EXHIBIT 1 STATEMENT OF ASSETS AND LIABILITIES AS OF MARCH 31, 2017 LEDGER NON-LEDGER ASSETS NOT ADMITTED DESCRIPTION ASSETS ASSETS ADMITTED ASSETS ASSETS: CASH $2,589,650.63 $0.00 $0.00 2,589,650.63 SHORT-TERM INVESTMENTS $30,466,862.81 $0.00 $0.00 30,466,862.81 ACCRUED INTEREST $0.00 $0.00 $0.00 0.00 UNREALIZED GAIN ON TREAS. NOTE $0.00 $0.00 $0.00 0.00 PREMIUMS RECEIVABLE $22,461.12 $0.00 $0.00 22,461.12 ALLOWANCE FOR DOUBTFUL ACCTS ($40,000.00) $0.00 $0.00 (40,000.00) RECEIVABLES: DUE FROM AGENTS $22,446.20 $0.00 $10,118.30 12,327.90 ASSESSMENTS RECEIVABLE $0.00 $0.00 $0.00 0.00 PP&E, PREPAID PENSION & OTHERS $533,957.19 $0.00 $533,957.19 0.00 TOTAL ASSETS $33,595,377.95 $0.00 $544,075.49 33,051,302.46 LIABILITIES AND EQUITY: RESERVE FOR: UNPAID LOSSES 2,398,343.99 UNPAID IBNR 342,314.96 UNPAID LOSS ADJUSTMENT EXP. 521,050.34 PREMIUM TAXES, FEES & FUNDS 317,797.60 UNPAID OPERATING EXPENSES 910,820.12 UNEARNED PREMIUM RESERVE 9,807,995.00 ADVANCE PREMIUMS NOT YET DUE 965,112.50 TOTAL RESERVES 15,263,434.51 OTHER LIABILITIES: COMMISSION PAYABLE TO AGENTS 182,651.03 OLD UNCASHED CHECKS 0.00 UNREALIZED LOSS (GAIN) ON TREAS. NOTES 0.00 ACCRUED PENSION BENEFIT OBLIGATION 0.00 TOTAL PAYABLES 182,651.03 MEMBERS' EQUITY (DEFICIT) 17,605,216.92 TOTAL LIABILITIES AND EQUITY 33,051,302.46
EXHIBIT 2 MEMBERS INCOME AND EQUITY ACCOUNT DESCRIPTION QUARTER YEAR-TO-DATE UNDERWRITING INCOME: GROSS PREMIUMS EARNED $4,822,341.14 $9,850,741.65 LESS: REINSURANCE CEDED ($351,450.00) ($703,938.00) NET PREMIUMS EARNED $4,470,891.14 $9,146,803.65 DEDUCTIONS: LOSSES INCURRED (INCLUDES IBNR) $2,469,189.37 $4,235,117.09 LOSS ADJUSTMENT EXPENSE $313,775.85 $698,422.32 COMMISSION EXPENSE $485,222.13 $949,114.73 GENERAL OPERATING EXPENSES $488,090.84 $1,043,435.57 PREMIUM TAXES, FEES AND FUNDS $161,800.50 $317,236.28 TOTAL DEDUCTIONS $3,918,078.69 $7,243,325.99 NET UNDERWRITING GAIN OR (LOSS) $552,812.45 $1,903,477.66 OTHER INCOME OR (OUTGO): NET INVESTMENT INCOME $14,842.36 $25,138.71 MISCELLANEOUS INCOME $0.00 $0.00 TOTAL OTHER INCOME OR (OUTGO) $14,842.36 $25,138.71 EQUITY ACCOUNT: MEMBERS' EQUITY (DEFICIT)(PRIOR PERIOD) $21,168,429.39 $19,812,241.49 NET INCOME OR (LOSS) $567,654.81 $1,928,616.37 OPERATIONAL ASSESSMENT $0.00 $0.00 CLOSING ASSESSMENTS & EQUITY ADJ.S $0.00 $0.00 FISCAL YEAR CLOSEOUTS ($3,999,724.00) ($3,999,724.00) ASSETS NON-ADMITTED ($131,143.28) ($135,916.94) NET CHANGE IN EQUITY ($3,563,212.47) ($2,207,024.57) MEMBERS' EQUITY (DEFICIT)(CURRENT PERIOD) $17,605,216.92 $17,605,216.92
MEMBERS' ACCOUNT BY EXHIBIT 3A QUARTER Item DESCRIPTION 2012 2013 2014 2015 2016 2017 TOTAL INCOME RECEIVED: 1 PREMIUMS WRITTEN 37.74 (314.14) (735.00) (1,827.38) (128,784.00) 5,014,684.92 4,883,062.14 1A REINSURANCE CEDED 0.00 0.00 0.00 0.00 0.00 (351,450.00) (351,450.00) 2 INTEREST RECEIVED 0.00 0.00 0.00 0.00 0.00 14,842.36 14,842.36 2A MISC. INCOME RECEIVED 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 Total Inc. (Items 1 Thru 2A) 37.74 (314.14) (735.00) (1,827.38) (128,784.00) 4,678,077.28 4,546,454.50 EXPENSES PAID: 4 LOSSES (LESS SALVAGE) 0.00 0.00 4,500.00 54,097.40 1,572,249.51 542,236.48 2,173,083.39 5 LOSS ADJUST. EXPENSES 0.00 0.00 0.00 12,042.51 108,653.81 167,843.23 288,539.55 6 COMMISSION EXPENSE (22.88) 118.09 (1.76) (125.42) (25,909.31) 470,329.57 444,388.29 7 GENERAL OPERATING EXP.S 0.00 0.00 0.00 0.00 0.00 516,484.37 516,484.37 7A PREMIUM TAXES & FEES 0.00 0.00 0.00 0.00 0.00 663,196.00 663,196.00 8 Total Exp.s (Items 4 Thru 7A) (22.88) 118.09 4,498.24 66,014.49 1,654,994.01 2,360,089.65 4,085,691.60 9 Net Cash Chg (Item 3 Less 8) 60.62 (432.23) (5,233.24) (67,841.87) (1,783,778.01) 2,317,987.63 460,762.90 RESERVES: DEDUCT (CURRENT PERIOD) 10 UNPAID LOSSES (INCL. IBNR) 0.00 0.00 15.00 328,101.81 1,637,289.68 775,252.46 2,740,658.95 11 UNPAID LOSS ADJ. EXP.S 0.00 0.00 1.42 31,123.74 166,137.29 323,787.89 521,050.34 12 UNPAID GENERAL EXP.S 0.00 0.00 0.00 0.00 0.00 961,365.13 961,365.13 13 COMMISSIONS PAYABLE 3.68 (30.66) (71.74) (178.37) (12,570.73) 195,498.85 182,651.03 14 PREMIUM TAXES & FEES (5.80) 34.26 (24.44) (102.15) (13,649.10) 331,544.83 317,797.60 15 UNEARNED PREMIUM 0.00 0.00 0.00 0.00 2,371,216.00 7,436,779.00 9,807,995.00 ADD (PRIOR PERIOD) 16 UNPAID LOSSES (INCL. IBNR) 0.00 0.00 4,015.00 348,897.85 1,795,098.39 296,541.73 2,444,552.97 17 UNPAID LOSS ADJ. EXP.S 0.00 0.00 382.15 33,208.10 186,855.62 275,368.17 495,814.04 18 UNPAID GENERAL EXP. 0.00 0.00 0.00 0.00 0.00 989,758.66 989,758.66 19 COMMISSIONS PAYABLE (19.20) 121.73 0.00 (112.69) (25,505.84) 167,333.19 141,817.19 20 PREMIUM TAXES & FEES (7.05) 44.70 0.00 (41.39) 654,390.29 164,806.55 819,193.10 21 UNEARNED PREMIUM 0.00 0.00 0.00 0.00 5,487,452.00 4,259,822.00 9,747,274.00 22 Net Resrv Chg (Items 10-21) 24.13 (162.83) (4,476.91) (23,006.84) (3,949,867.32) 3,870,597.86 (106,891.91) OTHER CHANGES: DEDUCT (PRIOR PERIOD) 23 ACCRUED INTEREST 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23A MISC. INCOME RECV 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 ASSETS NOT ADMITTED (6,953.38) (1,014.86) (1,583.26) (2,883.06) (380,121.83) (10,257.52) (402,813.91) ADD (CURRENT PERIOD) 25 ACCRUED INTEREST 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25A MISC. INCOME RECV 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ASSETS NOT ADMITTED (6,953.38) (827.84) (904.69) (2,792.91) (379,246.01) (143,232.36) (533,957.19) 27 Net Chg (Items 23 Thru 26) 0.00 187.02 678.57 90.15 875.82 (132,974.84) (131,143.28) 28 ADD: ASSMNTS & EQUITY ADJ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28A FISCAL YEAR CLOSEOUTS (3,999,724.00) 0.00 0.00 0.00 0.00 0.00 (3,999,724.00) CHANGE IN EQUITY (3,999,687.51) (82.38) (77.76) (44,744.88) 2,166,965.13 (1,685,585.07) (3,563,212.47) (Items 9, 22, 27 AND 28) BEGINNING EQUITY (DEFICIT) 14,220,519.06 2,043,678.42 3,019,354.48 4,463,261.77 (11,742.31) (2,566,642.03) 21,168,429.39 ENDING EQUITY (DEFICIT) 10,220,831.55 2,043,596.04 3,019,276.72 4,418,516.89 2,155,222.82 (4,252,227.10) 17,605,216.92 ============================================================================= ============
MEMBERS' ACCOUNT BY EXHIBIT 3B YEAR TO DATE Item DESCRIPTION 2012 2013 2014 2015 2016 2017 TOTAL INCOME RECEIVED: 1 PREMIUMS WRITTEN (174.32) 1,030.36 (735.00) (3,072.10) (410,499.29) 9,971,273.00 9,557,822.65 1A REINSURANCE CEDED 0.00 0.00 0.00 0.00 (3,988.00) (699,950.00) (703,938.00) 2 INTEREST RECEIVED 0.00 0.00 0.00 0.00 0.00 25,138.71 25,138.71 2A MISC. INCOME RECEIVED 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 Total Inc. (Items 1 Thru 2A) (174.32) 1,030.36 (735.00) (3,072.10) (414,487.29) 9,296,461.71 8,879,023.36 EXPENSES PAID: 4 LOSSES (LESS SALVAGE) 0.00 0.00 34,500.00 276,584.13 3,366,344.20 555,494.70 4,232,923.03 5 LOSS ADJUST. EXPENSES 0.00 273.00 2,115.54 28,257.15 319,073.85 342,926.41 692,645.95 6 COMMISSION EXPENSE (18.43) 117.10 (11.26) (1,944.82) 421,887.73 492,195.88 912,226.20 7 GENERAL OPERATING EXP.S 0.00 0.00 0.00 0.00 0.00 1,024,967.20 1,024,967.20 7A PREMIUM TAXES & FEES 0.00 0.00 0.00 0.00 0.00 663,196.00 663,196.00 8 Total Exp.s (Items 4 Thru 7A) (18.43) 390.10 36,604.28 302,896.46 4,107,305.78 3,078,780.19 7,525,958.38 9 Net Cash Chg (Item 3 Less 8) (155.89) 640.26 (37,339.28) (305,968.56) (4,521,793.07) 6,217,681.52 1,353,064.98 RESERVES: DEDUCT (CURRENT PERIOD) 10 UNPAID LOSSES (INCL. IBNR) 0.00 0.00 15.00 328,101.81 1,637,289.68 775,252.46 2,740,658.95 11 UNPAID LOSS ADJ. EXP.S 0.00 0.00 1.42 31,123.74 166,137.29 323,787.89 521,050.34 12 UNPAID GENERAL EXP. 0.00 0.00 0.00 0.00 0.00 961,365.13 961,365.13 13 COMMISSIONS PAYABLE 3.68 (30.66) (71.74) (178.37) (12,570.73) 195,498.85 182,651.03 14 PREMIUM TAXES & FEES (5.80) 34.26 (24.44) (102.15) (13,649.10) 331,544.83 317,797.60 15 UNEARNED PREMIUM 0.00 0.00 0.00 0.00 2,371,216.00 7,436,779.00 9,807,995.00 ADD (PRIOR PERIOD) 16 UNPAID LOSSES (INCL. IBNR) 0.00 0.00 56,015.00 544,457.15 2,137,992.74 0.00 2,738,464.89 17 UNPAID LOSS ADJ. EXP.S 0.00 0.00 5,272.13 51,244.31 458,757.53 0.00 515,273.97 18 UNPAID GENERAL EXP. 0.00 0.00 0.00 0.00 942,896.76 0.00 942,896.76 19 COMMISSIONS PAYABLE 8.75 (11.86) (9.50) (1,829.79) 450,053.00 (302,448.10) 145,762.50 20 PREMIUM TAXES & FEES (7.88) (31.96) (101.39) (19,795.10) 683,693.65 0.00 663,757.32 21 UNEARNED PREMIUM 0.00 0.00 0.00 0.00 10,100,914.00 0.00 10,100,914.00 22 Net Resrv Chg (Items 10-21) (2.99) 47.42 (61,256.00) (215,131.54) (10,625,884.54) 10,326,676.26 (575,551.39) OTHER CHANGES: DEDUCT (PRIOR PERIOD) 23 ACCRUED INTEREST 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23A MISC. INCOME RECV 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 ASSETS NOT ADMITTED (6,953.38) (1,201.88) (2,261.83) (2,973.21) (384,649.95) 0.00 (398,040.25) ADD (CURRENT PERIOD) 25 ACCRUED INTEREST 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25A MISC. INCOME RECV 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ASSETS NOT ADMITTED (6,953.38) (827.84) (904.69) (2,792.91) (379,246.01) (143,232.36) (533,957.19) 27 Net Chg (Items 23 Thru 26) 0.00 374.04 1,357.14 180.30 5,403.94 (143,232.36) (135,916.94) 28 ADD: ASSMNTS & EQUITY ADJ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28A FISCAL YEAR CLOSEOUTS (3,999,724.00) 0.00 0.00 0.00 0.00 0.00 (3,999,724.00) CHANGE IN EQUITY (3,999,876.90) 966.88 25,273.86 (90,656.72) 6,109,495.41 (4,252,227.10) (2,207,024.57) (Items 9, 22, 27 AND 28) BEGINNING EQUITY (DEFICIT) 14,220,708.45 2,042,629.16 2,994,002.86 4,509,173.61 (3,954,272.59) 0.00 19,812,241.49 ENDING EQUITY (DEFICIT) 10,220,831.55 2,043,596.04 3,019,276.72 4,418,516.89 2,155,222.82 (4,252,227.10) 17,605,216.92 ============================================================================= ============
EXHIBIT 4A STATISTICAL REPORT OF PREMIUMS BY QUARTER PREMIUMS WRITTEN 1 FIRE $37.74 ($193.14) ($405.00) ($1,074.38) ($78,774.00) $3,269,876.81 $3,189,468.03 3.1 EXTENDED COVERAGE $0.00 ($83.00) ($330.00) ($753.00) ($43,928.00) $1,539,931.15 $1,494,837.15 3.2 LIABILITY $0.00 ($38.00) $0.00 $0.00 ($4,440.00) $158,560.50 $154,082.50 3.3 THEFT $0.00 $0.00 $0.00 $0.00 ($1,642.00) $46,316.46 $44,674.46 5 TOTAL $37.74 ($314.14) ($735.00) ($1,827.38) ($128,784.00) $5,014,684.92 $4,883,062.14 UNEARNED PREMIUM (PRIOR PERIOD) 6 FIRE $0.00 $0.00 $0.00 $0.00 $3,533,917.00 $2,766,777.92 $6,300,694.92 8.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $0.00 $1,719,018.00 $1,307,574.03 $3,026,592.03 8.2 LIABILITY $0.00 $0.00 $0.00 $0.00 $179,832.00 $145,436.74 $325,268.74 8.3 THEFT $0.00 $0.00 $0.00 $0.00 $54,685.00 $40,033.31 $94,718.31 10 TOTAL $0.00 $0.00 $0.00 $0.00 $5,487,452.00 $4,259,822.00 $9,747,274.00 UNEARNED PREMIUMS (CURRENT PERIOD) 11 FIRE $0.00 $0.00 $0.00 $0.00 $1,528,706.00 $4,839,305.81 $6,368,011.81 13.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $0.00 $740,538.00 $2,286,696.18 $3,027,234.18 13.2 LIABILITY $0.00 $0.00 $0.00 $0.00 $78,016.00 $242,204.24 $320,220.24 13.3 THEFT $0.00 $0.00 $0.00 $0.00 $23,956.00 $68,572.77 $92,528.77 15 TOTAL $0.00 $0.00 $0.00 $0.00 $2,371,216.00 $7,436,779.00 $9,807,995.00 EARNED PREMIUMS 16 FIRE (1+6-11) $37.74 ($193.14) ($405.00) ($1,074.38) $1,926,437.00 $1,197,348.92 $3,122,151.14 18.1 EXTENDED COVERAGE (3.1+8.1-13.1) $0.00 ($83.00) ($330.00) ($753.00) $934,552.00 $560,809.00 $1,494,195.00 18.2 LIABILITY (3.2+8.2-13.2) $0.00 ($38.00) $0.00 $0.00 $97,376.00 $61,793.00 $159,131.00 18.3 THEFT (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 $29,087.00 $17,777.00 $46,864.00 20 TOTAL (5+10-15) $37.74 ($314.14) ($735.00) ($1,827.38) $2,987,452.00 $1,837,727.92 $4,822,341.14
EXHIBIT 4B STATISTICAL REPORT OF PREMIUMS BY YEAR TO DATE PREMIUMS WRITTEN 1 FIRE ($146.32) $599.36 ($405.00) ($1,744.10) ($248,950.29) $6,488,408.81 $6,237,762.46 3.1 EXTENDED COVERAGE ($28.00) $431.00 ($330.00) ($1,252.00) ($136,223.00) $3,060,789.18 $2,923,387.18 3.2 LIABILITY $0.00 $0.00 $0.00 ($76.00) ($19,590.00) $328,352.24 $308,686.24 3.3 THEFT $0.00 $0.00 $0.00 $0.00 ($5,736.00) $93,722.77 $87,986.77 5 TOTAL ($174.32) $1,030.36 ($735.00) ($3,072.10) ($410,499.29) $9,971,273.00 $9,557,822.65 UNEARNED PREMIUM (PRIOR PERIOD) 6 FIRE $0.00 $0.00 $0.00 $0.00 $6,491,120.00 $0.00 $6,491,120.00 8.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $0.00 $3,170,570.00 $0.00 $3,170,570.00 8.2 LIABILITY $0.00 $0.00 $0.00 $0.00 $338,544.00 $0.00 $338,544.00 8.3 THEFT $0.00 $0.00 $0.00 $0.00 $100,680.00 $0.00 $100,680.00 10 TOTAL $0.00 $0.00 $0.00 $0.00 $10,100,914.00 $0.00 $10,100,914.00 UNEARNED PREMIUMS (CURRENT PERIOD) 11 FIRE $0.00 $0.00 $0.00 $0.00 $1,528,706.00 $4,839,305.81 $6,368,011.81 13.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $0.00 $740,538.00 $2,286,696.18 $3,027,234.18 13.2 LIABILITY $0.00 $0.00 $0.00 $0.00 $78,016.00 $242,204.24 $320,220.24 13.3 THEFT $0.00 $0.00 $0.00 $0.00 $23,956.00 $68,572.77 $92,528.77 15 TOTAL $0.00 $0.00 $0.00 $0.00 $2,371,216.00 $7,436,779.00 $9,807,995.00 EARNED PREMIUMS 16 FIRE (1+6-11) ($146.32) $599.36 ($405.00) ($1,744.10) $4,713,463.71 $1,649,103.00 $6,360,870.65 18.1 EXTENDED COVERAGE (3.1+8.1-13.1) ($28.00) $431.00 ($330.00) ($1,252.00) $2,293,809.00 $774,093.00 $3,066,723.00 18.2 LIABILITY (3.2+8.2-13.2) $0.00 $0.00 $0.00 ($76.00) $240,938.00 $86,148.00 $327,010.00 18.3 THEFT (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 $70,988.00 $25,150.00 $96,138.00 20 TOTAL (5+10-15) ($174.32) $1,030.36 ($735.00) ($3,072.10) $7,319,198.71 $2,534,494.00 $9,850,741.65
EXHIBIT 4C STATISTICAL REPORT OF LOSSES BY QUARTER PAID LOSSES (LESS SALVAGE) 1 FIRE $0.00 $0.00 $4,500.00 $51,854.97 $1,119,544.46 $372,983.76 $1,548,883.19 3.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $1,242.43 $396,228.90 $161,901.58 $559,372.91 3.2 LIABILITY $0.00 $0.00 $0.00 $1,000.00 $56,476.15 $7,351.14 $64,827.29 3.3 THEFT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5 TOTAL $0.00 $0.00 $4,500.00 $54,097.40 $1,572,249.51 $542,236.48 $2,173,083.39 OUTSTANDING LOSSES (CURRENT PERIOD) 6 FIRE $0.00 $0.00 $0.00 $156,971.62 $1,200,931.52 $527,350.95 $1,885,254.09 8.1 EXTENDED COVERAGE $0.00 $0.00 $15.00 $20,130.19 $266,630.11 $127,153.46 $413,928.76 8.2 LIABILITY $0.00 $0.00 $0.00 $151,000.00 $169,198.00 $120,218.00 $440,416.00 8.3 THEFT $0.00 $0.00 $0.00 $0.00 $530.05 $530.05 $1,060.10 10 TOTAL $0.00 $0.00 $15.00 $328,101.81 $1,637,289.68 $775,252.46 $2,740,658.95 OUTSTANDING LOSSES (PRIOR PERIOD) 11 FIRE $0.00 $0.00 $4,000.00 $216,425.08 $1,170,031.88 $203,571.97 $1,594,028.93 13.1 EXTENDED COVERAGE $0.00 $0.00 $15.00 $30,472.77 $351,969.03 $33,617.27 $416,074.07 13.2 LIABILITY $0.00 $0.00 $0.00 $102,000.00 $272,337.00 $59,099.00 $433,436.00 13.3 THEFT $0.00 $0.00 $0.00 $0.00 $760.48 $253.49 $1,013.97 15 TOTAL $0.00 $0.00 $4,015.00 $348,897.85 $1,795,098.39 $296,541.73 $2,148,011.24 INCURRED LOSSES 16 FIRE (1+6-11) $0.00 $0.00 $500.00 ($7,598.49) $1,150,444.10 $696,762.74 $1,840,108.35 18.1 EXTENDED COVERAGE (3.1+8.1-13.1) $0.00 $0.00 $0.00 ($9,100.15) $310,889.98 $255,437.77 $557,227.60 18.2 LIABILITY (3.2+8.2-13.2) $0.00 $0.00 $0.00 $50,000.00 ($46,662.85) $68,470.14 $71,807.29 18.3 THEFT (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 ($230.43) $276.56 $46.13 20 TOTAL (5+10-15) $0.00 $0.00 $500.00 $33,301.36 $1,414,440.80 $1,020,947.21 $2,469,189.37 IBNR (CURRENT PERIOD) 21 FIRE (INCL'D IN LINE 6) $0.00 $0.00 $0.00 $0.00 $35,488.63 $35,488.63 $70,977.26 23.1 EXTENDED COVERAGE (INCL'D IN LINE 8.1) $0.00 $0.00 $0.00 $0.00 $16,940.80 $16,940.80 $33,881.60 23.2 LIABILITY (INCL'D IN LINE 8.2) $0.00 $0.00 $0.00 $0.00 $118,198.00 $118,198.00 $236,396.00 23.3 THEFT (INCL'D IN LINE 8.3) $0.00 $0.00 $0.00 $0.00 $530.05 $530.05 $1,060.10 25 TOTAL (INCLUDED IN LINE 10) $0.00 $0.00 $0.00 $0.00 $171,157.48 $171,157.48 $342,314.96 IBNR (PRIOR PERIOD) 26 FIRE (INCL'D IN LINE 11) $0.00 $0.00 $0.00 $0.00 $50,027.92 $16,675.97 $66,703.89 28.1 EXTENDED COVERAGE (INCL'D IN LINE 13.1 $0.00 $0.00 $0.00 $0.00 $24,171.80 $8,057.27 $32,229.07 28.2 LIABILITY (INCL'D IN LINE 13.2) $0.00 $0.00 $0.00 $0.00 $177,297.00 $59,099.00 $236,396.00 28.3 THEFT (INCL'D IN LINE 13.3) $0.00 $0.00 $0.00 $0.00 $760.48 $253.49 $1,013.97 30 TOTAL (INCLUDED IN LINE 15) $0.00 $0.00 $0.00 $0.00 $252,257.20 $84,085.73 $336,342.93
EXHIBIT 4D STATISTICAL REPORT OF LOSSES BY YEAR TO DATE PAID LOSSES (LESS SALVAGE) 1 FIRE $0.00 $0.00 $4,500.00 $237,685.92 $2,238,237.92 $374,240.47 $2,854,664.31 3.1 EXTENDED COVERAGE $0.00 $0.00 $0.00 $37,898.21 $1,070,630.13 $173,903.09 $1,282,431.43 3.2 LIABILITY $0.00 $0.00 $30,000.00 $1,000.00 $57,476.15 $7,351.14 $95,827.29 3.3 THEFT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 5 TOTAL $0.00 $0.00 $34,500.00 $276,584.13 $3,366,344.20 $555,494.70 $4,232,923.03 OUTSTANDING LOSSES (CURRENT PERIOD) 6 FIRE $0.00 $0.00 $0.00 $156,971.62 $1,200,931.52 $527,350.95 $1,885,254.09 8.1 EXTENDED COVERAGE $0.00 $0.00 $15.00 $20,130.19 $266,630.11 $127,153.46 $413,928.76 8.2 LIABILITY $0.00 $0.00 $0.00 $151,000.00 $169,198.00 $120,218.00 $440,416.00 8.3 THEFT $0.00 $0.00 $0.00 $0.00 $530.05 $530.05 $1,060.10 10 TOTAL $0.00 $0.00 $15.00 $328,101.81 $1,637,289.68 $775,252.46 $2,740,658.95 OUTSTANDING LOSSES (PRIOR PERIOD) 11 FIRE $0.00 $0.00 $0.00 $370,712.57 $1,538,404.63 $0.00 $1,909,117.20 13.1 EXTENDED COVERAGE $0.00 $0.00 $15.00 $71,744.58 $269,921.94 $0.00 $341,681.52 13.2 LIABILITY $0.00 $0.00 $56,000.00 $102,000.00 $328,396.00 $0.00 $486,396.00 13.3 THEFT $0.00 $0.00 $0.00 $0.00 $1,270.17 $0.00 $1,270.17 15 TOTAL $0.00 $0.00 $56,015.00 $544,457.15 $2,137,992.74 $0.00 $2,738,464.89 INCURRED LOSSES 16 FIRE (1+6-11) $0.00 $0.00 $4,500.00 $23,944.97 $1,900,764.81 $901,591.42 $2,830,801.20 18.1 EXTENDED COVERAGE (3.1+8.1-13.1) $0.00 $0.00 $0.00 ($13,716.18) $1,067,338.30 $301,056.55 $1,354,678.67 18.2 LIABILITY (3.2+8.2-13.2) $0.00 $0.00 ($26,000.00) $50,000.00 ($101,721.85) $127,569.14 $49,847.29 18.3 THEFT (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 ($740.12) $530.05 ($210.07) 20 TOTAL (5+10-15) $0.00 $0.00 ($21,500.00) $60,228.79 $2,865,641.14 $1,330,747.16 $4,235,117.09 IBNR (CURRENT PERIOD) 21 FIRE (INCL'D IN LINE 6) $0.00 $0.00 $0.00 $0.00 $35,488.63 $35,488.63 $70,977.26 23.1 EXTENDED COVERAGE (INCL'D IN LINE 8.1) $0.00 $0.00 $0.00 $0.00 $16,940.80 $16,940.80 $33,881.60 23.2 LIABILITY (INCL'D IN LINE 8.2) $0.00 $0.00 $0.00 $0.00 $118,198.00 $118,198.00 $236,396.00 23.3 THEFT (INCL'D IN LINE 8.3) $0.00 $0.00 $0.00 $0.00 $530.05 $530.05 $1,060.10 25 TOTAL (INCLUDED IN LINE 10) $0.00 $0.00 $0.00 $0.00 $171,157.48 $171,157.48 $342,314.96 IBNR (PRIOR PERIOD) 26 FIRE (INCL'D IN LINE 11) $0.00 $0.00 $0.00 $0.00 $70,178.82 $0.00 $70,178.82 28.1 EXTENDED COVERAGE (INCL'D IN LINE 13.1 $0.00 $0.00 $0.00 $0.00 $34,226.20 $0.00 $34,226.20 28.2 LIABILITY (INCL'D IN LINE 13.2) $0.00 $0.00 $0.00 $0.00 $236,396.00 $0.00 $236,396.00 28.3 THEFT (INCL'D IN LINE 13.3) $0.00 $0.00 $0.00 $0.00 $1,070.17 $0.00 $1,070.17 30 TOTAL (INCLUDED IN LINE 15) $0.00 $0.00 $0.00 $0.00 $341,871.19 $0.00 $341,871.19
EXHIBIT 4E STATISTICAL REPORT OF LOSS ADJUSTMENT EXPENSES QUARTER LOSS EXPENSES PAID 1 FIRE: ALLOCATED $0.00 $0.00 $0.00 $8,639.69 $47,201.96 $101,957.81 $157,799.46 3.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $0.00 $1,550.32 $55,875.39 $59,488.50 $116,914.21 3.2 LIABILITY: ALLOCATED $0.00 $0.00 $0.00 $1,852.50 $5,258.55 $5,177.09 $12,288.14 3.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $317.91 $1,219.83 $1,537.74 5 TOTAL $0.00 $0.00 $0.00 $12,042.51 $108,653.81 $167,843.23 $288,539.55 UNPAID LOSS EXPENSES (CURRENT PERIOD) 6 FIRE: ALLOCATED $0.00 $0.00 $0.00 $14,890.33 $116,164.66 $207,428.85 $338,483.84 8.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $1.42 $1,909.55 $26,363.87 $87,200.07 $115,474.91 8.2 LIABILITY: ALLOCATED $0.00 $0.00 $0.00 $14,323.86 $23,524.96 $26,757.75 $64,606.57 8.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $83.80 $2,401.22 $2,485.02 10 TOTAL $0.00 $0.00 $1.42 $31,123.74 $166,137.29 $323,787.89 $521,050.34 UNPAID LOSS EXPENSES (PRIOR PERIOD) 11 FIRE: ALLOCATED $0.00 $0.00 $380.72 $20,599.34 $114,536.41 $176,462.38 $311,978.85 13.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $1.43 $2,900.40 $35,033.39 $79,098.52 $117,033.74 13.2 LIABILITY: ALLOCATED $0.00 $0.00 $0.00 $9,708.36 $37,165.21 $17,395.26 $64,268.83 13.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $120.61 $2,412.01 $2,532.62 15 TOTAL $0.00 $0.00 $382.15 $33,208.10 $186,855.62 $275,368.17 $495,814.04 INCURRED LOSS EXPENSES 16 FIRE: ALLOCATED (1+6-11) $0.00 $0.00 ($380.72) $2,930.68 $48,830.21 $132,924.28 $184,304.45 18.1 EXT.COVERG: ALLOC'D (3.1+8.1-13.1 $0.00 $0.00 ($0.01) $559.47 $47,205.87 $67,590.05 $115,355.38 18.2 LIABILITY: ALLOCATED (3.2+8.2-13.2) $0.00 $0.00 $0.00 $6,468.00 ($8,381.70) $14,539.58 $12,625.88 18.3 THEFT: ALLOCATED (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 $281.10 $1,209.04 $1,490.14 20 TOTAL (5+10-15) $0.00 $0.00 ($380.73) $9,958.15 $87,935.48 $216,262.95 $313,775.85
EXHIBIT 4F STATISTICAL REPORT OF LOSS ADJUSTMENT EXPENSES YEAR TO DATE LOSS EXPENSES PAID 1 FIRE: ALLOCATED $0.00 $273.00 $0.00 $13,537.85 $91,017.04 $225,780.56 $330,608.45 3.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $315.00 $9,872.80 $216,542.65 $104,845.43 $331,575.88 3.2 LIABILITY: ALLOCATED $0.00 $0.00 $1,800.54 $4,846.50 $10,881.25 $9,733.46 $27,261.75 3.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $632.91 $2,566.96 $3,199.87 5 TOTAL $0.00 $273.00 $2,115.54 $28,257.15 $319,073.85 $342,926.41 $692,645.95 UNPAID LOSS EXPENSES (CURRENT PERIOD) 6 FIRE: ALLOCATED $0.00 $0.00 $0.00 $14,890.33 $116,164.66 $207,428.85 $338,483.84 8.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $1.42 $1,909.55 $26,363.87 $87,200.07 $115,474.91 8.2 LIABILITY: ALLOCATED $0.00 $0.00 $0.00 $14,323.86 $23,524.96 $26,757.75 $64,606.57 8.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $83.80 $2,401.22 $2,485.02 10 TOTAL $0.00 $0.00 $1.42 $31,123.74 $166,137.29 $323,787.89 $521,050.34 UNPAID LOSS EXPENSES (PRIOR PERIOD) 11 FIRE: ALLOCATED $0.00 $0.00 $0.00 $34,891.47 $301,050.05 $0.00 $335,941.52 13.1 EXTENDED COVERAGE: ALLOC'D $0.00 $0.00 $1.41 $6,752.60 $101,610.80 $0.00 $108,364.81 13.2 LIABILITY: ALLOCATED $0.00 $0.00 $5,270.72 $9,600.24 $53,594.38 $0.00 $68,465.34 13.3 THEFT: ALLOCATED $0.00 $0.00 $0.00 $0.00 $2,502.30 $0.00 $2,502.30 15 TOTAL $0.00 $0.00 $5,272.13 $51,244.31 $458,757.53 $0.00 $515,273.97 INCURRED LOSS EXPENSES 16 FIRE: ALLOCATED (1+6-11) $0.00 $273.00 $0.00 ($6,463.29) ($93,868.35) $433,209.41 $333,150.77 18.1 EXT.COVERG: ALLOC'D (3.1+8.1-13.1 $0.00 $0.00 $315.01 $5,029.75 $141,295.72 $192,045.50 $338,685.98 18.2 LIABILITY: ALLOCATED (3.2+8.2-13.2 $0.00 $0.00 ($3,470.18) $9,570.12 ($19,188.17) $36,491.21 $23,402.98 18.3 THEFT: ALLOCATED (3.3+8.3-13.3) $0.00 $0.00 $0.00 $0.00 ($1,785.59) $4,968.18 $3,182.59 20 TOTAL (5+10-15) $0.00 $273.00 ($3,155.17) $8,136.58 $26,453.61 $666,714.30 $698,422.32