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

Annual Financial Statements of Surety Companies - Schedule F

FMS 6312_Schedule-F.xls

Annual Financial Statements of Surety Companies - Schedule F

OMB: 1530-0008

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1530-0008 can be found here:

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Overview

Instructions
Section I
Section II
Section III
Section IV THRU V
Section VI
Section VII
Section VIII thru X
Funds Held Section
Summary Page
Section II Overflow Page
Section IV Overflow Page
Section VII Overflow Page
Section VIII Overflow Page
Funds Held Overflow Page

Sheet 1: Instructions

	U.S. Treasury Schedule F Instructions
	For the Year-Ended December 31, 2009	For the year ended December 31, 2012
	Spreadsheet Version 1.0

Please Enter Your Company Name in the Box	→→→

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

Within this worksheet you will find the following U.S. Treasury Schedule F Sections:
(Please note there are 36 total printable pages (excluding over-flow pages)- all pages will print in black and white (without color, shading,
or any other formats that have been included in this spreadsheet for presentation purposes only.)

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

Overflow Pages have been included as separate TAB items and may be used if additional pages of the
above-listed sections are required in order to complete your company's Treasury Schedule F.
If you enter data in the overflow pages it will be automatically carried to the appropriate Treasury Schedule F summary page sections.
If you require more overflow pages than those provided, you will need to reproduce the related worksheet and manually enter any totals from
your reproduced worksheet(s) on the appropriate summary page. Rows and columns have been established on the summary pages to allow for these types of entries.

Overflow Pages included with this spreadsheet program are:

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

Note:
Certain cell ranges within these worksheets have been write-protected to provide for easier data entry. Normally such protected cells contain formulas or information
that should not change. If you need to edit a protected cell (normally shaded green), you may unlock the cell by accessing the following menu options
"tools" "protection" unprotect" and entering the password " f ".

If you need to reproduce any of the overflow pages you will first need to unprotect the worksheet and then reproduce the worksheet via normal copy/past keystrokes.
For any reproduced worksheets, you'll need to enter your company totals manually in the appropriate summary page in the spaces provided.

Printing - All pages in this worksheet are designed to print on legal size paper. When printing your Schedule F for filing with the Treasury, you should print
all pages in sections I through the Summary Page.
In printing the overflow pages you may wish to specify the page(s) to print, otherwise blank overflow pages from a respective worksheet will print.

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

Sheet 2: Section I

							ANNUAL STATEMENT FOR THE YEAR 2012 OF								OMB No. 1510-0012
									Write or Stamp Name						OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Federal ID	NAIC Company	Name of Reinsurer	Domiciliary	+	(1) Reinsurance Premiums	(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue				(3) Total Overdue	(4) Percentage Overdue	(5) (Known Case) Reinsurance Recoverable on Unpaid Losses	(6) Incurred But Not Reported Losses and	(7) Unearned	(8) Total Recoverable
Number	Code		Jurisdiction		Ceded	(A) Current and 1 - 90	(B) 91 - 120	(C) Over 120	(D) Total	(Col 2B + 2C)	(Col 3/Col 2D)	and Unpaid Loss Adjustment Expense	Loss Adjustment Expense	Premiums	(Cols 2D+5+6+7)
SECTION I
TREASURY AUTHORIZED COMPANIES: Do not include reinsurance applicable to alien companies in this section. All such reinsurance is unauthorized and should be listed under Section VIII.

59-1362150	26379	ACCREDITED SURETY AND CASUALTY COMPANY, INC.	Florida						-	-	-				-
36-2704802	22950	ACSTAR INSURANCE COMPANY	Illinois						-	-	-				-
23-2035821	33898	Aegis Security Insurance Company	Pennsylvania						-	-	-				-
05-0254496	10014	Affiliated FM Insurance Company	Rhode Island						-	-	-				-
34-0935740	20222	ALL AMERICA INSURANCE COMPANY	Ohio						-	-	-				-
25-0315340	13285	Allegheny Casualty Company	Pennsylvania						-	-	-				-
25-1548154	34541	ALLEGHENY SURETY COMPANY	Pennsylvania						-	-	-				-
42-1201931	42579	ALLIED Property and Casualty Insurance Company	Iowa						-	-	-				-
06-1182357	22730	Allied World Reinsurance Company	New Hampshire						-	-	-				-
06-1481194	10829	Alterra Reinsurance USA Inc.	Connecticut						-	-	-				-
42-6054959	19100	AMCO Insurance Company	Iowa						-	-	-				-
36-2661954	10103	American Agricultural Insurance Company	Indiana						-	-	-				-
52-2048110	19720	AMERICAN ALTERNATIVE INSURANCE CORPORATION	Delaware						-	-	-				-
22-1608585	21849	American Automobile Insurance Company	Missouri						-	-	-				-
59-0593886	10111	AMERICAN BANKERS INSURANCE COMPANY OF FLORIDA	Florida						-	-	-				-
23-0342560	20427	American Casualty Company of Reading, Pennsylvania	Pennsylvania						-	-	-				-
95-4290651	10216	AMERICAN CONTRACTORS INDEMNITY COMPANY	California						-	-	-				-
35-1044900	19690	American Economy Insurance Company	Indiana						-	-	-				-
59-0141790	24066	American Fire and Casualty Company	Ohio						-	-	-				-
36-6071400	26247	American Guarantee and Liability Insurance Company	New York						-	-	-				-
13-5124990	19380	American Home Assurance Company	New York						-	-	-				-
22-0731810	21857	American Insurance Company (The)	Ohio						-	-	-				-
38-1630841	19631	AMERICAN ROAD INSURANCE COMPANY (THE)	Michigan						-	-	-				-
58-2056755	39969	American Safety Casualty Insurance Company	Oklahoma						-	-	-				-
36-3223936	42897	AMERICAN SERVICE INSURANCE COMPANY, INC.	Illinois						-	-	-				-
58-6016195	10235	American Southern Insurance Company	Kansas						-	-	-				-
35-0145400	19704	American States Insurance Company	Indiana						-	-	-				-
95-3730189	31380	American Surety Company	Indiana						-	-	-				-
38-0829210	23396	Amerisure Mutual Insurance Company	Michigan						-	-	-				-
98-4207369	10308	Antilles Insurance Company	Puerto Rico						-	-	-				-
43-0990710	11150	Arch Insurance Company	Missouri						-	-	-				-
06-1430254	10348	Arch Reinsurance Company	Nebraska						-	-	-				-
94-1390273	19801	Argonaut Insurance Company	Illinois						-	-	-				-
75-2344200	43460	ASPEN AMERICAN INSURANCE COMPANY	Texas						-	-	-				-
22-1708002	21865	Associated Indemnity Corporation	California						-	-	-				-
41-1435765	41769	ATHENA ASSURANCE COMPANY	Connecticut						-	-	-				-
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						-	-	-				-
04-2656602	37540	Beazley Insurance Company, Inc.	Connecticut						-	-	-				-
47-0574325	32603	Berkley Insurance Company	Delaware						-	-	-				-
43-1432586	29580	Berkley Regional Insurance Company	Delaware						-	-	-				-
36-0810360	20095	BITUMINOUS CASUALTY CORPORATION	Illinois						-	-	-				-
36-6054328	20109	BITUMINOUS FIRE AND MARINE INSURANCE COMPANY	Illinois						-	-	-				-
36-2761729	27081	BOND SAFEGUARD INSURANCE COMPANY	Illinois						-	-	-				-
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						-	-	-				-
59-3499140	10908	Capitol Preferred Insurance Company, Inc.	Florida						-	-	-				-
59-0733942	10510	Carolina Casualty Insurance Company	Iowa						-	-	-				-
63-0701609	34568	Centennial Casualty Company	Alabama						-	-	-				-
34-4202560	20230	CENTRAL MUTUAL INSURANCE COMPANY	Ohio						-	-	-				-
42-1194107	42765	Centurion Casualty Company	Iowa						-	-	-				-
31-0936702	36951	CENTURY SURETY COMPANY	Ohio						-	-	-				-
06-0291290	25615	Charter Oak Fire Insurance Company (The)	Connecticut						-	-	-				-
25-1118791	19402	Chartis Property Casualty Company	Pennsylvania						-	-	-				-
38-3464294	10642	Cherokee Insurance Company	Michigan						-	-	-				-
22-3291862	12777	CHUBB INDEMNITY INSURANCE COMPANY	New York						-	-	-				-
31-0826946	28665	Cincinnati Casualty Company (The)	Ohio						-	-	-				-
31-0542366	10677	Cincinnati Insurance Company (The)	Ohio						-	-	-				-
38-0421730	31534	CITIZENS INSURANCE COMPANY OF AMERICA	Michigan						-	-	-				-
52-1096670	34347	COLONIAL AMERICAN CASUALTY AND SURETY COMPANY	Maryland						-	-	-				-
23-0485115	10758	COLONIAL SURETY COMPANY	Pennsylvania						-	-	-				-
47-0530077	27812	Columbia Insurance Company	Nebraska						-	-	-				-
13-1938623	19410	COMMERCE AND INDUSTRY INSURANCE COMPANY	New York						-	-	-				-
57-0768836	12157	COMPANION PROPERTY AND CASUALTY INSURANCE COMPANY	South Carolina						-	-	-				-
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	Washington						-	-	-				-
66-0257478	18163	Cooperativa de Seguros Multiples de Puerto Rico	Puerto Rico						-	-	-				-
38-1775863	10499	CorePointe Insurance Company	Michigan						-	-	-				-
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						-	-	-				-
56-0997452	16624	Darwin National Assurance Company	Delaware						-	-	-				-
42-0429710	12718	Developers Surety and Indemnity Company	Iowa						-	-	-				-
39-0264050	21458	Employers Insurance Company of Wausau	Wisconsin						-	-	-				-
42-0234980	21415	Employers Mutual Casualty Company	Iowa						-	-	-				-
04-1288420	20648	EMPLOYERS' FIRE INSURANCE COMPANY (THE)	Massachusetts						-	-	-				-
03-0350908	10641	Endurance American Insurance Company	Delaware						-	-	-				-
35-2293075	11551	Endurance Reinsurance Corporation of America	Delaware						-	-	-				-
25-1232960	26263	Erie Insurance Company	Pennsylvania						-	-	-				-
54-1132719	39020	ESSEX INSURANCE COMPANY	Delaware						-	-	-				-
36-2950161	35378	EVANSTON INSURANCE COMPANY	Illinois						-	-	-				-
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						-	-	-				-
42-0245840	13897	FARMERS MUTUAL HAIL INSURANCE COMPANY OF IOWA	Iowa						-	-	-				-
06-1067463	41483	Farmington Casualty Company	Connecticut						-	-	-				-
42-0618271	13838	Farmland Mutual Insurance Company	Iowa						-	-	-				-
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	Maryland						-	-	-				-
42-1091525	35386	FIDELITY AND GUARANTY INSURANCE COMPANY	Iowa						-	-	-				-
52-0616768	25879	Fidelity and Guaranty Insurance Underwriters, Inc.	Wisconsin						-	-	-				-
68-0266416	25180	Fidelity National Insurance Company	California						-	-	-				-
16-0986300	16578	Fidelity National Property and Casualty Insurance Company	New York						-	-	-				-
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						-	-	-				-
04-3058503	33588	First Liberty Insurance Corporation (The)	Illinois						-	-	-				-
91-0742144	24724	First National Insurance Company of America	New Hampshire						-	-	-				-
66-0561082	10972	First Net Insurance Company	Guam						-	-	-				-
22-3129711	29930	First Trenton Indemnity Company	Connecticut						-	-	-				-
39-0301590	24414	General Casualty Company Of Wisconsin	Wisconsin						-	-	-				-
91-0231910	24732	General Insurance Company of America	New Hampshire						-	-	-				-
13-2673100	22039	General Reinsurance Corporation	Delaware						-	-	-				-
13-1958482	11967	GENERAL STAR NATIONAL INSURANCE COMPANY	Ohio						-	-	-				-
33-0763205	10836	GOLDEN EAGLE INSURANCE CORPORATION	New Hampshire						-	-	-				-
31-1769414	11136	GRANGE INSURANCE COMPANY OF MICHIGAN	Ohio						-	-	-				-
31-4192970	14060	GRANGE MUTUAL CASUALTY COMPANY	Ohio						-	-	-				-
73-1282413	26310	GRANITE RE, INC.	Oklahoma						-	-	-				-
02-0140690	23809	Granite State Insurance Company	Pennsylvania						-	-	-				-
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						-	-	-				-
41-0729473	20303	Great Northern Insurance Company	Indiana						-	-	-				-
95-1479095	22322	Greenwich Insurance Company	Delaware						-	-	-				-
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						-	-	-				-
04-1989660	26182	Harleysville Worcester Insurance Company	Pennsylvania						-	-	-				-
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						-	-	-				-
06-1010609	38288	Hartford Insurance Company of Illinois	Illinois						-	-	-				-
06-1008026	37478	Hartford Insurance Company of the Midwest	Indiana						-	-	-				-
06-1013048	38261	Hartford Insurance Company of the Southeast	Connecticut						-	-	-				-
06-0384680	11452	Hartford Steam Boiler Inspection and Insurance Company (The)	Connecticut						-	-	-				-
06-1222527	30104	Hartford Underwriters Insurance Company	Connecticut						-	-	-				-
74-2195939	42374	Houston Casualty Company	Texas						-	-	-				-
13-5150451	25054	Hudson Insurance Company	Delaware						-	-	-				-
13-2930697	35408	IMPERIUM INSURANCE COMPANY	Delaware						-	-	-				-
42-0333150	14257	IMT Insurance Company	Iowa						-	-	-				-
95-2545113	25550	Indemnity Company of California	California						-	-	-				-
64-0838376	18468	Indemnity National Insurance Company	Mississippi						-	-	-				-
76-0430879	10024	Independence Casualty and Surety Company	Texas						-	-	-				-
35-0410420	14265	Indiana Lumbermens Mutual Insurance Company	Indiana						-	-	-				-
47-6025666	23264	Inland Insurance Company	Nebraska						-	-	-				-
13-5540698	19429	Insurance Company of the State of Pennsylvania (The)	Pennsylvania						-	-	-				-
95-2769232	27847	Insurance Company of the West	California						-	-	-				-
74-2262949	43273	Insurors Indemnity Company	Texas						-	-	-				-
66-0317672	26778	INTEGRAND ASSURANCE COMPANY	Puerto Rico						-	-	-				-
39-0367560	14303	Integrity Mutual Insurance Company	Wisconsin						-	-	-				-
22-1010450	11592	International Fidelity Insurance Company	New Jersey						-	-	-				-
99-6004946	22845	ISLAND INSURANCE COMPANY, LIMITED	Hawaii						-	-	-				-
48-0287450	15962	Kansas Bankers Surety Company (The)	Kansas						-	-	-				-
25-1149494	19437	Lexington Insurance Company	Delaware						-	-	-				-
52-1662720	37940	LEXINGTON NATIONAL INSURANCE CORPORATION	Maryland						-	-	-				-
76-0128873	13307	Lexon Insurance Company	Texas						-	-	-				-
03-0316876	42404	Liberty Insurance Corporation	Illinois						-	-	-				-
04-1924000	23035	Liberty Mutual Fire Insurance Company	Wisconsin						-	-	-				-
04-1543470	23043	Liberty Mutual Insurance Company	Massachusetts						-	-	-				-
04-3058504	33600	LM Insurance Corporation	Illinois						-	-	-				-
43-1139865	35769	Lyndon Property Insurance Company	Missouri						-	-	-				-
23-2086596	36897	Manufacturers Alliance Insurance Company	Pennsylvania						-	-	-				-
54-1398877	28932	Markel American Insurance Company	Virginia						-	-	-				-
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						-	-	-				-
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						-	-	-				-
41-0299900	13331	Motorists Commercial Mutual Insurance Company	Ohio						-	-	-				-
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	Wisconsin						-	-	-				-
84-0982643	16217	NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY	Wisconsin						-	-	-				-
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						-	-	-				-
36-2704643	21881	National Surety Corporation	Illinois						-	-	-				-
62-0729866	20141	NATIONAL TRUST INSURANCE COMPANY	Indiana						-	-	-				-
25-0687550	19445	National Union Fire Insurance Company of Pittsburgh, PA	Pennsylvania						-	-	-				-
31-1399201	10070	Nationwide Indemnity Company	Ohio						-	-	-				-
31-4177110	23779	Nationwide Mutual Fire Insurance Company	Ohio						-	-	-				-
31-4177100	23787	Nationwide Mutual Insurance Company	Ohio						-	-	-				-
13-3138390	42307	NAVIGATORS INSURANCE COMPANY	New York						-	-	-				-
06-1053492	41629	New England Reinsurance Corporation	Connecticut						-	-	-				-
02-0172170	23841	New Hampshire Insurance Company	Pennsylvania						-	-	-				-
22-2187459	35432	New Jersey Re-Insurance Company	New Jersey						-	-	-				-
02-0170490	14788	NGM Insurance Company	Florida						-	-	-				-
98-0032627	27073	NIPPONKOA Insurance Company, Limited (U.S. Branch)	New York						-	-	-				-
02-0311919	29874	NORTH AMERICAN SPECIALTY INSURANCE COMPANY	New Hampshire						-	-	-				-
22-1964135	21105	North River Insurance Company (The)	New Jersey						-	-	-				-
04-2974375	38369	Northern Assurance Company of America (The)	Massachusetts						-	-	-				-
95-2379438	20338	NORTHWESTERN PACIFIC INDEMNITY COMPANY	Oregon						-	-	-				-
16-1140177	42552	NOVA Casualty Company	New York						-	-	-				-
47-0698507	23680	Odyssey Reinsurance Company	Connecticut						-	-	-				-
31-0396250	24074	Ohio Casualty Insurance Company (The)	Ohio						-	-	-				-
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						-	-	-				-
04-2475442	20621	OneBeacon America Insurance Company	Massachusetts						-	-	-				-
23-1502700	21970	OneBeacon Insurance Company	Pennsylvania						-	-	-				-
95-1077060	22748	Pacific Employers Insurance Company	Pennsylvania						-	-	-				-
95-1078160	20346	Pacific Indemnity Company	Wisconsin						-	-	-				-
96-0001575	18380	PACIFIC INDEMNITY INSURANCE COMPANY	Guam						-	-	-				-
06-1401918	10046	Pacific Insurance Company, Limited	Connecticut						-	-	-				-
04-1590940	11835	PARIS RE America Insurance Company	Delaware						-	-	-				-
13-3031176	38636	PARTNER REINSURANCE COMPANY OF THE U.S.	New York						-	-	-				-
13-3531373	10006	PARTNERRE INSURANCE COMPANY OF NEW YORK	New York						-	-	-				-
02-0177030	24198	Peerless Insurance Company	New Hampshire						-	-	-				-
37-6028411	24228	Pekin Insurance Company	Illinois						-	-	-				-
23-1471444	21962	Pennsylvania General Insurance Company	Pennsylvania						-	-	-				-
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						-	-	-				-
52-1952955	10357	PLATINUM UNDERWRITERS REINSURANCE, INC.	Maryland						-	-	-				-
56-0997453	18619	PLATTE RIVER INSURANCE COMPANY	Nebraska						-	-	-				-
58-1140651	30945	Plaza Insurance Company	Missouri						-	-	-				-
94-6078027	21903	ProCentury Insurance Company	Texas						-	-	-				-
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						-	-	-				-
06-1206728	29807	PXRE Reinsurance Company	Connecticut						-	-	-				-
23-1641984	10219	QBE Reinsurance Corporation	Pennsylvania						-	-	-				-
39-6062860	24449	Regent Insurance Company	Wisconsin						-	-	-				-
41-0451140	67105	ReliaStar Life Insurance Company	Minnesota						-	-	-				-
31-4290270	12475	Republic - Franklin Insurance Company	Ohio						-	-	-				-
76-0227154	28860	RLI Indemnity Company	Illinois						-	-	-				-
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						-	-	-				-
91-1115311	39012	SAFECO Insurance Company of Illinois	Illinois						-	-	-				-
91-0885519	24759	Safeco National Insurance Company	New Hampshire						-	-	-				-
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						-	-	-				-
22-1272390	12572	Selective Insurance Company of America	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 A Mutual Company	Wisconsin						-	-	-				-
36-2674180	21180	Sentry Select Insurance Company	Wisconsin						-	-	-				-
59-1786118	36560	SERVICE INSURANCE COMPANY	Florida						-	-	-				-
22-2842279	28240	SERVICE INSURANCE COMPANY INC. (THE)	New Jersey						-	-	-				-
13-2997499	38776	SIRIUS AMERICA INSURANCE COMPANY	New York						-	-	-				-
20-3248706	12294	SOUTHWEST MARINE AND GENERAL INSURANCE COMPANY	Arizona						-	-	-				-
04-1027270	20613	SPARTA Insurance Company	Connecticut						-	-	-				-
41-0406690	24767	St. Paul Fire and Marine Insurance Company	Connecticut						-	-	-				-
41-0963301	24775	ST. PAUL GUARDIAN INSURANCE COMPANY	Connecticut						-	-	-				-
41-1435766	41750	St. Paul Medical Liability Insurance Company	Connecticut						-	-	-				-
41-0881659	24791	St. Paul Mercury Insurance Company	Connecticut						-	-	-				-
36-2542404	19224	ST. PAUL PROTECTIVE INSURANCE COMPANY	Illinois						-	-	-				-
06-6033509	19070	Standard Fire Insurance Company (The)	Connecticut						-	-	-				-
38-2626205	18023	Star Insurance Company	Michigan						-	-	-				-
22-3590451	40045	StarNet Insurance Company	Delaware						-	-	-				-
57-6010814	25127	State Auto Property and Casualty Insurance Company	Iowa						-	-	-				-
31-4316080	25135	State Automobile Mutual Insurance Company	Ohio						-	-	-				-
37-0533080	25143	State Farm Fire and Casualty Company	Illinois						-	-	-				-
13-3031274	39187	Suecia Insurance Company	New York						-	-	-				-
76-0568746	10916	SureTec Insurance Company	Texas						-	-	-				-
46-0417363	24047	SURETY BONDING COMPANY OF AMERICA	South Dakota						-	-	-				-
13-1675535	25364	Swiss Reinsurance America Corporation	New York						-	-	-				-
75-1161565	20389	TEXAS PACIFIC INDEMNITY COMPANY	Texas						-	-	-				-
20-0940754	32301	TNUS Insurance Company	New York						-	-	-				-
13-2918573	42439	TOA REINSURANCE COMPANY OF AMERICA (THE)	Delaware						-	-	-				-
13-6108722	12904	Tokio Marine & Nichido Fire Insurance Co., Ltd.	New York						-	-	-				-
13-5616275	19453	TRANSATLANTIC REINSURANCE COMPANY	New York						-	-	-				-
06-6033504	19038	Travelers Casualty and Surety Company	Connecticut						-	-	-				-
06-0907370	31194	Travelers Casualty and Surety Company of America	Connecticut						-	-	-				-
06-1286266	36170	Travelers Casualty Company of Connecticut	Connecticut						-	-	-				-
06-0876835	19046	Travelers Casualty Insurance Company of America	Connecticut						-	-	-				-
06-1286268	36137	Travelers Commercial Insurance Company	Connecticut						-	-	-				-
06-0566050	25658	Travelers Indemnity Company (The)	Connecticut						-	-	-				-
58-6020487	25666	TRAVELERS INDEMNITY COMPANY OF AMERICA (THE)	Connecticut						-	-	-				-
06-0336212	25682	Travelers Indemnity Company of Connecticut (The)	Connecticut						-	-	-				-
36-3703200	38130	Travelers Personal Insurance Company	Connecticut						-	-	-				-
36-2719165	25674	Travelers Property Casualty Company of America	Connecticut						-	-	-				-
59-2174734	41211	TRITON INSURANCE COMPANY	Texas						-	-	-				-
06-1184984	27120	Trumbull Insurance Company	Connecticut						-	-	-				-
06-0732738	29459	Twin City Fire Insurance Company	Indiana						-	-	-				-
52-1504975	29599	U.S. Specialty Insurance Company	Texas						-	-	-				-
91-6027360	25747	Unigard Insurance Company	Wisconsin						-	-	-				-
58-1847495	36226	UNITED CASUALTY AND SURETY INSURANCE COMPANY	Massachusetts						-	-	-				-
42-0644327	13021	United Fire & Casualty Company	Iowa						-	-	-				-
74-6045664	19496	UNITED FIRE & INDEMNITY COMPANY	Texas						-	-	-				-
52-0515280	25887	United States Fidelity and Guaranty Company	Connecticut						-	-	-				-
13-5459190	21113	United States Fire Insurance Company	Delaware						-	-	-				-
52-1976385	10656	United States Surety Company	Maryland						-	-	-				-
66-0457223	44423	UNITED SURETY AND INDEMNITY COMPANY	Puerto Rico						-	-	-				-
47-0363416	25933	Universal Surety Company	Nebraska						-	-	-				-
43-1249228	41181	UNIVERSAL UNDERWRITERS INSURANCE COMPANY	Kansas						-	-	-				-
15-0476880	25976	Utica Mutual Insurance Company	New York						-	-	-				-
13-1963495	20397	Vigilant Insurance Company	New York						-	-	-				-
36-2860812	32778	Washington International Insurance Company	New Hampshire						-	-	-				-
31-0624491	44393	West American Insurance Company	Indiana						-	-	-				-
39-0698170	15350	WEST BEND MUTUAL INSURANCE COMPANY	Wisconsin						-	-	-				-
92-0040526	10030	Westchester Fire Insurance Company	Pennsylvania						-	-	-				-
41-0430825	15377	Western National Mutual Insurance Company	Minnesota						-	-	-				-
46-0204900	13188	Western Surety Company	South Dakota						-	-	-				-
34-6516838	24112	Westfield Insurance Company	Ohio						-	-	-				-
34-1022544	24120	Westfield National Insurance Company	Ohio						-	-	-				-
48-0921045	39845	Westport Insurance Corporation	Missouri						-	-	-				-
13-1290712	20583	XL Reinsurance America Inc.	New York						-	-	-				-
85-0277191	37885	XL Specialty Insurance Company	Delaware						-	-	-				-
95-1651549	13269	ZENITH INSURANCE COMPANY	California						-	-	-				-
36-4233459	16535	Zurich American Insurance Company	New York						-	-	-				-
SECTION I TOTALS WILL BE ENTERED IN SECTION V					-	-	-	-	-	-	-	-	-	-	-

Sheet 3: Section II

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Federal ID

NAIC Company

Name of Reinsurer

Domiciliary

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Number

Code

Jurisdiction

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

Section II

OTHER TREASURY AUTHORIZED COMPANIES:

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

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

corresponding columns, and submit a completely executed financial statement for each listed company. If you require additional worksheets goto the overflow page for Section II (orange tab)

(B) Reinsurance with other Treasury authorized companies.

SECTION II TOTALS WILL BE ENTERED IN SECTION V

Sheet 4: Section III

							ANNUAL STATEMENT FOR THE YEAR 2012 OF								OMB No. 1510-0012
									Write or Stamp Name						OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)

	Authorized	Name of Reinsurer		+	(1) Reinsurance Premiums	(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue				(3) Total Overdue	(4) Percentage Overdue	(5) (Known Case) Reinsurance Recoverable on Unpaid Losses	(6) Incurred But Not Reported Losses and	(7) Unearned	(8) Total Recoverable
	Percentage				Ceded	(A) Current and 1 - 90	(B) 91 - 120	(C) Over 120	(D) Total	(Col 2B + 2C)	(Col 3/Col 2D)	and Unpaid Loss Adjustment Expense	Loss Adjustment Expense	Premiums	(Cols 2D+5+6+7)
SECTION III
TREASURY AUTHORIZED POOLS AND ASSOCIATIONS: Show percentages as indicated, of authorized reinsurance in this section. If percentage is less than 100%, show remainder under Section VI.

	64	Alabama Commercial Automobile Procedure (AIPSO)	Johnston, RI						-	-	-				-
	67	Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	36	Alaska Workers' Compensation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	85	American Hull Insurance Syndicate	New York, NY						-	-	-				-
	84	American Nuclear Insurers - Domestic Liability Syndicate	West Hartford, CT						-	-	-				-
	96	American Nuclear Insurers - Domestic Property Syndicate	West Hartford, CT						-	-	-				-
	78	American Nuclear Insurers - Foreign Property and Liability Syndicate	West Hartford, CT						-	-	-				-
	100	American Offshore Insurance Syndicate	New York, NY						-	-	-				-
	69	Arizona Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	63	Arkansas Commercial Automobile Insurance Procedure	Johnston, RI						-	-	-				-
	86	Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	55	Arkansas Stock Pool for Assigned Risks (NCCI)	Boca Raton, FL						-	-	-				-
	88	Associated Aerospace Underwriters	Short Hills, NJ						-	-	-				-
	75	Associated Aviation Underwriters	Short Hills, NJ						-	-	-				-
	67	California Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	62	Colorado Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	24	Commonwealth Automobile Reinsurers	Boston, MA						-	-	-				-
	85	Connecticut Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	62	Delaware Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	85	District of Columbia Commercial Automobile Insurance Procedure	Washington, DC						-	-	-				-
	100	Excise Bond Underwriters	New York, NY						-	-	-				-
	69	Georgia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	90	Global Aerospace Underwriters	Short Hills, NJ						-	-	-				-
	57	Idaho Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	63	Illinois Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	67	Illinois Fair Plan Association	Chicago, IL						-	-	-				-
	72	Illinois Mutual Assigned Risk Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	55	Illinois Stock Pool For Assigned Risks (NCCI)	Boca Raton, FL						-	-	-				-
	62	Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	78	Indiana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	62	Iowa Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	57	Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	68	Kansas Commerical Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	79	Kentucky Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	69	Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	100	Lloyd's Underwriters	London, DC						-	-	-				-
	64	Louisiana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	59	Maine Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	58	Maine Workers Compensation Reinsurance Pool	Boca Raton, FL						-	-	-				-
	70	Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance	Boston, MA						-	-	-				-
	44	Massachusetts Workers Compenstation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	16	Michigan Catastrophic Claims Association (MCCA)	Livonia, MI						-	-	-				-
	43	Michigan Workers Compensation Placement Facility (NCCI)	Boca Raton, FL						-	-	-				-
	63	Minnesota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	62	Minnesota Workers' Compensation Insurers Association, Inc.	Minneapolis, MN						-	-	-				-
	57	Mississippi Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	49	Missouri Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	72	Montana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	50	Mutual Reinsurance Bureau	Cherry Valley, IL						-	-	-				-
	44	National Workers' Compensation Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	59	Nebraska Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	70	Nevada Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	60	New Hampshire Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	41	New Hampshire Reinsurance Facility Automobile (AIPSO)	Johnston, RI						-	-	-				-
	61	New Jersey Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	66	New Mexico Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	46	New Mexico Workers' Compensation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	65	New York Special Risk Distribution Program (AIPSO)	Johnston, RI						-	-	-				-
	43	North Carolina Reinsurance Facility (AIPSO)	Johnston, RI						-	-	-				-
	56	North Dakota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	78	Ohio Commerical Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	74	Oklahoma Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	49	Oregon Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	66	Pennsylvania Pooled Commercial Assignment Procedure (AIPSO)	Johnston, RI						-	-	-				-
	67	Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	77	Rhode Island Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	69	South Carolina Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	45	South Carolina Reinsurance Facility (AIPSO)	Johnston, RI						-	-	-				-
	52	South Dakota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	63	Tennessee Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	62	Tennessee Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	67	United States Aircraft Insurance Group	New York, NY						-	-	-				-
	71	Utah Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	65	Vermont Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	73	Virginia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	60	Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	59	Washington Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	84	West Virginia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	72	Wisconsin Compensation Rating Bureau	Milwaukee, WI						-	-	-				-
	65	Wisconsin Special Risk Distrib. Program (AIPSO)	Johnston, RI						-	-	-				-
	42	Workers Compensation Reinsurance Association	St. Paul, MN						-	-	-				-
	78	Workers' Compensation Reinsurance Bureau (The)	Minneapolis, MN						-	-	-				-
	66	Wyoming Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
									-	-	-				-
									-	-	-				-
									-	-	-				-
									-	-	-				-
									-	-	-				-
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									-	-	-				-
									-	-	-				-

		Syndicates for Lloyds' Underwriters
	AIIN
	AA 1122000 Lloyds of London (Authorized)		London						-	-	-				-
	AA1126002	2	London						-	-	-				-
	AA1126028	28	London						-	-	-				-
	AA1126033	33	London						-	-	-				-
	AA1126034	34	London						-	-	-				-
	AA1126040	40	London						-	-	-				-
	AA1126047	47	London						-	-	-				-
	AA1126048	48	London						-	-	-				-
	AA1126051	51	London						-	-	-				-
	AA1126052	52	London						-	-	-				-
	AA1126053	53	London						-	-	-				-
	AA1126055	55	London						-	-	-				-
	AA1126062	62	London						-	-	-				-
	AA1126079	79	London						-	-	-				-
	AA1126102	102	London						-	-	-				-
	AA1126112	112	London						-	-	-				-
	AA1126122	122	London						-	-	-				-
	AA1126123	123	London						-	-	-				-
	AA1126136	136	London						-	-	-				-
	AA1126138	138	London						-	-	-				-
	AA1126159	159	London						-	-	-				-
	AA1126172	172	London						-	-	-				-
	AA1126173	173	London						-	-	-				-
	AA1126178	178	London						-	-	-				-
	AA1126179	179	London						-	-	-				-
	AA1126183	183	London						-	-	-				-
	AA1126187	187	London						-	-	-				-
	AA1126190	190	London						-	-	-				-
	AA1126204	204	London						-	-	-				-
	AA1126205	205	London						-	-	-				-
	AA1126218	218	London						-	-	-				-
	AA1126219	219	London						-	-	-				-
	AA1126227	227	London						-	-	-				-
	AA1126228	228	London						-	-	-				-
	AA1126250	250	London						-	-	-				-
	AA1126270	270	London						-	-	-				-
	AA1126271	271	London						-	-	-				-
	AA1126282	282	London						-	-	-				-
	AA1126314	314	London						-	-	-				-
	AA1126318	318	London						-	-	-				-
	AA1126322	322	London						-	-	-				-
	AA1126328	328	London						-	-	-				-
	AA1126329	329	London						-	-	-				-
	AA1126340	340	London						-	-	-				-
	AA1126360	360	London						-	-	-				-
	AA1126362	362	London						-	-	-				-
	AA1126375	375	London						-	-	-				-
	AA1126376	376	London						-	-	-				-
	AA1126382	382	London						-	-	-				-
	AA1126386	386	London						-	-	-				-
	AA1126397	397	London						-	-	-				-
	AA1126431	431	London						-	-	-				-
	AA1126435	435	London						-	-	-				-
	AA1126441	441	London						-	-	-				-
	AA1126456	456	London						-	-	-				-
	AA1126457	457	London						-	-	-				-
	AA1126473	473	London						-	-	-				-
	AA1126483	483	London						-	-	-				-
	AA1126484	484	London						-	-	-				-
	AA1126488	488	London						-	-	-				-
	AA1126490	490	London						-	-	-				-
	AA1126500	500	London						-	-	-				-
	AA1126506	506	London						-	-	-				-
	AA1126507	507	London						-	-	-				-
	AA1126510	510	London						-	-	-				-
	AA1126529	529	London						-	-	-				-
	AA1126535	535	London						-	-	-				-
	AA1126536	536	London						-	-	-				-
	AA1126538	538	London						-	-	-				-
	AA1126539	539	London						-	-	-				-
	AA1126545	545	London						-	-	-				-
	AA1126552	552	London						-	-	-				-
	AA1126557	557	London						-	-	-				-
	AA1126566	566	London						-	-	-				-
	AA1126570	570	London						-	-	-				-
	AA1126575	575	London						-	-	-				-
	AA1126582	582	London						-	-	-				-
	AA1126588	588	London						-	-	-				-
	AA1126590	590	London						-	-	-				-
	AA1126609	609	London						-	-	-				-
	AA1126623	623	London						-	-	-				-
	AA1126624	624	London						-	-	-				-
	AA1126625	625	London						-	-	-				-
	AA1126626	626	London						-	-	-				-
	AA1126658	658	London						-	-	-				-
	AA1126672	672	London						-	-	-				-
	AA1126683	683	London						-	-	-				-
	AA1126702	702	London						-	-	-				-
	AA1126718	718	London						-	-	-				-
	AA1126724	724	London						-	-	-				-
	AA1126727	727	London						-	-	-				-
	AA1126732	732	London						-	-	-				-
	AA1126734	734	London						-	-	-				-
	AA1126735	735	London						-	-	-				-
	AA1126741	741	London						-	-	-				-
	AA1126744	744	London						-	-	-				-
	AA1126765	765	London						-	-	-				-
	AA1126766	766	London						-	-	-				-
	AA1126780	780	London						-	-	-				-
	AA1126800	800	London						-	-	-				-
	AA1126807	807	London						-	-	-				-
	AA1126808	808	London						-	-	-				-
	AA1126822	822	London						-	-	-				-
	AA1126823	823	London						-	-	-				-
	AA1126824	824	London						-	-	-				-
	AA1126839	839	London						-	-	-				-
	AA1126858	858	London						-	-	-				-
	AA1126861	861	London						-	-	-				-
	AA1126902	902	London						-	-	-				-
	AA1126920	920	London						-	-	-				-
	AA1126923	923	London						-	-	-				-
	AA1126925	925	London						-	-	-				-
	AA1126947	947	London						-	-	-				-
	AA1126955	955	London						-	-	-				-
	AA1126957	957	London						-	-	-				-
	AA1126958	958	London						-	-	-				-
	AA1126959	959	London						-	-	-				-
	AA1126960	960	London						-	-	-				-
	AA1126963	963	London						-	-	-				-
	AA1126990	990	London						-	-	-				-
	AA1126991	991	London						-	-	-				-
	AA1126994	994	London						-	-	-				-
	AA1126998	998	London						-	-	-				-
	AA1127003	1003	London						-	-	-				-
	AA1127007	1007	London						-	-	-				-
	AA1127009	1009	London						-	-	-				-
	AA1127010	1010	London						-	-	-				-
	AA1127019	1019	London						-	-	-				-
	AA1127023	1023	London						-	-	-				-
	AA1127027	1027	London						-	-	-				-
	AA1127028	1028	London						-	-	-				-
	AA1127036	1036	London						-	-	-				-
	AA1127038	1038	London						-	-	-				-
	AA1127047	1047	London						-	-	-				-
	AA1127051	1051	London						-	-	-				-
	AA1127055	1055	London						-	-	-				-
	AA1127057	1057	London						-	-	-				-
	AA1127069	1069	London						-	-	-				-
	AA1127084	1084	London						-	-	-				-
	AA1127087	1087	London						-	-	-				-
	AA1127093	1093	London						-	-	-				-
	AA1127095	1095	London						-	-	-				-
	AA1127096	1096	London						-	-	-				-
	AA1127101	1101	London						-	-	-				-
	AA1120105	1110	London						-	-	-				-
	AA1127115	1115	London						-	-	-				-
	AA1127119	1119	London						-	-	-				-
	AA1127121	1121	London						-	-	-				-
	AA1127124	1124	London						-	-	-				-
	AA1127141	1141	London						-	-	-				-
	AA1127165	1165	London						-	-	-				-
	AA1127173	1173	London						-	-	-				-
	AA1127175	1175	London						-	-	-				-
	AA1127176	1176	London						-	-	-				-
	AA1127179	1179	London						-	-	-				-
	AA1127183	1183	London						-	-	-				-
	AA1127185	1185	London						-	-	-				-
	AA1127200	1200	London						-	-	-				-
	AA1127202	1202	London						-	-	-				-
	AA1127203	1203	London						-	-	-				-
	AA1127204	1204	London						-	-	-				-
	AA1127205	1205	London						-	-	-				-
	AA1127206	1206	London						-	-	-				-
	AA1127207	1207	London						-	-	-				-
	AA1127208	1208	London						-	-	-				-
	AA1127209	1209	London						-	-	-				-
	AA1127210	1210	London						-	-	-				-
	AA1127211	1211	London						-	-	-				-
	AA1127212	1212	London						-	-	-				-
	AA1127213	1213	London						-	-	-				-
	AA1127214	1214	London						-	-	-				-
	AA1127215	1215	London						-	-	-				-
	AA1127218	1218	London						-	-	-				-
	AA1127221	1221	London						-	-	-				-
	AA1127223	1223	London						-	-	-				-
	AA1127224	1224	London						-	-	-				-
	AA1127225	1225	London						-	-	-				-
	AA1127227	1227	London						-	-	-				-
	AA1127229	1229	London						-	-	-				-
	AA1127232	1232	London						-	-	-				-
	AA1127234	1234	London						-	-	-				-
	AA1127236	1236	London						-	-	-				-
	AA1127239	1239	London						-	-	-				-
	AA1127241	1241	London						-	-	-				-
	AA1127242	1242	London						-	-	-				-
	AA1127243	1243	London						-	-	-				-
	AA1127245	1245	London						-	-	-				-
	AA1127251	1251	London						-	-	-				-
	AA1127265	1265	London						-	-	-				-
	AA1120085	1274	London						-	-	-				-
	AA1127301	1301	London						-	-	-				-
	AA1127308	1308	London						-	-	-				-
	AA1120095	1318	London						-	-	-				-
	AA1127323	1323	London						-	-	-				-
	AA1127400	1400	London						-	-	-				-
	AA1127411	1411	London						-	-	-				-
	AA1127414	1414	London						-	-	-				-
	AA1127415	1415	London						-	-	-				-
	AA1120102	1458	London						-	-	-				-
	AA1127511	1511	London						-	-	-				-
	AA1127607	1607	London						-	-	-				-
	AA1127611	1611	London						-	-	-				-
	AA1127688	1688	London						-	-	-				-
	AA1127861	1861	London						-	-	-				-
	AA1120096	1880	London						-	-	-				-
	AA1120109	1882	London						-	-	-				-
	AA1120054	1886	London						-	-	-				-
	AA1120131	1897	London						-	-	-				-
	AA1127900	1900	London						-	-	-				-
	AA1120083	1910	London						-	-	-				-
	AA1120064	1919	London						-	-	-				-
	AA1120124	1945	London						-	-	-				-
	AA1120084	1955	London						-	-	-				-
	AA1120103	1967	London						-	-	-				-
	AA1120106	1969	London						-	-	-				-
	AA1127999	1999	London						-	-	-				-
	AA1128000	2000	London						-	-	-				-
	AA1128001	2001	London						-	-	-				-
	AA1128003	2003	London						-	-	-				-
	AA1120071	2007	London						-	-	-				-
	AA1128010	2010	London						-	-	-				-
	AA1128011	2011	London						-	-	-				-
	AA1120104	2012	London						-	-	-				-
	AA1120114	2015	London						-	-	-				-
	AA1128020	2020	London						-	-	-				-
	AA1128021	2021	London						-	-	-				-
	AA1128027	2027	London						-	-	-				-
	AA1120072	2112	London						-	-	-				-
	AA1128121	2121	London						-	-	-				-
	AA1128147	2147	London						-	-	-				-
	AA1128176	2176	London						-	-	-				-
	AA1128183	2183	London						-	-	-				-
	AA1128227	2227	London						-	-	-				-
	AA1120112	2232	London						-	-	-				-
	AA1128241	2241	London						-	-	-				-
	AA1120081	2243	London						-	-	-				-
	AA1128271	2271	London						-	-	-				-
	AA1128322	2322	London						-	-	-				-
	AA1128323	2323	London						-	-	-				-
	AA1128341	2341	London						-	-	-				-
	AA1128345	2345	London						-	-	-				-
	AA1128376	2376	London						-	-	-				-
	AA1120097	2468	London						-	-	-				-
	AA1128488	2488	London						-	-	-				-
	AA1128490	2490	London						-	-	-				-
	AA1128506	2506	London						-	-	-				-
	AA1128591	2591	London						-	-	-				-
	AA1128607	2607	London						-	-	-				-
	AA1128623	2623	London						-	-	-				-
	AA1128658	2658	London						-	-	-				-
	AA1128659	2659	London						-	-	-				-
	AA1128724	2724	London						-	-	-				-
	AA1128734	2734	London						-	-	-				-
	AA1128741	2741	London						-	-	-				-
	AA1128791	2791	London						-	-	-				-
	AA1128923	2923	London						-	-	-				-
	AA1128947	2947	London						-	-	-				-
	AA1128987	2987	London						-	-	-				-
	AA1129000	3000	London						-	-	-				-
	AA1120082	3010	London						-	-	-				-
	AA1129030	3030	London						-	-	-				-
	AA1129210	3210	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						-	-	-				-
	AA1120048	5820	London						-	-	-				-
									-	-	-				-
									-	-	-				-
SECTION III TOTALS WILL BE ENTERED IN SECTION V					-	-	-	-	-	-	-	-	-	-	-

Sheet 5: Section IV THRU V

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Authorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

(A) Current and 1 - 90

(B) 91 - 120

(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).

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

Sheet 6: Section VI

							ANNUAL STATEMENT FOR THE YEAR 2012 OF								OMB No. 1510-0012
									Write or Stamp Name						OMB Expiration Date: 9-30-2013
Schedule F - Part 1
Ceded Reinsurance as of December 31, Current Year (000's Omitted)

	Unauthorized	Name of Reinsurer		+	(1) Reinsurance Premiums	(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue				(3) Total Overdue	(4) Percentage Overdue	(5) (Known Case) Reinsurance Recoverable on Unpaid Losses	(6) Incurred But Not Reported Losses and	(7) Unearned	(8) Total Recoverable
	Percentage				Ceded	(A) Current and 1 - 90	(B) 91 - 120	(C) Over 120	(D) Total	(Col 2B + 2C)	(Col 3/Col 2D)	and Unpaid Loss Adjustment Expense	Loss Adjustment Expense	Premiums	(Cols 2D+5+6+7)
SECTION VI
TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:

	36	Alabama Commercial Automobile Procedure (AIPSO)	Johnston, RI						-	-	-				-
	33	Alabama Workers' Compensation Reinsurance Pool for Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	64	Alaska Workers' Compensation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	15	American Hull Insurance Syndicate	New York, NY						-	-	-				-
	16	American Nuclear Insurers - Domestic Liability Syndicate	West Hartford, CT						-	-	-				-
	4	American Nuclear Insurers - Domestic Property Syndicate	West Hartford, CT						-	-	-				-
	22	American Nuclear Insurers - Foreign Property and Liability Syndicate	West Hartford, CT						-	-	-				-
	0	American Offshore Insurance Syndicate	New York, NY						-	-	-				-
	31	Arizona Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	37	Arkansas Commercial Automobile Insurance Procedure	Johnston, RI						-	-	-				-
	14	Arkansas Mutual Assigned Risk Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	45	Arkansas Stock Pool for Assigned Risks (NCCI)	Boca Raton, FL						-	-	-				-
	12	Associated Aerospace Underwriters	Short Hills, NJ						-	-	-				-
	25	Associated Aviation Underwriters	Short Hills, NJ						-	-	-				-
	33	California Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	38	Colorado Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	76	Commonwealth Automobile Reinsurers	Boston, MA						-	-	-				-
	15	Connecticut Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	38	Delaware Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	15	District of Columbia Commercial Automobile Insurance Procedure	Washington, DC						-	-	-				-
	0	Excise Bond Underwriters	New York, NY						-	-	-				-
	31	Georgia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	10	Global Aerospace Underwriters	Short Hills, NJ						-	-	-				-
	43	Idaho Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	37	Illinois Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	33	Illinois Fair Plan Association	Chicago, IL						-	-	-				-
	28	Illinois Mutual Assigned Risk Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	45	Illinois Stock Pool For Assigned Risks (NCCI)	Boca Raton, FL						-	-	-				-
	38	Illinois Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	22	Indiana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	38	Iowa Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	43	Iowa Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	32	Kansas Commerical Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	21	Kentucky Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	31	Kentucky Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	0	Lloyd's Underwriters	London, DC						-	-	-				-
	36	Louisiana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	41	Maine Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	42	Maine Workers Compensation Reinsurance Pool	Boca Raton, FL						-	-	-				-
	30	Massachusetts Voluntary Non-Stock Assigned Risk Pool For Workmens Compensation Insurance	Boston, MA						-	-	-				-
	56	Massachusetts Workers Compenstation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	84	Michigan Catastrophic Claims Association (MCCA)	Livonia, MI						-	-	-				-
	57	Michigan Workers Compensation Placement Facility (NCCI)	Boca Raton, FL						-	-	-				-
	37	Minnesota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	38	Minnesota Workers' Compensation Insurers Association, Inc.	Minneapolis, MN						-	-	-				-
	43	Mississippi Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	51	Missouri Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	28	Montana Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	50	Mutual Reinsurance Bureau	Cherry Valley, IL						-	-	-				-
	56	National Workers' Compensation Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	41	Nebraska Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	30	Nevada Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	40	New Hampshire Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	59	New Hampshire Reinsurance Facility Automobile (AIPSO)	Johnston, RI						-	-	-				-
	39	New Jersey Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	34	New Mexico Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	54	New Mexico Workers' Compensation Assigned Risk Pool (NCCI)	Boca Raton, FL						-	-	-				-
	35	New York Special Risk Distribution Program (AIPSO)	Johnston, RI						-	-	-				-
	57	North Carolina Reinsurance Facility (AIPSO)	Johnston, RI						-	-	-				-
	44	North Dakota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	22	Ohio Commerical Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	26	Oklahoma Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	51	Oregon Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	34	Pennsylvania Pooled Commercial Assignment Procedure (AIPSO)	Johnston, RI						-	-	-				-
	33	Pennsylvania Workers Compensation Insurance Plan and Reinsurance Pool (NCCI)	Boca Raton, FL						-	-	-				-
	23	Rhode Island Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	31	South Carolina Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	55	South Carolina Reinsurance Facility (AIPSO)	Johnston, RI						-	-	-				-
	48	South Dakota Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	37	Tennessee Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	38	Tennessee Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	33	United States Aircraft Insurance Group	New York, NY						-	-	-				-
	29	Utah Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	35	Vermont Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	27	Virginia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	40	Virginia Workers Compensation Reinsurance Pool For Coal Mine Risks (NCCI)	Boca Raton, FL						-	-	-				-
	41	Washington Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	16	West Virginia Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
	28	Wisconsin Compensation Rating Bureau	Milwaukee, WI						-	-	-				-
	35	Wisconsin Special Risk Distrib. Program (AIPSO)	Johnston, RI						-	-	-				-
	58	Workers Compensation Reinsurance Association	St. Paul, MN						-	-	-				-
	22	Workers' Compensation Reinsurance Bureau (The)	Minneapolis, MN						-	-	-				-
	34	Wyoming Commercial Automobile Insurance Procedure (AIPSO)	Johnston, RI						-	-	-				-
									-	-	-				-
SECTION VI TOTALS WILL BE ENTERED IN SECTION IX					-	-	-	-	-	-	-	-	-	-	-

Sheet 7: Section VII

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Unauthorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(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).

SECTION VII TOTALS WILL BE ENTERED IN SECTION IX

Sheet 8: Section VIII thru X

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Federal ID

NAIC Company

Name of Reinsurer

Domiciliary

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Number

Code

Jurisdiction

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(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).

SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX

SECTION IX

TREASURY UNAUTHORIZED:

Total Section VI

Total Section VII

Total Section VII Overflow Page (s) if applicable

Total Section VIII

Total Section VIII Overflow Page (s) if applicable

Unauthorized Reinsurance from company produced worksheets not included in totals above

Grand Total Treasury Unauthorized: (Enter in Section X)

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

SECTION X

ALL REINSURANCE:

Total Section V

Total Section IX

GRAND TOTAL: ALL REINSURANCE

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

Sheet 9: Funds Held Section

						ANNUAL STATEMENT FOR THE YEAR 2012 OF					OMB No. 1510-0012
								Write or Stamp Name			OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)

					(2)
Federal ID Number	NAIC Company Code	Name of Reinsurer	Domiciliary Jurisdiction	(1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8	(A) Funds Held By Company Under Reinsurance Treaties	(B) Letters of Credit	(C) Trust Agreements	(D) Other Allowed Offset Items	(E) Total Funds Held (Cols 2A Through 2D)	(3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E)	(4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
Companies may take credit for acceptable offsets to unauthorized reinsurance recoverables. Offsets can include funds held, letters of credit (issued by a bank on the NAIC approved bank list),									-	-
and trust funds. Reinsurance payables are acceptable so long as a legal right of offset exists in the contract language. Evidence should be submitted in support of such offsets for large or									-	-
material amounts. Materiality for Treasury purposes normally falls within a range of 5-10% of the reporting company's policyholders' surplus.									-	-
If you require additional worksheets to complete this section, please goto the funds held overflow page (orange tabs).									-	-
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TOTAL(COL. 3) WILL BE ENTERED ON THE SUMMARY PAGE OF THIS SCHEDULE)				-	-	-	-	-	-	-	-

Sheet 10: Summary Page

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Page 34 of 34

(000's OMITTED)

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

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

Total Unauthorized Reinsurance for Treasury purposes

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

Less:

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

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

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

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

Less:

* Liability for Unauthorized Reinsurance shown on the Company's

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

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

* Include provision for overdue Authorized Reinsurance as well

COMPANY CONTACT PERSON FOR THIS SCHEDULE:

(NAME)

(PHONE NO.)

Paperwork Reduction Act and

Privacy Act Statement - FMS Form 6314

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

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

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

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

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

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

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

Sheet 11: Section II Overflow Page

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section II Overflow Page

Federal ID

NAIC Company

Name of Reinsurer

Domiciliary

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Number

Code

Jurisdiction

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

Section II - Overflow Page

OTHER TREASURY AUTHORIZED COMPANIES:

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

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

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

(B) Reinsurance with other Treasury authorized companies

SECTION II TOTALS WILL BE ENTERED IN SECTION V

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section II Overflow Page

Federal ID

NAIC Company

Name of Reinsurer

Domiciliary

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Number

Code

Jurisdiction

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

Section II - Overflow Page

OTHER TREASURY AUTHORIZED COMPANIES:

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

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

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

(B) Reinsurance with other Treasury authorized companies

SECTION II TOTALS WILL BE ENTERED IN SECTION V

Sheet 12: Section IV Overflow Page

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section IV Overflow Page

Authorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

SECTION IV - Overflow Page

OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:

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

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

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

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

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

SECTION IV TOTALS WILL BE ENTERED IN SECTION V

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section IV Overflow Page

Authorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

SECTION IV - Overflow Page

OTHER TREASURY AUTHORIZED POOLS AND ASSOCIATIONS:

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

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

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

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

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

SECTION IV TOTALS WILL BE ENTERED IN SECTION V

Sheet 13: Section VII Overflow Page

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section VII Overflow Page

Unauthorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

SECTION VII - Overflow Page

OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:

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

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

SECTION VII TOTALS WILL BE ENTERED IN SECTION IX

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section VII Overflow Page

Unauthorized

Name of Reinsurer

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Percentage

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(D) Total

(Col 2B + 2C)

(Col 3/Col 2D)

and Unpaid Loss Adjustment Expense

Loss Adjustment Expense

Premiums

(Cols 2D+5+6+7)

SECTION VII - Overflow Page

OTHER TREASURY UNAUTHORIZED POOLS AND ASSOCIATIONS:

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

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

SECTION VII TOTALS WILL BE ENTERED IN SECTION IX

Sheet 14: Section VIII Overflow Page

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section VIII Overflow Page

Federal ID

NAIC Company

Name of Reinsurer

Domiciliary

(1) Reinsurance Premiums

(2) Recoverable on Paid Losses and Paid Loss Adjustment Expense, Days Overdue

(3) Total Overdue

(4) Percentage Overdue

(5) (Known Case) Reinsurance Recoverable on Unpaid Losses

(6) Incurred But Not Reported Losses and

(7) Unearned

(8) Total Recoverable

Number

Code

Jurisdiction

Ceded

(A) Current and 1 - 90

(B) 91 - 120

(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.

SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section 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

(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.

SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section 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

(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.

SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX

ANNUAL STATEMENT FOR THE YEAR 2012 OF

OMB No. 1510-0012

Write or Stamp Name

OMB Expiration Date: 9-30-2013

Schedule F - Part 1

Ceded Reinsurance as of December 31, Current Year (000's Omitted)

Section 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

(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.

SECTION VIII TOTALS WILL BE ENTERED IN SECTION IX

Sheet 15: Funds Held Overflow Page

						ANNUAL STATEMENT FOR THE YEAR 2012 OF					OMB No. 1510-0012
								Write or Stamp Name			OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page
					(2)
Federal ID Number	NAIC Company Code	Name of Reinsurer	Domiciliary Jurisdiction	(1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8	(A) Funds Held By Company Under Reinsurance Treaties	(B) Letters of Credit	(C) Trust Agreements	(D) Other Allowed Offset Items	(E) Total Funds Held (Cols 2A Through 2D)	(3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E)	(4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE				-	-	-	-	-	-	-	-



						ANNUAL STATEMENT FOR THE YEAR 2012 OF					OMB No. 1510-0012
								Write or Stamp Name			OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page
					(2)
Federal ID Number	NAIC Company Code	Name of Reinsurer	Domiciliary Jurisdiction	(1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8	(A) Funds Held By Company Under Reinsurance Treaties	(B) Letters of Credit	(C) Trust Agreements	(D) Other Allowed Offset Items	(E) Total Funds Held (Cols 2A Through 2D)	(3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E)	(4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE				-	-	-	-	-	-	-	-



						ANNUAL STATEMENT FOR THE YEAR 2012 OF					OMB No. 1510-0012
								Write or Stamp Name			OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page
					(2)
Federal ID Number	NAIC Company Code	Name of Reinsurer	Domiciliary Jurisdiction	(1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8	(A) Funds Held By Company Under Reinsurance Treaties	(B) Letters of Credit	(C) Trust Agreements	(D) Other Allowed Offset Items	(E) Total Funds Held (Cols 2A Through 2D)	(3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E)	(4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE				-	-	-	-	-	-	-	-



						ANNUAL STATEMENT FOR THE YEAR 2012 OF					OMB No. 1510-0012
								Write or Stamp Name			OMB Expiration Date: 9-30-2013
SCHEDULE F - Part 2
Funds Withheld on Account of Reinsurance in Unauthorized Companies as of December 31, Current Year (000's Omitted)
Overflow Page
					(2)
Federal ID Number	NAIC Company Code	Name of Reinsurer	Domiciliary Jurisdiction	(1) Reinsurance Recoverables From Unauthorized Companies - All Items From Part 1, Section IX, Col. 8	(A) Funds Held By Company Under Reinsurance Treaties	(B) Letters of Credit	(C) Trust Agreements	(D) Other Allowed Offset Items	(E) Total Funds Held (Cols 2A Through 2D)	(3) Total Credit Allowed For Funds Held (Smaller of Col 1 or Col 2E)	(4) Past Due Reinsurance Recoverable from Part 1, Section IX, Col 3
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Overflow Page FUNDS HELD TOTALS WILL BE ENTERED ON SUMMARY PAGE				-	-	-	-	-	-	-	-

File Type	application/vnd.ms-excel
Author	Gary Kosciolek
Last Modified By	Wolfgang, Dawn
File Modified	2013-09-30
File Created	2000-04-07