<PAGE>
Exhibit 99.3
QUARTERLY STATEMENT
AS OF June 30, 2000
OF THE CONDITION AND AFFAIRS OF THE
American Union Insurance Company
<TABLE>
--------------------------------------------------------------------------------------------------------------------
<S> <C> <C>
NAIC Group Code 0193 0193 NAIC Company Code 25828 Employer's ID Number
----------------, -------------- ------- -----------
(Current Period) (Prior Period)
Organized under the laws of the State of Illinois , using as the Port of Entry
-------------------------- ------------------
Incorporated 06/12/1916 Commenced Business 10/03/1916
--------------- -----------
Statutory Home Office 303 East Washington Street, Bloomington, IL 61701
----------------------------------------------------------------------------------------------
Main Administrative Office 303 East Washington Street
-----------------------------------------------------------------------------------------
Bloomington, IL 61701 (309) 829-1061
--------------------------------------------------------------------------------------------------------------------
Mail Address 303 East Washington Street, Bloomington, IL 61701
-------------------------------------------------------------------------------------------------------
Primary Location of Books and Records 303 East Washington Street
------------------------------------------------------------------------------
Bloomington, IL 61701 (309) 829-1061
--------------------------------------------------------------------------------------------------------------------
Quarterly Statement Contact James David Dickinson (309) 828-6543
----------------------------------------------------------------------------------------
E-Mail Address: n/a Fax Number: (309) 827-0303
------------------------------------------------------- -----------------------
</TABLE>
OFFICERS
President Gregory Mark Shepard
Secretary William Mark Dalton
Treasurer Tracy Morgan Shepard
Vice-Presidents
Tracy Morgan Shepard
Frederic Henry Backsmeier
William Mark Dalton
DIRECTORS OR TRUSTEES
Tracy Morgan Shepard
Patrick Francis Busch
Merrick Condit Hayes
Gregory Mark Shepard
Mark Allen Weaver
State of Illinois
-----------------
County of McLean ss
-----------------
The officers of this Company, being duly sworn, each depose and say that they
are the described officers of the said Insurer, and that on the reporting period
stated above, all of the herein described assets were the absolute property of
the said Insurer, free and clear from any liens or claims thereon, except as
herein stated, and that this Statement is a full and true statement of all the
assets and liabilities and of the condition and affairs of the said Insurer as
of the reporting period stated above, and of its income and deductions therefrom
for the period ended on that date, and have been completed in accordance with
the NAIC Quarterly Statement Instructions and accounting practices and
procedures manuals 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.
_______________________________________ ___________________________________
(Signature) (Signature)
_______________________________________ ___________________________________
(Printed Name) (Printed Name)
President Secretary
_______________________________________
(Signature)
_______________________________________
(Printed Name)
Treasurer
Subscribed and sworn to before me this
_____day of __________________, 2000
_______________________________
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
ASSETS
<TABLE>
<CAPTION>
====================================================================================================================================
Current Statement Date
------------------------------------------------------------------
1 2 3 4 5
December 31,
Non-Ledger Assets Not Net Admitted Assets Prior Year Net
Ledger Assets Assets Admitted (Columns 1 + 2 - 3) Admitted Assets
----------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
1 . Bonds (less $____________liability for asset
transfers with put options).................. 1,608,369 1,608,369 3,210,390
2 . Stocks:
2.1 Preferred stocks........................
2.2 Common stocks........................... 81,819,518 4,885,806 73,362,503 13,342,821 17,318,520
3 . Mortgage loans on real estate
3.1 First liens.............................
3.2 Other than first liens..................
4 . Real estate:
4.1 Properties occupied by the company
(less $_________ encumbrances)..........
4.2 Other properties (less $__________
encumbrances)...........................
5 . Cash ($________ 5,455 and short-term
investments $___________11,529).............. 16,984 16,984 1,056,991
6 . Other invested assets........................ 20,979,099 4,040,011 16,939,088 16,939,089
7 . Receivable for securities.................... 57,317
8 . Aggregate write-ins for invested assets......
----------------------------------------------------------------------------------
9 . Subtotals, cash and invested assets (Lines 1
to 8)........................................ 104,423,970 4,885,806 77,402,514 31,907,262 38,582,307
10 . Agents' balances or uncollected premiums
(net as to commissions and dividends):
10.1 Premiums and agents' balances in course
of collection (after deducting ceded
reinsurance balances payable of
$_______ ).............................. 14,478 14,478 14,478
10.2 Premiums, agents' balances and
installments booked but deferred and
not yet due (after deducting ceded
reinsurance balances payable of
$________) (including $________ earned but
unbilled premiums).......................
10.3 Accrued retrospective premiums (after
deducting ceded reinsurance balances
payable of $_________)...................
11 . Funds held by or deposited with reinsured
companies....................................
12 . Bills receivable, taken for premiums.........
13 . Reinsurance recoverables on loss and loss
adjustment expense payments..................
14 . Federal income tax recoverable and interest
thereon...................................... 68,625 68,625
14A.Guaranty funds receivable or on deposit......
15 . Electronic data processing equipment......... 210,860 210,860 268,062
16 . Interest, dividends and real estate income
due and accrued.............................. 7,833 7,833 35,333
17 . Receivable from parent, subsidiaries and
affiliates...................................
18 . Equities and deposits in pools and
associations.................................
19 . Amounts receivable relating to uninsured
accident and health plans....................
20 . Other assets nonadmitted.....................
21 . Aggregate write-ins for other than invested..
assets.......................................
---------------------------------------------------------------------------------
22 . TOTALS (Lines 9 through 21).................. 104,649,308 4,962,264 77,402,514 32,209,058 38,900,180
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
0801.............................................
0802.............................................
0803.............................................
0898. Summary of remaining write-ins for Line 8..
from overflow page.........................
----------------------------------------------------------------------------------
0899. TOTALS (Lines 0801 Through 0803 Plus
0898) (Line 8 Above).......................
------------------------------------------------------------------------------------------------------------------------------------
2101.............................................
2102.............................................
2103.............................................
2198. Summary of remaining write-ins for Line
21 from overflow page......................
----------------------------------------------------------------------------------
2199 TOTALS (Lines 2101 Through 2103 Plus 2198)
(Line 21 Above)............................
====================================================================================================================================
</TABLE>
State Manner of Presentation of Amounts:
2
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
LIABILITIES, SURPLUS AND OTHER FUNDS
<TABLE>
<CAPTION>
====================================================================================================================================
1 2
Current December 31,
Statement Date Prior Year
----------------------------------
<S> <C> <C>
1. Losses (current accident year $______________________ 36,500).......................... 143,023 260,249
1A. Reinsurance payable on paid losses and loss adjustment expenses........................
2. Loss adjustment expenses............................................................... 50,144 50,144
3. Contingent commissions and other similar charges....................................... 125 86,205
4. Other expenses (excluding taxes, licenses and fees).................................... 38,537 38,537
5. Taxes, licenses and fees (excluding federal and foreign income taxes).................. (185,350) (151,534)
6. Federal and foreign income taxes (excluding deferred taxes)............................ 208,293
7. Borrowed money......................................................................... 10,000,000 11,600,000
8. Interest, including $____________on borrowed money..................................... 183,958
9. Unearned premiums (after deducting ceded reinsurance unearned premiums of $_________).. 106,358 148,633
10. Dividends declared and unpaid:
A. Stockholders........................................................................
B. Policyholders.......................................................................
11. Funds held by company under reinsurance treaties.......................................
12. Amounts withheld or retained by company for account of others.......................... 25,925 26,479
13. Remittances and items not allocated....................................................
14. Provision for reinsurance..............................................................
15. Excess of statutory reserves over statement reserves................................... 130,000 130,000
16. Net adjustments in assets and liabilities due to foreign exchange rates................
17. Drafts outstanding.....................................................................
18. Payable to parent, subsidiaries and affiliates......................................... 177,588 354,236
19. Payable for securities.................................................................
20. Liability for amounts held under uninsured accident and health plans...................
21. Capital notes $_________ and interest thereon $___________.............................
22. Aggregate write-ins for liabilities....................................................
----------------------------------
23. TOTAL Liabilities (Lines 1 through 22)................................................. 10,486,350 12,935,200
----------------------------------
24. Aggregate write-ins for special surplus funds..........................................
25A. Common capital stock................................................................... 5,100,000 5,100,000
25B. Preferred capital stock................................................................
25C. Aggregate write-ins for other than special surplus funds...............................
26A. Surplus notes..........................................................................
26B. Gross paid in and contributed surplus.................................................. 23,999,277 23,999,277
26C. Unassigned funds (surplus)............................................................. (7,376,569) (3,134,297)
26D. Less treasury stock, at cost:
(1) _______________ shares common (value included in Line 25A $_____________)...........
(2) _______________ shares preferred (value included in Line 25B $__________)...........
----------------------------------
27. Surplus as regards policyholders (Lines 24 to 26C, less 26D)............................ 21,722,708 25,964,980
----------------------------------
28. TOTALS............................................................................... 32,209,058 38,900,180
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
2201.........................................................................................
2202.........................................................................................
2203.........................................................................................
2298. Summary of remaining write-ins for Line 22 from overflow page.........................
----------------------------------
2299. TOTALS (Lines 2201 Through 2203 Plus 2298) (Line 22 Above)............................
------------------------------------------------------------------------------------------------------------------------------------
2401.........................................................................................
2402.........................................................................................
2403.........................................................................................
2498. Summary of remaining write-ins for Line 24 from overflow page..........................
----------------------------------
2499. TOTALS (Lines 2401 Through 2403 Plus 2498) (Line 24 Above).............................
------------------------------------------------------------------------------------------------------------------------------------
25C01.........................................................................................
25C02.........................................................................................
25C03.........................................................................................
25C98. Summary of remaining write-ins for Line 25C from overflow page.........................
----------------------------------
25C99. TOTALS (Lines 25C0l Through 25C03 Plus 25C98) (Line 25C Above).........................
====================================================================================================================================
</TABLE>
3
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
STATEMENT OF INCOME
<TABLE>
<CAPTION>
====================================================================================================================================
1 2 3
Prior
Current Prior Year Ended
Year to Date Year to Date December 31
-----------------------------------------------
<S> <C> <C> <C>
UNDERWRITING INCOME
1. Premiums earned:
A. Direct (written $____________ 253,395)................................... 295,670 3,512,546 5,508,372
B. Assumed (written $___________)...........................................
C. Ceded (written $_____________)...........................................
D. Net (written $______________253,395.).................................... 295,670 3,512,546 5,508,372
DEDUCTIONS:
2. Losses incurred (current accident year $ _________ 155,169).:...............
A. Direct................................................................... 162,546 2,068,515 3,419,450
B. Assumed..................................................................
C. Ceded....................................................................
D. Net...................................................................... 162,546 2,068,515 3,419,450
3. Loss expenses incurred...................................................... 32,000 360,300 523,737
4. Other underwriting expenses incurred........................................ 343,019 1,600,969 3,174,511
5. Aggregate write-ins for underwriting deductions.............................
-----------------------------------------------
6. TOTAL underwriting deductions (Lines 2D through 5)....................... 537,565 4,026,784 7,117,698
-----------------------------------------------
7. Net underwriting gain or (loss) (Line 1D minus Line 6)...................... (241,895) (514,238) (1,609,326)
INVESTMENT INCOME
8. Net investment income earned................................................ 2,156,346 1,969,980 4,180,713
9. Net realized capital gains or (losses)...................................... 11,920,015 20,805,348
-----------------------------------------------
9A. Net investment gain or (loss)(Lines 8 + 9).................................. 2,156,346 13,889,995 24,986,061
OTHER INCOME
10. Net gain or (loss) from agents' or premium balances charged off
(amount recovered $_______________ amount charged off $____________)........
11. Finance and service charges not included in premiums
12. Aggregate write-ins for miscellaneous income................................ 686,395 2,145,312
-----------------------------------------------
13. TOTAL other income (Lines 10 through 12)................................. 686,395 2,145,312
-----------------------------------------------
14. Net income before dividends to policyholders and before federal.............
and foreign income taxes (Lines 7 + 9A + 13)................................ 1,914,451 14,062,152 25,522,047
14A. Dividends to policyholders..................................................
-----------------------------------------------
14B. Net income, after dividends to policyholders but before federal
and foreign income taxes (Line 14 minus Line 14A)........................... 1,914,451 14,062,152 25,522,047
15. Federal and foreign income taxes incurred................................... 326,591 2,879,861 6,473,063
-----------------------------------------------
16. Net income (Line 14B minus Line 15) (to Line 18)............................ 1,587,860 11,182,291 19,048,984
CAPITAL AND SURPLUS ACCOUNT
17. Surplus as regards policyholders, December 31 prior year.................... 25,964,982 10,667,425 10,667,425
GAINS AND (LOSSES) IN SURPLUS
18. Net income (from Line 16)................................................... 1,587,860 11,182,291 19,048,984
19. Net unrealized capital gains or losses...................................... (19,611,920) (35,065,756) (4,206,456)
20. Change in nonadmitted assets................................................ 13,781,788 29,579,740 731,123
21. Change in provision for reinsurance.........................................
22. Change in foreign exchange adjustment.......................................
23. Change in excess of statutory reserves over statement reserves.............. (51,000)
23A. Change in surplus notes.....................................................
24. Capital changes:
A. Paid in..................................................................
B. Transferred from surplus (Stock Dividend)................................
C. Transferred to surplus................................................... (5,100,000) (5,100,000)
25. Surplus adjustments:
A. Paid in..................................................................
B. Transferred to capital (Stock Dividend)..................................
C. Transferred from capital................................................. 5,100,000 5,100,000
26. Net remittances from or (to) Home Office....................................
27. Dividends to stockholders (cash)............................................
28. Change in treasury stock....................................................
29. Extraordinary amounts of taxes for prior years..............................
30. Aggregate write-ins for gains and losses in surplus......................... (225,094) (225,094)
-----------------------------------------------
31. Change in surplus as regards policyholders (Lines 18 through 3Q)............ (4,242,272) 5,471,181 15,297,557
-----------------------------------------------
32. Surplus as regards policyholders, as of statement date (Lines 17 plus 31)... 21,722,708 16,138,606 25,964,982
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
0501...............................................................................
0502...............................................................................
0503...............................................................................
0598. Summary of remaining write-ins for Line 5 from overflow page.................
-----------------------------------------------
0599. TOTALS (Lines 0501 Through 0503 Plus 0598) (Line 5 Above)....................
------------------------------------------------------------------------------------------------------------------------------------
1201. Non-Property & Casualty Activity............................................. 686,395 2,145,312
1202...............................................................................
1203...............................................................................
1298. Summary of remaining write-ins for Line 12 from overflow page................
-----------------------------------------------
1299. TOTALS (Lines 1201 Through 1203 Plus 1298) (Line 12 Above)................... 686,395 2,145,312
------------------------------------------------------------------------------------------------------------------------------------
3001. Merger Adjustment............................................................ (225,094) (225,094)
3002. .............................................................................
3003. .............................................................................
3098. Summary of remaining write-ins for Line 30 from overflow page................
-----------------------------------------------
3099. TOTALS (Lines 3001 Through 3003 Plus 3098) (Line 30 Above)................... (225,094) (225,094)
====================================================================================================================================
</TABLE>
4
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
CASH FLOW
<TABLE>
<CAPTION>
===================================================================================================================================
1 2
Prior Year
Current Ended
Year to Date December 31
------------ -------------
<S> <C> <C>
Cash from Operations
1. Premiums collected net of reinsurance .......................................................... 253,395 4,711,523
2. Loss and loss adjustment expenses paid (net of salvage and subrogation)......................... 311,771 4,984,001
3. Underwriting expenses paid ..................................................................... 463,042 3,460,184
4. Other underwriting income (expenses)............................................................
----------- -------------
5. Cash from underwriting (Line 1 minus Line 2 minus Line 3 plus Line 4) .......................... (521,418) (3,732,662)
6. Net investment income .......................................................................... 2,001,908 4,378,462
7. Other income (expenses):
7.1 Agents' balances charged off ..............................................................
7.2 Net funds held under reinsurance treaties..................................................
7.3 Net amount withheld or retained for account of others...................................... (554) (2,479)
7.4 Aggregate write-ins for miscellaneous items................................................ (317,095)
----------- -------------
7.5 TOTAL other income (Lines 7.1 through 7.4)................................................. (554) (319,574)
8. Dividends to policyholders on direct business, less $__________ dividends on reinsurance
assumed or ceded (net)..........................................................................
9. Federal and foreign income taxes (paid) recovered............................................... 603,509 (7,448,413)
----------- -------------
10. Net cash from operations (Line 5 plus Line 6 plus Line 7.5 minus Line 8 plus Line 9)............ 876,427 (7,122,187)
----------- -------------
Cash from Investments
11. Proceeds from investments sold, matured or repaid:
11.1 Bonds .................................................................................... 1,600,000
11.2 Stocks.................................................................................... 24,081,289
11.3 Mortgage loans............................................................................
11.4 Real estate...............................................................................
11.5 Other invested assets.....................................................................
11.6 Net gains or (losses) on cash and short-term investments.................................. 1,265
11.7 Miscellaneous proceeds....................................................................
----------- -------------
11.8 TOTAL investment proceeds (Lines 11.1 through 11.7)....................................... 1,600,000 24,082,554
12. Cost of investments acquired (long-term only):
12.1 Bonds.....................................................................................
12.2 Stocks.................................................................................... 4,957,644
12.3 Mortgage loans............................................................................
12.4 Real estate...............................................................................
12.5 Other invested assets..................................................................... 1,869,112 19,109,987
12.6 Miscellaneous applications................................................................
----------- -------------
12.7 TOTAL investments acquired (Lines 12.1 through 12.6)....................................... 1,869,112 24,067,631
----------- -------------
13. Net cash from investments (Line 11.8 minus Line 12.7)........................................... (269,112) 14,923
----------- -------------
Cash from Financing and Miscellaneous Sources
14. Cash provided:
14.1 Surplus notes, capital and surplus paid in................................................
14.2 Capital notes $_________ less amounts repaid $___________.................................
14.3 Net transfers from affiliates.............................................................
14.4 Borrowed funds received................................................................... 11,600,000
14.5 Other cash provided....................................................................... 114,645
----------- -------------
14.6 TOTAL (Lines 14.1 through 14.5) .......................................................... 114,645 11,600,000
15. Cash applied:
15.1 Dividends to stockholders paid ...........................................................
15.2 Net transfers to affiliates .............................................................. 161,968 3,222,213
15.3 Borrowed funds repaid .................................................................... 1,600,000
15.4 Other applications........................................................................ 397,267
----------- -------------
15.5 TOTAL (Lines 15.1 through 15.4)........................................................... 1,761,968 3,619,480
----------- -------------
16. Net cash from financing and miscellaneous sources (Line 14.6 minus Line 15.5)................... (1,647,323) 7,980,520
----------- -------------
RECONCILIATION OF CASH
AND SHORT-TERM INVESTMENTS
17. Net change in cash and short-term investments (Line 10 plus Line 13 plus Line 16)............... (1,040,008) 873,256
18. Cash and short-term investments:
18.1 Beginning of year......................................................................... 1,056,992 183,736
----------- -------------
18.2 End of period (Line 17 plus Line 18.1).................................................... 16,984 1,056,992
===================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
07.401 Finance Charges, Non-Property & Casualty Items................................................ (1,315)
07.402 Commissions or Reinsurance Ceded and Administrative Fees...................................... 2,029,438
07.403 Surrender Benefits............................................................................ (2,345,218)
07.498 Summary of remaining write-ins for Line 7.4 from overflow page................................
----------- -------------
07.499 TOTALS (Lines 07.401 Through 07.403 Plus 07.498) (Line 7.4 Above)............................. (317,095)
===================================================================================================================================
</TABLE>
5
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
RECONCILIATION OF LEDGER ASSETS
<TABLE>
<CAPTION>
==================================================================================================================================
1 2
Prior Year
Current Ended
Year to Date December 31
----------- -----------
<S> <C> <C>
INCREASE IN LEDGER ASSETS
1. Net premiums written (Direct$_________ 253,395 Reinsurance assumed $_______ Reinsurance ceded
$_____________)................................................................................ 253,395 4,792,658
2. Interest, dividends and real estate income received............................................ 2,642,155 4,711,625
3. From sale or maturity of ledger assets ........................................................ 20,830,204
4. Other income items or increases, viz.:
A. Agents' balances previously charged off....................................................
B. Remittances from home office to U.S. branch (gross)........................................
C. Funds held under reinsurance treaties (net)................................................
D. Borrowed money (gross).....................................................................
E. Amounts withheld or retained for account of others (net)...................................
F. Aggregate write-ins for increases in ledger assets......................................... 10,006,380
5. Adjustment in book value of ledger assets......................................................
6. Capital paid in................................................................................
7. Surplus paid in................................................................................
7A. Surplus notes..................................................................................
----------- -----------
8. TOTAL (Lines 1 to 7A) ............................................................. 2,895,550 40,340,867
DECREASE IN LEDGER ASSETS
9. Net losses paid (current accident year $_______ 118,669)....................................... 279,771 4,475,408
10. Expenses paid.................................................................................. 504,309 4,119,189
1OA. Interest expense............................................................................... 633,000 380,500
11. From sale or maturity of ledger assets......................................................... 24,856
11A. Surplus notes..................................................................................
12. Other disbursement items or decreases, viz.:
A. Agents' balances charged off................................................................
B. Remittances to home office from U.S. branch (gross).........................................
C. Funds held under reinsurance treaties (net).................................................
D. Borrowed money (gross)......................................................................
E. Amounts withheld or retained for account of others (net).................................... 2,479
F. Aggregate write-ins for decreases in ledger assets.......................................... 1,777,079 2,571,629
13. Adjustment in book value of ledger assets and depreciation.....................................
14. Federal and foreign income taxes paid.......................................................... 603,509 7,448,413
15. Dividends paid stockholders....................................................................
16. Dividends to policyholders on direct business, less $__________ dividends on reinsurance
assumed or ceded (net).........................................................................
----------- -----------
17. TOTAL (Lines 9 to 16).............................................................. 3,797,669 19,022,474
RECONCILIATION
18. Amount of ledger assets as per balance December 31 of prior year............................... 105,551,426 84,233,033
----------- -----------
19. Increase or (decrease) in ledger assets (Line 8 minus Line 17)................................. (902,118) 21,318,393
----------- -----------
20. Balance = ledger assets as of statement date.........................................104,649,308 105,551,426
==================================================================================================================================
DETAILS OF WRITE-INS
----------------------------------------------------------------------------------------------------------------------------------
04F01. Increase in Ledger Liabilities & Interest Payable............................................ 7,976,942
04F02. Commission on Insurance Ceded adn Administrative Fees from Illinois HealthCare Ins. Co....... 2,029,438
04F03...............................................................................................
04F98. Summary of remaining write-ins for Line 4F from overflow page................................
----------- -----------
04F99. TOTALS (Lines 04F0l Through 04F03 Plus 04F98) (Line 4F Above)................................ 10,006,380
----------------------------------------------------------------------------------------------------------------------------------
12F01. Surrender Benefits & Refunds................................................................. 2,346,535
12F02. Merger Adjustment............................................................................ 225,094
12F03. Decrease in Ledger Liabilities............................................................... 1,777,079
12F98. Summary of remaining write-ins for Line 12F from overflow page ............................
----------- -----------
12F99. TOTALS (Lines 12F0l Through 12F03 Plus 12F98) (Line 12F Above) ............................ 1,777,079 2,571,629
==================================================================================================================================
</TABLE>
6
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
7 Schedule A Part 2.......................... NONE
Schedule A Part 3.......................... NONE
Schedule A Verification.................... NONE
8 Schedule B Part 1.......................... NONE
Schedule B Part 2.......................... NONE
Schedule B Verification.................... NONE
7,8
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
SCHEDULE BA - PART I
Showing Other Long-Term Invested Assets Acquired during the Current Quarter
<TABLE>
<CAPTION>
===================================================================================================================================
1 Location 4 5
-----------------------------
2 3
Number of Units Year
and Description City State Name of Vendor Acquired
-----------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
Any Other Class of Admitted Assets
Loan to Gregory M. Shepard.................................... Bloomington, IL XXX
Subtotal - Any Other Class of Admitted Assets
1499999.......................................................
-----------------------------------------------------------------------------------------------------------------------------------
Aggregate Valuation Allowance
9999998.......................................................
-----------------------------------------------------------------------------------------------------------------------------------
Totals
9999999.......................................................
====================================================================================================================================
<CAPTION>
====================================================================================================================================
1 6 7 8 9 10
Increase
(Decrease)
by Adjustment
Book Value in Book Value
Number of Units Actual Amount of Less During Current Statement
and Description Cost Encumbrances Encumbrances Quarter Value
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
Any Other Class of Admitted Assets
Loan to Gregory M. Shepard.................................... 802,220 802,220 802,220
Subtotal - Any Other Class of Admitted Assets
1499999....................................................... 802,220 802,220 802,220
------------------------------------------------------------------------------------------------------------------------------------
Aggregate Valuation Allowance
9999998.......................................................
------------------------------------------------------------------------------------------------------------------------------------
Totals
9999999....................................................... 802,220 802,220 802,220
====================================================================================================================================
</TABLE>
SCHEDULE BA - PART 2
Showing Other Long-Term Invested Assets SOLD, Transferred or Paid in Full during
the Current Quarter
<TABLE>
<CAPTION>
===================================================================================================================================
1 Location 4 5
------------------------------
2 3
Name of Purchaser
Number of Units or Year
and Description City State Nature of Disposition Acquired
-----------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
NONE
-----------------------------------------------------------------------------------------------------------------------------------
Totals
9999999.......................................................
====================================================================================================================================
<CAPTION>
====================================================================================================================================
1 6 7 8 9 10
Increase
Book Value Less (Decrease) by
Encumbrances, Adjustment in Book Value
Prior Year Book Value Less
Number of Units End During Current Encumbrances Consideration Profit (Loss)
and Description Quarter at Disposition Received on Sale
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C>
------------------------------------------------------------------------------------------------------------------------------------
Totals
9999999.......................................................
====================================================================================================================================
</TABLE>
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
SCHEDULE BA - VERIFICATION
Other Invested Assets Included in Schedule BA
<TABLE>
<CAPTION>
==============================================================================================================================
Description 1 2 3
First Quarter Second Quarter Third Quarter
Current Year Current Year Current Year
------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C>
1. Book Value of Long-Term Invested Assets, December 31 of Prior Year..... 19,109,987 20,176,879
2. Cost of Acquisitions Beginning of Period:
2.1 Actual Cost at Time of Acquisition................................
2.2 Additional Investment Made After Acquisition...................... 1,066,892 802,220
3. Accrual of Discount....................................................
4. Increase by Adjustment.................................................
5. Profit on Sale.........................................................
---------------------------------------------------
6. TOTAL (Lines 1 Through 5).............................................. 20,176,879 20,949,099
7. Amounts Paid on Account or In Full During Year.........................
8. Amortization of Premium................................................
9. Decrease in Book Value or by Adjustment................................
10. Loss on Sale...........................................................
11. Book Value of Long-Term Invested Assets at End of Current Period....... 20,176,879 20,979,099
==============================================================================================================================
<CAPTION>
==============================================================================================================================
4
Prior Year Ended
December 31
------------------------------------------------------------------------------------------------------------------------------
<S> <C>
1. Book Value of Long-Term Invested Assets, December 31 of Prior Year.....
2. Cost of Acquisitions Beginning of Period:
2.1 Actual Cost at Time of Acquisition................................ 16,939,089
2.2 Additional Investment Made After Acquisition...................... 2,170,898
3. Accrual of Discount....................................................
4. Increase by Adjustment.................................................
5. Profit on Sale.........................................................
----------------------------------------------------
6. TOTAL (Lines 1 Through 5).............................................. 19,109,987
7. Amounts Paid on Account or In Full During Year.........................
8. Amortization of Premium................................................
9. Decrease in Book Value or by Adjustment................................
10. Loss on Sale...........................................................
11. Book Value of Long-Term Invested Assets at End of Current Period....... 19,109,987
===============================================================================================================================
</TABLE>
9.1
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union 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 Rating Class
<TABLE>
<CAPTION>
===========================================================================================================================
1 2 3 4
Statement Value Non-Trading
Beginning Acquisition During Dispositions During Activity During
Current Quarter Current Quarter Current Quarter Current Quarter
---------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
BONDS
1. Class 1...................... 1,608,369
2. Class 2......................
3. Class 3......................
4. Class 4......................
5. Class 5......................
6. Class 6......................
---------------------------------------------------------------------------------------------
7. TOTAL Bonds.................. 1,608,369
-----------------------------------------------------------------------------------------------------------------------------------
PREFERRED STOCK
8. Class 1.......................
9. Class 2.......................
10. Class 3.......................
11. Class 4.......................
12. Class 5.......................
13. Class 6.......................
---------------------------------------------------------------------------------------------
14. TOTAL Preferred Stock.........
---------------------------------------------------------------------------------------------
15. TOTAL Bonds & Preferred Stock 1,608,369
===================================================================================================================================
<CAPTION>
===================================================================================================================================
5 6 7 8
Statement Value Statement Value Statement Value Statement Value
End of End of End of December 31
First Quarter Second Quarter Third Quarter Prior Year
-----------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
BONDS
1. Class 1....................... 1,608,369 1,608,369 3,210,390
2. Class 2.......................
3. Class 3.......................
4. Class 4.......................
5. Class 5.......................
6. Class 6.......................
------------------------------------------------------------------------------------------
7. TOTAL Bonds................... 1,608,369 1,608,369 3,210,390
-----------------------------------------------------------------------------------------------------------------------------------
PREFERRED STOCK
8. Class 1.......................
9. Class 2.......................
10. Class 3.......................
11. Class 4.......................
12. Class 5.......................
13. Class 6.......................
------------------------------------------------------------------------------------------
14. TOTAL Preferred Stock.........
------------------------------------------------------------------------------------------
15. TOTAL Bonds & Preferred Stock 1,608,369 1,608,369 3,210,390
===================================================================================================================================
</TABLE>
10
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
11 Schedule D Part 3................. NONE
12 Schedule D Part 4................. NONE
11,12
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
SCHEDULE DA - PART 1
Short-Term Investments Owned End of Current Quarter
<TABLE>
<CAPTION>
===================================================================================================================================
1 2 3 4 5 6
Amount of
Interest Paid for
Book Par Statement Cost to Received Accrued
Value Value Value Company Current Quarter Interest
------------- ------------ -------------- ------------ ------------------- ------------
<S> <C> <C> <C> <C> <C> <C>
8099999.TOTALS ................. 11,529 XXX 11,529 11,529 3,205
===================================================================================================================================
</TABLE>
SCHEDULE DA - PART 2 - Verification
Short-Term Investments Owned
<TABLE>
<CAPTION>
===================================================================================================================================
1 2 3 4
Prior Year
First Quarter Second Quarter Third Quarter Ended
Current Year Current Year Current Year December 31
------------------------------------------------------------------
<S> <C> <C> <C> <C>
1. Book Value of Short-Term Investments, Beginning of Period..... 1,028,755 2,170,585 710,148
2. Cost of Short-Term Investments Acquired....................... 1,141,830 6,448,550
3. Increase by Adjustment in Book Value.......................... 28,430
4. Profit on Disposal of Short-Term Investments.................. 1,265
------------------------------------------------------------------
5. Subtotals (Sum of Lines 2 Through 4).......................... 1,141,830
6. Consideration Received on Disposal of Short-Term
Investments............................................... 2,159,056 6,159,638
7. Decrease by Adjustment in Book Value..........................
8. Loss on Disposal of Short-Term Investments....................
------------------------------------------------------------------
9. Subtotals (Sum of Lines 6 Through 8) ......................... 2,159,056 6,159,638
10. Book Value of Short-Term Investments, End of Period.......... 2,170,585 11,529 1,028,755
11. Income Collected............................................. 7,631 3,205 80,152
=================================================================================================================================
</TABLE>
13
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE Americann Union Insurance Company
14 Schedule DB Part A Section 1.................... NONE
Schedule DB Part B Section 1.................... NONE
15 Schedule DB Part C Section 1.................... NONE
Schedule DB Part D Section 1.................... NONE
16 Schedule DB Part F Section 1.................... NONE
Schedule DB Part F Section 2.................... NONE
14,15,16
<PAGE>
Statement as of June 30, 2000 of the American Union Insurance Company
SCHEDULE E - PART 1 - CASH
Month End Depository Balances
<TABLE>
<CAPTION>
===============================================================================================================================
1 2 3 4
Amount Amount of
of Interest Interest
Received Accrued at
During Current
Rate of Current Statement
Depository Interest Quarter Date
-------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C>
Open Depositories
Commerce Bank............................... Bloomington Illinois
0199998 Deposits in depositories * $100,000. XXX
Totals - Open Depositories
0199999..................................... XXX
-------------------------------------------------------------------------------------------------------------------------------
Total Cash On Deposit
0399999.....................................
-------------------------------------------------------------------------------------------------------------------------------
Cash In Company's Office
0499999..................................... xxx xxx
-------------------------------------------------------------------------------------------------------------------------------
Total
0599999.....................................
<CAPTION>
=============================================
Book Balance at End of Each
Month During Current Quarter
---------------------------------------------
5 6 7
Second
First Month Month Third Month
---------------------------------------------
<S> <C> <C>
(156,376) (163,527) 5,455
---------------------------------------------
(156,376) (163,527) 5,455
---------------------------------------------
(156,376) (163,527) 5,455
---------------------------------------------
---------------------------------------------
(156,376) (163,527) 5,455
---------------------------------------------
</TABLE>
===============================================================================
* =less than
17
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
18 Schedule F ...................................... NONE
18
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
SCHEDULE Y - INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING
COMPANY GROUP
All insurer members of a Holding Company Group that has acquired and/or disposed
of any domestic insurer(s) since filing the last annual or quarterly statement
shall prepare a common schedule for inclusion in each of the individual
quarterly statements.
PART 1 - ORGANIZATIONAL CHART
19
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
SCHEDULE T - EXHIBIT OF PREMIUMS WRITTEN
Current Year to Date - Allocated by States and Territories
<TABLE>
<CAPTION>
===================================================================================================================================
Direct Losses Paid
1a Direct Premiums Written (Deducting Salvage) Direct Losses Unpaid
-----------------------------------------------------------------------------------
1 Is 2 3 4 5 6 7
Insurer
Licensed Current Prior Current Prior Current Prior
States, etc. (Yes/No) Year To Date Year To Date Year To Date Year To Date Year To Date Year To Date
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C> <C>
1. Alabama ....................... AL No (60)
2. Alaska ........................ AK No
3. Arizona ....................... AZ No
4. Arkansas ...................... AR No
5. California .................... CA No
6. Colorado ...................... CO No
7. Connecticut ................... CT No
8. Delaware ...................... DE No
9. Dist. of Columbia ............. DC No
10. Florida ....................... FL No
11. Georgia ....................... GA No 380
12. Hawaii ........................ HI No
13. Idaho.......................... ID No
14. Illinois ...................... IL No 5,735 13,195 1,305 1,581 2,000 26,342
15. Indiana ....................... IN No 2,619,018 1,266,418 1,100,000
16. Iowa........................... IA No 31,998 232,987 157,610 125,338 10,000 160,000
17. Kansas......................... KS No
18. Kentucky ...................... KY No
19. Louisiana ..................... LA No
20. Maine.......................... ME No
21. Maryland ...................... MD No
22. Massachusetts ................. MA No 84
23. Michigan ...................... MI No
24. Minnesota ..................... MN No
25. Mississippi ................... MS No
26. Missouri ...................... MO No 215,662 250,526 129,771 73,906 131,023 75,942
27. Montana ....................... MT No
28. Nebraska ...................... NE No
29. Nevada ........................ NV No
30. New Hampshire ................. NH No
31. New Jersey .................... NJ No
32. New Mexico .................... NM No
33. New York ...................... NY No
34. North Carolina ................ NC No 100
35. North Dakota .................. ND No
36. Ohio .......................... OH No 1,141,816 123,842 396,637
37. Oklahoma ...................... OK No
38. Oregon ........................ OR No
39. Pennsylvania................... PA No
40. Rhode Island .................. RI No
41. South Carolina ................ SC No
42. South Dakota .................. SD No
43. Tennessee ..................... TN No
44. Texas ......................... TX No
45. Utah .......................... UT No
46. Vermont ....................... VT No
47. Virginia ...................... VA No
48. Washington .................... WA No
49. West Virginia ................. WV No
50. Wisconsin ..................... WI No
51. Wyoming ....................... WY No
52. American Samoa ................ AS No
53. Guam .......................... GU No
54. Puerto Rico ................... PR No
55. U.S. Virgin Is. ............... VI No
56. Canada ........................ CN No
57. Aggregate Other Alien ......... OT XXX
--------------------------------------------------------------------------------------------
58. TOTALS .......................... (a) 253,395 4,258,046 288,686 1,591,085 143,023 1,758,921
===================================================================================================================================
DETAILS OF WRITE-INS
-----------------------------------------------------------------------------------------------------------------------------------
5701 ................................ XXX
5702 ................................ XXX
5703. ................................ XXX
5798. Summary of remaining write-ins
for Line 57 from overflow page XXX
--------------------------------------------------------------------------------------------
5799. TOTALS (Lines 5701 Through 5703
Plus 5798) (Line 57 Above) XXX
===================================================================================================================================
</TABLE>
(a) Insert the Number of Yes Responses except for Canada and Other Alien
20
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
PART 1 - LOSS EXPERIENCE
<TABLE>
<CAPTION>
====================================================================================================================================
Current Year to Date
---------------------------------------------
1 2 3 4
Prior Year to
Direct Premiums Direct Losses Direct Loss Date Direct
Lines of Business Earned Incurred Percentage Loss Percentage
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
1. Fire...........................................................
2. Allied lines...................................................
3. Farmowners multiple peril......................................
4. Homeowners multiple peril......................................
5. Commercial multiple peril......................................
6. Mortgage guaranty..............................................
8. Ocean marine...................................................
9. Inland marine..................................................
10. Financial guaranty.............................................
11.1 Medical malpractice - occurrence...............................
11.2 Medical malpractice - claims made..............................
12. Earthquake.....................................................
13. Group accident and health......................................
14. Credit accident and health.....................................
15. Other accident and health...................................... 43,559 20,726 47.6 60.5
16. Workers' compensation..........................................
17.1 Other liability - occurrence...................................
17.2 Other liability - claims made..................................
18.1 Products liability - occurrence................................
18.2 Products liability - claims made...............................
19.1 19.2 Private passenger auto liability.......................... 130,818 78,756 60.2 39.2
19.3 19.4 Commercial auto liability.................................
21. Auto physical damage........................................... 121,293 63,063 52.0 38.0
22. Aircraft (all perils)..........................................
23. Fidelity.......................................................
24. Surety.........................................................
26. Burglary and theft.............................................
27. Boiler and machinery...........................................
28. Credit.........................................................
29. International..................................................
30A. Reinsurance - Nonproportional Assumed Property................. XXX XXX XXX XXX
30B. Reinsurance - Nonproportional Assumed Liability................ XXX XXX XXX XXX
30C. Reinsurance - Nonproportional Assumed Financial Lines.......... XXX XXX XXX XXX
31. Aggregate write-ins for other lines of business................
--------------------------------------------------------------
32. TOTALS..................................................... 295,670 162,545 55.0 .59
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
3101.................................................................
3102.................................................................
3103.................................................................
3198. Summary of remaining write-ins for Line 31 from overflow page..
--------------------------------------------------------------
3199. TOTALS (Lines 3101 Through 3103 Plus 3198) (Line 31 Above).....
====================================================================================================================================
</TABLE>
PART 2 - DIRECT PREMIUMS WRITTEN
<TABLE>
<CAPTION>
====================================================================================================================================
1 2 3
Current Current Prior Year
Quarter Year to Date Year to Date
-----------------------------------------------
<S> <C> <C> <C>
1. Fire..................................................................
2. Allied lines..........................................................
3. Farmowners multiple peril.............................................
4. Homeowners multiple peril.............................................
5. Commercial multiple peril.............................................
6. Mortgage guaranty.....................................................
8. Ocean marine..........................................................
9. Inland marine.........................................................
10. Financial guaranty....................................................
11.1 Medical malpractice - occurrence......................................
11.2 Medical malpractice - claims made.....................................
12. Earthquake............................................................
13. Group accident and health.............................................
14. Credit accident and health............................................
15. Other accident and health............................................. 12,537 31,999 3,990,828
16. Workers' compensation.................................................
17.1 Other liability - occurrence..........................................
17.2 Other liability - claims made.........................................
18.1 Products liability - occurrence.......................................
18.2 Products liability - claims made......................................
19.1 19.2 Private passenger auto liability................................. 53,151 115,126 138,015
19.3 19.4 Commercial auto liability........................................ 48,580 106,270 129,203
21. Auto physical damage..................................................
22. Aircraft (all perils).................................................
23. Fidelity..............................................................
24. Surety................................................................
26. Burglary and theft....................................................
27. Boiler and machinery..................................................
28. Credit................................................................
29. International.........................................................
30A. Reinsurance - Nonproportional Assumed Property........................ XXX XXX XXX
30B. Reinsurance - Nonproportional Assumed Liability....................... XXX XXX XXX
30C. Reinsurance - Nonproportional Assumed Financial Lines................. XXX XXX XXX
31. Aggregate write-ins for other lines of business.......................
-----------------------------------------------
32. TOTALS............................................................ 114,268 253,395 4,258,046
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
3101........................................................................
3102........................................................................
3103........................................................................
3198. Summary of remaining write-ins for Line 31 from overflow page.........
-----------------------------------------------
3199. TOTALS (Lines 3101 Through 3103 Plus 3198) (Line 31 Above)............
====================================================================================================================================
</TABLE>
21
<PAGE>
STATEMENT AS OF June 30, 2000 OF THE American Union Insurance Company
PART 3 - LOSS AND LOSS ADJUSTMENT EXPENSE RESERVES SCHEDULE
(000 Omitted)
<TABLE>
<CAPTION>
====================================================================================================================================
1 2 3 4 5
TOTAL
Prior Year-End 2000 Loss and 2000 Loss and
Loss and LAE Payments LAE Payments
Prior Year-End Prior Year-End LAE Reserves on Claims on Claims
Years in Which Known Case Loss IBNR Loss (a) Reported as of Unreported as of
Losses Occurred and LAE Reserves and LAE Reserves (Columns 1+2) Prior Year-End Prior Year-End
------------------------ ---------------- ---------------- ------------ -------------- ----------------
<S> <C> <C> <C> <C> <C>
A. 1997 and Prior ..... 52 52 1
B. 1998................ 6 7 13 5
C. Subtotals 1998 and
Prior............... 58 7 65 6
D. 1999................ 112 133 245 94 75
E. Subtotals 1999 and
Prior............... 170 140 310 100 75
F. 2000................ XXX XXX xxx xxx 137
G. TOTALS.............. 170 140 310 100 212
H. Prior Year-End's
Surplus as Regards
Policyholders....... 25,965
<CAPTION>
====================================================================================================================================
6 7 8 9 10
Q.S. Date Known
Q.S. Date known Case Loss and TOTAL Q.S.
Case Loss and LAE Reserves on Loss and LAE
TOTAL 2000 LAE Reserves on Claims Reported Reserves
Loss and Claims Reported or Reopened Q.S. Date (b)
Years in Which LAE Payments and Open as of Subsequent to IBNR Loss and (Columns
Losses Occurred (Columns 4+5) Prior Year-End Prior Year-End LAE Reserves 7+8+9)
----------------------- ------------- --------------- --------------- ------------- ----------
<S> <C> <C> <C> <C> <C>
A. 1997 and Prior ..... 1 50 8 58
B. 1998................ 5 10 2 12
C. Subtotals 1998 and
Prior............... 6 60 10 70
D. 1999................ 169 33 50 83
E. Subtotals 1999 and
Prior............... 175 93 60 153
F. 2000................ 137 XXX 2 38 40
G. TOTALS.............. 312 93 2 98 193
H. Prior Year-End's
Surplus as Regards
Policyholders.......
<CAPTION>
============================================================================================
11 12 13
Prior Year-End Prior Year-End Prior Year-End
Known Case Loss IBNR Loss and Total Loss and
and LAE Reserves LAE Reserves LAE Reserves
Developed Developed Developed
(Savings)/ (Savings)/ (Savings)/
Deficiency Deficiency Deficiency
Years in Which (Columns 4+7 (Columns 5+8+9 (c)
Losses Occurred Minus Column 1) Minus Column 2) (Columns 11+12)
------------------------ ---------------- --------------- ---------------
<S> <C> <C> <C>
A. 1997 and Prior ..... (1) 8 7
B. 1998................ 9 (5) 4
C. Subtotals 1998 and
Prior............... 8 3 11
D. 1999................ 15 (8) 7
E. Subtotals 1999 and
Prior............... 23 (5) 18
F. 2000................ XXX XXX XXX
G. TOTALS.............. 23 (5) 18
H. Prior Year-End's
Surplus as Regards
Policyholders.......
=============================================================================================
</TABLE>
Col. 11, Line G as % of Col. 1, Line G________13.529 Col. 12, Line G as % of
Col. 2, Line G_________(3.571) Col, 13, Line G as % of Col. 3, Line
G_______5.806 Col. 13, Line G/Line H_______0.069
(a) Should Equal Prior Year-End Annual Statement; Page 3, Column 1, Lines 1 + 2
(b) Should Equal Q,S. Page 3, Column 1, Lines 1 and 2
(c) Should Also Equal Columns 6 + 10 less Column 3 for Lines A through E only
22
<PAGE>
Statement as of June 30, 2000 of the American Union Insurance Company
GENERAL INTERROGATORIES
(The responses to these interrogatories should be based on changes that have
occurred since the prior year end.)
<TABLE>
<S> <C> <C> <C>
1. (a) Did the Company Implement any Significant Accounting Policy Changes Which
Would Require Disclosure in the Notes to the Financial Statements? Yes[_] No[X]
(b) If "Yes," explain:
2. (a) Did the Company 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]
(b) If "Yes," Has the Report Been Filed with the Domiciliary State? Yes[_] No[X]
3. (a) Were any of the Stocks, Bonds or Other Assets of the Company Loaned,
Placed Under Option Agreement, or Otherwise Made Available for use by
Another Person? (Exclude Securities Under Securities Lending Agreements.) Yes[_] No[X]
(b) If "Yes," Give Full and Complete Information Relating Thereto:
4. (a) Has There Been Any Change in the Company's Own Preferred or Common
Stock? Yes[_] No[X]
(b) If "Yes," Explain:
5. (a) State as of What Date the Latest Financial Examination of the Company was
Made or is Being Made. 12/31/1995
(b) State the as of Date of the Latest Financial Examination Report that is
Available from Either the State of Domicile or the Company. This Date
Should be the Date of the Examined Balance Sheet and not the Date the
Report was Completed or Released. 12/31/1995
(c) 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 Company. This is the Release Date or Completion Date of the
Examination Report and not the Date of the Examination (Balance Sheet
Date). 05/08/1998
(d) By What Department or Departments?
6. (a) 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
Company? Yes[_] No[X]
(b) If "Yes," Date of Change: / /
If not Previously Filed, Furnish Herewith a Certified Copy of the
Instrument as Amended.
7. (a) Have there been any Substantial Changes in the Organizational Chart
Since Year End? Yes[_] No[X]
(b) If "Yes," Attach an Organizational Chart.
8. (a) If the Company 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? Yes[_] No[X] N/A[_]
(b) If "Yes," Attach an Explanation.
9. Amount of Real Estate and Mortgages Held in Other Invested Assets in
Schedule BA: $__________________________
10. (a) If the Company is a Member of a Pooling Arrangement, Did the Agreement
or the Company's Participation Change? Yes[_] No[X] N/A[_]
(b) If "Yes," Attach an Explanation.
11. (a) Has the Company Reinsured Any Risk With Any Other Company and Agreed to
Release Such Company from Liability, In Whole or In Part, From Any Loss
that May Occur on the Risk, or Portion Thereof, Reinsured? Yes[_] No[X]
(b) If "Yes," Attach an Explanation.
12. (a) Have any of the Company's Primary Reinsurance Contracts Been Cancelled? Yes[_] No[X]
(b) If "Yes," Give Full and Complete Information Thereto.
</TABLE>
23
<PAGE>
STATEMENT AS June 30, 2000 OF THE American Union Insurance Company
GENERAL INTERROGATORIES (Continued)
(The responses to these interrogatories should be based on changes that have
occurred since the prior year end.)
13. (a) Are any of the Liabilities for Unpaid Losses and Loss Adjustment
Expenses other than Certain Workers' Compensation Liabilities 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]
(b) If "Yes," Complete the Following Schedule:
<TABLE>
<CAPTION>
====================================================================================================================================
TOTAL DISCOUNT
-----------------------------------------------------------------
Maximum Discount 1 2 3 4
Line of Business Interest Rate Unpaid Losses Unpaid LAE IBNR TOTAL
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C> <C> <C>
31. Aggregate write-ins for other
lines of business....................
32 TOTALS.......................
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
3101.....................................
3102.....................................
3103.....................................
3198. Summary of remaining
write-ins for Line 31 from
overflow page......................
---------------------------------------------------------------------------------------
3199. TOTALS (Lines 3101 Through
3103 Plus 3198) (Line 31
Above).............................
====================================================================================================================================
<CAPTION>
====================================================================================================================================
DISCOUNT TAKEN DURING PERIOD
---------------------------------------------------------------
5 6 7 8
Line of Business Unpaid Losses Unpaid LAE IBNR TOTAL
------------------------------------------------------------------------------------------------------------------------------------
<S> <C> <C> <C> <C>
31. Aggregate write-ins for other
lines of business....................
32 TOTALS.......................
====================================================================================================================================
DETAILS OF WRITE-INS
------------------------------------------------------------------------------------------------------------------------------------
3101.....................................
3102.....................................
3103.....................................
3198. Summary of remaining
write-ins for Line 31 from
overflow page......................
3199. TOTALS (Lines 3101 Through
3103 Plus 3198) (Line 31
Above).............................
====================================================================================================================================
</TABLE>
14. (a) Has the Company been a Party to a Merger or Consolidation During the
Period Covered by this Statement? Yes[_] No[X]
(b) If Yes, Provide Name of Company, NAIC Company Code, and State of
Domicile (Use two Letter State Abbreviation) for Any Company that has
Ceased to Exist as a Result of the Merger or Consolidation.
15. (a) Has this Company had any Certificates of Authority, Licenses or
Registrations (Including Corporate Registration, if Applicable)
Suspended or Revoked by Any Governmental Entity During the Reporting
Period? (You Need not Report an Action, Either Formal or Informal, If a
Confidentiality Clause is Part of the Agreement.) Yes[_] No[X]
(b) If Yes, Give Full Information:
16. (a) Does the Company have Any Investments in Parent, Subsidiaries and
Affiliates? Yes[_] No[X]
(b) If Yes, Please Complete the Following:
<TABLE>
<CAPTION>
====================================================================================================================================
1 2
Prior Year-End Current Quarter
Statement Value Statement Value
---------------------------------------------------------
<S> <C> <C>
01 Bonds.........................................................
02 Preferred Stock...............................................
03 Common Stock..................................................
04 Short-term Investments........................................
05 Mortgages, Loans or Real Estate...............................
06 All Other.....................................................
---------------------------------------------------------
07 Investment in Parent, Subsidiaries and Affiliates
(Subtotal Lines 1 to 6 above).................................
08 TOTAL Investment in Parent included in Lines 1 to 6 above.....
09 Receivable from Parent not included in Lines 1 to 6 above.....
====================================================================================================================================
</TABLE>
24
<PAGE>
STATEMENT AS June 30, 2000 OF THE American Union Insurance Company
SUPPLEMENTAL EXHIBITS AND SCHEDULES
INTERROGATORIES
1 . The SVO Compliance Certification is a Required Filing for all Companies.
Will the SVO Compliance Certification be filed with this Department with
this Statement? Yes[X] No[_]
If No, please explain:
If Response is No and the form is `None,' affix Bar Code (Document
Identifier 470) here:
2. (a) Is your Company a U.S. Branch of an Alien Insurer? Yes[_] No[X]
(b) Will the Trusteed Surplus Statement be filed with this Department
with this Statement? Yes[_] No[X]
If First Response is Yes and Second Response is No, please explain:
If Second Response is No and the form is `None', affix Bar Code (Document
Identifier 490) here:
3. (a) Does your Company write Medical Malpractice Insurance? Yes[_] No[X]
(b) Will Supplement A to Schedule T (Medical Malpractice Supplement) be
filed with this Department with this Statement? Yes[_] No[X]
If First Response is Yes and Second Response is No, please explain:
If Second Response is No and the form is `None', affix Bar Code (Document
Identifier 450) here:
25
