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Liquidity - Top Ten Tables

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					                                                           STATE OF NEW YORK
                                                         INSURANCE DEPARTMENT
David A. Paterson                                         ONE COMMERCE PLAZA                          James J. Wrynn
    Governor                                             ALBANY, NEW YORK 12257                       Superintendent



                              Liquidity and Severe Mortality Inquiry
                                                            February 3, 2010



                    Company Name
                    NAIC Number
                    Name of Chief Financial Officer or
                    Highest Ranking Financial Officer

                    Email Address

                    Phone Number

                    Fax Number

                    Date of Response


If an insurer submitting information pursuant to this Survey deems such information to be a trade secret or
contends that such information, if disclosed, would cause substantial injury to the competitive position of the
insurer, it may, at the time the report is submitted, request that the Department except such information from
disclosure. The request shall be in writing and shall state the reasons why the information should be excepted
from disclosure. Entitlement to such exception shall be determined in accordance with the procedures set forth in
Section 89(5) of the Public Officer's Law and Insurance Department Regulation No. 71 (11 NYCRR 241).
Company Name
NAIC #

TABLE ONE - Cash Demands (in thousands) as of 12/31/2009


Demand Class                                                                0 to 7days      8 to 14 days     15 to 30 days       31 to 90 days       91 to 180 days      181 to 365 days      Total
A       Large* or institutional** cash demands                                                                                                                                                        $0
A1 Statutory liability of (A)                                                                                                                                                                         $0
A2 Amount of (A) deferrable for 6 months                                                                                                                                                              $0
A3 Reinsurance receivable on amounts in (A)                                                                                                                                                           $0
B       Other policy/contract cash demands (includes retail business)                                                                                                                                 $0
B1 Statutory liability of (B)                                                                                                                                                                         $0
B2 Amount of (B) deferrable for 6 months                                                                                                                                                              $0
B3 Reinsurance receivable on amounts in (B)                                                                                                                                                           $0
Itemize other cash demands
    1                                                                                                                                                                                                 $0
    2                                                                                                                                                                                                 $0
    3                                                                                                                                                                                                 $0
    4                                                                                                                                                                                                 $0
    5                                                                                                                                                                                                 $0

Footnotes to Table One:
  • Provide the maximum possible contractual cash demand on the Company (through surrender, loan or other contractual benefits except claims that have not occured) for business in-force as of
    year end. Other contract cash demands include incurred claims, installment payments and maturities.

    • Report demands from direct and reinsurance assumed business. Report reinsurance ceded offsets separately in A3 and B3. Report cash demands in the earliest period payable if the demand
      were made immediately (e.g., if $80 can be demanded now or $100 in 90 days, report the $80 in the 0 to 7 days column.)

    • Assume the company exercises any contractual rights with institutional customers to defer, limit, restrict or make payments in installments and report each such payment in the appropriate
      period.

    • In lines A1 and B1, provide the amount by which the statement value of liabilities would be reduced as a result of meeting the entire cash demand shown in A and B. This value may differ from
      the cash demands due to surrender charges, withdrawal charges, market-value adjustments or statutory valuations in excess of account values. Use end of year market conditions where
      needed to determine the reduction in the statement value of liabilities, for example, to calculate a market value adjustment.

    • Exclude associated changes in AVR or IMR in lines A1 and B1.

    • In lines A, A1, B and B1, report demands before contractual deferral rights and report amounts deferrable for six months under Sections 4223(a)(1)(B) or 4221(a)(8) of New York Insurance Law
      separately in A2 and B2.


    • Itemized other demands would include, but are not limited to, investment commitments, off balance sheet risk, credit guarantees, support agreements for affiliates, and demands related to
      securities lending.

    • *Large cash demand is defined as equal to or greater than 10% of company surplus.

    • **Institutional is defined as cash value products of at least $10 million, under common control or ownership, for which the decision to access the cash is in a single person/entity.
Company Name
NAIC #

TABLE TWO - Cash Resources (in thousands) from general and guaranteed separate accounts as of 12/31/2009


Investment Category                                                                              Market Value           Statement Value
A     Total Cash, Cash Equivalents and Short Term Investments (Page 2, Line 5)
B     Investments maturing within one month from (C) through (K)
      Publicly Traded
C     US Gov’t debt and agency debentures (not including structured securities)
D     Corporate debt - Investment Grade (not including structured securities)
E     Corporate debt - Below Investment Grade (not including structured securities)
F     Structured Securities - Investment Grade (e.g., MBS, CMO, CDO)
G     Non-affiliated Equity Investments
H     All other publicly traded
      Non - publicly Traded
I     Corporate debt - Investment Grade
J     Corporate debt - Below Investment Grade
      All other non-publicly traded (including commercial mortgages, structured Securities
K
      and Schedule BA investments)
      Itemize other cash resources




Footnotes to Table Two:
  • (B) includes scheduled sinking fund payments and coupon income.

    • Report each cash resource only once. Do not double-count. Items (C) through (K) should exclude what has been reported in (B).

    • Indicate the market value (e.g., FAS 115 estimates) and statement value for each cash resource at year end.

    • On-balance sheet cash resources should be included in Items (A) through (K), including on-balance sheet collateral held in connection to
      a securities lending program. Other cash resources should exclude what has been reported in (a) through (K)

    • Other cash resources would include but are not limited to lines of credit, support agreements from affiliates, contractually required
      premiums and considerations, and collateral held off-balance sheet in connection to a securites lending program.
Company Name
NAIC #

TABLE 3 - GICs or Funding Agreements as of 12/31/2009
List the 10 largest (in terms of withdrawal value) holders of GICs or funding agreements or similar instruments
with contract holder cash-out options. Liabilities associated with a given holder should be aggregated.
Amounts should be provided in thousands (000 omitted).

Does the Company have GICs, funding arrangements or similar instruments?                         Yes    No



                                                   Scheduled       Can contract holder      Terms/Conditions under
         Holder Name             Amount             Maturity       move funds at B.V.?     which funds can be moved
  1                                         $0
  2                                         $0
  3                                         $0
  4                                         $0
  5                                         $0
  6                                         $0
  7                                         $0
  8                                         $0
  9                                         $0
 10                                         $0
Company Name
NAIC #

TABLE 4 - Corporate Owned Life Insurance (COLI) & Bank Owned Life Insurance (BOLI) as of 12/31/2009
List the 10 largest (in terms of withdrawal value) holders of COLI and BOLI.
Liabilities associated with a given holder should be aggregated.
Amounts should be provided in thousands (000 omitted).

Does the Company have COLI or BOLI business?                  Yes    No



                        Holder Name                                 Amount
  1                                                                                 $0
  2                                                                                 $0
  3                                                                                 $0
  4                                                                                 $0
  5                                                                                 $0
  6                                                                                 $0
  7                                                                                 $0
  8                                                                                 $0
  9                                                                                 $0
 10                                                                                 $0

				
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