Download quarterly statement - Prepared Insurance

PROPERTY AND CASUALTY COMPANIES - ASSOCIATION EDITION
*13687201420100102*
QUARTERLY STATEMENT
As of June 30, 2014
of the Condition and Affairs of the
Prepared Insurance Company
NAIC Group Code..... ,
NAIC Company Code..... 13687
Employer's ID Number..... 26-4756872
(Current Period) (Prior Period)
Organized under the Laws of Florida
State of Domicile or Port of Entry Florida
Country of Domicile
Incorporated/Organized..... April 16, 2009
Commenced Business..... September 18, 2009
Statutory Home Office
1715 N Westshore Blvd Suite 930….. Tampa ..... FL ..... US ..... 33607
(Street and Number)
Main Administrative Office
(City or Town, State, Country and Zip Code)
1715 N Westshore Blvd Suite 930….. Tampa ..... FL ..... US ..... 33607
(Street and Number)
(City or Town, State, Country and Zip Code)
1715 N Westshore Blvd Suite 930….. Tampa ..... FL ..... US ..... 33607
Primary Location of Books and Records
1715 N Westshore Blvd Suite 930….. Tampa ..... FL ..... US ..... 33607
(Street and Number or P. O. Box)
Internet Web Site Address
Statutory Statement Contact
813-286-3730
(Area Code) (Telephone Number)
Mail Address
(Street and Number)
US
(City or Town, State, Country and Zip Code)
(City or Town, State, Country and Zip Code)
Jeffrey Eugene Myers
813-286-3730
(Area Code) (Telephone Number)
813-286-3732
(Name)
(Area Code) (Telephone Number) (Extension)
[email protected]
813-286-3737
(E-Mail Address)
(Fax Number)
OFFICERS
Name
1. Eric Lee Gobble
Title
Chief Executive Officer, Chief Risk
Officer and Pr
Chief Claim Officer
3. Michael Ernest Rubio
Name
2. Jeffrey Eugene Myers
4. Stephanie Elaine Siewert
OTHER
Title
Chief Financial Officer, Secretary,
and Treasurer
Chief Operating Officer and Chief
Marketing Office
DIRECTORS OR TRUSTEES
Eric Lee Gobble
Varnavas Louis Zagaris
State of........
County of.....
Martin Lloyd Schaffel
Oscar Armando Garcia
John Howard Sykes
Danny Correa
Panayiotis Vasiloudes
Florida
Hillsborough
The officers of this reporting entity being duly sworn, each depose and say that they are the described officers of said reporting entity, and that on the reporting period
stated above, all of the herein described assets were the absolute property of the said reporting entity, free and clear from any liens or claims thereon, except as
herein stated, and that this statement, together with related exhibits, schedules and explanations therein contained, annexed or referred to, is a full and true statement
of all the assets and liabilities and of the condition and affairs of the said reporting entity as of the reporting period stated above, and of its income and deductions
therefrom for the period ended, and have been completed in accordance with the NAIC Annual Statement Instructions and Accounting Practices and Procedures
manual except to the extent that: (1) state law may differ; or, (2) that state rules or regulations require differences in reporting not related to accounting practices and
procedures, according to the best of their information, knowledge and belief, respectively. Furthermore, the scope of this attestation by the described officers also
includes the related corresponding electronic filing with the NAIC, when required, that is an exact copy (except for formatting differences due to electronic filing) of the
enclosed statement. The electronic filing may be requested by various regulators in lieu of or in addition to the enclosed statement.
(Signature)
(Signature)
(Signature)
Eric Lee Gobble
1. (Printed Name)
Jeffrey Eugene Myers
2. (Printed Name)
Michael Ernest Rubio
3. (Printed Name)
Chief Executive Officer, Chief Risk Officer and Pr
(Title)
Chief Financial Officer, Secretary, and Treasurer
(Title)
Chief Claim Officer
(Title)
Subscribed and sworn to before me
This
day of
a. Is this an original filing?
b. If no:
1. State the amendment number
2. Date filed
3. Number of pages attached
Yes [ X ]
No [ ]
Statement for June 30, 2014 of the
Prepared Insurance Company
ASSETS
1
Current Statement Date
2
Assets
Nonadmitted
Assets
3
Net Admitted
Assets
(Cols. 1 - 2)
4
December 31
Prior Year Net
Admitted Assets
1.
Bonds........................................................................................................................................... ...............27,653,319 ................................... ...............27,653,319 ...............27,283,451
2.
Stocks:
3.
4.
5.
2.1
Preferred stocks................................................................................................................. ....................979,016 ................................... ....................979,016 ....................911,598
2.2
Common stocks................................................................................................................. ......................52,698 ................................... ......................52,698 ......................28,927
Mortgage loans on real estate:
3.1
First liens............................................................................................................................ ................................... ................................... ...............................0 ...................................
3.2
Other than first liens........................................................................................................... ................................... ................................... ...............................0 ...................................
Real estate:
4.1
Properties occupied by the company (less $..........0
encumbrances).................................................................................................................. ................................... ................................... ...............................0 ...................................
4.2
Properties held for the production of income (less $..........0
encumbrances).................................................................................................................. ................................... ................................... ...............................0 ...................................
4.3
Properties held for sale (less $..........0 encumbrances)..................................................... ................................... ................................... ...............................0 ...................................
Cash ($.....20,503,241), cash equivalents ($..........0)
and short-term investments ($.....374,328).................................................................................. ...............20,877,569 ................................... ...............20,877,569 ...............12,384,281
6.
Contract loans (including $..........0 premium notes).................................................................... ................................... ................................... ...............................0 ...................................
7.
Derivatives................................................................................................................................... ................................... ................................... ...............................0 ...................................
8.
Other invested assets.................................................................................................................. ................................... ................................... ...............................0 ...................................
9.
Receivables for securities............................................................................................................ ................................... ................................... ...............................0 ...................................
10. Securities lending reinvested collateral assets............................................................................ ................................... ................................... ...............................0 ...................................
11. Aggregate write-ins for invested assets....................................................................................... ...............................0 ...............................0 ...............................0 ...............................0
12. Subtotals, cash and invested assets (Lines 1 to 11).................................................................... ...............49,562,602 ...............................0 ...............49,562,602 ...............40,608,257
13. Title plants less $..........0 charged off (for Title insurers only)..................................................... ................................... ................................... ...............................0 ...................................
14. Investment income due and accrued........................................................................................... ....................198,546 ................................... ....................198,546 ....................195,754
15. Premiums and considerations:
15.1 Uncollected premiums and agents' balances in the course of collection........................... ....................219,098 ........................2,042 ....................217,056 ....................198,435
15.2 Deferred premiums, agents' balances and installments booked but deferred
and not yet due (including $..........0 earned but unbilled premiums)................................. .................2,402,974 ................................... .................2,402,974 .................1,886,220
15.3 Accrued retrospective premiums....................................................................................... ................................... ................................... ...............................0 ...................................
16. Reinsurance:
16.1 Amounts recoverable from reinsurers................................................................................ ................................... ................................... ...............................0 ...................................
16.2 Funds held by or deposited with reinsured companies...................................................... ................................... ................................... ...............................0 ...................................
16.3 Other amounts receivable under reinsurance contracts.................................................... ................................... ................................... ...............................0 ...................................
17. Amounts receivable relating to uninsured plans.......................................................................... ................................... ................................... ...............................0 ...................................
18.1 Current federal and foreign income tax recoverable and interest thereon................................... ....................950,570 ................................... ....................950,570 ...................................
18.2 Net deferred tax asset.................................................................................................................. ....................712,552 ......................26,238 ....................686,314 .................1,038,198
19. Guaranty funds receivable or on deposit..................................................................................... ....................163,232 ................................... ....................163,232 ....................468,904
20. Electronic data processing equipment and software................................................................... ................................... ................................... ...............................0 ...................................
21. Furniture and equipment, including health care delivery assets ($..........0)................................. ................................... ................................... ...............................0 ...................................
22. Net adjustment in assets and liabilities due to foreign exchange rates....................................... ................................... ................................... ...............................0 ...................................
23. Receivables from parent, subsidiaries and affiliates.................................................................... ........................7,926 ................................... ........................7,926 ....................443,498
24. Health care ($..........0) and other amounts receivable................................................................. ................................... ................................... ...............................0 ...................................
25. Aggregate write-ins for other than invested assets...................................................................... ...............................0 ...............................0 ...............................0 ...............................0
26. Total assets excluding Separate Accounts, Segregated Accounts and Protected
Cell Accounts (Lines 12 through 25)............................................................................................ ...............54,217,500 ......................28,280 ...............54,189,220 ...............44,839,266
27. From Separate Accounts, Segregated Accounts and Protected Cell Accounts.......................... ................................... ................................... ...............................0 ...................................
28. Total (Lines 26 and 27)................................................................................................................ ...............54,217,500 ......................28,280 ...............54,189,220 ...............44,839,266
DETAILS OF WRITE-INS
1101. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
1102. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
1103. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
1198. Summary of remaining write-ins for Line 11 from overflow page................................................. ...............................0 ...............................0 ...............................0 ...............................0
1199. Totals (Lines 1101 thru 1103 plus 1198) (Line 11 above)........................................................... ...............................0 ...............................0 ...............................0 ...............................0
2501. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
2502. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
2503. ..................................................................................................................................................... ................................... ................................... ...............................0 ...................................
2598. Summary of remaining write-ins for Line 25 from overflow page................................................. ...............................0 ...............................0 ...............................0 ...............................0
2599. Totals (Lines 2501 thru 2503 plus 2598) (Line 25 above)........................................................... ...............................0 ...............................0 ...............................0 ...............................0
Q02
Statement for June 30, 2014 of the
Prepared Insurance Company
LIABILITIES, SURPLUS AND OTHER FUNDS
1
Current
Statement Date
2
December 31
Prior Year
1.
Losses (current accident year $.....3,441,717)......................................................................................................................... ...............................6,287,877
...............................5,586,153
2.
Reinsurance payable on paid losses and loss adjustment expenses...................................................................................... ................................................. .................................................
3.
Loss adjustment expenses....................................................................................................................................................... ...............................1,407,281 ...............................1,372,468
4.
Commissions payable, contingent commissions and other similar charges............................................................................ ................................................. .................................................
5.
Other expenses (excluding taxes, licenses and fees).............................................................................................................. ..................................154,228 ..................................177,858
6.
Taxes, licenses and fees (excluding federal and foreign income taxes).................................................................................. ..................................127,749 ..................................159,877
7.1
Current federal and foreign income taxes (including $.....(950,570) on realized capital gains (losses)).................................. ................................................. ..................................154,830
7.2
Net deferred tax liability............................................................................................................................................................ ................................................. .................................................
8.
Borrowed money $..........0 and interest thereon $..........0....................................................................................................... ................................................. .................................................
9.
Unearned premiums (after deducting unearned premiums for ceded reinsurance of $.....19,236,501 and including
warranty reserves of $..........0 and accrued accident and health experience rating refunds
including $..........0 for medical loss ratio rebate per the Public Health Service Act................................................................. ...............................7,568,731 .............................13,203,295
10.
Advance premium.................................................................................................................................................................... ...............................1,760,720 ..................................904,864
11.
Dividends declared and unpaid:
11.1 Stockholders.................................................................................................................................................................... ................................................. .................................................
11.2 Policyholders................................................................................................................................................................... ................................................. .................................................
12.
Ceded reinsurance premiums payable (net of ceding commissions)....................................................................................... .............................20,985,274 ...............................7,317,403
13.
Funds held by company under reinsurance treaties................................................................................................................ ................................................. .................................................
14.
Amounts withheld or retained by company for account of others............................................................................................. ..................................287,813 ..................................182,668
15.
Remittances and items not allocated....................................................................................................................................... .................................(109,066) .........................................305
16.
Provision for reinsurance (including $..........0 certified)........................................................................................................... ................................................. .................................................
17.
Net adjustments in assets and liabilities due to foreign exchange rates.................................................................................. ................................................. .................................................
18.
Drafts outstanding.................................................................................................................................................................... ................................................. .................................................
19.
Payable to parent, subsidiaries and affiliates........................................................................................................................... ................................................. .................................................
20.
Derivatives................................................................................................................................................................................ ................................................. .................................................
21.
Payable for securities............................................................................................................................................................... ................................................. .................................................
22.
Payable for securities lending.................................................................................................................................................. ................................................. .................................................
23.
Liability for amounts held under uninsured plans..................................................................................................................... ................................................. .................................................
24.
Capital notes $..........0 and interest thereon $..........0............................................................................................................. ................................................. .................................................
25.
Aggregate write-ins for liabilities............................................................................................................................................... .............................................0 .............................................0
26.
Total liabilities excluding protected cell liabilities (Lines 1 through 25).................................................................................... .............................38,470,607 .............................29,059,721
27.
Protected cell liabilities............................................................................................................................................................. ................................................. .................................................
28.
Total liabilities (Lines 26 and 27).............................................................................................................................................. .............................38,470,607 .............................29,059,721
29.
Aggregate write-ins for special surplus funds........................................................................................................................... .............................................0 .............................................0
30.
Common capital stock.............................................................................................................................................................. ...............................5,000,000 ...............................5,000,000
31.
Preferred capital stock.............................................................................................................................................................. ................................................. .................................................
32.
Aggregate write-ins for other than special surplus funds......................................................................................................... .............................................0 .............................................0
33.
Surplus notes........................................................................................................................................................................... ...............................6,100,000 ...............................6,100,000
34.
Gross paid in and contributed surplus...................................................................................................................................... ...............................5,514,000 ...............................5,514,000
35.
Unassigned funds (surplus)...................................................................................................................................................... .................................(895,387) .................................(834,455)
36.
Less treasury stock, at cost:
36.1 ..........0.000 shares common (value included in Line 30 $..........0)............................................................................... ................................................. .................................................
36.2 ..........0.000 shares preferred (value included in Line 31 $..........0).............................................................................. ................................................. .................................................
37.
Surplus as regards policyholders (Lines 29 to 35, less 36)...................................................................................................... .............................15,718,613 .............................15,779,545
38.
Totals (Page 2, Line 28, Col. 3)................................................................................................................................................ .............................54,189,220 .............................44,839,266
DETAILS OF WRITE-INS
2501. ................................................................................................................................................................................................. ................................................. .................................................
2502. ................................................................................................................................................................................................. ................................................. .................................................
2503. ................................................................................................................................................................................................. ................................................. .................................................
2598. Summary of remaining write-ins for Line 25 from overflow page............................................................................................. .............................................0 .............................................0
2599. Totals (Lines 2501 thru 2503 plus 2598) (Line 25 above)........................................................................................................ .............................................0 .............................................0
2901. ................................................................................................................................................................................................. ................................................. .................................................
2902. ................................................................................................................................................................................................. ................................................. .................................................
2903. ................................................................................................................................................................................................. ................................................. .................................................
2998. Summary of remaining write-ins for Line 29 from overflow page............................................................................................. .............................................0 .............................................0
2999. Totals (Lines 2901 thru 2903 plus 2998) (Line 29 above)........................................................................................................ .............................................0 .............................................0
3201. ................................................................................................................................................................................................. ................................................. .................................................
3202. ................................................................................................................................................................................................. ................................................. .................................................
3203. ................................................................................................................................................................................................. ................................................. .................................................
3298. Summary of remaining write-ins for Line 32 from overflow page............................................................................................. .............................................0 .............................................0
3299. Totals (Lines 3201 thru 3203 plus 3298) (Line 32 above)........................................................................................................ .............................................0 .............................................0
Q03
Statement for June 30, 2014 of the
Prepared Insurance Company
STATEMENT OF INCOME
1
Current Year
to Date
2
Prior Year
to Date
3
Prior Year Ended
December 31
................22,881,393
...................................
................10,116,186
................12,765,207
................17,402,092
...................................
..................7,628,275
..................9,773,817
................37,984,857
...................................
................16,908,669
................21,076,188
..................5,351,501
...................................
...................................
..................5,351,501
..................1,055,000
..................6,888,332
................................0
................13,294,833
...................................
....................(529,626)
..................3,106,142
...................................
...................................
..................3,106,142
..................1,054,197
..................5,297,580
................................0
..................9,457,919
...................................
.....................315,898
..................7,461,527
...................................
...................................
..................7,461,527
..................2,242,864
................10,786,181
................................0
................20,490,572
...................................
.....................585,616
UNDERWRITING INCOME
1. Premiums earned:
1.1 Direct.............. (written $.....28,115,918)................................................................................................................
1.2 Assumed........ (written $..........0)...........................................................................................................................
1.3 Ceded............. (written $.....20,985,274)................................................................................................................
1.4 Net.................. (written $.....7,130,644)..................................................................................................................
DEDUCTIONS:
2. Losses incurred (current accident year $.....5,102,459):
2.1 Direct........................................................................................................................................................................
2.2 Assumed..................................................................................................................................................................
2.3 Ceded.......................................................................................................................................................................
2.4 Net............................................................................................................................................................................
3. Loss adjustment expenses incurred...............................................................................................................................
4. Other underwriting expenses incurred...........................................................................................................................
5. Aggregate write-ins for underwriting deductions............................................................................................................
6. Total underwriting deductions (Lines 2 through 5).........................................................................................................
7. Net income of protected cells.........................................................................................................................................
8. Net underwriting gain (loss) (Line 1 minus Line 6 + Line 7)...........................................................................................
INVESTMENT INCOME
9. Net investment income earned....................................................................................................................................... .....................352,180 .....................246,957 .....................561,335
10. Net realized capital gains (losses) less capital gains tax of $.....7,600.......................................................................... ........................(7,600) ...........................(112) .........................5,606
11. Net investment gain (loss) (Lines 9 + 10)....................................................................................................................... .....................344,580 .....................246,845 .....................566,941
OTHER INCOME
12. Net gain or (loss) from agents' or premium balances charged off
(amount recovered $.....(34,159) amount charged off $..........0)....................................................................................
13. Finance and service charges not included in premiums................................................................................................
14. Aggregate write-ins for miscellaneous income...............................................................................................................
15. Total other income (Lines 12 through 14)......................................................................................................................
16. Net income before dividends to policyholders, after capital gains tax and before all other federal and
foreign income taxes (Lines 8 + 11 + 15).......................................................................................................................
17. Dividends to policyholders..............................................................................................................................................
18. Net income after dividends to policyholders, after capital gains tax and before all other federal and
foreign income taxes (Line 16 minus Line 17)................................................................................................................
19. Federal and foreign income taxes incurred....................................................................................................................
20. Net income (Line 18 minus Line 19) (to Line 22)...........................................................................................................
......................(34,159)
.......................30,943
.............................(31)
........................(3,247)
........................(6,158)
.......................24,604
...........................(172)
.......................18,274
........................(4,567)
.......................59,721
...........................(313)
.......................54,841
....................(188,293) .....................581,017 ..................1,207,398
................................... ................................... ...................................
....................(188,293) .....................581,017 ..................1,207,398
....................(413,000) ................................... .....................639,700
.....................224,707 .....................581,017 .....................567,698
CAPITAL AND SURPLUS ACCOUNT
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
34.
35.
36.
37.
38.
39.
Surplus as regards policyholders, December 31 prior year...........................................................................................
Net income (from Line 20)..............................................................................................................................................
Net transfers (to) from Protected Cell accounts.............................................................................................................
Change in net unrealized capital gains or (losses) less capital gains tax of $..........0...................................................
Change in net unrealized foreign exchange capital gain (loss)......................................................................................
Change in net deferred income tax................................................................................................................................
Change in nonadmitted assets.......................................................................................................................................
Change in provision for reinsurance...............................................................................................................................
Change in surplus notes.................................................................................................................................................
Surplus (contributed to) withdrawn from protected cells................................................................................................
Cumulative effect of changes in accounting principles...................................................................................................
Capital changes:
32.1 Paid in...................................................................................................................................................................
32.2 Transferred from surplus (Stock Dividend)............................................................................................................
32.3 Transferred to surplus...........................................................................................................................................
Surplus adjustments:
33.1 Paid in...................................................................................................................................................................
33.2 Transferred to capital (Stock Dividend).................................................................................................................
33.3 Transferred from capital........................................................................................................................................
Net remittances from or (to) Home Office......................................................................................................................
Dividends to stockholders..............................................................................................................................................
Change in treasury stock................................................................................................................................................
Aggregate write-ins for gains and losses in surplus.......................................................................................................
Change in surplus as regards policyholders (Lines 22 through 37)...............................................................................
Surplus as regards policyholders, as of statement date (Lines 21 plus 38)...................................................................
0501.
0502.
0503.
0598.
0599.
1401.
1402.
1403.
1498.
1499.
3701.
3702.
3703.
3798.
3799.
DETAILS OF WRITE-INS
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
Summary of remaining write-ins for Line 5 from overflow page.....................................................................................
Totals (Lines 0501 thru 0503 plus 0598) (Line 5 above)................................................................................................
FHCF assessment written-off.........................................................................................................................................
CPIC assessment written-off..........................................................................................................................................
.......................................................................................................................................................................................
Summary of remaining write-ins for Line 14 from overflow page...................................................................................
Totals (Lines 1401 thru 1403 plus 1498) (Line 14 above)..............................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
Summary of remaining write-ins for Line 37 from overflow page...................................................................................
Totals (Lines 3701 thru 3703 plus 3798) (Line 37 above)..............................................................................................
33.
Q04
................15,779,545
.....................224,707
...................................
.......................68,270
...................................
....................(345,097)
........................(8,812)
...................................
...................................
...................................
...................................
................12,204,193
.....................581,017
...................................
......................(20,114)
...................................
....................(197,546)
.....................197,545
...................................
..................2,500,000
...................................
...................................
................12,204,193
.....................567,698
...................................
......................(88,657)
...................................
.....................269,694
.....................326,617
...................................
..................2,500,000
...................................
...................................
................................... ..................4,990,000 ..................4,990,000
................................... ................................... ...................................
................................... ................................... ...................................
...................................
...................................
...................................
...................................
...................................
...................................
................................0
......................(60,932)
................15,718,613
.................(4,990,000)
...................................
...................................
...................................
...................................
...................................
................................0
..................3,060,902
................15,265,095
.................(4,990,000)
...................................
...................................
...................................
...................................
...................................
................................0
..................3,575,352
................15,779,545
...................................
...................................
...................................
................................0
................................0
.............................(21)
.............................(10)
...................................
................................0
.............................(31)
...................................
...................................
...................................
................................0
................................0
...................................
...................................
...................................
................................0
................................0
.............................(33)
...........................(139)
...................................
................................0
...........................(172)
...................................
...................................
...................................
................................0
................................0
...................................
...................................
...................................
................................0
................................0
.............................(73)
...........................(240)
...................................
................................0
...........................(313)
...................................
...................................
...................................
................................0
................................0
Statement for June 30, 2014 of the
Prepared Insurance Company
CASH FLOW
1
Current Year
to Date
2
Prior Year
To Date
3
Prior Year Ended
December 31
CASH FROM OPERATIONS
1.
Premiums collected net of reinsurance............................................................................................................................... ...............21,116,970 ...............18,540,038 ...............28,700,262
2.
Net investment income........................................................................................................................................................ ....................557,960 ....................467,541 ....................968,930
3.
Miscellaneous income......................................................................................................................................................... .......................(3,247) ......................18,274 ......................54,841
4.
Total (Lines 1 through 3)..................................................................................................................................................... ...............21,671,683 ...............19,025,853 ...............29,724,033
5.
Benefit and loss related payments...................................................................................................................................... .................4,649,777 .................3,481,982 .................6,784,888
6.
Net transfers to Separate Accounts, Segregated Accounts and Protected Cell Accounts................................................ ................................... ................................... ...................................
7.
Commissions, expenses paid and aggregate write-ins for deductions.............................................................................. .................7,658,605 .................5,895,857 ...............12,380,234
8.
Dividends paid to policyholders........................................................................................................................................... ................................... ................................... ...................................
9.
Federal and foreign income taxes paid (recovered) net of $..........0 tax on capital gains (losses)................................... ....................700,000 ....................160,000 ...................(230,218)
10.
Total (Lines 5 through 9)..................................................................................................................................................... ...............13,008,382 .................9,537,839 ...............18,934,904
11.
Net cash from operations (Line 4 minus Line 10)............................................................................................................... .................8,663,301 .................9,488,014 ...............10,789,129
12.
Proceeds from investments sold, matured or repaid:
CASH FROM INVESTMENTS
12.1 Bonds........................................................................................................................................................................ .................2,822,340 .................6,030,496 ...............10,084,040
12.2 Stocks........................................................................................................................................................................ ................................... ....................999,403 ....................999,403
12.3 Mortgage loans......................................................................................................................................................... ................................... ................................... ...................................
12.4 Real estate................................................................................................................................................................ ................................... ................................... ...................................
12.5 Other invested assets............................................................................................................................................... ................................... ................................... ...................................
12.6 Net gains or (losses) on cash, cash equivalents and short-term investments......................................................... ................................... ................................... .............................84
12.7 Miscellaneous proceeds........................................................................................................................................... .....................(22,392) ................................... ...................................
12.8 Total investment proceeds (Lines 12.1 to 12.7)....................................................................................................... .................2,799,948 .................7,029,899 ...............11,083,527
13.
Cost of investments acquired (long-term only):
13.1 Bonds........................................................................................................................................................................ .................3,377,536 .................6,550,671 ...............14,247,367
13.2 Stocks........................................................................................................................................................................ ......................23,771 .................1,999,413 .................2,027,738
13.3 Mortgage loans......................................................................................................................................................... ................................... ................................... ...................................
13.4 Real estate................................................................................................................................................................ ................................... ................................... ...................................
13.5 Other invested assets............................................................................................................................................... ................................... ................................... ...................................
13.6 Miscellaneous applications....................................................................................................................................... ................................... ................................... ...................................
13.7 Total investments acquired (Lines 13.1 to 13.6)...................................................................................................... .................3,401,307 .................8,550,084 ...............16,275,105
14.
Net increase or (decrease) in contract loans and premium notes...................................................................................... ................................... ................................... ...................................
15.
Net cash from investments (Line 12.8 minus Line 13.7 and Line 14)................................................................................ ...................(601,359) ................(1,520,185) ................(5,191,578)
16.
Cash provided (applied):
CASH FROM FINANCING AND MISCELLANEOUS SOURCES
16.1 Surplus notes, capital notes...................................................................................................................................... ................................... .................2,500,000 .................2,500,000
16.2 Capital and paid in surplus, less treasury stock....................................................................................................... ................................... ................................... ...................................
16.3 Borrowed funds......................................................................................................................................................... ................................... ................................... ...................................
16.4 Net deposits on deposit-type contracts and other insurance liabilities.................................................................... ................................... ................................... ...................................
16.5 Dividends to stockholders......................................................................................................................................... ................................... ................................... ...................................
16.6 Other cash provided (applied).................................................................................................................................. ....................431,346 ...................(388,772) ....................926,656
17.
Net cash from financing and miscellaneous sources (Lines 16.1 through 16.4 minus Line 16.5 plus Line 16.6)............ ....................431,346 .................2,111,228 .................3,426,656
RECONCILIATION OF CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS
18.
Net change in cash, cash equivalents and short-term investments (Line 11 plus Line 15 plus Line 17).......................... .................8,493,288 ...............10,079,057 .................9,024,207
19.
Cash, cash equivalents and short-term investments:
19.1 Beginning of year...................................................................................................................................................... ...............12,384,281 .................3,360,074 .................3,360,074
19.2 End of period (Line 18 plus Line 19.1)..................................................................................................................... ...............20,877,569 ...............13,439,131 ...............12,384,281
Note: Supplemental disclosures of cash flow information for non-cash transactions:
20.0001 ................................................................................................................................................................................... ................................... ................................... ...................................
Q05
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
Note 1 - Summary of Significant Accounting Policies
A.
Accounting Practices
State of
Domicile
NET INCOME
(1) Prepared Insurance Company state basis (Page 4, Line 20, Columns 1 & 3)
(2) State Prescribed Practices that increase/decrease NAIC SAP
2014
2013
FL
224,707
567,698
FL
224,707
567,698
FL
15,718,613
15,779,545
FL
15,718,613
15,779,545
(3) State Permitted Practices that increase/decrease NAIC SAP
(4) NAIC SAP (1 – 2 – 3 = 4)
SURPLUS
(5) Prepared Insurance Company state basis (Page 3, line 37, Columns 1 & 2)
(6) State Prescribed Practices that increase/decrease NAIC SAP
(7) State Permitted Practices that increase/decrease NAIC SAP
(8) NAIC SAP (5 – 6 – 7 = 8)
The accompanying financial statements of Prepared Insurance Company have been prepared on the statutory basis of
accounting as defined and in accordance with the NAIC Accounting Practices and Procedures manual except to the extent
state law differs. The Commissioner of the Florida Office of Insurance Regulation has the right to permit specific practices
that deviate from prescribed practices.
B.
Use of Estimates in the Preparation of the Financial Statements
The preparation of financial statements in conformity with statutory accounting principles requires management to make
estimates and assumptions that affect the reported amounts of assets and liabilities. It also requires disclosure of
contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and
expenses during the period. Actual results could differ from those estimates.
C.
Accounting Policies
Premiums are earned over the terms of the related insurance policies and reinsurance contracts. Unearned premium
reserves are established to cover the unexpired portion of premiums written. Such reserves are computed by pro rata
methods for direct and ceded business.
Expenses incurred in connection with acquiring new insurance business, including such acquisition costs as sales
commissions, are charged to operations as incurred. Expenses incurred are reduced for ceding allowances received or
receivable.
In addition, the company uses the following accounting policies:
1.
Short-term investments are stated at amortized cost. Non-investment grade short-term investments are stated at
the lower of amortized value or fair value.
2.
Investment grade bonds not backed by other loans are stated at amortized value using the interest method.
Non-investment grade bonds with NAIC designations of 3 through 6 are stated at the lower of amortized value or
fair value.
3.
Investments in common stocks are stated at market value.
4.
Investments in preferred stocks are stated at market value.
5.
The Company holds no mortgage loans.
6.
The Company has no investments in loan-backed subsidiaries.
7.
The Company has no investments in insurance subsidiaries.
8.
The Company has no investments in limited partnerships.
9.
The Company holds no derivatives.
10.
The Company has no premium deficiency reserves.
11.
Unpaid losses and loss adjustment expenses include an amount determined from individual case estimates and
loss reports and an amount, based on industry experience, for losses incurred but not reported. Such liabilities are
necessarily based on assumptions and estimates and, while management believes the amount is adequate, the
ultimate liability may be in excess of or less than the amount provided. The methods for making such estimates
and for establishing the resulting liability is continually reviewed and any adjustments are reflected in the period
determined.
Q06
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
12.
The Company has not modified its capitalization policy from the prior period.
13.
Not applicable as the Company does not write major medical insurance with prescription drug coverage.
Note 2 - Accounting Changes and Corrections of Errors
No significant change.
Note 3 - Business Combinations and Goodwill
No significant change.
Note 4 - Discontinued Operations
No significant change.
Note 5 - Investments
D.
Loan-Backed Securities
(1)
1
2
Amortized Cost Basis
Before
Other-than-Temporary
Other-than-Temporary Impairment Recognized in
Impairment
Loss
(2)
3
Fair Value
1–2
OTTI recognized 1st Quarter
a. Intent to sell
b. Inability or lack of intent to retain the investment in
the security for a period of time sufficient to recover
the amortized cost basis
c. Total 1st Quarter
OTTI recognized 2nd Quarter
d. Intent to sell
e. Inability or lack of intent to retain the investment in
the security for a period of time sufficient to recover
the amortized cost basis
f.
Total 2nd Quarter
OTTI recognized 3rd Quarter
g.
h.
i.
Intent to sell
Inability or lack of intent to retain the investment in
the security for a period of time sufficient to recover
the amortized cost basis
Total 4th Quarter
OTTI recognized 4th Quarter
j.
Intent to sell
k.
Inability or lack of intent to retain the investment in
the security for a period of time sufficient to recover
the amortized cost basis
l.
Total 4th Quarter
m.
Annual aggregate total
XXX
XXX
(3) Recognized OTTI securities
CUSIP
Book/Adjusted
Carrying Value
Amortized Cost
Before Current
Period OTTI
Present Value
of Projected
Cash Flows
Recognized
Other-Than-Tem
porary
Impairment
Amortized Cost
After
Other-Than-Te
mporary
Impairment
Fair Value at
Time of OTTI
Date of Financial
Statement Where
Reported
Total
(4) All impaired securities (fair value is less than cost or amortized cost) for which an other-than-temporary impairment has not been recognized
in earnings as a realized loss (including securities with a recognized other-than-temporary impairment for non-interest related declines when a
non-recognized interest related impairment remains):
E.
a.
The aggregate amount of unrealized losses:
b.
The aggregate related fair value of securities with
unrealized losses:
1.
2.
1.
2.
Repurchase Agreements and/or Securities Lending Transactions
(3) Collateral Received
Q06.1
Less than 12 Months
12 Months or Longer
Less than12 Months
12 Months or Longer
(4,185)
(88,564)
1,483,508
3,622,514
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
The fair value of that collateral and of the portion of that collateral that it has sold or repledged
b
F. Real Estate
Not applicable
G. Low Income Housing Tax Credits
Not applicable
H. Other Disclosures and Unusual Items
Not applicable
I.
Working Capital Finance Investments
(2) Aggregate Maturity Distribution on the Underlying Working Capital Finance Programs
Book/Adjusted Carrying Value
(a)
(b)
(c)
Up to 180 Days
181 to 365 Days
Total
(3)
Note 6 - Joint Ventures, Partnerships and Limited Liability Companies
No significant change.
Note 7 - Investment Income
No significant change.
Note 8 - Derivative Instruments
No significant change.
Note 9 - Income Taxes
No significant change.
Note 10 - Information Concerning Parent, Subsidiaries, Affiliates and Other Related Parties
No significant change.
Note 11 - Debt
B.
FHLB (Federal Home Loan Bank) Agreements
(1)
(2) a.
FHLB Capital Stock – Aggregate Totals
1.
Current Year
1
Total
2+3
(a)
(b)
(c)
(d)
(e)
(f)
2.
Membership Stock – Class A
Membership Stock – Class B
Activity Stock
Excess Stock
Aggregate Total
Actual or estimated borrowing
capacity as determined by the
insurer
2
General
Account
3
Protected Cell
Accounts
XXX
XXX
2
General
Account
3
Protected Cell
Accounts
Prior Year
1
Total
2+3
(a)
(b)
(c)
Membership Stock – Class A
Membership Stock – Class B
Activity Stock
Q06.2
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
1
Total
2+3
3
Protected Cell
Accounts
XXX
XXX
(d)
(e)
(f)
b.
Excess Stock
Aggregate Total
Actual or estimated borrowing
capacity as determined by the
insurer
Membership Stock (Class A and B) Eligible for Redemption
2
General
Account
Current Period
Total
1.
Class A
2.
Class B
Not Eligible for
Redemption
Less Than 6
Months
6 Months to
Less than 1
Year
1 to Less than 3
Years
3 to 5 Years
(3) Collateral Pledged to FHLB
a.
Amount Pledged as of Reporting Date
1. Current Period Total General and Protected Cell Accounts
Fair Value
Total Collateral Pledged
2.
Carrying Value
Aggregate Total Borrowing
Fair Value
Carrying Value
Aggregate Total Borrowing
Fair Value
Carrying Value
Aggregate Total Borrowing
Prior Year Total General and Protected Cell Accounts
Fair Value
Total Collateral Pledged
Carrying Value
Aggregate Total Borrowing
Fair Value
Carrying Value
Amount of Borrowed at Time
of Maximum Collateral
Fair Value
Carrying Value
Amount of Borrowed at Time
of Maximum Collateral
Fair Value
Carrying Value
Amount of Borrowed at Time
of Maximum Collateral
Carrying Value
Amount of Borrowed at Time
of Maximum Collateral
Current Period General Account
Total Collateral Pledged
3.
Current Period Protected Cell Accounts
Total Collateral Pledged
4.
b.
Maximum Amount Pledged During Reporting Period
1. Current Period Total General and Protected Cell Accounts
Total Collateral Pledged
2.
Current Period General Account
Total Collateral Pledged
3.
Current Period Protected Cell Accounts
Total Collateral Pledged
4.
Prior Year Total General and Protected Cell Accounts
Fair Value
Total Collateral Pledged
(4) Borrowing from FHLB
a.
Amount as of the Reporting Date
1. Current Year
1
Total
2+3
2
General
Account
3
Protected Cell
Account
4
Funding Agreements
Established
1
Total
2+3
2
General
Account
3
Protected Cell
Account
4
Funding Agreements
Established
Maximum Amount During Reporting Period (Current Year)
1
Total
2+3
2
General
Account
3
Protected Cell
Account
(a)
(b)
(c)
(d)
2.
Prior Year-end
(a)
(b)
(c)
(d)
b.
Debt
Funding Agreements
Other
Aggregate Total
Debt
Funding Agreements
Other
Aggregate Total
Q06.3
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
1.
2.
3.
4.
c.
Debt
Funding Agreements
Other
Aggregate Total
FHLB Prepayment Obligations
Does the company
have prepayment
obligations under
the following
arrangements?
1.
2.
3.
Debt
Funding Agreements
Other
Note 12 - Retirement Plans, Deferred Compensation, Postemployment Benefits and Compensated Absences and Other Postretirement Benefit
Plans
A.
Defined Benefit Plan
(1)
(2)
(3)
(4)
Components of net periodic benefit
cost
Pension Benefits
2014
a.
b.
c.
d.
e.
f.
g.
h.
2013
Postretirement Benefits
2014
2013
Postemployment
2014
2013
Service cost
Interest cost
Expected return on plan assets
Transition asset or obligation
Gains and losses
Prior service cost or credit
Gain or loss recognized due to a
settlements curtailment
Total net periodic benefit cost
Note 13 - Capital and Surplus, Dividend Restrictions and Quasi-Reorganizations
As of September 30, 2011 Prepared Insurance Company had a subordinate debenture of $ 800,000
payable to Prepared Holdings, LLC with interest at prime plus 2% adjusted quarterly, interest payable annually
commencing March 31, 2011, with unpaid principal and interest due on December 31, 2014. Payments of all
principal and interest are subject to advance approval by the Florida Office of Insurance Regulation. No accrued
interest payable has been reflected against surplus as of September 30,2013.
In accordance with SSAP # 72, on June 30, 2011, the Company filed with and received approval from the State of
Florida Office of Insurance Regulation (OIR) of its request to approve the infusion of $1,400,000 of surplus notes
which were funded on July 15, 2011. This $1,400,000 subordinate debenture is payable to Prepared Holdings,
LLC with interest at prime plus 3% adjusted quarterly, interest payable annually commencing September 30
2011, with unpaid principal and interest due on December 31, 2015. No accrued interest payable has been
reflected against surplus as of September 30,2013.
In accordance with SSAP # 72, on December 18, 2012, the Company filed with and received approval from the
State of Florida Office of Insurance Regulation (OIR) of its request to approve the infusion of $1,400,000 of surplus
notes which were funded on January 15, 2013. This $1,400,000 subordinate debenture is payable to Prepared
Holdings, LLC with interest at prime plus 5% adjusted quarterly, interest payable annually commencing
March 31, 2013 with unpaid principal and interest due on December 31, 2018.No accrued interest payable has been
reflected against surplus as of September 30,2013.
In accordance with SSAP # 72, on May 7, 2013, the Company filed with and received approval from the State of
Florida Office of Insurance Regulation (OIR) of its request to approve the infusion of $2,500,000 of surplus notes
which were funded on May 24, 2013. This $2,500,000 subordinate debenture is payable to Prepared
Holdings, LLC with interest at prime plus 5% adjusted quarterly, interest payable annually commencing
July 1, 2013 with unpaid principal and interest due on December 31, 2019. No accrued interest payable has been
reflected against surplus as of September 30,2013.
Note 14 - Contingencies
No significant change.
Q06.4
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
Note 15 - Leases
No significant change.
Note 16 - Information About Financial Instruments With Off-Balance Sheet Risk and Financial Instruments With Concentrations of Credit Risk
No significant change.
Note 17 - Sale, Transfer and Servicing of Financial Assets and Extinguishments of Liabilities
A.
Transfers of Receivables Reported as Sales
Not applicable
B.
Transfer and Servicing of Financial Assets
(2)
b.
(4)
a.
b.
C.
Wash Sales
(1)
In the course of the Company's asset management, securities are sold and reacquired within the 30 days of the
sale date to enhance the yield of the investments.
(2) The details by NAIC designation 3 or below, or unrated of securities sold during the current period, 2014 and reacquired within 30 days of the
sale date are:
NAIC
Designation
Description
Number of
Transactions
Book Value of
Securities Sold
Cost of
Securities
Repurchased
Gain/(Loss)
Note 18 - Gain or Loss to the Reporting Entity from Uninsured Plans and the Uninsured Portion of Partially Insured Plans
No significant change.
Note 19 - Direct Premium Written/Produced by Managing General Agents/Third Party Administrators
No significant change.
Note 20 - Fair Value
A.
(1) Fair Value Measurements at Reporting Date
Assets at Fair Value
Perpetual Preferred Stocks
Total
Liabilities at Fair Value
Level 1
428,420
428,420
Level 2
Level 3
Total
428,420
428,420
Level 1
Level 2
Level 3
Total
Total
(2) Fair Value Measurements in (Level 3) of the Fair Value Hierarchy
a. Assets
Beginning
Balance at
Period
Transfers
Into Level
3
Transfers
Out of
Level 3
Total Gains
and
(Losses)
Included in
Net Income
Total Gains
and
(Losses)
Included in
Surplus
Transfers
Out of
Level 3
Total Gains
and
(Losses)
Included in
Net Income
Total Gains
and
(Losses)
Included in
Surplus
Purchases
Issuances
Sales
Settlements
Ending
Balance at
Period
Settlements
Ending
Balance at
Period
Total
b. Liabilities
Beginning
Balance at
Period
Transfers
Into Level
3
Total
(3)
(4)
Q06.5
Purchases
Issuances
Sales
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
(5)
B.
C.
Type of Financial Instrument
Aggregate Fair
Value
Admitted Assets
(Level 1)
(Level 2)
(Level 3)
Total
D.
Not Practicable to Estimate Fair Value
Type of Class or Financial Instrument
Carrying Value
Effective
Interest Rate
0.000
Maturity Date
Explanation
Total
Note 21 - Other Items
The Company is not authorized to write Workers Compensation Insurance in the state of Florida , and the
Company does not take credit for any recoveries from the Special Disability Trust Fund.
Agent's Balance Certification
Amounts
A
1.
Agent's Balances or Uncollected Premium as reported (page 2, Line 15.1)
$ 217,056
2.
Amount of Agents' Balances or Uncollected Premiums (from Page 2, Line 15.1)
that is due from "controlled” or "controlling" persons
Amount Reported in #2 above and secured by a : Trust Fund, Letter of Credit,
N/A
and Financial Guaranty Bond as required by Section 625.012, Florida Statutes.
G.
Offsetting and Netting of Assets and Liabilities
I.
Risk Sharing Provisions of the Affordable Care Act
(1) Permanent Risk Adjustment Program
Assets
a. Premium adjustments receivable
Amount
$
Liabilities
b. Risk adjustment user fees payable
c. Premium adjustments payable
$
$
Operations (Revenue & Expense)
d. Premium for accident and health contracts (written/collected)
$
(2) Transitional Reinsurance Program
Assets
a. Amounts recoverable for claims paid
b. Amounts recoverable for claims unpaid
c. Amounts receivable relating to uninsured plans
$
$
$
Liabilities
d. Claims unpaid-ceded
e. Contributions payable-not reported as ceded premium
f. Ceded reinsurance premiums payable
g. Liability for amounts held under uninsured plans
$
$
$
$
Operations (Revenue & Expense)
h. Ceded reinsurance premiums
i. Reinsurance recoveries
j. Contributions-not reported as ceded premium
$
$
$
(3) Temporary Risk Corridors Program
Assets
a. Accrued retrospective premium
$
Liabilities
b. Reserve for rate credits or policy experience rating refunds
$
Operations (Revenue & Expense)
c. Net premium income (paid/received)
d. Change in reserves for rate credits
$
$
Q06.6
N/A
Not Practicable
(Carrying Value)
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
(4) Have there been any material re-estimations and/or impairments for the reporting period
Yes/No
Note 22 - Events Subsequent
No significant change.
Note 23 - Reinsurance
No significant change.
Note 24 - Retrospectively Rated Contracts & Contracts Subject to Redetermination
F.
Risk Sharing Provisions of the Affordable Care Act
(1) Permanent Risk Adjustment Program
Assets
a. Premium adjustments receivable
Amount
$
Liabilities
b. Risk adjustment user fees payable
c. Premium adjustments payable
$
$
Operations (Revenue & Expense)
d. Premium for accident and health contracts (written/collected)
$
(2) Transitional Reinsurance Program
Assets
a. Amounts recoverable for claims paid
b. Amounts recoverable for claims unpaid
c. Amounts receivable relating to uninsured plans
$
$
$
Liabilities
d. Claims unpaid-ceded
e. Contributions payable-not reported as ceded premium
f. Ceded reinsurance premiums payable
g. Liability for amounts held under uninsured plans
$
$
$
$
Operations (Revenue & Expense)
h. Ceded reinsurance premiums
i. Reinsurance recoveries
j. Contributions-not reported as ceded premium
$
$
$
(3) Temporary Risk Corridors Program
Assets
a. Accrued retrospective premium
$
Liabilities
b. Reserve for rate credits or policy experience rating refunds
$
Operations (Revenue & Expense)
c. Net premium income (paid/received)
d. Change in reserves for rate credits
$
$
(4) Have there been any material re-estimations and/or impairments for the reporting period
Yes/No
Note 25 - Change in Incurred Losses and Loss Adjustment Expenses
Reserves as of June 30, 2014 were $7,695,158. As of June 30, 2014, $3,643,207 has been paid for incurred losses and
loss adjustment expenses attributable to insured events of prior years. Reserves remaining for prior years are now
$3,691,471 as a result of re-estimation of unpaid claims and claim adjustment expense principally on homeowners lines
of insurance. There has been no significant development of prior-year losses as of June 30, 2014.
Note 26 - Intercompany Pooling Arrangements
No significant change.
Note 27 - Structured Settlements
No significant change.
Note 28 - Health Care Receivables
No significant change.
Note 29 - Participating Policies
No significant change.
Note 30 - Premium Deficiency Reserves
Q06.7
Statement for June 30, 2014 of the
Prepared Insurance Company
NOTES TO FINANCIAL STATEMENTS
No significant change.
Note 31 - High Deductibles
No significant change.
Note 32 - Discounting of Liabilities for Unpaid Losses or Unpaid Loss Adjustment Expenses
No significant change.
Note 33 - Asbestos/Environmental Reserves
No significant change.
Note 34 - Subscriber Savings Accounts
No significant change.
Note 35 - Multiple Peril Crop Insurance
No significant change.
Note 36 - Financial Guaranty Insurance
The Company does not write Financial Guaranty Insurance.
B.
Schedule of Insured Financial Obligations at the End of the Period:
A
1.
2.
3.
B
Number of policies
Remaining weighted average contract
period (in years)
Insured contractual payments outstanding:
a. Principal
b. Interest
c. Total
Gross claim liability
4.
Less
5. a. Gross potential recoveries
b. Discount, net
6. Net claim liability
7. Unearned premium revenue
8. Reinsurance recoverables
Q06.8
Surveillance Categories
C
D
Total
Statement for June 30, 2014 of the
Prepared Insurance Company
GENERAL INTERROGATORIES
PART 1 - COMMON INTERROGATORIES - GENERAL
1.1
Did the reporting entity experience any material transactions requiring the filing of Disclosure of Material Transactions with the State of Domicile, as
required by the Model Act?
Yes [ ]
No [ X ]
1.2
If yes, has the report been filed with the domiciliary state?
Yes [ ]
No [ X ]
2.1
Has any change been made during the year of this statement in the charter, by-laws, articles of incorporation, or deed of settlement of the reporting entity?
Yes [ ]
No [ X ]
2.2
If yes, date of change:
3.1
Is the reporting entity a member of an Insurance Holding Company System consisting of two or more affiliated persons, one or more of which is an insurer?
........................................
Yes [ X ]
No [ ]
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
If yes, complete Schedule Y, Parts 1 and 1A.
3.2
Have there been any substantial changes in the organizational chart since the prior quarter end?
3.3
If the response to 3.2 is yes, provide a brief description of those changes.
4.1
Has the reporting entity been a party to a merger or consolidation during the period covered by this statement?
4.2
If yes, provide name of entity, NAIC Company Code, and state of domicile (use two letter state abbreviation) for any entity that has ceased to exist
as a result of the merger or consolidation.
1
2
3
NAIC
State of
Name of Entity
Company Code
Domicile
5.
If the reporting entity is subject to a management agreement, including third-party administrator(s), managing general agent(s), attorney-in-fact,
or similar agreement, have there been any significant changes regarding the terms of the agreement or principals involved?
If yes, attach an explanation.
Yes [ ] No [ X ] N/A [ ]
6.1
State as of what date the latest financial examination of the reporting entity was made or is being made.
Florida.............................
6.2
State the as of date that the latest financial examination report became available from either the state of domicile or the reporting entity. This date should
be the date of the examined balance sheet and not the date the report was completed or released.
..........12/31/2012............
State as of what date the latest financial examination report became available to other states or the public from either the state of domicile or
the reporting entity. This is the release date or completion date of the examination report and not the date of the examination (balance sheet date).
..........6/20/2014..............
6.3
6.4
By what department or departments?
Florida Office of Insurance Regulation
6.5
Have all financial statement adjustments within the latest financial examination report been accounted for in a subsequent financial statement
filed with Departments?
Yes [ ] No [ ] N/A [ X ]
6.6
Have all of the recommendations within the latest financial examination report been complied with?
Yes [ ] No [ ] N/A [ X ]
7.1
Has this reporting entity had any Certificates of Authority, licenses or registrations (including corporate registration, if applicable) suspended or revoked
by any governmental entity during the reporting period?
7.2
If yes, give full information:
8.1
Is the company a subsidiary of a bank holding company regulated by the Federal Reserve Board?
8.2
If response to 8.1 is yes, please identify the name of the bank holding company.
8.3
Is the company affiliated with one or more banks, thrifts or securities firms?
8.4
If the response to 8.3 is yes, please provide below the names and location (city and state of the main office) of any affiliates regulated by a federal
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
Yes [ X ]
No [ ]
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
regulatory services agency [i.e. the Federal Reserve Board (FRB), the Office of the Comptroller of the Currency (OCC), the Federal Deposit
Insurance Corporation (FDIC) and the Securities Exchange Commission (SEC)] and identify the affiliate's primary federal regulator].
9.1
1
2
3
4
5
6
Affiliate Name
Location (City, State)
FRB
OCC
FDIC
SEC
Are the senior officers (principal executive officer, principal financial officer, principal accounting officer or controller, or persons performing
similar functions) of the reporting entity subject to a code of ethics, which includes the following standards?
(a)
Honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and
professional relationships;
(b)
Full, fair, accurate, timely and understandable disclosure in the periodic reports required to be filed by the reporting entity;
(c)
Compliance with applicable governmental laws, rules and regulations;
(d)
The prompt internal reporting of violations to an appropriate person or persons identified in the code; and
(e)
Accountability for adherence to the code.
9.11 If the response to 9.1 is No, please explain:
9.2
Has the code of ethics for senior managers been amended?
9.21 If the response to 9.2 is Yes, provide information related to amendment(s).
9.3
Have any provisions of the code of ethics been waived for any of the specified officers?
Q07
Statement for June 30, 2014 of the
Prepared Insurance Company
GENERAL INTERROGATORIES
PART 1 - COMMON INTERROGATORIES - GENERAL
9.31 If the response to 9.3 is Yes, provide the nature of any waiver(s).
PART 1 - FINANCIAL
10.1 Does the reporting entity report any amounts due from parent, subsidiaries or affiliates on Page 2 of this statement?
Yes [ X ]
10.2 If yes, indicate any amounts receivable from parent included in the Page 2 amount:
No [ ]
$............................................0
PART 1 - INVESTMENT
11.1 Were any of the stocks, bonds, or other assets of the reporting entity loaned, placed under option agreement, or otherwise made available
for use by another person? (Exclude securities under securities lending agreements.)
Yes [ ]
No [ X ]
11.2 If yes, give full and complete information relating thereto:
12. Amount of real estate and mortgages held in other invested assets in Schedule BA:
$................................0
13. Amount of real estate and mortgages held in short-term investments:
$................................0
14.1 Does the reporting entity have any investments in parent, subsidiaries and affiliates?
Yes [ ]
14.2 If yes, please complete the following:
14.21
14.22
14.23
14.24
14.25
14.26
14.27
14.28
Bonds.............................................................................................................................................................
Preferred Stock..............................................................................................................................................
Common Stock...............................................................................................................................................
Short-Term Investments.................................................................................................................................
Mortgage Loans on Real Estate.....................................................................................................................
All Other.........................................................................................................................................................
Total Investment in Parent, Subsidiaries and Affiliates (Subtotal Lines 14.21 to 14.26)................................
Total Investment in Parent included in Lines 14.21 to 14.26 above...............................................................
No [ X ]
1
2
Prior Year-End
Current Quarter
Book/Adjusted Carrying Value
Book/Adjusted Carrying Value
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
$ ..................................0
15.1 Has the reporting entity entered into any hedging transactions reported on Schedule DB?
Yes [ ]
No [ X ]
15.2 If yes, has a comprehensive description of the hedging program been made available to the domiciliary state?
If no, attach a description with this statement.
Yes [ ]
No [ ]
16. For the reporting entity's security lending program, state the amount of the following as of current statement date:
16.1 Total fair value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2:
16.2 Total book adjusted/carrying value of reinvested collateral assets reported on Schedule DL, Parts 1 and 2:
16.3 Total payable for securities lending reported on the liability page:
$................................0
$................................0
$................................0
17. Excluding items in Schedule E-Part 3-Special Deposits, real estate, mortgage loans and investments held physically in the reporting
entity's offices, vaults or safety deposit boxes, were all stocks, bonds and other securities, owned throughout the current year held
pursuant to a custodial agreement with a qualified bank or trust company in accordance with Section 1, III - General Examination Considerations,
F. Outsourcing of Critical Functions, Custodial or Safekeeping Agreements of the NAIC Financial Condition Examiners Handbook?
17.1
For all agreements that comply with the requirements of the NAIC Financial Condition Examiners Handbook,
complete the following:
1
2
Name of Custodian(s)
Custodian Address
MORGAN STANLEY TRUST,N.A.
1 New York Plaza 7th Floor, New York, NY 10004
JHS CAPITAL ADVISORS, LLC
501 E Kennedy Blvd, Tampa FL 33602
17.2
For all agreements that do not comply with the requirements of the NAIC Financial Condition Examiners Handbook, provide the
name, location and a complete explanation.
1
2
Name(s)
Location(s)
17.3
Have there been any changes, including name changes, in the custodian(s) identified in 17.1 during the current quarter?
17.4
If yes, give full and complete information relating thereto:
1
Old Custodian
17.5
2
New Custodian
3
Date of Change
Identify all investment advisors, broker/dealers or individuals acting on behalf of broker/dealers that have access
to the investment accounts, handle securities and have authority to make investments on behalf of the reporting entity:
1
2
Central Registration Depository
Name(s)
Q07.1
Yes [ X ]
No [ ]
Yes [ ]
No [ X ]
3
Complete Explanation(s)
4
Reason
3
Address
Statement for June 30, 2014 of the
Prepared Insurance Company
PART 1 - INVESTMENT
18.1 Have all the filing requirements of the Purposes and Procedures Manual of the NAIC Securities Valuation Office been followed?
18.2 If no, list exceptions:
Q07.2
Yes [ X ]
No [ ]
Statement for June 30, 2014 of the
Prepared Insurance Company
GENERAL INTERROGATORIES (continued)
PART 2
PROPERTY & CASUALTY INTERROGATORIES
1. If the reporting entity is a member of a pooling arrangement, did the agreement or the reporting entity's participation change?
Yes [ ] No [ ] N/A [ X ]
If yes, attach an explanation.
2. Has the reporting entity reinsured any risk with any other reporting entity and agreed to release such entity from liability, in whole or in part, from
any loss that may occur on the risk, or portion thereof, reinsured?
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
If yes, attach an explanation.
3.1 Have any of the reporting entity's primary reinsurance contracts been canceled?
3.2 If yes, give full and complete information thereto:
4.1 Are any of the liabilities for unpaid losses and loss adjustment expenses other than certain workers' compensation tabular reserves (see
Annual Statement Instructions pertaining to disclosure of discounting for definition of "tabular reserves,") discounted at a rate of interest greater
than zero?
Yes [ ]
No [ X ]
4.2 If yes, complete the following schedule:
1
2
3
Total Discount
Discount Taken During Period
4
5
6
7
8
9
10
11
Maximum
Disc.
Unpaid
Unpaid
Unpaid
Unpaid
Line of Business
Interest
Rate
Losses
LAE
IBNR
Total
Losses
LAE
IBNR
Total
................... ....................... ....................... ....................... ....................... ....................0 ....................... ....................... ....................... ....................0
Total..................................... ........XXX... ........XXX........ ....................0 ....................0 ....................0 ....................0 ....................0 ....................0 ....................0 ....................0
5. Operating Percentages:
5.1 A&H loss percent
0.0 %
5.2 A&H cost containment percent
0.0 %
5.3 A&H expense percent excluding cost containment expenses
0.0 %
6.1 Do you act as a custodian for health savings accounts?
Yes [ ]
No [ X ]
Yes [ ]
No [ X ]
6.2 If yes, please provide the amount of custodial funds held as of the reporting date.
0
6.3 Do you act as an administrator for health savings accounts?
6.4 If yes, please provide the amount of funds administered as of the reporting date.
0
Q08
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE F - CEDED REINSURANCE
Showing All New Reinsurers - Current Year to Date
1
2
3
4
5
6
7
NAIC
Certified
Effective Date
Company
ID
Domiciliary
Type of
Reinsurer Rating of Certified
Code
Number
Name of Reinsurer
Jurisdiction
Reinsurer
(1 through 6) Reinsurer Rating
U.S. Insurers
19453................. 135616275.......... Transatlantic Reinsurance Company.................................................................................... NY............. Authorized........ .......................... .........................
22039................. 132673100.......... General Reinsurance Corporation........................................................................................ DE............. Authorized........ .......................... .........................
All Other Insurers
00000................. AA3191190.......... Hamilton Re.......................................................................................................................... BMU.......... Unauthorized.... .......................... .........................
00000................. AA1120158.......... Lloyd's Syndicate No.2014 ACA........................................................................................... GBR.......... Certified............ ..........3............. .......01/01/2011
00000................. CR3190829.......... Markel Bermuda Ltd ............................................................................................................ BMU.......... Certified............ ..........3............. .......07/01/2011
00000................. AA3191264.......... Market RE Ltd 2014-2 Prepared (c/o Horeshoe Management) ........................................... BMU.......... Unauthorized.... .......................... .........................
00000................. AA3190686.......... Partner Re Ltd. .................................................................................................................... BMU.......... Certified............ ..........3............. .......01/01/2011
00000................. AA5320039.......... Peak Reinsurance Company Ltd (Pioneer Underwriters)..................................................... HKG.......... Unauthorized.... .......................... .........................
Q09
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE T - EXHIBIT OF PREMIUMS WRITTEN
Current Year to Date - Allocated by States and Territories
1
States, Etc.
Active
Status
Direct Premiums Written
2
3
Current Year
Prior Year
to Date
to Date
Direct Losses Paid (Deducting Salvage)
4
5
Current Year
Prior Year
to Date
to Date
Direct Losses Unpaid
6
7
Current Year
Prior Year
to Date
to Date
1.
Alabama..................................AL .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
2.
Alaska.....................................AK .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
3.
Arizona....................................AZ .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
4.
Arkansas................................AR .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
5.
California................................CA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
6.
Colorado................................CO .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
7.
Connecticut.............................CT .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
8.
Delaware................................DE .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
9.
District of Columbia................DC .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
10.
Florida.....................................FL .......L........ ...............28,115,918 ...............23,304,461 .................4,649,778 .................3,481,772 .................3,441,717 .................4,456,840
11.
Georgia..................................GA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
12.
Hawaii......................................HI .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
13.
Idaho........................................ID .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
14.
Illinois.......................................IL .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
15.
Indiana.....................................IN .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
16.
Iowa.........................................IA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
17.
Kansas....................................KS .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
18.
Kentucky.................................KY .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
19.
Louisiana.................................LA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
20.
Maine.....................................ME .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
21.
Maryland................................MD .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
22.
Massachusetts.......................MA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
23.
Michigan..................................MI .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
24.
Minnesota..............................MN .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
25.
Mississippi..............................MS .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
26.
Missouri.................................MO .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
27.
Montana.................................MT .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
28.
Nebraska................................NE .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
29.
Nevada...................................NV .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
30.
New Hampshire......................NH .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
31.
New Jersey.............................NJ .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
32.
New Mexico...........................NM .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
33.
New York................................NY .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
34.
North Carolina........................NC .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
35.
North Dakota..........................ND .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
36.
Ohio.......................................OH .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
37.
Oklahoma...............................OK .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
38.
Oregon...................................OR .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
39.
Pennsylvania..........................PA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
40.
Rhode Island............................RI .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
41.
South Carolina........................SC .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
42.
South Dakota..........................SD .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
43.
Tennessee..............................TN .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
44.
Texas......................................TX .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
45.
Utah........................................UT .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
46.
Vermont..................................VT .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
47.
Virginia....................................VA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
48.
Washington............................WA .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
49.
West Virginia.........................WV .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
50.
Wisconsin................................WI .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
51.
Wyoming................................WY .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
52.
American Samoa....................AS .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
53.
Guam.....................................GU .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
54.
Puerto Rico.............................PR .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
55.
US Virgin Islands.....................VI .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
56.
Northern Mariana Islands.......MP .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
57.
Canada................................CAN .......N........ ................................... ................................... ................................... ................................... ................................... ...................................
58.
Aggregate Other Alien............OT .....XXX..... ...............................0 ...............................0 ...............................0 ...............................0 ...............................0 ...............................0
59.
Totals........................................... (a)..........1 ...............28,115,918 ...............23,304,461 .................4,649,778 .................3,481,772 .................3,441,717 .................4,456,840
58001.
58002.
58003.
58998.
DETAILS OF WRITE-INS
.................................................... .....XXX..... ................................... ................................... ................................... ................................... ................................... ...................................
.................................................... .....XXX..... ................................... ................................... ................................... ................................... ................................... ...................................
.................................................... .....XXX..... ................................... ................................... ................................... ................................... ................................... ...................................
Summary of remaining write-ins
for Line 58 from overflow page.... .....XXX..... ...............................0 ...............................0 ...............................0 ...............................0 ...............................0 ...............................0
58999. Totals (Lines 58001 thru 58003+
Line 58998) (Line 58 above)....... .....XXX..... ...............................0 ...............................0 ...............................0 ...............................0 ...............................0 ...............................0
(L) - Licensed or Chartered - Licensed Insurance Carrier or Domicilied RRG; (R) - Registered - Non-domiciled RRGs; (Q) - Qualified - Qualified or Accredited Reinsurer;
(E) - Eligible - Reporting Entities eligible or approved to write Surplus Lines in the state; (N) - None of the above - Not allowed to write business in the state.
(a) Insert the number of L responses except for Canada and Other Alien.
Q10
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE Y – INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP
PART 1 – ORGANIZATIONAL CHART
P r e p a r e d H o ld in g s , L L C
(P H L L C ) F T IN : 2 7 -1 2 0 3 0 8 5
Q11
P re p a re d In s u ra n c e C o (P IC ) F T IN :
2 6 -4 7 5 6 8 7 2
P re p a re d M a n a g e rs , L L C (P M L L C )
F T IN : 2 6 2 9 3 8 2 0 2
P re p a re d In v e s to rs &
B o a r d o f D ir e c to r s
P r e p a r e d F in a n c ia l S e r v ic e s , L L C
(P F L L C ) F T IN : 4 5 -5 3 3 3 0 1 2
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE Y
1
2
3
4
5
6
7
Name of
Securities
Exchange
if Publicly
Traded
(U.S. or
International)
PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM
8
9
10
11
12
13
Type of
Control
(Ownership
Board,
If Control is
Management Ownership
Attorney-in-Fact, Provide
Influence, Other) Percentage
14
15
NAIC
Federal
Names of
Relationship
Group
Group
Company
ID
Federal
Parent, Subsidiaries
Domiciliary to Reporting
Directly Controlled by
Ultimate Controlling
Code
Name
Code
Number
RSSD
CIK
or Affiliates
Location
Entity
(Name of Entity/Person)
Entity(ies)/Person(s)
*
Members
.............. ....................................................... ............... 27-1203085 ................... ................... .......................... Prepared Holdings, LLC......................................... DE............ UDP............. Investors............................................................. Board................ ...100.000 Prepared Holdings, LLC..................................... .............
.............. ....................................................... ............... 26-2938202 ................... ................... .......................... Prepared Managers, LLC....................................... FL............. NIA............... Prepared Holdings, LLC..................................... Board................ ...100.000 Prepared Holdings, LLC..................................... .............
.............. ....................................................... 13687...... 26-4756872 ................... ................... .......................... Prepared Insurance Company................................ FL............. IA................. Prepared Holdings, LLC..................................... Board................ ...100.000 Prepared Holdings, LLC..................................... .............
.............. ....................................................... ............... 45-5333012 ................... ................... .......................... Prepared Financial Service, LLC............................ FL............. IA................. Prepared Holdings, LLC..................................... Board................ ...100.000 Prepared Holdings, LLC..................................... .............
Q12
Asterisk
Explanation
NONE
Statement for June 30, 2014 of the
Prepared Insurance Company
PART 1 - LOSS EXPERIENCE
1.
2.
3.
4.
5.
6.
8.
9.
10.
11.1.
11.2.
12.
13.
14.
15.
16.
17.1
17.2
17.3
18.1
18.2
19.1,
19.3,
21.
22.
23.
24.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Lines of Business
Fire.................................................................................................................
Allied lines......................................................................................................
Farmowners multiple peril..............................................................................
Homeowners multiple peril.............................................................................
Commercial multiple peril...............................................................................
Mortgage guaranty.........................................................................................
Ocean marine................................................................................................
Inland marine.................................................................................................
Financial guaranty..........................................................................................
Medical professional liability - occurrence.....................................................
Medical professional liability - claims-made...................................................
Earthquake.....................................................................................................
Group accident and health.............................................................................
Credit accident and health.............................................................................
Other accident and health..............................................................................
Workers' compensation..................................................................................
Other liability-occurrence...............................................................................
Other liability-claims made.............................................................................
Excess workers' compensation......................................................................
Products liability-occurrence..........................................................................
Products liability-claims made........................................................................
19.2 Private passenger auto liability.............................................................
19.4 Commercial auto liability.......................................................................
Auto physical damage....................................................................................
Aircraft (all perils)...........................................................................................
Fidelity............................................................................................................
Surety.............................................................................................................
Burglary and theft...........................................................................................
Boiler and machinery.....................................................................................
Credit.............................................................................................................
International...................................................................................................
Warranty........................................................................................................
Reinsurance-nonproportional assumed property...........................................
Reinsurance-nonproportional assumed liability.............................................
Reinsurance-nonproportional assumed financial lines..................................
Aggregate write-ins for other lines of business..............................................
Totals.............................................................................................................
3401.
3402.
3403.
3498.
3499.
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Sum. of remaining write-ins for Line 34 from overflow page..........................
Totals (Lines 3401 thru 3403 plus 3498) (Line 34)........................................
Current Year to Date
1
2
Direct Premiums
Direct Losses
Earned
Incurred
.............................224,716 ...............................40,000
..........................1,044,675 .............................200,000
........................................... ...........................................
........................21,612,002 ..........................5,111,501
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
...................XXX................. ...................XXX.................
...................XXX................. ...................XXX.................
...................XXX................. ...................XXX.................
........................................0 ........................................0
........................22,881,393 ..........................5,351,501
DETAILS OF WRITE-INS
........................................... ...........................................
........................................... ...........................................
........................................... ...........................................
........................................0 ........................................0
........................................0 ........................................0
3
Direct
Loss Percentage
...................................17.8
...................................19.1
.....................................0.0
...................................23.7
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
...................XXX.................
...................XXX.................
...................XXX.................
.....................................0.0
...................................23.4
4
Prior Year to Date
Direct Loss
Percentage
...................................57.5
...................................16.6
...........................................
...................................17.4
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...........................................
...................XXX.................
...................XXX.................
...................XXX.................
...........................................
...................................17.8
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
.....................................0.0
...........................................
...........................................
...........................................
...................XXX.................
...........................................
PART 2 - DIRECT PREMIUMS WRITTEN
1.
2.
3.
4.
5.
6.
8.
9.
10.
11.1
11.2
12.
13.
14.
15.
16.
17.1
17.2
17.3
18.1
18.2
19.1
19.3
21.
22.
23.
24.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Lines of Business
Fire...................................................................................................................
Allied lines........................................................................................................
Farmowners multiple peril................................................................................
Homeowners multiple peril...............................................................................
Commercial multiple peril.................................................................................
Mortgage guaranty...........................................................................................
Ocean marine...................................................................................................
Inland marine....................................................................................................
Financial guaranty............................................................................................
Medical professional liability - occurrence........................................................
Medical professional liability - claims made.....................................................
Earthquake.......................................................................................................
Group accident and health...............................................................................
Credit accident and health................................................................................
Other accident and health................................................................................
Workers' compensation....................................................................................
Other liability-occurrence..................................................................................
Other liability-claims made...............................................................................
Excess workers' compensation........................................................................
Products liability-occurrence............................................................................
Products liability-claims made..........................................................................
19.2 Private passenger auto liability................................................................
19.4 Commercial auto liability.........................................................................
Auto physical damage......................................................................................
Aircraft (all perils).............................................................................................
Fidelity..............................................................................................................
Surety...............................................................................................................
Burglary and theft.............................................................................................
Boiler and machinery........................................................................................
Credit................................................................................................................
International......................................................................................................
Warranty...........................................................................................................
Reinsurance-nonproportional assumed property.............................................
Reinsurance-nonproportional assumed liability................................................
Reinsurance-nonproportional assumed financial lines.....................................
Aggregate write-ins for other lines of business................................................
Totals................................................................................................................
3401.
3402.
3403.
3498.
3499.
.........................................................................................................................
.........................................................................................................................
.........................................................................................................................
Sum. of remaining write-ins for Line 34 from overflow page............................
Totals (Lines 3401 thru 3403 plus 3498) (Line 34)...........................................
1
Current
Quarter
............................................103,693
............................................531,211
...........................................................
.......................................16,456,831
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
.........................XXX..........................
.........................XXX..........................
.........................XXX..........................
.......................................................0
.......................................17,091,735
DETAILS OF WRITE-INS
...........................................................
...........................................................
...........................................................
.......................................................0
.......................................................0
Q13
2
Current
Year to Date
............................................234,365
.........................................1,114,292
...........................................................
.......................................26,767,261
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
.........................XXX..........................
.........................XXX..........................
.........................XXX..........................
.......................................................0
.......................................28,115,918
3
Prior Year
Year to Date
............................................209,235
............................................954,381
...........................................................
.......................................22,140,845
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
.........................XXX..........................
.........................XXX..........................
.........................XXX..........................
.......................................................0
.......................................23,304,461
...........................................................
...........................................................
...........................................................
.......................................................0
.......................................................0
...........................................................
...........................................................
...........................................................
.......................................................0
.......................................................0
Prepared Insurance Company
Statement for June 30, 2014 of the
PART 3 (000 omitted)
LOSS AND LOSS ADJUSTMENT EXPENSE RESERVES SCHEDULE
Years in Which
Losses
Occurred
1
2
3
Prior Year-End
Known Case
Loss and LAE
Reserves
Prior Year-End
IBNR
Loss and LAE
Reserves
Total Prior
Year-End
Loss and
LAE Reserves
(Cols. 1 + 2)
4
5
2014
2014
Loss and LAE
Loss and LAE
Payments on Claims Payments on Claims
Reported as of Prior
Unreported as of
Year-End
Prior Year-End
6
Total 2014
Loss and
LAE Payments
(Cols. 4 + 5)
7
8
Q.S. Date Known
Q.S. Date Known
Case Loss and
Case Loss and LAE
LAE Reserves on
Reserves on Claims
Claims Reported and Reported or Reopened
Open as of Prior
Subsequent to
Year-End
Prior Year-End
9
10
Q.S. Date
IBNR
Loss and LAE
Reserves
Total Q.S.
Loss and LAE
Reserves
(Cols. 7 + 8 + 9)
11
12
Prior Year-End Known
Prior Year-End
Case Loss and LAE
IBNR Loss and LAE
Reserves Developed Reserves Developed
(Savings)/Deficiency (Savings)/Deficiency
(Cols. 4 + 7
(Cols. 5 + 8 + 9
minus Col. 1)
minus Col. 2)
13
Prior Year-End
Total Loss
and LAE Reserve
Developed
(Savings)/Deficiency
(Cols. 11 + 12)
1. 2011 + Prior........ .......................1,330 ..............................5 .......................1,335 ...........................635 ...............................1 ..........................636 ...........................888 ..................................... ................................. ..........................888 .............................193 ...............................(4) ............................189
2. 2012..................
.......................1,255 ..........................188 .......................1,443 ...........................872 ................................... ..........................872 ...........................760 ..................................... ................................. ..........................760 .............................377 ...........................(188) ............................189
3. Subtotals
2012 + Prior........ .......................2,585 ..........................193 .......................2,778 ........................1,507 ...............................1 .......................1,508 ........................1,648 .................................0 ..............................0 .......................1,648 .............................570 ...........................(192) ............................378
4. 2013..................
.......................2,570 .......................1,608 .......................4,178 ........................2,018 ...........................117 .......................2,135 ........................1,204 ..................................... ..........................839 .......................2,043 .............................652 ...........................(652) ................................0
5. Subtotals
2013 + Prior........ .......................5,155 .......................1,801 .......................6,956 ........................3,525 ...........................118 .......................3,643 ........................2,852 .................................0 ..........................839 .......................3,691 ..........................1,222 ...........................(844) ............................378
Q14
6. 2014................... ...............XXX........... ...............XXX........... ...............XXX........... ...............XXX............ ........................2,027 .......................2,027 ...............XXX............ ..........................2,811 .......................1,192 .......................4,003 ...............XXX.............. ...............XXX............. ...............XXX.............
7. Totals.................. .......................5,155 .......................1,801 .......................6,956 ........................3,525 ........................2,145 .......................5,670 ........................2,852 ..........................2,811 .......................2,031 .......................7,694 ..........................1,222 ...........................(844) ............................378
8. Prior YearEnd's Surplus
As Regards
Policyholders
Col. 11, Line 7
As % of Col. 1,
Line 7
Col. 12, Line 7
As % of Col. 2,
Line 7
Col. 13, Line 7
As % of Col. 3,
Line 7
.....................15,780
1. ....................23.7 % 2. ..................(46.9)% 3. .....................5.4 %
Col. 13, Line 7
Line 8
4. .....................2.4 %
Statement for June 30, 2014 of the
Prepared Insurance Company
SUPPLEMENTAL EXHIBITS AND SCHEDULES INTERROGATORIES
The following supplemental reports are required to be filed as part of your statement filing. However, in the event that your company does not transact the type of
business for which the special report must be filed, your response of NO to the specific interrogatory will be accepted in lieu of filing a "NONE" report and a bar code
will be printed below. If the supplement is required of your company but is not being filed for whatever reason, enter SEE EXPLANATION and provide an
explanation following the interrogatory questions.
Response
1.
Will the Trusteed Surplus Statement be filed with the state of domicile and the NAIC with this statement?
NO
2.
Will Supplement A to Schedule T (Medical Professional Liability Supplement) be filed with this statement?
NO
3.
Will the Medicare Part D Coverage Supplement be filed with the state of domicile and the NAIC with this statement?
NO
4.
Will the Director and Officer Supplement be filed with the state of domicile and the NAIC with this statement?
NO
Explanation:
1.
2.
3.
4.
Bar Code:
*13687201449000002*
*13687201445500002*
*13687201436500002*
*13687201450500002*
Q15
Statement for June 30, 2014 of the
Prepared Insurance Company
Overflow Page for Write-Ins
NONE
Q16
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE A - VERIFICATION
Real Estate
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
2
Prior Year Ended
Year to Date
December 31
Book/adjusted carrying value, December 31 of prior year....................................................................................................... ...............................................0 ...................................................
Cost of acquired:
2.1 Actual cost at time of acquisition...................................................................................................................................... ................................................... ...................................................
2.2 Additional investment made after acquisition................................................................................................................... ................................................... ...................................................
Current year change in encumbrances................................................................................................................................... ................................................... ...................................................
Total gain (loss) on disposals.................................................................................................................................................. ................................................... ...................................................
Deduct amounts received on disposals................................................................................................................................... ................................................... ...................................................
Total foreign exchange change in book/adjusted carrying value............................................................................................. ................................................... ...................................................
Deduct current year's other than temporary impairment recognized....................................................................................... ................................................... ...................................................
Deduct current year's depreciation.......................................................................................................................................... ................................................... ...................................................
Book/adjusted carrying value at end of current period (Lines 1+2+3+4-5+6-7-8)................................................................... ...............................................0 ...............................................0
Deduct total nonadmitted amounts.......................................................................................................................................... ................................................... ...................................................
Statement value at end of current period (Line 9 minus Line 10)............................................................................................ ...............................................0 ...............................................0
NONE
SCHEDULE B - VERIFICATION
Mortgage Loans
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
2
Prior Year Ended
Year to Date
December 31
Book value/recorded investment excluding accrued interest, December 31 of prior year....................................................... ...............................................0 ...................................................
Cost of acquired:
2.1 Actual cost at time of acquisition...................................................................................................................................... ................................................... ...................................................
2.2 Additional investment made after acquisition................................................................................................................... ................................................... ...................................................
Capitalized deferred interest and other................................................................................................................................... ................................................... ...................................................
Accrual of discount.................................................................................................................................................................. ................................................... ...................................................
Unrealized valuation increase (decrease)............................................................................................................................... ................................................... ...................................................
Total gain (loss) on disposals.................................................................................................................................................. ................................................... ...................................................
Deduct amounts received on disposals................................................................................................................................... ................................................... ...................................................
Deduct amortization of premium and mortgage interest points and commitment fees............................................................ ................................................... ...................................................
Total foreign exchange change in book value/recorded investment excluding accrued interest............................................. ................................................... ...................................................
Deduct current year's other than temporary impairment recognized....................................................................................... ................................................... ...................................................
Book value/recorded investment excluding accrued interest at end of current period (Lines 1+2+3+4+5+6-7-8+9-10)......... ...............................................0 ...............................................0
Total valuation allowance........................................................................................................................................................ ................................................... ...................................................
Subtotal (Line 11 plus Line 12)................................................................................................................................................ ...............................................0 ...............................................0
Deduct total nonadmitted amounts.......................................................................................................................................... ................................................... ...................................................
Statement value at end of current period (Line 13 minus Line 14).......................................................................................... ...............................................0 ...............................................0
NONE
SCHEDULE BA - VERIFICATION
Other Long-Term Invested Assets
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
2
Prior Year Ended
Year to Date
December 31
Book/adjusted carrying value, December 31 of prior year....................................................................................................... ...............................................0 ...................................................
Cost of acquired:
2.1 Actual cost at time of acquisition...................................................................................................................................... ................................................... ...................................................
2.2 Additional investment made after acquisition................................................................................................................... ................................................... ...................................................
Capitalized deferred interest and other................................................................................................................................... ................................................... ...................................................
Accrual of discount.................................................................................................................................................................. ................................................... ...................................................
Unrealized valuation increase (decrease)............................................................................................................................... ................................................... ...................................................
Total gain (loss) on disposals.................................................................................................................................................. ................................................... ...................................................
Deduct amounts received on disposals................................................................................................................................... ................................................... ...................................................
Deduct amortization of premium and depreciation.................................................................................................................. ................................................... ...................................................
Total foreign exchange change in book/adjusted carrying value............................................................................................. ................................................... ...................................................
Deduct current year's other than temporary impairment recognized....................................................................................... ................................................... ...................................................
Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5+6-7-8+9-10)......................................................... ...............................................0 ...............................................0
Deduct total nonadmitted amounts.......................................................................................................................................... ................................................... ...................................................
Statement value at end of current period (Line 11 minus Line 12).......................................................................................... ...............................................0 ...............................................0
NONE
SCHEDULE D - VERIFICATION
Bonds and Stocks
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Book/adjusted carrying value of bonds and stocks, December 31 of prior year......................................................................
Cost of bonds and stocks acquired.........................................................................................................................................
Accrual of discount..................................................................................................................................................................
Unrealized valuation increase (decrease)...............................................................................................................................
Total gain (loss) on disposals..................................................................................................................................................
Deduct consideration for bonds and stocks disposed of.........................................................................................................
Deduct amortization of premium..............................................................................................................................................
Total foreign exchange change in book/adjusted carrying value.............................................................................................
Deduct current year's other than temporary impairment recognized.......................................................................................
Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9)...............................................................
Deduct total nonadmitted amounts..........................................................................................................................................
Statement value at end of current period (Line 10 minus Line 11)..........................................................................................
QSI01
1
Year to Date
...............................28,223,978
.................................3,401,305
........................................7,270
......................................68,270
......................................22,392
.................................2,822,340
....................................215,842
...................................................
...................................................
...............................28,685,033
...................................................
...............................28,685,033
2
Prior Year Ended
December 31
...............................23,508,547
...............................16,275,105
......................................12,143
.....................................(88,658)
........................................8,410
...............................11,083,443
....................................408,126
...................................................
...................................................
...............................28,223,978
...................................................
...............................28,223,978
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE D - PART 1B
Showing the Acquisitions, Dispositions and Non-Trading Activity
During the Current Quarter for all Bonds and Preferred Stock by NAIC Designation
NAIC Designation
1
Book/Adjusted Carrying
Value Beginning
of Current Quarter
2
Acquisitions
During
Current Quarter
3
Dispositions
During
Current Quarter
4
Non-Trading Activity
During
Current Quarter
5
Book/Adjusted Carrying
Value End of
First Quarter
6
Book/Adjusted Carrying
Value End of
Second Quarter
7
Book/Adjusted Carrying
Value End of
Third Quarter
8
Book/Adjusted Carrying
Value December 31
Prior Year
BONDS
QSI02
1.
NAIC 1 (a)................................................................................................................ ..........................18,035,271 ............................3,097,533 ............................2,851,098 ................................(63,619) ..........................18,035,271 ..........................18,218,087 ............................................. ..........................18,038,693
2.
NAIC 2 (a)................................................................................................................ ............................9,497,430 ............................................. ............................................. ................................(42,001) ............................9,497,430 ............................9,455,429 ............................................. ............................9,477,027
3.
NAIC 3 (a)................................................................................................................ ...............................233,205 ............................................. ............................................. ..........................................7 ...............................233,205 ...............................233,212 ............................................. ...............................233,199
4.
NAIC 4 (a)................................................................................................................ ...............................120,600 ............................................. ............................................. ......................................319 ...............................120,600 ...............................120,919 ............................................. ...............................120,450
5.
NAIC 5 (a)................................................................................................................ ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................
6.
NAIC 6 (a)................................................................................................................ ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................
7.
Total Bonds.............................................................................................................. ..........................27,886,506 ............................3,097,533 ............................2,851,098 ..............................(105,294) ..........................27,886,506 ..........................28,027,647 ..........................................0 ..........................27,869,369
PREFERRED STOCK
8.
NAIC 1..................................................................................................................... ...............................300,000 ............................................. ............................................. ............................................. ...............................300,000 ...............................300,000 ............................................. ...............................300,000
9.
NAIC 2..................................................................................................................... ...............................466,197 ............................................. ............................................. .................................14,099 ...............................466,197 ...............................480,296 ............................................. ...............................443,598
10. NAIC 3..................................................................................................................... ...............................186,400 ............................................. ............................................. .................................12,320 ...............................186,400 ...............................198,720 ............................................. ...............................168,000
11. NAIC 4..................................................................................................................... ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................
12. NAIC 5..................................................................................................................... ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................
13. NAIC 6..................................................................................................................... ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. ............................................. .............................................
14. Total Preferred Stock............................................................................................... ...............................952,597 ..........................................0 ..........................................0 .................................26,419 ...............................952,597 ...............................979,016 ..........................................0 ...............................911,598
15. Total Bonds and Preferred Stock............................................................................. ..........................28,839,103 ............................3,097,533 ............................2,851,098 ................................(78,875) ..........................28,839,103 ..........................29,006,663 ..........................................0 ..........................28,780,967
(a)
Book/Adjusted Carrying Value column for the end of the current reporting period includes the following amount of non-rated short-term and cash equivalent bonds by NAIC designation:
NAIC 1 $.....116,233; NAIC 2 $..........0; NAIC 3 $..........0; NAIC 4 $..........0; NAIC 5 $..........0; NAIC 6 $..........0.
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE DA - PART 1
Short-Term Investments
1
Book/Adjusted
Carrying Value
2
Par Value
3
Actual
Cost
4
Interest Collected
Year To Date
5
Paid for Accrued Interest
Year To Date
9199999........................................................ .................................374,328 ................XXX....................... ................................377,263 ....................................2,906 ..............................................
SCHEDULE DA - VERIFICATION
Short-Term Investments
1
Year to Date
2
Prior Year Ended
December 31
1. Book/adjusted carrying value, December 31 of prior year....................................................................................................... ....................................585,919 .................................1,390,450
2.
Cost of short-term investments acquired................................................................................................................................. .................................2,802,297 ...............................11,522,963
3.
Accrual of discount.................................................................................................................................................................. ................................................... ...................................................
4.
Unrealized valuation increase (decrease)............................................................................................................................... ................................................... ...................................................
5.
Total gain (loss) on disposals.................................................................................................................................................. ................................................... .............................................84
6.
Deduct consideration received on disposals........................................................................................................................... .................................3,011,430 ...............................12,325,370
7. Deduct amortization of premium.............................................................................................................................................. ........................................2,458 ........................................2,208
8. Total foreign exchange change in book/adjusted carrying value............................................................................................. ................................................... ...................................................
9.
Deduct current year's other than temporary impairment recognized....................................................................................... ................................................... ...................................................
10. Book/adjusted carrying value at end of current period (Lines 1+2+3+4+5-6-7+8-9)............................................................... ....................................374,328 ....................................585,919
11. Deduct total nonadmitted amounts.......................................................................................................................................... ................................................... ...................................................
12. Statement value at end of current period (Line 10 minus Line 11).......................................................................................... ....................................374,328 ....................................585,919
QSI03
Statement for June 30, 2014 of the
Prepared Insurance Company
Sch. DB-Pt A-Verification
NONE
Sch. DB-Pt B-Verification
NONE
Sch. DB-Pt C-Sn 1
NONE
Sch. DB-Pt C-Sn 2
NONE
Sch. DB-Verification
NONE
Sch. E-Verification
NONE
Sch. A-Pt 2
NONE
Sch. A-Pt 3
NONE
Sch. B-Pt 2
NONE
Sch. B-Pt 3
NONE
Sch. BA-Pt 2
NONE
Sch. BA-Pt 3
NONE
QSI04, QSI05, QSI06, QSI07, QSI08, QE01, QE02, QE03
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE D - PART 3
Show all Long-Term Bonds and Stock Acquired During the Current Quarter
1
2
3
4
5
6
7
8
CUSIP
Identification
Description
Foreign
Date
Acquired
Name of Vendor
Number of
Shares of Stock
Actual Cost
Par Value
9
Paid for
Accrued Interest
and Dividends
10
NAIC Designation
or Market
Indicator (a)
Bonds - U.S. Special Revenue and Special Assessment
9 FNMA PASS-THRU LNG 30 YEAR.................................................................................................................... ........... ....05/27/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................550,103
.....................................520,000
.........................................1,676 1................................
3199999. Total Bonds - U.S. Special Revenue and Special Assessment................................................................................................................................... .................................................................................................................................................................................................... .....................................550,103
31418B
D2
.....................................520,000
.........................................1,676 ..........XXX.................
Bonds - Industrial and Miscellaneous
17310M AG
5 CITIGROUP COML MTG 2006-C5..................................................................................................................... ........... ....06/03/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................168,197
.....................................154,000
..............................................70 1FE...........................
12591R AX
8 COMM MTG TR 2014-CCRE15.......................................................................................................................... ........... ....06/06/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................139,894
.....................................135,000
............................................121 1FE...........................
36248E AB
1 GS MTG COML 2010-C2 144A.......................................................................................................................... ........... ....04/08/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................112,699
.....................................100,000
............................................143 1FE...........................
637417 AF
3 NATIONAL RETAIL PPTYS INC......................................................................................................................... ........... ....06/18/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................212,412
.....................................220,000
.........................................1,371 1FE...........................
10553Y AF
2 BRASKEM FINANCE LIMITED........................................................................................................................... R........ ....04/25/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................207,014
.....................................200,000
.........................................3,118 1FE...........................
93443T AB
2 WARNER CHILCOTT CORP.............................................................................................................................. R........ ....04/22/2014 Morgan Stanley......................................................................................................................... ............................................... .....................................186,463
.....................................175,000
.........................................1,507 1FE...........................
3899999. Total Bonds - Industrial and Miscellaneous.................................................................................................................................................................. .................................................................................................................................................................................................... ..................................1,026,679
.....................................984,000
.........................................6,330 ..........XXX.................
8399997. Total Bonds - Part 3...................................................................................................................................................................................................... .................................................................................................................................................................................................... ..................................1,576,782
..................................1,504,000
.........................................8,006 ..........XXX.................
8399999. Total Bonds................................................................................................................................................................................................................... .................................................................................................................................................................................................... ..................................1,576,782
..................................1,504,000
.........................................8,006 ..........XXX.................
Common Stocks - Money Market Mutual Funds
74926P
72
0 RBC RESERVE CLASS MMKT.......................................................................................................................... ........... ....06/30/2014 JHS CAPITAL........................................................................................................................... ............................10,166.810
.......................................10,167 .....................XXX....................... ................................................... L................................
9399999. Total Common Stocks - Money Market Mutual Funds................................................................................................................................................. .................................................................................................................................................................................................... .......................................10,167 .....................XXX....................... ................................................0 ..........XXX.................
9799997. Total Common Stocks - Part 3...................................................................................................................................................................................... .................................................................................................................................................................................................... .......................................10,167 .....................XXX....................... ................................................0 ..........XXX.................
9799999. Total Common Stocks.................................................................................................................................................................................................. .................................................................................................................................................................................................... .......................................10,167 .....................XXX....................... ................................................0 ..........XXX.................
QE04
9899999. Total Preferred and Common Stocks........................................................................................................................................................................... .................................................................................................................................................................................................... .......................................10,167 .....................XXX....................... ................................................0 ..........XXX.................
9999999. Total Bonds, Preferred and Common Stocks............................................................................................................................................................... .................................................................................................................................................................................................... ..................................1,586,949 .....................XXX....................... .........................................8,006 ..........XXX.................
(a) For all common stock bearing the NAIC market indicator "U" provide: the number of such issues:...............0.
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE D - PART 4
Show All Long-Term Bonds and Stock Sold, Redeemed or Otherwise Disposed of During the Current Quarter
1
2
CUSIP
Identification
Description
3
F
o
r
e
i
g
n
4
5
6
7
8
9
10
Change in Book/Adjusted Carrying Value
12
13
14
Current
Year's
Unrealized
Current
Other Than
Total
Valuation
Year's
Temporary
Change in
Increase/ (Amortization)/ Impairment
B./A.C.V.
(Decrease)
Accretion
Recognized (11+12-13)
11
Disposal
Date
Name of Purchaser
Number of
Shares of
Stock
Consideration
Par Value
Actual Cost
Prior Year
Book/
Adjusted
Carrying
Value
16
17
18
19
Book/
Adjusted
Carrying
Value At
Disposal Date
Foreign
Exchange
Gain
(Loss)
on
Disposal
Realized
Gain
(Loss)
on
Disposal
Total
Gain
(Loss)
on
Disposal
15
Total
Foreign
Exchange
Change in
B./A.C.V.
20
21
22
NAIC
Bond
DesigInterest/
nation
Stock
Stated
or
Dividends Contractual Market
Received
Maturity Indicator
During Year
Date
(a)
Bonds - U.S. Government
36202E
ZJ
1 GNMA POOL #004345.............................................. ..... 06/20/2014 PRINCIPAL RECEIPT................ .......................... ................5,738 ................5,738 ................6,226 ................6,212 .................... ............(474) .................... ..............(474) .................. ................5,738 .................. .................. ...............0
36200M
SE
4 GNMA POOL #604517.............................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ...................378 ...................378 ...................395 ...................390 .................... ..............(11) .................... ................(11) .................. ...................378 .................. .................. ...............0 ...............7 08/15/2018 1...........
...........154 01/20/2039 1...........
36202S
A7
3 GNMA POOL #607630.............................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... .....................99 .....................99 ...................105 ...................105 .................... ................(6) .................... ..................(6) .................. .....................99 .................. .................. ...............0 ...............2 01/15/2033 1...........
36202W
Y3
7 GNMA POOL #611930.............................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... .....................36 .....................36 .....................38 .....................37 .................... ................(2) .................... ..................(2) .................. .....................36 .................. .................. ...............0 ...............1 05/15/2033 1...........
36290X
PL
8 GNMA POOL #620627.............................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ...................438 ...................438 ...................467 ...................466 .................... ..............(27) .................... ................(27) .................. ...................438 .................. .................. ...............0
0599999. Total Bonds - U.S Government.................................................................................................................................................................... ................6,689 ................6,689 ................7,231 ................7,210 .................0 ............(520) .................0 ..............(520) ...............0 ................6,689
.............11 09/15/2033 1...........
...............0 ...............0 ...............0
...........175 ......XXX... ..XXX....
Bonds - U.S. States, Territories and Possessions
6 CALIFORNIA ST GO BDS......................................... ..... 04/01/2014 MATURITY................................. .......................... ............275,000
............275,000
............288,337
............278,062 .................... .........(3,062) .................... ...........(3,062) .................. ............275,000 .................. .................. ...............0
........7,219 04/01/2014 1FE......
1799999. Total Bonds - U.S. States, Territories and Possessions............................................................................................................................... ............275,000
13063A
5B
............275,000
............288,337
............278,062 .................0 .........(3,062) .................0 ...........(3,062) ...............0
........7,219 ......XXX... ..XXX....
............275,000
............274,725
............274,729 .................... ...............16 .................... .................16 .................. ............274,745 .................. ...........255
............275,000 ...............0 ...............0 ...............0
Bonds - U.S. Special Revenue and Special Assessment
QE05
3133ED
AR
3 FEDERAL FARM CR BKS......................................... ..... 05/23/2014 CALLED @ 100.0000000............ .......................... ............275,000
...........255
........3,193 02/27/2020 1...........
3128MB
DD
6 FHLMC GOLD POOL #G12600................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ...................548 ...................548 ...................589 ...................580 .................... ..............(32) .................... ................(32) .................. ...................548 .................. .................. ...............0
.............13 03/01/2022 1...........
3128PG
LG
6 FHLMC GOLD POOL #J04827.................................. ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ...................268 ...................268 ...................285 ...................282 .................... ..............(13) .................... ................(13) .................. ...................268 .................. .................. ...............0 ...............6 05/01/2022 1...........
3137A1 WC
3 FHLMC REMIC SERIES 3728................................... ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ..............11,032 ..............11,032 ..............11,356 ..............11,657 .................... ............(625) .................... ..............(625) .................. ..............11,032 .................. .................. ...............0
...........130 09/15/2020 1...........
3137A3 RW
1 FHLMC REMIC SERIES 3776................................... ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ..............11,511 ..............11,511 ..............12,202 ..............12,196 .................... ............(685) .................... ..............(685) .................. ..............11,511 .................. .................. ...............0
...........194 09/15/2028 1...........
3137A4
5Y
9 FHLMC REMIC SERIES 3778................................... ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ..............11,768 ..............11,768 ..............12,282 ..............12,247 .................... ............(478) .................... ..............(478) .................. ..............11,768 .................. .................. ...............0
...........178 03/15/2025 1...........
3137A8 RM
2 FHLMC REMIC SERIES 3841................................... ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ..............14,116 ..............14,116 ..............14,734 ..............14,733 .................... ............(616) .................... ..............(616) .................. ..............14,116 .................. .................. ...............0
...........203 11/15/2028 1...........
31411R
TJ
7 FNMA PASS-THRU ADJ LIBOR.............................. ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................6,777 ................6,777 ................7,107 ................7,099 .................... ............(322) .................... ..............(322) .................. ................6,777 .................. .................. ...............0
.............58 03/01/2037 1...........
3138A8
SR
8 FNMA PASS-THRU INT 15 YEAR........................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................8,082 ................8,082 ................8,417 ................8,399 .................... ............(316) .................... ..............(316) .................. ................8,082 .................. .................. ...............0
...........133 03/01/2026 1...........
31417Y
XX
0 FNMA PASS-THRU LNG 30 YEAR......................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................9,916 ................9,916 ..............10,064 ..............10,063 .................... ............(147) .................... ..............(147) .................. ................9,916 .................. .................. ...............0
...........186 04/01/2041 1...........
31418B
D2
9 FNMA PASS-THRU LNG 30 YEAR........................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ...................908 ...................908 ...................960 .......................... .................... ..............(53) .................... ................(53) .................. ...................908 .................. .................. ...............0 ...............3 06/01/2044 1...........
31418R
P7
0 FNMA PASS-THRU LNG 30 YEAR........................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ..............15,060 ..............15,060 ..............16,086 ..............16,076 .................... .........(1,016) .................... ...........(1,016) .................. ..............15,060 .................. .................. ...............0
...........296 04/01/2040 1...........
31403D
PX
1 FNMA POOL #745738............................................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................1,007 ................1,007 ................1,096 ................1,093 .................... ..............(87) .................... ................(87) .................. ................1,007 .................. .................. ...............0
.............29 08/01/2036 1...........
31403D
VZ
9 FNMA POOL #745932............................................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ...................844 ...................844 ...................919 ...................917 .................... ..............(73) .................... ................(73) .................. ...................844 .................. .................. ...............0
.............23 11/01/2036 1...........
3199999. Total Bonds - U.S. Special Revenue and Special Assessment.................................................................................................................... ............366,837
............366,838
............370,822
............370,071 .................0 .........(4,447) .................0 ...........(4,447) ...............0
............366,582 ...............0
...........255
...........255
........4,645 ......XXX... ..XXX....
Bonds - Industrial and Miscellaneous
04541G
QB
1 ABS CORP HEQ 2005-HE2....................................... ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ..............15,050 ..............15,050 ..............14,974 ..............15,014 .................... ...............36 .................... .................36 .................. ..............15,050 .................. .................. ...............0
.............52 02/25/2035 1FM.....
03064F
AT
0 AMERCREDIT AUTO REC 2010............................... ..... 06/08/2014 PRINCIPAL RECEIPT................ .......................... ..............58,067 ..............58,067 ..............58,836 ..............58,451 .................... ............(384) .................... ..............(384) .................. ..............58,067 .................. .................. ...............0
...........663 05/08/2016 1FE......
06051G
DY
2 BANK AMER CORP SR NT....................................... ..... 05/15/2014 MATURITY................................. .......................... ............300,000
............305,256 .................... .........(5,256) .................... ...........(5,256) .................. ............300,000 .................. .................. ...............0
......11,063 05/15/2014 1FE......
07383F
5K
0 BEAR STEARNS CMBS 2005-TOP18....................... ..... 06/13/2014 PRINCIPAL RECEIPT................ .......................... ...................663 ...................663 ...................725 ...................687 .................... ..............(24) .................... ................(24) .................. ...................663 .................. .................. ...............0
.............14 02/13/2042 1FM.....
07388N
AE
6 BEAR STEARNS CMBS 2006-TOP24....................... ..... 06/12/2014 PRINCIPAL RECEIPT................ .......................... ................3,988 ................3,988 ................4,430 ................4,173 .................... ............(185) .................... ..............(185) .................. ................3,988 .................. .................. ...............0
...........108 10/12/2041 1FM.....
07387E
EQ
6 BEAR STEARNS COS INC....................................... ..... 04/10/2014 MATURITY................................. .......................... ..............60,000 ..............60,000 ..............58,731 ..............59,726 .................... .............274 .................... ...............274 .................. ..............60,000 .................. .................. ...............0
...........564 04/10/2014 1FE......
59022H MU
3 ML MTG TRUST 2005-CKI1 20371112 FL................ ..... 06/12/2014 PRINCIPAL RECEIPT................ .......................... ................2,394 ................2,394 ................2,564 ................2,531 .................... ............(137) .................... ..............(137) .................. ................2,394 .................. .................. ...............0
.............60 11/12/2037 1FM.....
81744U
AA
2 SEQUOIA MTG TR 2012-2 20420425 FLT................ ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................9,411 ................9,411 ................9,517 ................9,513 .................... ............(103) .................... ..............(103) .................. ................9,411 .................. .................. ...............0
...........147 04/25/2042 1FM.....
81744U
AB
0 SEQUOIA MTG TR 2012-2 20420425 FLT................ ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................4,429 ................4,429 ................4,484 ................4,479 .................... ..............(50) .................... ................(50) .................. ................4,429 .................. .................. ...............0
.............69 04/25/2042 1FM.....
............300,000
............341,472
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE D - PART 4
Show All Long-Term Bonds and Stock Sold, Redeemed or Otherwise Disposed of During the Current Quarter
1
2
CUSIP
Identification
Description
3
F
o
r
e
i
g
n
4
5
6
7
8
9
10
Change in Book/Adjusted Carrying Value
12
13
14
Current
Year's
Unrealized
Current
Other Than
Total
Valuation
Year's
Temporary
Change in
Increase/ (Amortization)/ Impairment
B./A.C.V.
(Decrease)
Accretion
Recognized (11+12-13)
11
Disposal
Date
Name of Purchaser
Number of
Shares of
Stock
Consideration
Par Value
Actual Cost
Prior Year
Book/
Adjusted
Carrying
Value
16
17
18
19
Book/
Adjusted
Carrying
Value At
Disposal Date
Foreign
Exchange
Gain
(Loss)
on
Disposal
Realized
Gain
(Loss)
on
Disposal
Total
Gain
(Loss)
on
Disposal
15
Total
Foreign
Exchange
Change in
B./A.C.V.
20
21
22
NAIC
Bond
DesigInterest/
nation
Stock
Stated
or
Dividends Contractual Market
Received
Maturity Indicator
During Year
Date
(a)
81745F
AA
4 SEQUOIA MTG TR 2012-3 20420725 FLT................ ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................6,685 ................6,685 ................6,702 ................6,702 .................... ..............(16) .................... ................(16) .................. ................6,685 .................. .................. ...............0
.............95 07/25/2042 1FM.....
81744T
AB
3 SEQUOIA MTG TRUST 2012-1 20420125................ ..... 06/25/2014 PRINCIPAL RECEIPT................ .......................... ................4,942 ................4,942 ................5,019 ................5,017 .................... ..............(75) .................... ................(75) .................. ................4,942 .................. .................. ...............0
.............76 01/25/2042 1FM.....
92978P
AE
9 WACHOVIA CMBS 2006-C29................................... ..... 06/15/2014 PRINCIPAL RECEIPT................ .......................... ...................251 ...................251 ...................269 ...................260 .................... ................(8) .................... ..................(8) .................. ...................251 .................. .................. ...............0 ...............5 11/15/2048 1FM.....
92937E
AB
0 WFRBS COML MTG TR 2013-C11........................... ..... 06/06/2014 Morgan Stanley........................... .......................... ............141,739
............140,000
............141,559 .......................... .................... ............(111) .................... ..............(111) .................. ............141,447 .................. ...........292
...........292
...........789 03/17/2045 1FM.....
10553Y
AF
2 BRASKEM FINANCE LIMITED................................. R.. 05/08/2014 Morgan Stanley........................... .......................... ............214,100
............200,000
............207,014 .......................... .................... ..............(19) .................... ................(19) .................. ............206,995 .................. ........7,105
........7,105
........3,583 02/03/2024 1FE......
3899999. Total Bonds - Industrial and Miscellaneous.................................................................................................................................................. ............821,719
............805,879
............856,296
............471,809 .................0 .........(6,058) .................0 ...........(6,058) ...............0
............814,322 ...............0
........7,397
........7,397
......17,288 ......XXX... ..XXX....
8399997. Total Bonds - Part 4.................................................................................................................................................................................... .........1,470,245
.........1,454,407
.........1,522,686
.........1,127,152 .................0
.......(14,087) .................0 .........(14,087) ...............0
.........1,462,593 ...............0
........7,652
........7,652
......29,327 ......XXX... ..XXX....
8399999. Total Bonds................................................................................................................................................................................................. .........1,470,245
.........1,454,407
.........1,522,686
.........1,127,152 .................0
.......(14,087) .................0 .........(14,087) ...............0
.........1,462,593 ...............0
........7,652
........7,652
......29,327 ......XXX... ..XXX....
9999999. Total Bonds, Preferred and Common Stocks............................................................................................................................................... .........1,470,245 ...........XXX........ .........1,522,686
.........1,127,152 .................0
.......(14,087) .................0 .........(14,087) ...............0
.........1,462,593 ...............0
........7,652
........7,652
......29,327 ......XXX... ..XXX....
(a) For all common stock bearing the NAIC market indicator "U" provide: the number of such issues:...............0.
QE05.1
Statement for June 30, 2014 of the
Prepared Insurance Company
Sch. DB-Pt A-Sn 1
NONE
Sch. DB-Pt A-Sn 1-Footnote A
NONE
Sch. DB-Pt A-Sn 1-Footnote B
NONE
Sch. DB-Pt B-Sn 1
NONE
Sch. DB-Pt B-Sn 1-Footnote A
NONE
Sch. DB-Pt B-Sn 1-Footnote B
NONE
Sch. DB-Pt B-Sn 1B-Broker List
NONE
Sch. DB-Pt D-Sn 1
NONE
Sch. DB-Pt D-Sn 2
NONE
Sch. DL-Pt. 1
NONE
Sch. DL-Pt. 2
NONE
QE06, QE07, QE08, QE09, QE10, QE11
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE E - PART 1 - CASH
Month End Depository Balances
1
Depository
2
3
Code
Rate
of
Interest
4
Amount of
Interest
Received During
Current Quarter
5
Amount of
Interest Accrued
at Current
Statement Date
6
Book Balance at End of Each
Month During Current Quarter
7
9
8
First Month
Second Month
Third Month
*
...............300,000
...............300,000
...............300,000 XXX..
NORTHSTAR BANK MM................................................. NorthStar Bank........................................ ................... ..................... ......................7,838 ................................ ............9,548,953
..........12,953,693
..........14,803,694 XXX..
Open Depositories
NORTHSTAR BANK CD................................................. NorthStar Bank........................................ SD.............. ...........0.700 .........................431 ...........................64
NORTHSTAR BANK CHECKING ACCCOUNT.............. NorthStar Bank........................................ ................... ..................... ................................ ................................ ..............(508,867) ..............(337,504) ..............(749,248) XXX..
NORTHSTAR BANK PREMIUM TRUST........................ NorthStar Bank........................................ ................... ..................... ................................ ................................ ...............151,250
.................42,190
...............354,785 XXX..
MORGAN STANLEY ACCT 558-185019-267................. NorthStar Bank........................................ ................... ..................... ................................ ................................ ...................3,048 ............................. .................12,921 XXX..
JHS CAPITAL ACCT 866-14274..................................... JHS Capital............................................. ................... ..................... ................................ ................................ ............................. ............................. ...................3,438 XXX..
PNC BANK MM ACCT 12-1633-5373............................. Morgan Stanley....................................... ................... ..................... .........................749 ................................ ............1,502,960
............1,503,207
............1,503,462 XXX..
BANK UNITED ACCT 9853120862................................. PNC Bank................................................ ................... ..................... ......................4,388 ................................ ............2,003,932
............2,005,424
............2,006,681 XXX..
SYNOVUS BANK MM ACCT 1005694250...................... Bank United............................................. ................... ..................... .........................174 ................................ ...............250,567
...............250,628
...............250,680 XXX..
SYNOVUS BANK OPERATING ACCT 1005694243...... Synovus Bank......................................... ................... ..................... ................................ ................................ ...................1,000
...................1,000
...................1,000 XXX..
SYNOVUS BANK CD ACCT 3880644319...................... Synovus Bank......................................... ................... ..................... .........................889 ................................ ............1,007,325
............1,007,615
............1,007,914 XXX..
SYNOVUS BANK CD ACCT 3880739268...................... Synovus Bank......................................... ................... ..................... .........................889 ................................ ............1,007,325
............1,007,615
............1,007,914 XXX..
0199999. Total Open Depositories.................................................................................................... ....XXX........ ......XXX........ ....................15,358 ...........................64
..........15,267,493
..........18,733,868
..........20,503,241 XXX..
0399999. Total Cash on Deposit......................................................................................................... ....XXX........ ......XXX........ ....................15,358 ...........................64
..........15,267,493
..........18,733,868
..........20,503,241 XXX..
0599999. Total Cash........................................................................................................................... ....XXX........ ......XXX........ ....................15,358 ...........................64
..........15,267,493
..........18,733,868
..........20,503,241 XXX..
QE12
Statement for June 30, 2014 of the
Prepared Insurance Company
SCHEDULE E - PART 2 - CASH EQUIVALENTS
Show Investments Owned End of Current Quarter
1
2
3
4
5
6
7
8
Description
Code
Date
Acquired
Rate of
Interest
Maturity
Date
Book/Adjusted
Carrying Value
Amount of Interest
Due & Accrued
Amount Received
During Year
QE13
NONE