigan | - | - | - | |||||||||
31-6016426 | 19992 | American Select Insurance Company | Ohio | - | - | - | |||||||||
58-6016195 | 10235 | American Southern Insurance Company | Kansas | - | - | - | |||||||||
95-3730189 | 31380 | American Surety Company | Indiana | - | - | - | |||||||||
38-1869912 | 19488 | Amerisure Insurance Company | Michigan | - | - | - | |||||||||
38-0829210 | 23396 | Amerisure Mutual Insurance Company | Michigan | - | - | - | |||||||||
38-3553788 | 11050 | Amerisure Partners Insurance Company | Michigan | - | - | - | |||||||||
98-4207369 | 10308 | Antilles Insurance Company | Puerto Rico | - | - | - | |||||||||
43-0990710 | 11150 | Arch Insurance Company | Missouri | - | - | - | |||||||||
06-1430254 | 10348 | Arch Reinsurance Company | Delaware | - | - | - | |||||||||
94-1390273 | 19801 | Argonaut Insurance Company | Illinois | - | - | - | |||||||||
75-2344200 | 43460 | ASPEN AMERICAN INSURANCE COMPANY | Texas | - | - | - | |||||||||
13-3362309 | 27154 | Atlantic Specialty Insurance Company | New York | - | - | - | |||||||||
38-0315280 | 18988 | Auto-Owners Insurance Company | Michigan | - | - | - | |||||||||
06-0848755 | 19062 | Automobile Insurance Company of Hartford, Connecticut (The) | Connecticut | - | - | - | |||||||||
52-0795746 | 10367 | AVEMCO INSURANCE COMPANY | Maryland | - | - | - | |||||||||
39-1338397 | 37273 | AXIS Insurance Company | Illinois | - | - | - | |||||||||
51-0434766 | 20370 | AXIS Reinsurance Company | New York | - | - | - | |||||||||
59-1673015 | 33162 | Bankers Insurance Company | Florida | - | - | - | |||||||||
59-1320184 | 18279 | Bankers Standard Insurance Company | Pennsylvania | - | - | - | |||||||||
04-2656602 | 37540 | Beazley Insurance Company, Inc. | Connecticut | - | - | - | |||||||||
47-0574325 | 32603 | Berkley Insurance Company | Delaware | - | - | - | |||||||||
43-1432586 | 29580 | Berkley Regional Insurance Company | Iowa | - | - | - | |||||||||
47-0529945 | 20044 | Berkshire Hathaway Homestate Insurance Company | Nebraska | - | - | - | |||||||||
63-0202590 | 22276 | Berkshire Hathaway Specialty Insurance Company | Nebraska | - | - | - | |||||||||
36-0810360 | 20095 | BITCO GENERAL INSURANCE CORPORATION | Illinois | - | - | - | |||||||||
36-6054328 | 20109 | BITCO NATIONAL INSURANCE COMPANY | Illinois | - | - | - | |||||||||
36-2761729 | 27081 | BOND SAFEGUARD INSURANCE COMPANY | South Dakota | - | - | - | |||||||||
26-0159619 | 12965 | Bondex Insurance Company | New Jersey | - | - | - | |||||||||
46-0310317 | 30279 | Boston Indemnity Company, Inc. | South Dakota | - | - | - | |||||||||
64-0911627 | 10993 | Brierfield Insurance Company | Mississippi | - | - | - | |||||||||
75-1509104 | 32875 | BRITISH AMERICAN INSURANCE COMPANY | Texas | - | - | - | |||||||||
39-0971527 | 10472 | Capitol Indemnity Corporation | Wisconsin | - | - | - | |||||||||
59-0733942 | 10510 | Carolina Casualty Insurance Company | Iowa | - | - | - | |||||||||
63-0701609 | 34568 | Centennial Casualty Company | Alabama | - | - | - | |||||||||
34-4202560 | 20230 | CENTRAL MUTUAL INSURANCE COMPANY | Ohio | - | - | - | |||||||||
31-0936702 | 36951 | CENTURY SURETY COMPANY | Ohio | - | - | - | |||||||||
13-3531373 | 10006 | CERITY INSURANCE COMPANY | New York | - | - | - | |||||||||
06-0291290 | 25615 | Charter Oak Fire Insurance Company (The) | Connecticut | - | - | - | |||||||||
38-3464294 | 10642 | Cherokee Insurance Company | Michigan | - | - | - | |||||||||
22-3291862 | 12777 | CHUBB INDEMNITY INSURANCE COMPANY | New York | - | - | - | |||||||||
31-0826946 | 28665 | Cincinnati Casualty Company (The) | Ohio | - | - | - | |||||||||
31-1241230 | 23280 | CINCINNATI INDEMNITY COMPANY, THE | Ohio | - | - | - | |||||||||
31-0542366 | 10677 | Cincinnati Insurance Company (The) | Ohio | - | - | - | |||||||||
38-0421730 | 31534 | CITIZENS INSURANCE COMPANY OF AMERICA | Michigan | - | - | - | |||||||||
52-1096670 | 34347 | COLONIAL AMERICAN CASUALTY AND SURETY COMPANY | Illinois | - | - | - | |||||||||
23-0485115 | 10758 | COLONIAL SURETY COMPANY | Pennsylvania | - | - | - | |||||||||
47-0530077 | 27812 | Columbia Insurance Company | Nebraska | - | - | - | |||||||||
13-1938623 | 19410 | COMMERCE AND INDUSTRY INSURANCE COMPANY | New York | - | - | - | |||||||||
36-2114545 | 20443 | Continental Casualty Company | Illinois | - | - | - | |||||||||
87-0363183 | 39551 | CONTINENTAL HERITAGE INSURANCE COMPANY | Florida | - | - | - | |||||||||
13-5010440 | 35289 | Continental Insurance Company (The) | Pennsylvania | - | - | - | |||||||||
91-1082952 | 37206 | CONTRACTORS BONDING AND INSURANCE COMPANY | Illinois | - | - | - | |||||||||
66-0257478 | 18163 | Cooperativa de Seguros Multiples de Puerto Rico | Puerto Rico | - | - | - | |||||||||
38-1775863 | 10499 | CorePointe Insurance Company | Delaware | - | - | - | |||||||||
68-0066866 | 18961 | Crestbrook Insurance Company | Ohio | - | - | - | |||||||||
22-2868548 | 31348 | Crum & Forster Indemnity Company | Delaware | - | - | - | |||||||||
22-2464174 | 42471 | CRUM AND FORSTER INSURANCE COMPANY | New Jersey | - | - | - | |||||||||
39-0972608 | 10847 | CUMIS INSURANCE SOCIETY, INC. | Iowa | - | - | - | |||||||||
20-5548208 | 12758 | CUMIS Specialty Insurance Company, Inc. | Iowa | - | - | - | |||||||||
91-6027360 | 25747 | Dairyland American Insurance Company | Wisconsin | - | - | - | |||||||||
42-0429710 | 12718 | Developers Surety and Indemnity Company | California | - | - | - | |||||||||
23-1336198 | 13692 | DONEGAL MUTUAL INSURANCE COMPANY | Pennsylvania | - | - | - | |||||||||
39-0264050 | 21458 | Employers Insurance Company of Wausau | Wisconsin | - | - | - | |||||||||
42-0234980 | 21415 | Employers Mutual Casualty Company | Iowa | - | - | - | |||||||||
03-0350908 | 10641 | Endurance American Insurance Company | Delaware | - | - | - | |||||||||
35-2293075 | 11551 | Endurance Assurance Corporation | Delaware | - | - | - | |||||||||
25-1232960 | 26263 | Erie Insurance Company | Pennsylvania | - | - | - | |||||||||
25-6038677 | 26271 | Erie Insurance Exchange | Pennsylvania | - | - | - | |||||||||
52-0222226 | 20516 | Euler Hermes North America Insurance Company | Maryland | - | - | - | |||||||||
36-2950161 | 35378 | EVANSTON INSURANCE COMPANY | Illinois | - | - | - | |||||||||
22-2660372 | 10120 | Everest National Insurance Company | Delaware | - | - | - | |||||||||
22-2005057 | 26921 | Everest Reinsurance Company | Delaware | - | - | - | |||||||||
36-2467238 | 12750 | Evergreen National Indemnity Company | Ohio | - | - | - | |||||||||
13-2912259 | 35181 | Executive Risk Indemnity Inc. | Delaware | - | - | - | |||||||||
94-2784519 | 40029 | Explorer Insurance Company | California | - | - | - | |||||||||
05-0316605 | 21482 | Factory Mutual Insurance Company | Rhode Island | - | - | - | |||||||||
13-3333610 | 35157 | Fair American Insurance and Reinsurance Company | New York | - | - | - | |||||||||
48-0214040 | 19194 | Farmers Alliance Mutual Insurance Company | Kansas | - | - | - | |||||||||
95-2575893 | 21652 | Farmers Insurance Exchange | California | - | - | - | |||||||||
42-0245840 | 13897 | FARMERS MUTUAL HAIL INSURANCE COMPANY OF IOWA | Iowa | - | - | - | |||||||||
06-1067463 | 41483 | Farmington Casualty Company | Connecticut | - | - | - | |||||||||
59-1365094 | 10178 | FCCI Insurance Company | Florida | - | - | - | |||||||||
13-1963496 | 20281 | Federal Insurance Company | Indiana | - | - | - | |||||||||
41-0417460 | 13935 | FEDERATED MUTUAL INSURANCE COMPANY | Minnesota | - | - | - | |||||||||
13-3046577 | 39306 | Fidelity and Deposit Company of Maryland | Illinois | - | - | - | |||||||||
42-1091525 | 35386 | FIDELITY AND GUARANTY INSURANCE COMPANY | Iowa | - | - | - | |||||||||
52-0616768 | 25879 | Fidelity and Guaranty Insurance Underwriters, Inc. | Wisconsin | - | - | - | |||||||||
75-2304982 | 35009 | Financial Casualty & Surety, Inc. | Texas | - | - | - | |||||||||
68-0111081 | 31453 | Financial Pacific Insurance Company | California | - | - | - | |||||||||
06-1325038 | 39136 | Finial Reinsurance Company | Connecticut | - | - | - | |||||||||
94-1610280 | 21873 | Fireman's Fund Insurance Company | California | - | - | - | |||||||||
36-2694846 | 11177 | FIRST FINANCIAL INSURANCE COMPANY | Illinois | - | - | - | |||||||||
20-1384826 | 12150 | First Founders Assurance Company | New Jersey | - | - | - | |||||||||
99-0218317 | 41742 | First Insurance Company of Hawaii, Ltd. | Hawaii | - | - | - | |||||||||
66-0561082 | 10972 | First Net Insurance Company | Guam | - | - | - | |||||||||
38-0555290 | 13986 | Frankenmuth Mutual Insurance Company | Michigan | - | - | - | |||||||||
39-0301590 | 24414 | General Casualty Company Of Wisconsin | Wisconsin | - | - | - | |||||||||
13-2673100 | 22039 | General Reinsurance Corporation | Delaware | - | - | - | |||||||||
13-1958482 | 11967 | GENERAL STAR NATIONAL INSURANCE COMPANY | Delaware | - | - | - | |||||||||
33-0763205 | 10836 | GOLDEN EAGLE INSURANCE CORPORATION | New Hampshire | - | - | - | |||||||||
31-4192970 | 14060 | GRANGE INSURANCE COMPANY | Ohio | - | - | - | |||||||||
31-1769414 | 11136 | GRANGE INSURANCE COMPANY OF MICHIGAN | Ohio | - | - | - | |||||||||
73-1282413 | 26310 | GRANITE RE, INC. | Minnesota | - | - | - | |||||||||
02-0140690 | 23809 | Granite State Insurance Company | Illinois | - | - | - | |||||||||
72-1326720 | 10671 | GRAY CASUALTY & SURETY COMPANY (THE) | Louisiana | - | - | - | |||||||||
72-0824217 | 36307 | GRAY INSURANCE COMPANY (THE) | Louisiana | - | - | - | |||||||||
95-1542353 | 26832 | Great American Alliance Insurance Company | Ohio | - | - | - | |||||||||
31-0501234 | 16691 | Great American Insurance Company | Ohio | - | - | - | |||||||||
13-5539046 | 22136 | GREAT AMERICAN INSURANCE COMPANY OF NEW YORK | New York | - | - | - | |||||||||
31-1209419 | 31135 | Great American Security Insurance Company | Ohio | - | - | - | |||||||||
76-0154296 | 18694 | Great Midwest Insurance Company | Texas | - | - | - | |||||||||
41-0729473 | 20303 | Great Northern Insurance Company | Indiana | - | - | - | |||||||||
38-2907623 | 36650 | Guarantee Company of North America USA (The) | Michigan | - | - | - | |||||||||
13-5129825 | 22292 | Hanover Insurance Company (The) | New Hampshire | - | - | - | |||||||||
13-6108721 | 26433 | HARCO NATIONAL INSURANCE COMPANY | Illinois | - | - | - | |||||||||
06-0383030 | 22357 | Hartford Accident and Indemnity Company | Connecticut | - | - | - | |||||||||
06-0294398 | 29424 | Hartford Casualty Insurance Company | Indiana | - | - | - | |||||||||
06-0383750 | 19682 | Hartford Fire Insurance Company | Connecticut | - | - | - | |||||||||
06-1008026 | 37478 | Hartford Insurance Company of the Midwest | Indiana | - | - | - | |||||||||
06-1222527 | 30104 | Hartford Underwriters Insurance Company | Connecticut | - | - | - | |||||||||
74-2195939 | 42374 | Houston Casualty Company | Texas | - | - | - | |||||||||
13-5150451 | 25054 | Hudson Insurance Company | Delaware | - | - | - | |||||||||
42-0333150 | 14257 | IMT Insurance Company | Iowa | - | - | - | |||||||||
06-1016108 | 43575 | Indemnity Insurance Company of North America | Pennsylvania | - | - | - | |||||||||
64-0838376 | 18468 | Indemnity National Insurance Company | Mississippi | - | - | - | |||||||||
35-0410420 | 14265 | Indiana Lumbermens Mutual Insurance Company | Indiana | - | - | - | |||||||||
47-6025666 | 23264 | Inland Insurance Company | Nebraska | - | - | - | |||||||||
23-0723970 | 22713 | Insurance Company Of North America | Pennsylvania | - | - | - | |||||||||
13-5540698 | 19429 | Insurance Company of the State of Pennsylvania (The) | Illinois | - | - | - | |||||||||
95-2769232 | 27847 | Insurance Company of the West | California | - | - | - | |||||||||
74-2262949 | 43273 | Insurors Indemnity Company | Texas | - | - | - | |||||||||
39-0367560 | 14303 | Integrity Insurance Company | Ohio | - | - | - | |||||||||
22-1010450 | 11592 | International Fidelity Insurance Company | New Jersey | - | - | - | |||||||||
41-0121640 | 23647 | IRONSHORE INDEMNITY INC. | Illinois | - | - | - | |||||||||
99-6004946 | 22845 | ISLAND INSURANCE COMPANY, LIMITED | Hawaii | - | - | - | |||||||||
25-1149494 | 19437 | Lexington Insurance Company | Delaware | - | - | - | |||||||||
52-1662720 | 37940 | LEXINGTON NATIONAL INSURANCE CORPORATION | Florida | - | - | - | |||||||||
76-0128873 | 13307 | Lexon Insurance Company | Texas | - | - | - | |||||||||
04-1924000 | 23035 | Liberty Mutual Fire Insurance Company | Wisconsin | - | - | - | |||||||||
04-1543470 | 23043 | Liberty Mutual Insurance Company | Massachusetts | - | - | - | |||||||||
04-3058504 | 33600 | LM Insurance Corporation | Illinois | - | - | - | |||||||||
23-2086596 | 36897 | Manufacturers Alliance Insurance Company | Pennsylvania | - | - | - | |||||||||
54-1398877 | 28932 | Markel American Insurance Company | Virginia | - | - | - | |||||||||
06-1481194 | 10829 | Markel Global Reinsurance Company | Delaware | - | - | - | |||||||||
36-3101262 | 38970 | MARKEL INSURANCE COMPANY | Illinois | - | - | - | |||||||||
04-2217600 | 22306 | Massachusetts Bay Insurance Company | New Hampshire | - | - | - | |||||||||
42-0410010 | 14494 | Merchants Bonding Company (Mutual) | Iowa | - | - | - | |||||||||
11-3658357 | 11595 | Merchants National Bonding, Inc. | Iowa | - | - | - | |||||||||
75-1629914 | 36838 | Mesa Underwriters Specialty Insurance Company | New Jersey | - | - | - | |||||||||
38-0828980 | 14508 | Michigan Millers Mutual Insurance Company | Michigan | - | - | - | |||||||||
95-6016640 | 21687 | Mid-Century Insurance Company | California | - | - | - | |||||||||
73-0556513 | 23418 | MID-CONTINENT CASUALTY COMPANY | Ohio | - | - | - | |||||||||
22-3818012 | 20362 | Mitsui Sumitomo Insurance Company of America | New York | - | - | - | |||||||||
13-3467153 | 22551 | Mitsui Sumitomo Insurance USA Inc. | New York | - | - | - | |||||||||
31-4259550 | 14621 | Motorists Mutual Insurance Company | Ohio | - | - | - | |||||||||
38-0855585 | 22012 | Motors Insurance Corporation | Michigan | - | - | - | |||||||||
13-4924125 | 10227 | Munich Reinsurance America, Inc. | Delaware | - | - | - | |||||||||
47-0247300 | 23663 | National American Insurance Company | Oklahoma | - | - | - | |||||||||
38-0865250 | 11991 | National Casualty Company | Ohio | - | - | - | |||||||||
84-0982643 | 16217 | NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY | North Carolina | - | - | - | |||||||||
47-6021331 | 20079 | National Fire & Marine Insurance Company | Nebraska | - | - | - | |||||||||
06-0464510 | 20478 | National Fire Insurance Company of Hartford | Illinois | - | - | - | |||||||||
47-0355979 | 20087 | National Indemnity Company | Nebraska | - | - | - | |||||||||
36-2403971 | 20052 | National Liability & Fire Insurance Company | Connecticut | - | - | - | |||||||||
62-0729866 | 20141 | NATIONAL TRUST INSURANCE COMPANY | Indiana | - | - | - | |||||||||
25-0687550 | 19445 | National Union Fire Insurance Company of Pittsburgh, PA | Pennsylvania | - | - | - | |||||||||
42-1015537 | 28223 | Nationwide Agribusiness Insurance Company | Iowa | - | - | - | |||||||||
31-1399201 | 10070 | Nationwide Indemnity Company | Ohio | - | - | - | |||||||||
31-4177110 | 23779 | Nationwide Mutual Fire Insurance Company | Ohio | - | - | - | |||||||||
31-4177100 | 23787 | Nationwide Mutual Insurance Company | Ohio | - | - | - | |||||||||
42-1265237 | 25240 | NAU Country Insurance Company | Minnesota | - | - | - | |||||||||
13-3138390 | 42307 | NAVIGATORS INSURANCE COMPANY | New York | - | - | - | |||||||||
06-1053492 | 41629 | New England Reinsurance Corporation | Connecticut | - | - | - | |||||||||
02-0172170 | 23841 | New Hampshire Insurance Company | Illinois | - | - | - | |||||||||
22-2187459 | 35432 | New Jersey Re-Insurance Company | New Jersey | - | - | - | |||||||||
13-2703894 | 16608 | NEW YORK MARINE AND GENERAL INSURANCE COMPANY | New York | - | - | - | |||||||||
02-0170490 | 14788 | NGM Insurance Company | Florida | - | - | - | |||||||||
02-0311919 | 29874 | NORTH AMERICAN SPECIALTY INSURANCE COMPANY | New Hampshire | - | - | - | |||||||||
22-1964135 | 21105 | North River Insurance Company (The) | New Jersey | - | - | - | |||||||||
16-1140177 | 42552 | NOVA Casualty Company | New York | - | - | - | |||||||||
45-2871218 | 14190 | OBI National Insurance Company | Pennsylvania | - | - | - | |||||||||
47-0698507 | 23680 | Odyssey Reinsurance Company | Connecticut | - | - | - | |||||||||
31-0396250 | 24074 | Ohio Casualty Insurance Company (The) | New Hampshire | - | - | - | |||||||||
34-0438190 | 24104 | Ohio Farmers Insurance Company | Ohio | - | - | - | |||||||||
31-0620146 | 26565 | Ohio Indemnity Company | Ohio | - | - | - | |||||||||
73-0773259 | 23426 | Oklahoma Surety Company | Ohio | - | - | - | |||||||||
59-2070420 | 40231 | OLD DOMINION INSURANCE COMPANY | Florida | - | - | - | |||||||||
36-6067575 | 24139 | Old Republic General Insurance Corporation | Illinois | - | - | - | |||||||||
25-0410420 | 24147 | Old Republic Insurance Company | Pennsylvania | - | - | - | |||||||||
39-1395491 | 40444 | Old Republic Surety Company | Wisconsin | - | - | - | |||||||||
95-1078160 | 20346 | Pacific Indemnity Company | Wisconsin | - | - | - | |||||||||
96-0001575 | 18380 | PACIFIC INDEMNITY INSURANCE COMPANY | Guam | - | - | - | |||||||||
06-1401918 | 10046 | Pacific Insurance Company, Limited | Connecticut | - | - | - | |||||||||
13-3031176 | 38636 | PARTNER REINSURANCE COMPANY OF THE U.S. | New York | - | - | - | |||||||||
04-1590940 | 11835 | PartnerRe America Insurance Company | Delaware | - | - | - | |||||||||
02-0177030 | 24198 | Peerless Insurance Company | New Hampshire | - | - | - | |||||||||
37-6028411 | 24228 | Pekin Insurance Company | Illinois | - | - | - | |||||||||
23-2217934 | 41424 | Pennsylvania Manufacturers Indemnity Company | Pennsylvania | - | - | - | |||||||||
23-1642962 | 12262 | Pennsylvania Manufacturers' Association Insurance Company | Pennsylvania | - | - | - | |||||||||
23-0961349 | 14990 | Pennsylvania National Mutual Casualty Insurance Company | Pennsylvania | - | - | - | |||||||||
23-1738402 | 18058 | PHILADELPHIA INDEMNITY INSURANCE COMPANY | Pennsylvania | - | - | - | |||||||||
06-0303275 | 25623 | Phoenix Insurance Company (The) | Connecticut | - | - | - | |||||||||
56-0997453 | 18619 | PLATTE RIVER INSURANCE COMPANY | Nebraska | - | - | - | |||||||||
58-1140651 | 30945 | Plaza Insurance Company | Iowa | - | - | - | |||||||||
36-3030511 | 37257 | Praetorian Insurance Company | Pennsylvania | - | - | - | |||||||||
94-6078027 | 21903 | ProCentury Insurance Company | Michigan | - | - | - | |||||||||
34-6513736 | 24260 | Progressive Casualty Insurance Company | Ohio | - | - | - | |||||||||
34-1318335 | 38628 | PROGRESSIVE NORTHERN INSURANCE COMPANY | Wisconsin | - | - | - | |||||||||
91-1187829 | 42919 | Progressive Northwestern Insurance Company | Ohio | - | - | - | |||||||||
35-6021485 | 12416 | Protective Insurance Company | Indiana | - | - | - | |||||||||
43-1139865 | 35769 | Protective Property & Casualty Insurance Company | Missouri | - | - | - | |||||||||
22-2311816 | 39217 | QBE Insurance Corporation | Pennsylvania | - | - | - | |||||||||
23-1641984 | 10219 | QBE Reinsurance Corporation | Pennsylvania | - | - | - | |||||||||
39-6062860 | 24449 | Regent Insurance Company | Wisconsin | - | - | - | |||||||||
52-1952955 | 10357 | RENAISSANCE REINSURANCE U.S. INC. | Maryland | - | - | - | |||||||||
31-4290270 | 12475 | Republic - Franklin Insurance Company | Ohio | - | - | - | |||||||||
37-0915434 | 13056 | RLI Insurance Company | Illinois | - | - | - | |||||||||
59-2136562 | 42706 | Roche Surety and Casualty Company, Inc. | Florida | - | - | - | |||||||||
25-1620138 | 35505 | Rockwood Casualty Insurance Company | Pennsylvania | - | - | - | |||||||||
91-0742148 | 24740 | SAFECO Insurance Company of America | New Hampshire | - | - | - | |||||||||
59-1786118 | 36560 | SafePort Insurance Company | Florida | - | - | - | |||||||||
43-0727872 | 15105 | Safety National Casualty Corporation | Missouri | - | - | - | |||||||||
35-1524574 | 40460 | Sagamore Insurance Company | Indiana | - | - | - | |||||||||
75-1444207 | 30058 | SCOR REINSURANCE COMPANY | New York | - | - | - | |||||||||
39-0355180 | 22543 | SECURA INSURANCE, A Mutual Company | Wisconsin | - | - | - | |||||||||
20-2278041 | 11074 | Selective Auto Insurance Company of New Jersey | New Jersey | - | - | - | |||||||||
45-5561231 | 14376 | Selective Casualty Insurance Company | New Jersey | - | - | - | |||||||||
45-5565296 | 14377 | Selective Fire and Casualty Insurance Company | New Jersey | - | - | - | |||||||||
22-1272390 | 12572 | Selective Insurance Company of America | New Jersey | - | - | - | |||||||||
01-0471708 | 11867 | Selective Insurance Company of New England | New Jersey | - | - | - | |||||||||
16-1209233 | 13730 | Selective Insurance Company of New York | New York | - | - | - | |||||||||
56-0564874 | 19259 | Selective Insurance Company of South Carolina | Indiana | - | - | - | |||||||||
56-1285899 | 39926 | Selective Insurance Company of the Southeast | Indiana | - | - | - | |||||||||
22-2001995 | 26301 | Selective Way Insurance Company | New Jersey | - | - | - | |||||||||
13-2941133 | 10936 | Seneca Insurance Company, Inc. | New York | - | - | - | |||||||||
06-1552103 | 11000 | SENTINEL INSURANCE COMPANY, LTD. | Connecticut | - | - | - | |||||||||
39-0333950 | 24988 | Sentry Insurance Company | Wisconsin | - | - | - | |||||||||
36-2674180 | 21180 | Sentry Select Insurance Company | Wisconsin | - | - | - | |||||||||
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 | - | - | - | |||||||||
41-0406690 | 24767 | St. Paul Fire and Marine Insurance Company | Connecticut | - | - | - | |||||||||
41-0963301 | 24775 | ST. PAUL GUARDIAN INSURANCE COMPANY | Connecticut | - | - | - | |||||||||
41-0881659 | 24791 | St. Paul Mercury Insurance Company | Connecticut | - | - | - | |||||||||
36-2542404 | 19224 | ST. PAUL PROTECTIVE INSURANCE COMPANY | Connecticut | - | - | - | |||||||||
06-6033509 | 19070 | Standard Fire Insurance Company (The) | Connecticut | - | - | - | |||||||||
38-2626205 | 18023 | Star Insurance Company | Michigan | - | - | - | |||||||||
22-3590451 | 40045 | StarNet Insurance Company | Iowa | - | - | - | |||||||||
75-1670124 | 38318 | Starr Indemnity & Liability Company | Texas | - | - | - | |||||||||
81-4566522 | 16109 | Starr Specialty Insurance Company | Texas | - | - | - | |||||||||
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 | - | - | - | |||||||||
68-0266416 | 25180 | Stillwater Insurance Company | California | - | - | - | |||||||||
16-0986300 | 16578 | Stillwater Property and Casualty 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 | - | - | - | |||||||||
02-0449082 | 42376 | Technology Insurance Company, Inc. | Delaware | - | - | - | |||||||||
20-0940754 | 32301 | TNUS Insurance Company | New York | - | - | - | |||||||||
13-2918573 | 42439 | TOA REINSURANCE COMPANY OF AMERICA (THE) | Delaware | - | - | - | |||||||||
13-4032666 | 10945 | Tokio Marine America Insurance Company | 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 | - | - | - | |||||||||
41-1435765 | 41769 | Travelers Casualty Company (The) | 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 | - | - | - | |||||||||
41-1435766 | 41750 | Travelers Constitution State 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 | - | - | - | |||||||||
47-0547953 | 25844 | Union Insurance Company | Iowa | - | - | - | |||||||||
58-1847495 | 36226 | UNITED CASUALTY AND SURETY INSURANCE COMPANY | Nebraska | - | - | - | |||||||||
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 | - | - | - | |||||||||
35-1372324 | 32867 | Universal Fire & Casualty Insurance Company | Indiana | - | - | - | |||||||||
47-0363416 | 25933 | Universal Surety Company | Nebraska | - | - | - | |||||||||
43-1249228 | 41181 | UNIVERSAL UNDERWRITERS INSURANCE COMPANY | Illinois | - | - | - | |||||||||
15-0476880 | 25976 | Utica Mutual Insurance Company | New York | - | - | - | |||||||||
76-0430879 | 10024 | VerTerra Insurance Company | Texas | - | - | - | |||||||||
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 | - | - | - | |||||||||
36-4233459 | 16535 | Zurich American Insurance Company | New York | - | - | - | |||||||||
SECTION I TOTALS WILL BE ENTERED IN SECTION V | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 parents, subsidiaries and affiliates (PSAs) | |||||||||||||||
Credit may be allowed for reinsurance cessions to PSAs 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) | |||||||||||||||
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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 2021 OF | OMB No. 1530-0008 | |||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | |||||||||||||||
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. | ||||||||||||||||
74 | Alabama Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
73 | Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
55 | Alaska Workers' Compensation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
93 | American Nuclear Insurers - Domestic Liability Syndicate | Glastonbury, CT | - | - | - | |||||||||||
97 | American Nuclear Insurers - Domestic Property Syndicate | Glastonbury, CT | - | - | - | |||||||||||
100 | American Nuclear Insurers - Foreign Property and Liability Syndicate | Glastonbury, CT | - | - | - | |||||||||||
68 | Arizona Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
69 | Arkansas Commercial Automobile Insurance Procedure | Johnston, RI | - | - | - | |||||||||||
87 | Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
63 | Arkansas Stock Pool for Assigned Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
55 | Associated Aviation Underwriters | Short Hills, NJ | - | - | - | |||||||||||
61 | California Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
62 | Colorado Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
27 | Commonwealth Automobile Reinsurers | Boston, MA | - | - | - | |||||||||||
78 | Connecticut Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
60 | Delaware Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
83 | District of Columbia Commercial Automobile Insurance Procedure | Washington, DC | - | - | - | |||||||||||
100 | Excise Bond Underwriters | New York, NY | - | - | - | |||||||||||
62 | Georgia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
81 | Global Aerospace Underwriters | Short Hills, NJ | - | - | - | |||||||||||
57 | Idaho Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
52 | Illinois Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
70 | Illinois Fair Plan Association | Chicago, IL | - | - | - | |||||||||||
74 | Illinois Mutual Assigned Risk Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
61 | Illinois Stock Pool For Assigned Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
67 | Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
77 | Indiana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
67 | Iowa Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
63 | Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
72 | Kansas Commerical Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
80 | Kentucky Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
75 | Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
100 | Lloyd's Underwriters | London, DC | - | - | - | |||||||||||
61 | Louisiana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
56 | Maine Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
69 | Maine Workers Compensation Reinsurance Pool | Boca Raton, FL | - | - | - | |||||||||||
67 | Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance | Boston, MA | - | - | - | |||||||||||
61 | Massachusetts Workers Compenstation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
14 | Michigan Catastrophic Claims Association (MCCA) | Livonia, MI | - | - | - | |||||||||||
46 | Michigan Workers Compensation Placement Facility (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
67 | Minnesota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
65 | Minnesota Workers' Compensation Insurers Association, Inc. | Minneapolis, MN | - | - | - | |||||||||||
72 | Mississippi Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
59 | Missouri Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
67 | Montana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
40 | Mutual Reinsurance Bureau | Cherry Valley, IL | - | - | - | |||||||||||
45 | National Workers' Compensation Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
66 | Nebraska Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
63 | Nevada Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
24 | New Hampshire Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
56 | New Hampshire Reinsurance Facility Automobile (AIPSO) | Johnston, RI | - | - | - | |||||||||||
48 | New Jersey Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
74 | New Mexico Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
41 | New Mexico Workers' Compensation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
49 | New York Special Risk Distribution Program (AIPSO) | Johnston, RI | - | - | - | |||||||||||
23 | North Carolina Reinsurance Facility (AIPSO) | Johnston, RI | - | - | - | |||||||||||
65 | North Dakota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
78 | Ohio Commerical Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
73 | Oklahoma Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
53 | Oregon Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
63 | Pennsylvania Pooled Commercial Assignment Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
72 | Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
71 | Rhode Island Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
70 | South Carolina Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
56 | South Dakota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
73 | Tennessee Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
47 | Tennessee Workers' Compensation Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
67 | Tennessee Workers' Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
100 | United States Aircraft Insurance Group | New York, NY | - | - | - | |||||||||||
68 | Utah Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
60 | Vermont Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
73 | Virginia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
66 | Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
64 | Washington Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
89 | West Virginia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
68 | Wisconsin Special Risk Distrib. Program (AIPSO) | Johnston, RI | - | - | - | |||||||||||
61 | Wisconsin Workers Compensation Insurance Pool | Milwaukee, WI | - | - | - | |||||||||||
35 | Workers Compensation Reinsurance Association | St. Paul, MN | - | - | - | |||||||||||
61 | Wyoming Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
Syndicates for Lloyds' Underwriters | ||||||||||||||||
AIIN | ||||||||||||||||
AA1122000 | 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 | - | - | - | |||||||||||
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AA1126545 | 545 | London | - | - | - | |||||||||||
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AA1126575 | 575 | London | - | - | - | |||||||||||
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AA1126960 | 960 | London | - | - | - | |||||||||||
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AA1126990 | 990 | London | - | - | - | |||||||||||
AA1126991 | 991 | London | - | - | - | |||||||||||
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AA1127003 | 1003 | London | - | - | - | |||||||||||
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AA1127057 | 1057 | London | - | - | - | |||||||||||
AA1127069 | 1069 | London | - | - | - | |||||||||||
AA1127084 | 1084 | London | - | - | - | |||||||||||
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AA1127229 | 1229 | London | - | - | - | |||||||||||
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AA1120085 | 1274 | London | - | - | - | |||||||||||
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AA1120102 | 1458 | London | - | - | - | |||||||||||
AA1120169 | 1492 | London | - | - | - | |||||||||||
AA1127511 | 1511 | London | - | - | - | |||||||||||
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AA1127688 | 1688 | London | - | - | - | |||||||||||
AA1120157 | 1729 | London | - | - | - | |||||||||||
AA1120195 | 1840 | London | - | - | - | |||||||||||
AA1120171 | 1856 | London | - | - | - | |||||||||||
AA1127861 | 1861 | London | - | - | - | |||||||||||
AA1120096 | 1880 | London | - | - | - | |||||||||||
AA1120109 | 1882 | London | - | - | - | |||||||||||
AA1120166 | 1884 | London | - | - | - | |||||||||||
AA1120054 | 1886 | London | - | - | - | |||||||||||
AA1120131 | 1897 | London | - | - | - | |||||||||||
AA1127900 | 1900 | London | - | - | - | |||||||||||
AA1120083 | 1910 | London | - | - | - | |||||||||||
AA1120064 | 1919 | London | - | - | - | |||||||||||
AA1120124 | 1945 | London | - | - | - | |||||||||||
AA1120186 | 1947 | London | - | - | - | |||||||||||
AA1120084 | 1955 | London | - | - | - | |||||||||||
AA1120103 | 1967 | London | - | - | - | |||||||||||
AA1120106 | 1969 | London | - | - | - | |||||||||||
AA1120185 | 1975 | London | - | - | - | |||||||||||
AA1120161 | 1980 | London | - | - | - | |||||||||||
AA1120142 | 1991 | London | - | - | - | |||||||||||
AA1127999 | 1999 | London | - | - | - | |||||||||||
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AA1128001 | 2001 | London | - | - | - | |||||||||||
AA1128003 | 2003 | London | - | - | - | |||||||||||
AA1120071 | 2007 | London | - | - | - | |||||||||||
AA1128010 | 2010 | London | - | - | - | |||||||||||
AA1128011 | 2011 | London | - | - | - | |||||||||||
AA1120104 | 2012 | London | - | - | - | |||||||||||
AA1120158 | 2014 | London | - | - | - | |||||||||||
AA1120114 | 2015 | London | - | - | - | |||||||||||
AA1120193 | 2019 | London | - | - | - | |||||||||||
AA1128020 | 2020 | London | - | - | - | |||||||||||
AA1128021 | 2021 | London | - | - | - | |||||||||||
AA1128027 | 2027 | London | - | - | - | |||||||||||
AA1120164 | 2088 | London | - | - | - | |||||||||||
AA1120072 | 2112 | London | - | - | - | |||||||||||
AA1128121 | 2121 | London | - | - | - | |||||||||||
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AA1128227 | 2227 | London | - | - | - | |||||||||||
AA1120112 | 2232 | London | - | - | - | |||||||||||
AA1128241 | 2241 | London | - | - | - | |||||||||||
AA1120081 | 2243 | London | - | - | - | |||||||||||
AA1128271 | 2271 | London | - | - | - | |||||||||||
AA1120194 | 2288 | London | - | - | - | |||||||||||
AA1128322 | 2322 | London | - | - | - | |||||||||||
AA1128323 | 2323 | London | - | - | - | |||||||||||
AA1128341 | 2341 | London | - | - | - | |||||||||||
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AA1128376 | 2376 | London | - | - | - | |||||||||||
AA1120097 | 2468 | London | - | - | - | |||||||||||
AA1128488 | 2488 | London | - | - | - | |||||||||||
AA1128490 | 2490 | London | - | - | - | |||||||||||
AA1128506 | 2506 | London | - | - | - | |||||||||||
AA1120139 | 2526 | London | - | - | - | |||||||||||
AA1128591 | 2591 | London | - | - | - | |||||||||||
AA1128607 | 2607 | London | - | - | - | |||||||||||
AA1128623 | 2623 | London | - | - | - | |||||||||||
AA1128658 | 2658 | London | - | - | - | |||||||||||
AA1128659 | 2659 | London | - | - | - | |||||||||||
AA1120182 | 2689 | London | - | - | - | |||||||||||
AA1128724 | 2724 | London | - | - | - | |||||||||||
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AA1120172 | 2786 | London | - | - | - | |||||||||||
AA1128791 | 2791 | London | - | - | - | |||||||||||
AA1128923 | 2923 | London | - | - | - | |||||||||||
AA1128947 | 2947 | London | - | - | - | |||||||||||
AA1128987 | 2987 | London | - | - | - | |||||||||||
AA1120179 | 2988 | London | - | - | - | |||||||||||
AA1129000 | 3000 | London | - | - | - | |||||||||||
AA1120082 | 3010 | London | - | - | - | |||||||||||
AA1129030 | 3030 | London | - | - | - | |||||||||||
AA1129210 | 3210 | London | - | - | - | |||||||||||
AA1120184 | 3268 | London | - | - | - | |||||||||||
AA1120113 | 3334 | London | - | - | - | |||||||||||
AA1120055 | 3623 | London | - | - | - | |||||||||||
AA1120098 | 3624 | London | - | - | - | |||||||||||
AA1120056 | 3786 | London | - | - | - | |||||||||||
AA1120068 | 3820 | London | - | - | - | |||||||||||
AA1120116 | 3902 | London | - | - | - | |||||||||||
AA1126005 | 4000 | London | - | - | - | |||||||||||
AA1120075 | 4020 | London | - | - | - | |||||||||||
AA1120069 | 4040 | London | - | - | - | |||||||||||
AA1120086 | 4141 | London | - | - | - | |||||||||||
AA1120067 | 4242 | London | - | - | - | |||||||||||
AA1126004 | 4444 | London | - | - | - | |||||||||||
AA1126006 | 4472 | London | - | - | - | |||||||||||
AA1120090 | 4711 | London | - | - | - | |||||||||||
AA1126003 | 5000 | London | - | - | - | |||||||||||
AA1120080 | 5151 | London | - | - | - | |||||||||||
AA1120065 | 5555 | London | - | - | - | |||||||||||
AA1120163 | 5678 | London | - | - | - | |||||||||||
AA1120048 | 5820 | London | - | - | - | |||||||||||
AA1120181 | 5886 | London | - | - | - | |||||||||||
SECTION III TOTALS WILL BE ENTERED IN SECTION V | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | - | - | - | - | - | - | - | - | - | - | |||||
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 | - | - | - | ||||||||||||
GRAND TOTAL TREASURY AUTHORIZED WILL BE ENTERED IN SECTION X | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | |||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | |||||||||||||||
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: | ||||||||||||||||
26 | Alabama Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
27 | Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
45 | Alaska Workers' Compensation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
7 | American Nuclear Insurers - Domestic Liability Syndicate | Glastonbury, CT | - | - | - | |||||||||||
3 | American Nuclear Insurers - Domestic Property Syndicate | Glastonbury, CT | - | - | - | |||||||||||
0 | American Nuclear Insurers - Foreign Property and Liability Syndicate | Glastonbury, CT | - | - | - | |||||||||||
32 | Arizona Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
31 | Arkansas Commercial Automobile Insurance Procedure | Johnston, RI | - | - | - | |||||||||||
13 | Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
37 | Arkansas Stock Pool for Assigned Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
45 | Associated Aviation Underwriters | Short Hills, NJ | - | - | - | |||||||||||
39 | California Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
38 | Colorado Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
73 | Commonwealth Automobile Reinsurers | Boston, MA | - | - | - | |||||||||||
22 | Connecticut Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
40 | Delaware Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
17 | District of Columbia Commercial Automobile Insurance Procedure | Washington, DC | - | - | - | |||||||||||
0 | Excise Bond Underwriters | New York, NY | - | - | - | |||||||||||
38 | Georgia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
19 | Global Aerospace Underwriters | Short Hills, NJ | - | - | - | |||||||||||
43 | Idaho Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
48 | Illinois Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
30 | Illinois Fair Plan Association | Chicago, IL | - | - | - | |||||||||||
26 | Illinois Mutual Assigned Risk Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
39 | Illinois Stock Pool For Assigned Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
33 | Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
23 | Indiana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
33 | Iowa Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
37 | Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
28 | Kansas Commerical Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
20 | Kentucky Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
25 | Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
0 | Lloyd's Underwriters | London, DC | - | - | - | |||||||||||
39 | Louisiana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
44 | Maine Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
31 | Maine Workers Compensation Reinsurance Pool | Boca Raton, FL | - | - | - | |||||||||||
33 | Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance | Boston, MA | - | - | - | |||||||||||
39 | Massachusetts Workers Compenstation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
86 | Michigan Catastrophic Claims Association (MCCA) | Livonia, MI | - | - | - | |||||||||||
54 | Michigan Workers Compensation Placement Facility (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
33 | Minnesota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
35 | Minnesota Workers' Compensation Insurers Association, Inc. | Minneapolis, MN | - | - | - | |||||||||||
28 | Mississippi Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
41 | Missouri Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
33 | Montana Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
60 | Mutual Reinsurance Bureau | Cherry Valley, IL | - | - | - | |||||||||||
55 | National Workers' Compensation Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
34 | Nebraska Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
37 | Nevada Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
76 | New Hampshire Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
44 | New Hampshire Reinsurance Facility Automobile (AIPSO) | Johnston, RI | - | - | - | |||||||||||
52 | New Jersey Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
26 | New Mexico Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
59 | New Mexico Workers' Compensation Assigned Risk Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
51 | New York Special Risk Distribution Program (AIPSO) | Johnston, RI | - | - | - | |||||||||||
77 | North Carolina Reinsurance Facility (AIPSO) | Johnston, RI | - | - | - | |||||||||||
35 | North Dakota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
22 | Ohio Commerical Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
27 | Oklahoma Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
47 | Oregon Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
37 | Pennsylvania Pooled Commercial Assignment Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
28 | Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
29 | Rhode Island Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
30 | South Carolina Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
44 | South Dakota Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
27 | Tennessee Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
53 | Tennessee Workers' Compensation Reinsurance Pool (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
33 | Tennessee Workers' Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
0 | United States Aircraft Insurance Group | New York, NY | - | - | - | |||||||||||
32 | Utah Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
40 | Vermont Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
27 | Virginia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
34 | Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI) | Boca Raton, FL | - | - | - | |||||||||||
36 | Washington Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
11 | West Virginia Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
32 | Wisconsin Special Risk Distrib. Program (AIPSO) | Johnston, RI | - | - | - | |||||||||||
39 | Wisconsin Workers Compensation Insurance Pool | Milwaukee, WI | - | - | - | |||||||||||
65 | Workers Compensation Reinsurance Association | St. Paul, MN | - | - | - | |||||||||||
39 | Wyoming Commercial Automobile Insurance Procedure (AIPSO) | Johnston, RI | - | - | - | |||||||||||
SECTION VI TOTALS WILL BE ENTERED IN SECTION IX | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | |||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | |||||||||||||||
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 | - | - | - | - | - | - | - | - | - | - | ||||||
Statutory Schedule F Reconciliation (To be completed by company) | ||||||||||||||||
Per Schedule F Part 3 - Column 15 Total | - | Column 15 Total | ||||||||||||||
Less Contingent Commissions | - | Column 14 Total | ||||||||||||||
- | Difference |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||
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) | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||||||||
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 Bureau of Fiscal Service, Forms Management Officer, Parkersburg, WV 26106-1328. | |||||||||||||||||||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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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SECTION II TOTALS WILL BE ENTERED IN SECTION V | - | - | - | - | - | - | - | - | - | - | |||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1510-0012 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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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SECTION II TOTALS WILL BE ENTERED IN SECTION V | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 2021 OF | OMB No. 1510-0012 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | |||||||||||||||
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SECTION VII TOTALS WILL BE ENTERED IN SECTION IX | - | - | - | - | - | - | - | - | - | - | |||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1510-0012 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | |||||||||||||||
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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX | - | - | - | - | - | - | - | - | - | - | |||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | |||||||||||||||
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SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX | - | - | - | - | - | - | - | - | - | - | |||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | - | - | - | - | - | - | - | - | - | - | |||||
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1510-0012 | ||||||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||||||
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 | - | - | - | - | - | - | - | - | - | - |
ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||
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 |
Funds Held - Overflow Page | |||||||||||
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ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||
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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ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||
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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ANNUAL STATEMENT FOR THE YEAR 2021 OF | OMB No. 1530-0008 | ||||||||||
Write or Stamp Name | OMB Expiration Date: 6-30-2023 | ||||||||||
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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File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |